Participant Demographic Characteristics
Participant’s demographic characteristics are summarized in Table 2. Most participants (n = 10, 91%) self-identified as white and non-Hispanic, all participants had completed high school and most had completed college (n = 7, 64%). Most of the study participants (n = 9, 81%) had health insurance and the majority (n = 6, 55%) had children. The mean age of the participants was 34 years and the majority were female (n = 6, 55%)
Table 2
Demographics of Participants
Age (mean) | 34 |
Gender |
Male | 45% |
Female | 55% |
Race/Ethnicity |
White | 91% |
Black | 0% |
Hispanic | 9% |
Asian | 0% |
Education |
High School or Higher | 100% |
College or Higher | 82% |
Graduate School/Professional | 64% |
Annual Household Income |
< 10,000 | 9% |
10,001–25,000 | 18% |
25,001–40,000 | 9% |
40,001–60,000 | 27% |
60,001–75,000 | 27% |
> 75,000 | 0% |
Health Insurance |
Yes | 81% |
Private | 45% |
Public | 36% |
No | 9% |
Vaccinated? | 100% |
Tetanus | |
Yes | 82% |
Unsure | 18% |
Tdap | |
Yes | 27% |
Unsure | 73% |
Has Children | 55% |
Children Vaccinated | 100% |
Children have DTaP | 100% |
Theme 1: Attitudes Towards Vaccination
The majority of respondents (n = 8, 73%) held positive attitudes regarding vaccination in general. If participants had had children, they reported that they had their children vaccinated and up-to-date according to current recommendations. Expressions of support ranged from vague positivity to explicit and thorough sentiment. For example, Aileen said that they “think [vaccination] is generally a good thing,” and Amelia reported that they “think vaccinations are a great thing,” and even considered getting vaccinated part of their civil duty. They continued, “I think that in order to keep people healthy that is basically a civil…part of being a citizen is to have your children vaccinated…”
Three (27%) participants had either mixed or negative feelings about at least some aspect of vaccination. Vaguely negative sentiments expressed included Fred indicating that they perceived the necessity of vaccines differently by age group, stating “I think some vaccines work. Obviously, the ones for the polio, the ones you receive as kids. I think those work and flu vaccines are needed maybe for children and the elderly but not as a yearly thing.” Explicitly negative sentiments included participants doubting the efficacy of some vaccine completely; as Rosemary said, “The flu shot…that’s just a load of crap.”
Theme 2: Reasons for Supporting Vaccination
The most commonly offered explanation when asked why parents chose to vaccinate their children was to prevent their children from getting diseases. “Because we don’t want [them] to get sick,” shared David. Most participants that held positive beliefs about vaccination also cited historical prevalence of many diseases as a contributing factor to their consideration of vaccination. Aileen shared that one of their major considerations when considering vaccination as a general practice was the availability of modern technology and medicine to prevent diseases,
Because children used to die because we had all of these diseases that killed off I don’t know how many children in their early years and I think it is incredible that we have these things where you can have one shot and then we don’t have to worry that our kids are going to die of all these…I mean it makes me want to cry that I don’t’ have to worry about it. So I just think it of one of those achievements of modern medicine that we can eradicate and prevent some really awful things.
Others shared that they would feel guilty if their child got someone else sick. David expressed concerned that they “wouldn’t want [their child] to be the vector that got one of [their] immune-suppressed friends sick.”
Theme Three: Concerns and Reasons for Hesitancy
Number of Vaccines Administered
Vaccine-hesitant participants cited side effects and the number of vaccines administered at once as the primary reasons for delaying their children’s vaccination schedule. Aileen said that they felt like “it’s a lot of stuff to put in [their] tiny body in one visit.” Fred and Rosemary also expressed the same concern. “Personally, I think if you pump five vaccines into your child, their poor little bodies can’t deal with it,” Rosemary offered. Fred asked “How much can your auto-immune system take? Is that something that you should really be pushing with your children’s health?”
