Vaccine Hesitancy Among Parents in Croatia: Findings from a Nationwide PACV-Based Cross-Sectional Study

Background: Childhood vaccination remains one of the most effective public health interventions. Despite consistently high national coverage, vaccine hesitancy persists among parents and may undermine herd immunity. The Parent Attitudes about Childhood Vaccines (PACV) questionnaire provides a validated framework for identifying parental concerns and patterns of hesitancy. Methods: A cross-sectional online survey was conducted in May 2025 using the Croatian version of the Parent Attitudes about Childhood Vaccines (PACV) questionnaire. The study included 1087 parents aged 18-65 years. PACV scores were transformed to a 0-100 scale, with values ≥50 indicating vaccine hesitancy. Associations between PACV scores and parental age and educational level were analysed using non-parametric statistical tests. Results: Most respondents were mothers (87.7%) and aged between 30 and 45 years (71.8%). Approximately one fifth of parents reported postponing vaccination (22.7%), and 19.2% indicated having refused at least one vaccine dose. While 63.7% expressed full acceptance of recommended childhood vaccines, a substantial proportion either refused vaccination (20.8%) or remained undecided (15.5%). Higher educational attainment was significantly associated with lower PACV scores, whereas no significant association was observed with parental age. Conclusions: Although overall vaccination acceptance in Croatia remains high, vaccine hesitancy continues to affect a considerable proportion of parents. Strengthening tailored communication strategies and reinforcing trust-based counselling-particularly within pediatric and community nursing services-may support informed decision-making and improve vaccine confidence.