Parental experiences of caring for their preschool children after declining vaccines: a qualitative systematic review

This review synthesizes qualitative research about the experiences of parental caregivers enhancing their children's health after making the decision to not vaccinate their preschool children. This review aims to help health care providers understand the parental work involved in caring for under-vaccinated or unvaccinated children.

Much of the current qualitative research literature about parents who are vaccine-hesitant or who decide not to vaccinate their children focuses on parental perceptions about the safety and efficacy of vaccines and decision-making. However, limited attention has been paid to measures taken by parents to help their young children avoid contracting vaccine-preventable communicable diseases, promote resistance, and enhance their children's health.

This review considered qualitative studies that described parents' experiences of caring for their young children, aged 0 to 6 years, after making the decision not to vaccinate. Studies undertaken in any context were considered. Studies that focused on young children who were unvaccinated or not fully vaccinated for reasons not related to parental refusal were excluded.

The JBI methodology for systematic reviews of qualitative evidence was followed. Databases were searched from 1998 onward, and included Web of Science Core Collection, MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (EBSCOhost), Google Scholar, and ProQuest Dissertations and Theses, with no language limits. Following critical appraisal, findings that described parental experiences and the care activities they performed relating to their young children were extracted. The JBI process of meta-aggregation was used to identify categories and synthesize findings. The ConQual approach was used to assess confidence in the findings.

Forty studies met the criteria for inclusion. The studies were conducted in 14 countries across 4 continents, with approximately 676 participants. From these studies, 115 findings were extracted and combined to form 12 categories based on similarity in meaning and 3 synthesized findings: i) Parental care strategies in the home-focused on the individual and family, ii) Parental care strategies in the community-managing social interactions and community networks, and iii) Parental care strategies at the systems-level-challenging societal discourses and institutional work processes.

The major conclusions from this review highlight the laborious activities that parents undertake to care for their children's health after declining vaccines. Care activities extended from the household to the community, encompassing myriad anticipatory and reactive measures. Parents demonstrated a strong commitment to their children's health and well-being while responding to stigma they experienced among their friends, children's teachers, and health care providers. While facing or expecting penalties related to their vaccine choices, parents reached out to like-minded peers for support and planned next steps should punitive measures become overwhelming.

PROSPERO CRD42021241781.

A Farsi-language version of the abstract of this review is available at: http://links.lww.com/SRX/A78 .