Childhood immunization refusal: provider and parent perceptions

Parental concerns may contribute to immunization refusals and low infant immunization rates. Little knowledge is available about how often and why parents refuse immunizations for their children. This study was conducted to estimate, based on reports from health care providers and parents, the frequency of and reasons for immunization refusal.

In 1998, we conducted 32 focus groups of parents and providers in six cities. We then mailed a survey to a random sample of private practice family physicians and pediatricians and public health nurses who immunize children. The overall survey response rate was 77%, and the final sample size was 544.

Focus group findings indicated that parents rarely refused vaccines but occasionally resisted specific vaccines. Parents who were unsure about vaccinating were open to discussions about vaccines with a trusted provider. Most of these parents agreed to immunize after discussing concerns with their provider. In a subsequent survey of providers, respondents estimated that they immunized a mean of 3536 (median 1560) children annually. The reported mean number of refusals per 1000 children age >18 years immunized was 7.2 (median 0.4), with varicella vaccine being the most commonly refused. Means did not vary by region or specialty. Providers indicated that fear of side effects heard about from media/word of mouth was the most commonly expressed reason for parents to refuse vaccines (52%). Religious (28%) or philosophical (26%) reasons or belief that the disease was not harmful (26%) were less common reasons. Providers reported that few parents refused because of anti-government sentiment (8%).

Providers indicate low vaccine refusal rates within offices of traditional primary care providers and in public health clinics. Strategies for efficient provider-patient communication are needed to address parental concerns about vaccines.