Sosyal Bilimler ve Sağlık Bülteni

Özgün Makale

No. 15 (2025)

How Prepared Are We to Confront Childhood Vaccine Hesitancy? An Evaluation Based on Training Feedback

Submitted
July 17, 2025
Published
2025-08-22

Abstract

Vaccine hesitancy is not merely a product of individual knowledge gaps, but a complex and multi-layered phenomenon shaped by interactions with the health system, access to information, and levels of societal trust. This study aims to explore the experiences, communication needs, and perceived structural challenges of family health workers who encounter childhood vaccine hesitancy in their routine practice, based on written feedback collected after an in-service training program. The study adopts a descriptive, qualitative design and draws on open-ended written feedback provided by FHWs who participated in a training session on childhood vaccine hesitancy and refusal. The data were analysed using a basic content analysis approach. Findings indicate that many health workers equate vaccine hesitancy with outright refusal and rely heavily on one-way, persuasion-based communication strategies. Participants frequently reported gaps in their knowledge about vaccine ingredients and side effects, as well as emotional burdens associated with interacting with hesitant parents. Performance-based requirements and documentation procedures related to vaccine refusal were described as increasing administrative workload and undermining trustful communication with families. Although the training was positively evaluated by participants particularly regarding improvements in communication skills and empathetic approaches, structural issues such as the lack of supportive mechanisms and institutional loneliness remained prominent concerns. He findings highlight that in-service training programs addressing vaccine hesitancy should extend beyond technical knowledge and place greater emphasis on enhancing communication skills and fostering shared decision-making. System-level changes are needed to reduce the burden on frontline workers and improve the quality of engagement with hesitant parents. Collecting structured feedback during such trainings may also help identify context-specific areas for improvement in both education and service delivery.

Keywords: Vaccine hesitancy, vaccine refusal, childhood immunizations, communication, in-service training

