Facilitators and barriers to childhood immunization in Canada: a scoping review

Immunization is a primary prevention public health strategy that has saved more lives than any other health service. Achieving the recommended 95% childhood immunization coverage rate remains a challenge in Canada, especially post-COVID-19. This challenge highlights the need to better understand current immunization facilitators and barriers to improve coverage rates. This study aimed to determine: (1) Factors that support and create barriers to childhood immunization for families with children 0-6 years of age in Canada (2) If childhood immunization facilitators and barriers changed from pre-to-post-COVID-19.

Using Arksey and O'Malley scoping review framework informed by Levac et al. and JBI Scoping Review Guidelines, seven databases were searched: MedLine (OVID), EMBASE (OVID), Web of Science (Clarivate), CINAHL (EBSCOhost), Cochrane Library (Wiley), APA PsycArticles (OVID), ProQuest Dissertations and Theses (Clarivate) for peer-reviewed literature. Articles were screened against inclusion/exclusion criteria, data extracted and thematically analyzed using the Braun and Clarke framework.

Thirty-one studies were included. Five identified themes had a dual role supporting and creating barriers to childhood immunization and included: access to healthcare services, cognitive reasoning, affective influences on decision-making, external influences, and information. Two standalone barriers included: use of alternative medicine and colonial institutional practices. Differences pre-to-post-COVID-19 in factors supporting immunization included: cognitive reasoning and access to healthcare services; barriers included cognitive reasoning, information, access to healthcare services, and colonial institutional practices.

This scoping review highlighted factors from caregiver perspectives that support and create barriers to childhood immunization including cognitive reasoning, affective influences on decision-making, and information. Post-COVID-19 considerations noted in our findings were affective influences on decision-making - trust and relationships and access to healthcare services. There appears an immunization information time gap in the prenatal period. Colonial institutional practices create access challenges for Indigenous families. To better understand these gaps, additional research is needed to understand current immunization information practices in the prenatal period, the contextual nuances of immunization service delivery, and Indigenous Peoples' experiences with immunization services. Further exploration of these areas may help to inform strategies to address identified barriers, strengthen immunization services, and improve immunization coverage rates.