Understanding vaccination refusal: a qualitative study of parents' health beliefs and practices

Abstract

Vaccinations and immunisations have become one of the cornerstones of health promotion and preventive health care globally and they are firmly embedded within the bio-medical model of medicine. That there have been objectors to mass vaccination programmes from the very beginnings of its history is often forgotten. Objectors are often characterised as dissenters, as irresponsible and implicated in the failure of public health policy to prevent epidemics by interfering with herd immunity protection of the population. This thesis aims to explore the reasons why some people actively choose not to vaccinate their children and to examine their health beliefs and practices. Existing work with non-vaccinating parents has been dominated by quantitative and epidemiological studies attempting to determine why parents do not vaccinate or mixed method studies which also focus on lay perspectives; they aim to identify issues in order to help programmes to increase vaccination uptake. There is a shortage of studies focusing on the health beliefs of parents who make active decisions not to vaccinate in the context of those beliefs and health related practices. This study focuses on a small group of parents who have consciously decided not to have their children vaccinated for the common childhood illnesses and extends to those parents where travel vaccinations were also refused. Fifteen adults were studied, one was not a parent; in depth open ended interviews were conducted. The research process highlights both the level of trust between researcher and respondent and the experience of feeling marginalised and misunderstood for their beliefs. Both influence the data generated. The findings indicate that parents’ experience with healthcare practitioners varied enormously; from support and encouragement for their stance on vaccination to accusations of being a ‘bad parent’. In this study the respondents chose not to partake of the vaccination regime for their children because they believed that the vaccinations were either an unnecessary intervention, or, might do more harm than good. Some parents would never have any vaccination for themselves or their children in any circumstances as they did not agree with the principle at the outset. Others did not rule out all vaccinations in all circumstances, but kept an open mind. How people came to their points of view, who and what influenced them in their health beliefs and decision making varied and was complicated. Influences included the media, books, individual alternative health-care practitioners, parents, friends, the world wide web or some kind of ‘gut feeling’ that the practice was ‘wrong’, or a combination of some or all of these. There was no evidence for anti-vaccination pressure from any one organisation or person. Lack of faith, trust or belief in science as a health promoting body of knowledge was a significant aspect for some of the parents. Mistrust in the ethics of the pharmaceutical companies and their relationships with both the government and general practitioners made some of the parents mistrust their advice. Those parents who had a scientific background disagreed with the science of vaccinations. The conclusion highlights the difficult position people who do not believe in vaccination find themselves in and the role of health beliefs that are embedded in different understandings of what constitutes health-illness and how health can be maintained.