Introduction. While the scientific consensus on the benefits of vaccination is unambiguous, there is a growing proportion of the population that is skeptical about vaccination. The idea that vaccination programs are losing their momentum concerns public health agencies throughout the world. Many studies assessing determinants of vaccine acceptance have been published in the last decade.Areas covered. In this article, we review the existing qualitative literature on parents’ attitudes toward childhood vaccination. Studies were included if they: (1) focused on the views, decision-making, or experiences of caregivers (hereafter, referred to as ‘parents’) regarding vaccinations for young children; (2) used qualitative methods for both data and data analysis; (3) were conducted in countries that ranked ‘very high’ on the 2016 United Nations Human Development Index; and (4) had been peer-reviewed. Twenty-two (22) studies met our inclusion criteria and were reviewed, using the socio-ecological model as a...

Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies.

Background Childhood vaccination is one of the most effective ways to prevent serious illnesses and deaths in children. However, worldwide, many children do not receive all recommended vaccinations, for several potential reasons. Vaccines might be unavailable, or parents may experience difficulties in accessing vaccination services; for instance, because of poor quality health services, distance from a health facility, or lack of money. Some parents may not accept available vaccines and vaccination services. Our understanding of what influences parents' views and practices around childhood vaccination, and why some parents may not accept vaccines for their children, is still limited. This synthesis links to Cochrane Reviews of the effectiveness of interventions to improve coverage or uptake of childhood vaccination. Objectives - Explore parents' and informal caregivers' views and practices regarding routine childhood vaccination, and the factors influencing acceptance, hesitancy, or nonacceptance of routine childhood vaccination. - Develop a conceptual understanding of what and how different factors reduce parental acceptance of routine childhood vaccination. - Explore how the findings of this review can enhance our understanding of the related Cochrane Reviews of intervention effectiveness. Search methods We searched MEDLINE, Embase, CINAHL, and three other databases for eligible studies from 1974 to June 2020. Selection criteria We included studies that: utilised qualitative methods for data collection and analysis; focused on parents' or caregivers' views, practices, acceptance, hesitancy, or refusal of routine vaccination for children aged up to six years; and were from any setting globally where childhood vaccination is provided. Data collection and analysis We used a pre-specified sampling frame to sample from eligible studies, aiming to capture studies that were conceptually rich, relevant to the review's phenomenon of interest, from diverse geographical settings, and from a range of income-level settings. We extracted contextual and methodological data from each sampled study. We used a meta-ethnographic approach to analyse and synthesise the evidence. We assessed methodological limitations using a list of criteria used in previous Cochrane Reviews and originally based on the Critical Appraisal Skills Programme quality assessment tool for qualitative studies. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. We integrated the findings of this review with those from relevant Cochrane Reviews of intervention effectiveness. We did this by mapping whether the underlying theories or components of trial interventions included in those reviews related to or targeted the overarching factors influencing parental views and practices regarding routine childhood vaccination identified by this review. Main results We included 145 studies in the review and sampled 27 of these for our analysis. Six studies were conducted in Africa, seven in the Americas, four in South-East Asia, nine in Europe, and one in the Western Pacific. Studies included urban and rural settings, and high-, middle-, and low-income settings. Many complex factors were found to influence parents' vaccination views and practices, which we divided into four themes. Firstly, parents' vaccination ideas and practices may be influenced by their broader ideas and practices surrounding health and illness generally, and specifically with regards to their children, and their perceptions of the role of vaccination within this context. Secondly, many parents' vaccination ideas and practices were influenced by the vaccination ideas and practices of the people they mix with socially. At the same time, shared vaccination ideas and practices helped some parents establish social relationships, which in turn strengthened their views and practices around vaccination. Thirdly, parents' vaccination ideas and practices may be influenced by wider political issues and concerns, and particularly their trust (or distrust) in those associated with vaccination programmes. Finally, parents' vaccination ideas and practices may be influenced by their access to and experiences of vaccination services and their frontline healthcare workers. We developed two concepts for understanding possible pathways to reduced acceptance of childhood vaccination. The first concept, 'neoliberal logic', suggests that many parents, particularly from high-income countries, understood health and healthcare decisions as matters of individual risk, choice, and responsibility. Some parents experienced this understanding as in conflict with vaccination programmes, which emphasise generalised risk and population health. This perceived conflict led some parents to be less accepting of vaccination for their children. The second concept, 'social exclusion', suggests that some parents, particularly from low- and middle-income countries, were less accepting of childhood vaccination due to their experiences of social exclusion. Social exclusion may damage trustful relationships between government and the public, generate feelings of isolation and resentment, and give rise to demotivation in the face of public services that are poor quality and difficult to access. These factors in turn led some parents who were socially excluded to distrust vaccination, to refuse vaccination as a form of resistance or a way to bring about change, or to avoid vaccination due to the time, costs, and distress it creates. Many of the overarching factors our review identified as influencing parents' vaccination views and practices were underrepresented in the interventions tested in the four related Cochrane Reviews of intervention effectiveness. Authors' conclusions Our review has revealed that parents' views and practices regarding childhood vaccination are complex and dynamic social processes that reflect multiple webs of influence, meaning, and logic. We have provided a theorised understanding of the social processes contributing to vaccination acceptance (or not), thereby complementing but also extending more individualistic models of vaccination acceptance. Successful development of interventions to promote acceptance and uptake of childhood vaccination will require an understanding of, and then tailoring to, the specific factors influencing vaccination views and practices of the group(s) in the target setting. The themes and concepts developed through our review could serve as a basis for gaining this understanding, and subsequent development of interventions that are potentially more aligned with the norms, expectations, and concerns of target users.

Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis.

Midwives' perceptions of vaccines and their role as vaccinators: The emergence of a new immunization corps.

Malgré le réel développement des études qualitatives et de leur publication, il persiste encore des freins solides dans la communauté médicale liés à des représentations négatives et à une méconnaissance de leurs concepts et méthodes. Nous proposons dans cet éditorial une réflexion issue de ces constats sur sa justification épistémologique en perspective de la démarche EBM. Deux grands paradigmes cohabitent dans l'histoire des sciences : le premier sous la bannière du positivisme/objectivisme et le second sous celle du subjectivisme/constructivisme. À chacun correspond une recherche : qualifiée pour le premier « d'explicative », avec comme finalité la mesure objectivable de variables et de leurs effets, reproductible et généralisable ; et pour le second, une recherche dite « en compréhension » de phénomènes impliquant le sujet-acteur de la recherche. Leur légitimité et utilité communes ont été largement débattues par des auteurs de la deuxième moitié du XX siècle. Aujourd'hui, on parle de complémentarité dans laquelle les deux paradigmes s'unissent pour produire une connaissance plus globale des phénomènes humains.

[Qualitative research: An opportunity to think again about evidence-based medicine].

ABSTRACT The effectiveness of motivational interviewing (MI) for reducing vaccine hesitancy (VH) has been demonstrated in Quebec. We conducted a study to evaluate the acquisition of MI skills after MI training via videoconferencing for interns training as general practitioners (GPs) in southeastern France. A vaccination-specific MI training workshop was offered to interns in 2021, consisting of two separate Zoom videoconference sessions. Participants completed the Motivational Interviewing Skills in Immunization questionnaire before and after the training to measure skills acquisition. We used pairwise exact Wilcoxon-Pratt signed rank tests for the analysis. Among 45 GP interns enrolled in the first MI session, 34 (75.6%) attended both sessions and completed the questionnaire at 3 different time points. After the first session, MI knowledge scores improved significantly (+21.1 ± 21.6; P < .0001), as did application of MI skills (+36.8 ± 36.7; P < .0001), and MI practice confidence (+21.2 ± 11.1; P < .0001). The second MI session maintained the skills developed after the first session without further improvement. Participant satisfaction was high. This is the first study in France assessing the impact of a vaccination-specific MI training for GP interns. It shows a substantial improvement in knowledge, application of MI skills, and self-confidence in the practice of MI. GP interns were highly satisfied with the training despite the videoconference format. These promising results will allow the integration of MI training in GP medical curricula in order to prepare future GPs for communication in the field of vaccination.

https://www.tandfonline.com/doi/pdf/10.1080/21645515.2022.2114253?needAccess=true

Assessment of training of general practice interns in motivational interviews about vaccination

OBJECTIVE: To understand parents' representations based on their own lived experiences and their influence on the decision to vaccinate their children. METHODS: This was a qualitative, in-depth, phenomenological study using semi-structured interviews with 14 volunteer parents who have children age-eligible for vaccination. The participants were recruited through family doctors in the Montpellier region (France). The methodology is modeled on grounded theory. The data, collected by audio recording, were analyzed using a semio-pragmatic method that brought forth conceptual categories giving meaning to the phenomenon being studied. RESULTS: Parents are unaware of the diseases for which there are vaccines and express a need for information. A perception of the inequality of the individual in face of the disease and the vaccine greatly influences the parents' vaccination decision. It induces in them a reasoned "sifting" of vaccines and leads them to strike a risk/benefit balance. They trust more in their doctor and their personal experience than in publicized information. CONCLUSION: Parents' lack of awareness of diseases, even those for which immunization exists, would suggest a need to better inform parents on this matter. Their perception of the inequality of the individual (their child) in face of the disease and the vaccine is the main determinant in their decision to vaccinate. Parents approach immunization in a thoughtful educated way, influenced by such factors as lifestyle, personal experiences and confidence in their doctor. These results make them very "critical" with regard to basic vaccination recommendations.

Marion Vallart

Papers

Comprendre la décision vaccinale des parents pour mieux accompagner leurs choix : étude qualitative phénoménologique auprès des parents français