Parents' Perceptions and Intention to Vaccinate Their Children Against COVID-19: Results From a Cross-Sectional National Survey in India

Unveiling parental perspectives: COVID-19 vaccination for children in India

Background

Irrespective of the availability of a safe and effective COVID-19 vaccine and its success rate in adults, administering vaccines to children remains a challenge for healthcare workers. Children's vaccine hesitancy among parents remains substantial and is exacerbated due to misleading information. In the present study, we aimed to investigate the hesitancy of parents and their concern about the vaccination and clinical characteristics of COVID-19 in their children.

Methods

A cross-sectional web-based and offline survey comprised of questions about the demographic of children, the status of COVID-19 infection, its severity, vaccination status, sources of information, willingness, concerns and attitude of parents to vaccinate their children against the COVID-19 virus, was conducted. Overall, 846 responses from parents fulfilling the inclusion criteria were analysed by GraphPad Prism 5.

Results

Out of the 846 responses, 51.2% (n = 433) of children were vaccinated against COVID-19. Out of vaccinated children (51.2%), 60.3% (n = 261) had experienced adverse events. Around 21% (n = 98) of children had a history of exposure to the SARS-CoV-2 virus. Among the infected children, 14.3% were asymptomatic and 85.7% had symptoms. Approximately 8% of children had comorbidities, with chronic lung diseases and asthma being the most common. Among the 846 participating parents, 59.5% were mothers and the remaining 40.5% were fathers. A total of 2.7% and 22.2% of parents were found hesitant to administer the COVID-19 vaccine to their children aged 15-18 years and below 15 years, respectively. Among hesitant parents, mothers were found slightly more hesitant as compared to fathers. Also, 35.5% of parents were found hesitant about their own COVID-19 vaccination. Furthermore, the concern for COVID-19 vaccine unwillingness among parents is that a child has already achieved natural immunity after COVID-19 infections (76.8%) followed by vaccine safety and its side effects. The motivating factors to convince parents for their children's COVID-19 vaccination were if their doctors recommend it, followed by detailed information on vaccine side effects and efficacy in children. The most trusted source of information for the parents was found to be the healthcare workers.

Conclusion

These results suggest that data and reviews regarding the safety and efficacy of the COVID-19 vaccine readily available in the public domain could serve as a highly effective strategy for promoting and implementing widespread vaccination among children. By providing easily accessible and comprehensive information, public health authorities can address parental concerns, dispel misconceptions and foster a greater sense of trust in the vaccination process.

Healthcare professionals' acceptance of COVID-19 vaccination for their children: A cross-sectional study at a tertiary care hospital in Western India

Background and Aims

Establishing a transparent and forthright dialog between healthcare professionals (HCPs) and the public is paramount in promoting the effective acceptance of COVID-19 vaccination for children. Hence, this study aimed to assess the COVID-19 vaccine acceptance, knowledge, and perception among HCPs for their children.

Methods

A cross-sectional study was conducted among HCPs at a tertiary care teaching hospital in Western India. A structured questionnaire was designed and validated to collect data. Descriptive statistics were used for data analysis.

Results

The study found that more than 80% of HCPs had good knowledge about COVID-19 vaccines, and 92.74% of them were willing to accept the vaccine for their children. Doctors were more likely to vaccinate their children, and 73% of HCPs had a favorable attitude toward immunizing their children if a new COVID-19 vaccine was available. Academic/peer-reviewed publications were considered the most reliable source of information for COVID-19 vaccination, followed by government sources.

Conclusion

This study found that parental vaccine hesitancy was significantly lower among the HCP group. The majority of HCPs were in favor of vaccinating their children against COVID-19, indicating that they can serve as an effective channel for promoting parental acceptance of COVID-19 vaccines in the community.

