Introduction The discovery and continued development of vaccines is arguably one of the most important innovations in human history. Vaccination greatly reduces the worldwide incidence and transmission of diseases, preventing permanent injury and premature death. Mass vaccination campaigns have led to the eradication or partial eradication of severe infectious such as smallpox and polio, have reduced childhood mortality, and has led to an overall increase in average health in the human population globally. Despite the documented benefits of vaccination, vaccine hesitancy is increasing, and the uptake of some vaccines is low. Vaccines have been so successful at preventing disease that portions of the population are now more afraid of the possible side-effects of vaccines then they are of the serious symptoms and maladies that vaccines prevent. Vaccine hesitancy is a serious concern for the global medical community. The incidence of infectious disease is inversely proportional to vaccine uptake; as fewer people are vaccinated against preventable diseases, the frequency at which people get sick increases. A reduction in vaccination rates due to vaccine hesitancy reduces herd immunity, which increases the risk for the whole population, especially immunocompromised individuals who are unable to receive vaccines. Vaccines that protect against high-risk strains of Human Papillomavirus (HPV) have recently been developed and released to the worldwide population. High-risk HPV strains can cause persistent infection and various cancers. Although HPV vaccines have been extensively tested and are recommended by the Centers for Disease Control and Prevention and the World Health Organization, uptake among some demographics is low. Understanding what factors impact HPV vaccine hesitancy can guide the design of effective interventions which can increase vaccine uptake. High HPV uptake will lead to a reduction of HPV associated cancers and reduce the transmission of high-risk subtypes. Research Significance Vaccine hesitancy is a growing challenge for the medical community and could potentially put global health at risk by undermining 200 years of progress towards eliminating infectious diseases. A better understanding of what factors impact vaccine hesitancy allows public health professionals to design better policies and interventions policies and helps primary care providers better address concerns the concerns of their patients. Better understanding of the factors which cause vaccine hesitance can be used to tailor education about vaccines. This leads to higher vaccine uptake and better community health overall. Methodology Electronically distributed surveys and statistical analysis were the primary tools used in this research. Surveys were used to generate data from a sample population, including: demographic factors, attitudes towards vaccination, and intent to vaccinate against HPV. Barriers to HPV vaccine uptake and factors that impact HPV vaccine acceptance were identified through statistical analysis, including confirmatory factor analysis, structural equation modeling, regression and univariate analysis. Findings We found that general attitudes toward vaccination had the greatest impact on the intent of parents to vaccinate their children against HPV. Parents who view vaccination positively intend to vaccinate their children against HPV or have already vaccinated their children against HPV. Parents who are somewhat unsure about vaccines are more hesitant about vaccinating their children against HPV. Knowledge about HPV increases intent to vaccinate. We found that traditionally religious parents who felt that religious adherence provided some protection against HPV were more hesitant about HPV vaccinations. We found that both a religious-focused intervention and an education-focused interventions increased parental intent to vaccinate more than a control intervention. Our study of Utah residents confirmed our earlier findings that general attitudes toward vaccination had the greatest impact on the intent of parents to vaccinate their children against HPV. Our study also confirmed that knowledge about HPV increases intent to vaccinate. We found that high religious practice negatively impacts parental intent to vaccinate. Cautious sexual attitudes also negatively impact intent to vaccinate against HPV. High religious practice is correlated with cautious sexual attitudes which explains the negative impact of high religious practice on intent to vaccinate. The findings of this research work will be used to inform future religious and educational based interventions in Utah and beyond.

