Childhood Vaccine Refusal: Sociodemographic, Behavioral, and Vaccine Confidence Factors in Konya, Türkiye

Background/Objectives: Childhood vaccine refusal may negatively affect immunization programs in Türkiye, where regional clusters of hesitancy have emerged despite high national coverage. This study aimed to identify sociodemographic, behavioral, and vaccine confidence-related factors independently associated with childhood vaccine refusal in Konya, Türkiye. Methods: An unmatched case-control study was conducted between July and October 2025 in family health centers across Konya. Cases were parents who had refused at least one routine childhood vaccine (n = 406); controls were parents whose children had completed all routine vaccinations (n = 412). Data were collected through face-to-face interviews using a 47-item structured questionnaire and the Turkish version of the Vaccine Hesitancy Scale (VHS). Independent associations were assessed using multivariable logistic regression, with multicollinearity evaluated by variance inflation factors. Results: Maternal employment (aOR = 0.371, 95% CI: 0.218-0.633), parental COVID-19 vaccination (aOR = 0.131, 95% CI: 0.086-0.200), mother's complete childhood immunization (aOR = 0.418, 95% CI: 0.262-0.667), tetanus vaccination during pregnancy (aOR = 0.259, 95% CI: 0.159-0.421), and neonatal vitamin K administration (aOR = 0.256, 95% CI: 0.132-0.497) were independently associated with lower refusal odds. Higher number of children (aOR = 1.281) and perceived vaccine-related adverse events in the social environment (aOR = 16.982, 95% CI: 9.914-29.089) increased refusal odds. VHS scores were significantly lower in the refusal group (22.2 ± 6.4 vs. 39.8 ± 6.5; p < 0.001), indicating greater hesitancy. Notably, 21.9% of refusing parents reported being advised by a healthcare professional not to vaccinate. Conclusions: Childhood vaccine refusal in Konya was associated with sociodemographic, behavioral, preventive health-related, and vaccine confidence-related factors. The findings suggest relatively reduced engagement with selected preventive health practices, greater reliance on non-professional information sources, and lower vaccine confidence among refusing parents. Interventions should focus on strengthening healthcare-professional communication, trust-building, transparent risk communication, and evidence-based social media strategies.