From mandatory to voluntary vaccination: intention to vaccinate in the case of policy changes

The aim of the study was to assess the association between sociodemographic characteristics and attitudes according to health belief model (HBM) attributes with the intention to vaccinate children in cases of non-mandatory vaccination to support informed decisions in planned revision of our vaccination policy.

This is a cross-sectional study carried out on a random sample of 3,854 women with young children in Slovenia.

The participants' attitudes were grouped within six HBM attributes (perceived susceptibility, severity, benefits, barriers, clue to action and self-efficacy). Possible associations between the intention to vaccinate children in cases of non-mandatory vaccination and sociodemographic characteristics or attitudinal attributes according to HBM were explored in univariate analyses by calculating odds ratios (ORs) with 95% confidence interval (CI) estimates.

Just more than half (56.2%; 95% CI: 53.8-58.5%) of the women reported on their intention to vaccinate their children in the case of non-mandatory vaccination, and 23.4% (95% CI: 21.4-25.5%) were undecided. There were no significant sociodemographic predictor variables in relation to this intention. Those who perceived higher susceptibility to vaccine-preventable diseases or the benefits of vaccination were more likely to intend to vaccinate in the case of non-mandatory vaccination (OR = 5.70; 95% CI: 4.64-7.00) and (OR = 7.62; 95% CI: 5.96-9.76). Perceived barriers to vaccinate (fear of side-effects or lack of comprehensive information from physicians) and parents not getting enough useful information in general as a clue to action were significant predictors of an intention not to vaccinate.

Our results show that a mandatory vaccination policy is an important factor in ensuring high levels of vaccination coverage in Slovenia. In future, more comprehensive communication activities focused on vaccine-preventable diseases and the benefits and safety of vaccination (for the education of parents and their healthcare providers) are needed to diminish the reliance on a mandatory vaccination policy.