References

  1. Bärnighausen, T., Bloom, D. E., Cafiero-Fonseca, E. T., & O’Brien, J. C. (2014). Valuing vaccination. Proceedings of the National Academy of Sciences, 111(34), 12313-12319. https://doi.org/10.1073/pnas.1400475111
  2. Bloom, D. E. (2011). The Value of Vaccination. Içinde N. Curtis, A. Finn, & A. J. Pollard (Ed.), Hot Topics in Infection and Immunity in Children VII (ss. 1-8). Springer. https://doi.org/10.1007/978-1-4419-7185-2_1
  3. Cagnotta, C., Lettera, N., Cardillo, M., Pirozzi, D., Catalán-Matamoros, D., Capuano, A., & Scavone, C. (2025). Parental vaccine hesitancy: Recent evidences support the need to implement targeted communication strategies. Journal of Infection and Public Health, 18(2), 102648. https://doi.org/10.1016/j.jiph.2024.102648
  4. Diaconu, K., Falconer, J., Verbel, A., Fretheim, A., & Witter, S. (2021). Paying for performance to improve the delivery of health interventions in low- and middle-income countries. Cochrane Database of Systematic Reviews, 2021(5). https://doi.org/10.1002/14651858.cd007899.pub3
  5. Fox, J. P., Elveback, L., Scott, W., Gatewood, L., & Ackerman, E. (1971). Herd Immunity: Basic Concept and Revelance to Public Health Immunization Practices. American Journal of Epidemiology, 94(3), 179-189. https://doi.org/10.1093/oxfordjournals.aje.a121310
  6. Hasnan, S., & Tan, N. C. (2021). Multi-domain narrative review of vaccine hesitancy in childhood. Vaccine, 39(14), 1910-1920. https://doi.org/10.1016/j.vaccine.2021.02.057
  7. Holford, D., Anderson, E. C., Biswas, A., Garrison, A., Fisher, H., Brosset, E., Gould, V. C., Verger, P., & Lewandowsky, S. (2024). Healthcare professionals’ perceptions of challenges in vaccine communication and training needs: A qualitative study. BMC Primary Care, 25(1). https://doi.org/10.1186/s12875-024-02509-y
  8. Humble, R. M., Scott, S. D., Dubé, E., Olson, J., & MacDonald, S. E. (2023). The impact of the COVID-19 pandemic on parents’ perceptions and acceptance of routine childhood vaccination in Canada: A national longitudinal study. Vaccine, 41(2), 407-415. https://doi.org/10.1016/j.vaccine.2022.11.052
  9. Jegan, R., Rose, A., & Dierickx, K. (2025). Institutional financial incentives in healthcare: A review of normative considerations. BMC Medical Ethics, 26(1). https://doi.org/10.1186/s12910-025-01252-y
  10. Kaufman, J., Ryan, R., Walsh, L., Horey, D., Leask, J., Robinson, P., & Hill, S. (2018). Face-to-face interventions for informing or educating parents about early childhood vaccination. Cochrane Database of Systematic Reviews, 2018(5). https://doi.org/10.1002/14651858.cd010038.pub3
  11. Klassen, A. C., Lee, G., Chiang, S., Murray, R., Guan, M., Lo, W.-J., Hill, L., Leader, A. E., Manganello, J., & Massey, P. M. (2024). Did the COVID-19 experience change U.S. parents’ attitudes towards HPV vaccination? Results from a national survey. Vaccine, 42(7), 1704-1713. https://doi.org/10.1016/j.vaccine.2024.01.105
  12. Lermytte, E., Bracke, P., & Ceuterick, M. (2024). Healthcare Professionals’ Discursive Constructions of Parental Vaccine Hesitancy: A Tale of Multiple Moralities. Qualitative Health Research, 34(14), 1384-1397. https://doi.org/10.1177/10497323241245646
  13. Li, J., Qin, X., Wang, H., & Yuan, B. (2025). Performance-based payments and intrinsic motivation among primary healthcare workers in China: A cross-sectional survey. BMJ Open, 15(6), e090145. https://doi.org/10.1136/bmjopen-2024-090145
  14. MacDonald, N. E. (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161-4164. https://doi.org/10.1016/j.vaccine.2015.04.036
  15. Martin, B., Jones, J., Miller, M., & Johnson-Koenke, R. (2020). Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 57. https://doi.org/10.1177/0046958020917491
  16. Martínez-Serrano, A., Pulido-Fuentes, M., Notario-Pacheco, B., Palmar-Santos, A. M., Cobo-Cuenca, A. I., & Díez-Fernández, A. (2025). Immunity Awareness—Strategies to Improve the Degree of Acceptance of Vaccines: A Systematic Review. Vaccines, 13(6), 618. https://doi.org/10.3390/vaccines13060618
  17. Obohwemu, K., Christie-de Jong, F., & Ling, J. (2022). Parental childhood vaccine hesitancy and predicting uptake of vaccinations: A systematic review. Primary Health Care Research & Development, 23. https://doi.org/10.1017/s1463423622000512
  18. Olson, O., Berry, C., & Kumar, N. (2020). Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies. Vaccines, 8(4), 590. https://doi.org/10.3390/vaccines8040590
  19. Riumallo-Herl, C., Chang, A. Y., Clark, S., Constenla, D., Clark, A., Brenzel, L., & Verguet, S. (2018). Poverty reduction and equity benefits of introducing or scaling up measles, rotavirus and pneumococcal vaccines in low-income and middle-income countries: A modelling study. BMJ Global Health, 3(2), e000613. https://doi.org/10.1136/bmjgh-2017-000613
  20. Rodrigues, C. M. C., & Plotkin, S. A. (2020). Impact of Vaccines; Health, Economic and Social Perspectives. Frontiers in Microbiology, 11, 1526. https://doi.org/10.3389/fmicb.2020.01526
  21. Scott, A., Sivey, P., Ait Ouakrim, D., Willenberg, L., Naccarella, L., Furler, J., & Young, D. (2011). The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd008451.pub2
  22. Shattock, A. J., Johnson, H. C., Sim, S. Y., Carter, A., Lambach, P., Hutubessy, R. C. W., Thompson, K. M., Badizadegan, K., Lambert, B., Ferrari, M. J., Jit, M., Fu, H., Silal, S. P., Hounsell, R. A., White, R. G., Mosser, J. F., Gaythorpe, K. A. M., Trotter, C. L., Lindstrand, A., … Bar-Zeev, N. (2024). Contribution of vaccination to improved survival and health: Modelling 50 years of the Expanded Programme on Immunization. The Lancet, 403(10441), 2307-2316. https://doi.org/10.1016/S0140-6736(24)00850-X
  23. Skirrow, H., Lewis, C., Haque, H., Choundary-Salter, L., Foley, K., Whittaker, E., Costelloe, C., Bedford, H., & Saxena, S. (2024). The impact of the COVID-19 pandemic on UK parents’ attitudes towards routine childhood vaccines: A mixed-methods study. PLOS ONE, 19(8), e0306484. https://doi.org/10.1371/journal.pone.0306484
  24. Yang, X., Shi, N., Liu, C., Zhang, J., Miao, R., & Jin, H. (2024). Relationship between vaccine hesitancy and vaccination behaviors: Systematic review and meta-analysis of observational studies. Vaccine, 42(2), 99-110. https://doi.org/10.1016/j.vaccine.2023.11.051