Are parents' willing to vaccinate their children against COVID-19? A qualitative study based on the Health Belief Model

In response to the COVID-19 pandemic, several countries have started implementing voluntary or involuntary mass vaccination programs. Although vaccine acceptance is high among adults, uncertainty about whether to vaccinate children against COVID-19 remains a controversial theme. To date, few qualitative studies have explored parents' views on this topic. A qualitative descriptive study design was used to collect data and individual in-depth interviews were conducted with 50 parents in the Makkah region of Saudi Arabia. The Health Belief Model (HBM) was used as a guide in developing the interview guide. Each question was related to a construct of the HBM. The data were then analyzed using thematic content analysis and interpreted using NVivo software. Two major themes emerged: motivation to vaccinate children, which was influenced by perceived benefits, perceived severity, perceived suitability, collective responsibilities, confidence, and cues to action; and barriers to vaccination in children, which included complacency, rapid vaccine development, and uncertainty about the long-term side effects of the vaccine. The findings of this study revealed that the public is not sufficiently informed about the efficacy or side effects of the COVID-19 vaccine, increasing the awareness of which will help parents make informed decisions regarding vaccinating their children and potentially increase vaccine acceptance.

Nigerian parents and caregivers knowledge, attitude and willingness to vaccinate their children against COVID-19

Objectives

In order to achieve herd immunity against COVID-19, a significant proportion of the population will need to be vaccinated. Experts have recommended that African children be allowed to get vaccinated to protect them from emerging variants of COVID-19 infection. This study investigated Nigerian parents and caregivers' knowledge, attitude, and willingness to vaccinate their children against COVID-19 once the vaccines are made available to them.

Methods

A cross-sectional online survey of 500 parents/caregivers was conducted in Nigeria. Participants were asked to complete a questionnaire about their sociodemographic characteristics, knowledge of and attitude toward COVID-19 infection and vaccination, willingness to vaccinate their child and factors that could influence their decision to vaccinate their child. A scoring system was used to classify the level of knowledge and attitude of participants into 2 categories, namely poor, and good. We analyzed data obtained using SPSS Version 22.

Results

Majority of the participants were females (63.6%). Analysis of responses revealed good knowledge and attitude in 265 (53.0%) and 266 (53.2%) respondents, respectively. Overall, less than half of the parents/caregivers (48.4%) expressed intention to vaccinate their children against COVID-19. Factors associated with willingness to vaccinate children against COVID-19 included age greater than 40 years, male gender, residing in Southern Nigeria, having good knowledge, knowing an infected person or a vaccinated person, feeling they or their child is at risk of contracting COVID-19 infection, willingness to vaccinate self against COVID-19 and good attitude. Significant predictors of willingness to vaccinate their child include age greater than 40 years [AOR: 2.56; 95% CI = (1.14-5.76)], willingness to vaccinate self [AOR: 1016.81; 95% CI = (128.51-8045.60)] and good attitude [AOR: 6.21; 95% CI = (2.83-13.64)].

Conclusion

This study revealed that parental willingness to vaccinate their children against COVID-19 is low and identified factors influencing it. It is important to develop and implement health education programs iterating the risk of children getting infected with SARS-CoV-2 and its emerging variants to ensure optimal uptake of the COVID-19 vaccine in Nigerian children.

Systematic review: Impact of parental decision on paediatric COVID-19 vaccination

OBJECTIVE

The objective was to carry out a systematic review on the acceptance of parents to vaccinate their children against COVID-19 and the factors that contribute for vaccination hesitancy.

METHODS

The Preferred Reporting Items for Systematic Re- views and Meta-Analyses (PRISMA) guidelines and the Patient, Intervention, Comparison and Outcome (PICO) strategy were followed. A search was carried out in the VHL Regional Portal, PubMed, Scielo, Web of Science, Embase and Scopus databases. We included articles that assessed the rate of acceptance and/or hesitation of parents and the factors that affect the decision about vaccination against COVID-19 for their children in cross-sectional studies. Laboratory studies, animal models, tests and case reports that elected other aspects related to COVID-19 were excluded. The methodological quality of the studies was based on the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data, developed by the Joanna Briggs Institute.

