RESEARCH – June 2019

Parental beliefs towards scheduled immunization in Estonia and factors associated with vaccination behaviour: results of an internetbased survey

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Background. The decrease of vaccine preventable diseases has led to vaccine hesitancy and even refusal of vaccination in many countries, but evidence-based information about the beliefs Estonia is still missing.

Aim. We aimed to identify Estonian parents` vaccination behaviour, their beliefs towards the scheduled immunization programme, and the socio-demographical and socioeconomic factors associated with the vaccination behaviour. Methods. A web-based anonymous questionnaire was carried out in 2017 (November 8th to December 7th). Altogether 1,557 parents (roughly 0.1% of the Estonian population) with the youngest child aged ≤5, were enrolled. According to the questionnaire, we divided the respondents into three groups: Vaccinators (V; 72.3%), Uncertain group (U; 11.9%), and Refusers (R; 15.8%). In order to identify the independent risk factors associated with the vaccination behaviour, univariate and multiple logistic regression analyses were used, and to measure beliefs, the Likert scale (5-point) was used.

Results. The results of multiple logistic regression analysis showed higher odds to vaccinate their children among parents with lower income (0–800 and 801–1500 vs. ≥1501 €; OR=1.52; 95% CI 1.03–2.25 and OR=1.59; 95% CI 1.15–2.2, respectively). The R, on the contrary, had more likely higher income and ≥2 children in the family. The main factor associated with being in the U group was the parents’ age (>35 vs 25–34 years; OR=1.73; 95% CI 1.25–2.38). The opinions regarding vaccination were significantly different in all groups. The majority of the parents believed that vaccines help to prevent diseases (78.7%; V 96.4%, U 65.1%, R 8.1%), and vaccine-prevented diseases are serious (74.3%; V 90.9%, U 62.4%, R 7.3%). Only 27.9% (V 8.2%; U 57.5%, R 95.9%) were concerned about immunizations overloading the child’s immune system and would cause allergic reactions (29.3%; V 11.6%, U 51.6%, R 93.5%). The U and R parents were significantly less likely to report confidence in medical and public health sources, compared to the V parents; healthcare education was not associated with the vaccination behaviour.

Conclusions. Despite the fact that Estonian vaccination rates are relatively high, the current study shows strong hesitancy regarding the safety of vaccination. As vaccine safety is perceived as a concern by many parents (including the ones that are U and R), it is important to build trust in vaccination in order to prevent further increase in refusal.