Determinants of vaccine hesitancy among parents: a cross-sectional survey-based study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20263085Keywords:
Determinants, PACV scale, Parents, Saudi Arabia, Taif city, Vaccine hesitancyAbstract
Background: Vaccine hesitancy is among the top 10 global health threats. In Saudi Arabia, despite good vaccination coverage (e.g., 96% for measles-mumps-rubella), parental confidence is low. This study assessed the frequency of vaccine hesitancy among parents in Taif City, Saudi Arabia, and its associated demographic and health-related characteristics, including domain-specific attitudes (behavior, attitude, safety, and efficacy).
Methods: Parents of children aged 2 months-7 years completed an online Arabic questionnaire collecting sociodemographic data, vaccination history, and the parent attitudes on childhood vaccines (PACV) measure. The scale ranged from 0 to 100, with a score of 50 or higher suggesting indecision. Associations were analyzed by the chi-square or Fisher’s exact test, the Mann-Whitney U test, or the Kruskal-Wallis H test.
Results: The prevalence of hesitating was 19.8% (87/440). The mean PACV score was 34.1±19.4. The highest score was in the attitude category (4.99±3.9), followed by safety and efficacy (4.12±2.5) and behavior (1.03±1.4). Strong predictors were divorced or widowed status (50.0% versus 17.2%; p<0.001), younger age (75.0%; p=0.017), incomplete immunization (38.5% versus 14.2%; p<0.001), and previous refusal (62.3% versus 14.0%; p<0.001).
Conclusions: Hesitancy towards vaccination was observed among ~20% of the parents in Taif. Their attitudes and concerns regarding safety and efficacy were of great significance. General hesitancy is low, but specific communication strategies, systematic screening with the PACV measure, and interventions for first-time parents and single mothers are recommended.
References
Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet. 2011;378:526-35.
de Figueiredo A, Simas C, Karafillakis E, Paterson P, Larson HJ. Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: a large-scale retrospective temporal modelling study. Lancet. 2020;396(10255):898-908.
Siddiqui M, Salmon DA, Omer SB. Epidemiology of vaccine hesitancy in the United States. Hum Vaccine Immunother. 2013;9:2643-8.
Gellin BG, Maibach EW, Marcuse EK, National Network for Immunization Information Steering Committee. Do parents understand immunizations? A national telephone survey. Pediatrics. 2000;106(5):1097-102.
Offit P. Vaccines and autism revisited: the Hannah Poling case. N Engl J Med. 2008;358:2089-91.
Offit PA, Quarles J, Gerber MA, Hackett CJ, Marcuse EK, Kollman TR, et al. Addressing parents’ concerns: do multiple vaccines overwhelm or weaken the immune system? Pediatrics. 2002;109:124-9.
Chatterjee A, O’Keefe C. Current controversies in the USA regarding vaccine safety. Expert Rev Vaccines. 2010;9:497-502.
Dubé E, Gagnon D, Nickels E, Jeram S, Schuster M. Mapping vaccine hesitancy: Country-specific characteristics of a global phenomenon. Vaccine. 2014;32:6649-54.
The Strategic Advisory Group of Experts (SAGE). Report of the SAGE working group on vaccine hesitancy. WHO; 2014.
Smith PJ, Kennedy AM, Wooten K, Gust DA, Pickering LK. Association between health care providers’ influence on parents who have concerns about vaccine safety and vaccination coverage. Pediatrics. 2006;118:1287-92.
Opel DJ, Taylor JA, Zhou C, Catz S, Myaing M, Mangione-Smith R. The relationship between parent attitudes about childhood vaccines and their child’s immunization status. Pediatrics. 2011;127(6):e1515‑21.
Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald NE, Wilson R. Measuring vaccine hesitancy: the development of a survey tool. Vaccine. 2015;33(34):4165-75.
Al-Shehri SN, Al-Shammari SA, Khoja TA. Missed opportunities for immunization. Can Fam Phys. 1992;38:1087-91.
Ministry of Health. Annual statistical year book 2017. Available from: https://www.moh.gov.sa/en/ Ministry/Statistics/book/Documents/ANNUAL-STATISTICAL-BOOK-1438H.pdf. Accessed on 10 June 2019.
Ministry of Health. EPI increased to more than 95% in the Kingdom. Updated 2019. Available from: http://www.moh.gov.sa/en/Ministry/MediaCenter/News/Pages/NEWS-2011-5-3-001.aspx. Accessed on 12 March 2012.
Orenstein WA, Hinman AR. The immunization system in the United States-the role of school immunization laws. Vaccine. 1999;17:S19-24.
Alsubaie SS, Gosadi IM, Alsaadi BM, Albacker NB, Bawazir MA, Bin-Daud N, et al. Vaccine hesitancy among Saudi parents and its determinants: Result from the WHO SAGE working group on vaccine hesitancy survey tool. Saudi Med J. 2019;40(12):1242.
Ruiz JB, Bell RA. Parental COVID-19 vaccine hesitancy in the United States. Public Health Rep. 2022;137(6):1162-9.
Al-Iede M, Aljahalin M, Fashho E, Sweis S, Mesmeh R, Hamad LB, et al. Hesitancy toward childhood and influenza vaccines: experiences from highly educated Jordanian parents. Vaccines. 2024;12(8):945.
Qatipi L, Fico A, Toci E, Shtylla M, Biles M. Sociodemographic factors influencing childhood vaccination in Albania: a cross-sectional study. Eur J Public Health. 2025;35(6):1115-21.
Sulaimani M, Al-Mehmadi S, Sulaimani M, Alsubhi S, Sulaimani Sr M, Alsubhi Sr S. Prevalence and determinants of routine childhood vaccination hesitancy in Makkah, Saudi Arabia. Cureus. 2024;16(6).
Althobaiti S, Hameed A. Parental attitudes toward childhood vaccination in Madinah, Saudi Arabia: a Cross-Sectional Study. SSRN. 2025.
Alzahrani AA, Alghamdi AN. Vaccine hesitancy among parents during COVID-19 in Taif City, Saudi Arabia. Cureus. 2023;15(6).
Cao X, Borah P, Lee DK, Vishnevskaya A, Su Y, Lorenzano K. Beyond the post: the impact of politized anti-vaccine misinformation comments and challenges of correction on social media. Vaccine. 2025;65:127760.
Novilla ML, Goates MC, Redelfs AH, Quenzer M, Novilla LK, Leffler T, et al. Why parents say no to having their children vaccinated against measles: a systematic review of the social determinants of parental perceptions on MMR vaccine hesitancy. Vaccines. 2023;11(5):926.