RESULTS

From the 708 articles found, 237 studies remained after removal of duplicates. Titles and abstracts of these publications were evaluated and, applying the exclusion criteria, 56 articles were selected. Inclusion criteria were employed and 28 studies were eligible. Overall average vaccination acceptance rate was 55.81%, and the main reasons for vaccine hesitancy were uncertainty of vaccine efficacy and safety, concerns about side effects, and lack of access to relevant information.

CONCLUSION

The research results can be useful for the development of health education and parental awareness strategies in order to promote greater adherence to vaccination against COVID-19.

Factors associated with parental intention to vaccinate their preschool children against COVID-19: a cross-sectional survey in urban area of Jakarta, Indonesia

Purpose

We reported a survey-based study assessing the parental intention to vaccinate children of 5 to 7 years old against coronavirus disease 2019 (COVID-19). The aim of this study is to assess factors influencing the parental intention to vaccinate their children against COVID-19.

Materials and Methods

This study adopted a cross-sectional design, held at the public health center of Senen district, Jakarta, Indonesia from November 1-30, 2022. The off-line questionnaires were distributed via the school administrator to all eligible parents. Factors associated with intention to vaccinate were analyzed with the regression logistic models.

Results

Of the 435 parents in this study, 215 had already vaccinated their children against COVID-19 (49.4%), and the overall intention of the participants to vaccinate was 69.7%. Factors associated with intention to vaccinate the children against COVID-19 were parental employment status, parental COVID-19 vaccine status and concern of contracting COVID-19. Parents who are employed, had completed vaccines with COVID-19 booster vaccine, and had concern of their children contracting COVID-19 were more likely to vaccinate their children (odds ratio [OR], 2.10; 95% confidence interval [CI], 1.22-3.69; p=0.011; OR, 2.15; 95% CI, 1.21-3.83; p=0.013; OR, 2.40; 95% CI, 1.34-4.30; p=0.004, respectively). Concern on the vaccine's side effects was negatively associated with the willingness to vaccinate.

Conclusion

This study showed that childhood COVID-19 vaccine only covered half of the population, with parental intentions for childhood COVID-19 vaccination being high, reaching almost two-thirds of the study participants. Factors influencing parental intentions were employment status, parental COVID-19 vaccine status, concerns about COVID-19 and concerns about vaccine side effects.

Exploring Determinants of COVID-19 Vaccine Acceptance, Uptake, and Hesitancy in the Pediatric Population: A Study of Parents and Caregivers in Saudi Arabia during the Initial Vaccination Phase

OBJECTIVES

This study aims to assess COVID-19 vaccine acceptance, uptake, and hesitancy among parents and caregivers of children in Saudi Arabia during the initial rollout of pediatric COVID-19 vaccination.

METHODS

An electronic survey was used to collect data from participants who visited a COVID-19 vaccine center. The survey included demographic data, COVID-19 vaccine status among participants and their children, and reasons for vaccine acceptance or rejection. The Vaccine Hesitancy Scale (VHS) tool was also employed to assess vaccine hesitancy and attitudes toward the COVID-19 vaccine and routine childhood vaccination. Multivariate binary regression analysis was used to identify predictors of actual COVID-19 vaccine uptake among children.

RESULTS

Of the 873 respondents included in the analysis, 61.5% were parents and 38.5% were other caregivers. Of the participants, 96.9% had received the COVID-19 vaccine. Six hundred and ninety-four participants accepted the vaccine for their children, with the main reasons being an endorsement by the Saudi Ministry of Health (60%) and the importance of going back to school (55%). One hundred and seventy-nine participants would not vaccinate their children, with the most common reasons being fear of adverse effects (49%) and inadequate data about vaccine safety (48%). Factors such as age, COVID-19 vaccination status, self-rated family commitment level, attitudes toward routine children's vaccines, and participants' generalized anxiety disorder (GAD7) score did not significantly correlate with children's COVID-19 vaccination status. Parents were less likely to vaccinate their children compared to other caregivers, and participants with a higher socioeconomic status were more likely to vaccinate their children.

