A deliberate choice? Exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors

Kim A. G. J. Romijnders*, Stephne L. van Seventer, Manon Scheltema, Liesbeth van Osch, Hein de Vries, Liesbeth Mollema

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objective: In light of the decline in childhood vaccination coverage, the question rises concerning what factors play a role in informed decision-making about childhood vaccination. Insight into factors related to this decision helps us to support parents' informed decision-making about childhood vaccination.

Method: We conducted 12 semi-structured focus group interviews across the Netherlands based on a definition of informed decision-making: three with acceptors, three with refusers, and six with partial acceptors to ask about knowledge, attitudes, deliberation, and information needs. We performed a thematic analysis of the transcripts.

Results: Acceptors viewed the decision to participate in the National Immunization Program (NIP) as self-evident. Refusers and partial acceptors, however, reported to extensively deliberate the pros and cons of accepting or refusing the NIP in much detail. Their answers indicated that their knowledge was not always evidence-based. In addition, refusers and partial acceptors perceived fewer risks of vaccine preventable diseases (VPDs), more risks of side-effects of vaccines, less social support from their environment, less trust in child welfare centers (CWCs), and information provided than acceptors.

Conclusion: We observed distinct differences in factors related to decision-making about childhood vaccination between acceptors, refusers, and partial acceptors. Acceptors in the current study perceived accepting childhood vaccinations as self-evident, refusers relied mostly on anecdotal information rather than evidence-based information to weigh up the pros and cons vaccines and the VPDs, and partial acceptors elaborately deliberated the pros and cons of each vaccine and VPD individually, which was time-consuming and difficult. To strengthen and support decision-making among parents, more elaborate dialogues are needed between Child Vaccine Providers (CVPs) and parents. These discussions could build trust between parents and CVPs, be used to discuss the evidence-based advantages of childhood vaccinations, and to decrease parents' susceptibility to anecdotal information and misperceptions about childhood vaccinations shared by other parents. (C) 2019 The Authors. Published by Elsevier Ltd.

Original languageEnglish
Pages (from-to)5637-5644
Number of pages8
Issue number37
Publication statusPublished - 3 Sept 2019


  • Childhood vaccination
  • Decision-making
  • Focus groups
  • Qualitative research
  • Vaccine hesitancy
  • Alternative vaccination schedule
  • BIAS

Cite this