Bakgrund Alla barn i Sverige har rätt till barnhälsovård, vars uppgift bland annat är att följa och stödja barnets hälsa och utveckling. Forskning visar att vaccination är den enskilda orsaken till att sjukdomsutbrott i samhället har minskat. Trots detta råder ibland tveksamhet hos föräldrar att vaccinera sina barn. Bristande kunskap (hälsolitteracitet) hos föräldrar om sjukdomar, vaccin och dess biverkningar har visat sig vara en orsak till tveksamheten. Syfte Syftet med denna studie är att beskriva sjuksköterskors upplevelse av hälsolitteracitet hos de föräldrar som är tveksamma till vaccination av sina barn. Metod Studien har genomförts som en kvalitativ intervjustudie och induktiv ansats. Data har samlats in från åtta sjuksköterskor i Dalarnas län med hjälp av semistrukturerade intervjuer. Data har analyserats med tematisk analys enligt Braun & Clarke. Resultat Resultatet i denna studie visar att de tveksamma föräldrarna vanligen har fått sin information från sociala medier, släkt och vänner vilket skapar en rädsla för att barnet ska få biverkningar av vaccinet eller ett förändrat immunsystem. En del föräldrar har bristande förtroende för sjuksköterskan och vården och lyssnar hellre på information från sociala medier vilket sjuksköterskorna ofta upplever har ”en stark röst”. Sjuksköterskorna önskar mer kunskap och fakta från staten för att kunna delge föräldrarna relevant och tillförlitlig information. Slutsats Samtliga sjuksköterskor i studien är överens om att det är viktigt att visa respekt och förståelse för föräldrarnas åsikter och möta dem på deras nivå för att skapa ett förtroende och därmed bidra till att öka föräldrars hälsolitteracitet. / Background In Sweden every child has the right to child health. The overall goal of Child health care is to monitor and support the child's health and development. Research shows that vaccination is the only reason why disease outbreaks in society have decreased. Despite this, some parents sometimes hesitate to vaccinate their children. A lack of knowledge (health literacy) among parents about diseases, vaccines and their side effects has been shown to be a reason for the hesitation. Aim The purpose of this study is to describe the nurse's experience of health literacy of parents who are hesitant to vaccinate their children. Method The study has been conducted as a qualitative interview study and an inductive approach. Data has been collected from eight nurses in Dalarna by using semi-structured interviews. The data analysing method was thematic according to Braun & Clarke. Results The results of this study show that the nurse is often faced with difficult challenges. The hesitant parents have usually received their information from social media, relatives and friends which lead to a fear that the child will have side effects from the vaccine or a changed immune system. Some parents have little trust in the nurse and the health care system and prefer to listen to information from social media, which the nurse often feels has "a strong voice". The nurses want more knowledge and facts from the state to be able to provide the parents with relevant and reliable information. Conclusions In this study, all the nurses agreed that it is important to show respect and understanding for parents' opinions and meet them at their level to create trust and be able to increase parents' health literacy.

Syfte: Syftet var att belysa BHV-sjuksköterskans upplevelse av att bemöta och vägleda föräldrar som är tveksamma till vaccination. Metod: En empirisk intervjustudie med kvalitativ ansats genomfördes. Studien baserades på semistrukturerade intervjuer med sex BHV-sjuksköterskor. Analysen utfördes i form av manifest innehållsanalys. Resultat: Resultatet bildade fyra huvudkategorier: Vägleda genom att guida och informera, Förutsättningar för att vägleda, Förhållningssätt för ett gott bemötande och BHV-sjuksköterskans upplevelser av att bemöta tveksamma föräldrar samt 13 underkategorier. Huvudresultaten visade att BHV-sjuksköterskans sätt att vägleda tveksamma föräldrar var ganska lika, men även olikheter fanns. Att informera om vaccination upplevdes som nyckeln för att vägleda föräldrarna på bästa sätt. Det var av vikt att informationen individanpassades och att föräldrarna vägleddes att ta ett genomtänkt beslut efter diskussion om risker i jämförelse med nyttan av vaccination. Förutsättningar för att kunna vägleda på ett bra sätt var tid, kunskap och stöd. BHV-sjuksköterskan eftersträvade en god relation med föräldrarna utifrån genuin omtanke och respekt för föräldrarnas beslut. BHV-sjuksköterskan upplevde ändå känslor i bemötandet som frustration, oro, nervositet och att bemötandet kunde kännas besvärligt. Det kunde även upplevas svårt att bemöta tveksamhet men det varierade med föräldrarnas inställning. Slutsats: BHV-sjuksköterskan kan genom att individanpassa vägledningen och bemöta tveksamma föräldrar med omtanke och respekt öka möjligheten att tveksamma föräldrar väljer att vaccinera sitt barn. / Aim: The aim of the study was to highlight the child health care nurse’s experience of responding and guiding vaccine hesitant parents. Method: An empirical interview study with a qualitative approach was carried out. The study was based on semi-structured interviews with six child health care nurses. The analysis was formed as a manifest content analysis. Results: The analysis resulted in four main categories: Guiding by informing, Requirements to guide, Approaches to respond in a good way and The Child Health Care Nurse’s experiences of responding hesitant parents as well as thirteen subcategories. The main results showed that child health care nurse’s ways of guiding hesitant parents were quite similar to each other, but differences also occured. The key to guiding parents was to inform them about vaccination. It was important to individualize the information and guide after discussion about risks versus benefits and that parents were guided to take a considered decision. Conditions to guide parents in a good way was time, knowledge and support. The child health care nurse sought a good relationship with the parents through genuine consideration and respect for the decision that the parents made. The child health care nurse experienced emotions such as frustration, anxiety, nervousness, and that responding could feel awkward. It could even be difficult to responding hesitant parents, but that varied with the parent’s attitude. Conclusion: The child health care nurse can increase the possibility that parents may choose to vaccinate their child, through individualized guidance and responding hesitant parents in consideration and respect.