CONCLUSION

Vaccine acceptance and uptake were high during the initial pediatric COVID-19 vaccination rollout in Saudi Arabia. Still, the ongoing endorsement of the Ministry of Health and healthcare authorities should continue to advocate for better vaccine uptake in children.

Worldwide Estimation of Parental Acceptance of COVID-19 Vaccine for Their Children: A Systematic Review and Meta-Analysis

Currently, the best method to well control the spread of COVID-19 without severe mental health problems is to reach herd immunity. Therefore, the vaccination rate of the COVID-19 vaccine is critical. Among the populations, children are the vulnerable ones to get vaccinated; therefore, it is important to assess parents’ and guardians’ willingness to have their children vaccinated. The present systematic review and meta-analysis synthesized evidence to estimate the parents’ acceptance rate of COVID-19 vaccination toward their children. Additionally, factors explaining the acceptance rate were investigated. Four academic databases (PubMed, Scopus, Web of Science, and ProQuest) together with Google Scholar were searched, and the references of the included publications were searched as well. Using the PECO-S framework (population, exposure, comparison, outcome, and study design), observational studies of cross-sectional, cohort, or case-control studies were included. The outcome was parents’ or guardians’ willingness to let their children be vaccinated. The studies included in the present review were restricted to English and peer-reviewed papers published between December 2019 and July 2022. A total of 98 papers across 69 different countries with 413,590 participants were included. The mean age of the parents was 39.10 (range: 18–70) years and that of their children was 8.45 (range: 0–18) years. The pooled estimated prevalence of parental acceptance to vaccinate their children with the COVID-19 vaccine was 57% (98 studies, 95% CI: 52–62%, I2: 99.92%, τ2: 0.06). Moreover, data collection time was a significant factor explaining parental willingness in the multivariable meta-regression, with a 13% decrease in parental willingness by each month increase in time, explaining 11.44% of variance. Qualitative synthesis results showed that parents’ COVID-19 vaccine knowledge, trust in theCOVID-19 vaccine, and facilitators in vaccination (e.g., low cost, good vaccine accessibility, and government incentive) were significant factors for higher willingness, while mental health problems (e.g., having worries and psychological distress) were significant factors for lower willingness. Given that the acceptance rate was relatively low (57%) and does not achieve the requirement of herd immunity (i.e., 70%), governments and healthcare authorities should try to elevate parents’ knowledge and trust in the COVID-19 vaccine, facilitate in vaccination, and reduce their mental difficulties to improve the overall vaccination rate among children.

Discrepancy of human papillomavirus vaccine uptake and intent between girls 9-14 and their mothers in a pilot region of Shanghai, China

Human papillomavirus (HPV) vaccine uptake remains low in China, especially among girls. Recently, China has initiated a pilot program on HPV immunization for girls aged 9-14 years. We conducted a cross-sectional online survey in Minhang district of Shanghai, a pilot region for the program, to investigate HPV vaccination status among mothers and their daughters 9-14. A total of 1031 parents and 1122 daughters 9-14 were included. Of them, 18.6% of mothers and 4.5% of daughters had been vaccinated with HPV vaccines or made an appointment; additionally, 62.7% and 78.4% intended to receive vaccination but did not make an appointment. Notably, 6.2% of parents did not intend to receive vaccination for themselves (or their wives) but intended to vaccinate their daughters. Moreover, we calculated parental knowledge and awareness scores toward HPV infection and vaccination. Both scores were significantly higher among the parents who had received HPV vaccination than those who intended to across mothers' vaccination status (P < .001 for knowledge and P = .019 for awareness), whereas similar between the two groups across daughters' vaccination status (P = .694 and P = .737). Parents believed mothers had a significantly higher susceptibility to HPV infection and lower health consequences, compared to daughters 9-12 (P = .002 and P < .001) or those 13-14 (both P < .001). In conclusion, HPV vaccine uptake remains a discrepancy between mothers and their daughters 9-14. However, their intents to receive HPV vaccination were both high. Parental knowledge and awareness may improve vaccination intent for daughters 9-14 in China. It warrants a certain health education toward susceptibility to HPV infection and health consequences.