Denial of Efficacy and Safety Concerns
Some participants reported that a major contributor to their refusal or hesitancy to get vaccines included not trusting vaccine efficacy. “The flu shot…that’s just a load of crap,” shared Fred. “Like, you’re injecting the flu shot into your body. It’s a virus…you can’t kill it. So your chances of getting the flu when you take the shot are higher than when you don’t.” Not only does this reject that the influenza vaccine is effective it also suggests that the vaccine causes the very illness it is intended to prevent.
Fred was the only participant to explicitly reject vaccines as effective.
Concern Regarding Safety, Side Effects, or Negative Consequences of Vaccination
Most (n = 9, 82%) participants expressed minimal concern regarding the safety of vaccines and stated that while they had safety concerns, they were not significant enough to cause them to delay or deny vaccines for themselves or their children. David reported that when they were getting their first child vaccinated they were concerned that their child would have an allergic reaction or adverse outcome because of the ingredients. “Oh there’s egg albumin, does she have any allergies? Then the idea that mercury is one of the preservatives…,” David recalled from when they had their first child and said that their concern as normal, explaining “Oh, we’re parents! We worry.”
Some participants had major concerns about side effects and other adverse outcomes. When discussing vaccines and particularly the influenza vaccine with Rosemary, they expressed major concerns about the vaccine’s safety and its impact. “The thing that I worry about, really, is these diseases mutating and making a comeback…kind of like how the flu makes a new strand every time they come out with a new vaccine.” Fred added,
I don’t think [influenza vaccines] are healthy for adults. The RNA mutation is a big concern. And they say that the influenza in the shot is dead but I’m like ‘yeah but how do you know that?’ That’s what I can’t seem to get an answer for. A virus can reanimate at any time and you can’t guarantee that. Other than that, I think the rest of them are safe.
Risk Perception of Getting Pertussis
Most participants conceptualized risk of disease differently for their children than they did for themselves. In fact, many reported that their children were fully vaccinated against pertussis, but they themselves were not sure if they were up to date. Aileen seemed to become aware of this incongruence between their behaviors and self-described attitudes while discussing risk in adult and children. “I feel in some ways that my attitudes are more pro than my actions,” they said while discussing them not receiving an influenza vaccine this year while their children did. They went on to say that “maybe I have some kind of division in my mind between children and adults.”
All participants perceived themselves at very low risk for contracting pertussis. Fred thought that “now that the kids are older, I don’t see how we could get it.” Rosemary stated, “I don’t think we can get it. The doctor says everyone carries it around but from what I’ve been told, the chances of an adult getting it are slimmer than elderly or an infant so we’re not worried.” Other notable responses included “I feel like I’ve heard that it effects a lot of elderly people, maybe? That’s about it,” offered Ted. Nancy thought they didn’t “think [they] could get it, because [they’ve] had the vaccine.” “I hope,” they continued, “And if I did get it, it probably wouldn’t be as serious.”
Theme Four: Knowledge and Information Sources
The majority of participants reported speaking with physicians or another healthcare provider about vaccines when prompted, but otherwise reported either not intentionally seeking information or seeking it on the internet. Participants that reported never having sought information themselves reported that they spoke with their doctor when it was necessary.
Conversations with doctors, pamphlets at physicians’ offices, and internet research were the most cited sources of information about vaccinations. Elizabeth stated that they talked to “my doctor and my kids’ doctors. My husband a little bit. And I’ve heard stories on the news or heard things on the radio, people on TV.” They admitted “Sometimes I google things about ‘what is this…’ but generally I get more information when I go to the doctor and they hand you a sheet that has pros and cons and possible reactions…”.
Amelia reported that they consulted their “primary care physician” and got most of their information at the “the doctor’s office. They give you those pamphlets.” Though the same participant also said, “I’ll also go online and look up things…I’ll google and then go to maybe Mayo Clinic, or someplace I recognize…Cleveland Clinic, CDC, some place I feel is more credible.”
Participants who perceived their knowledge of pertussis and vaccination as high did not have high knowledge of these topics and referenced popular science writing as their primary information sources. Fred and Rosemary cited vague sources like “medical books from the library” and popular science blogs including “IFL Science” as sources of information.
Many parents that participated in this study (n = 6, 55%) reported that they did not do much research about vaccinations or side effects until faced with the idea of vaccinating their children. Aileen said that they went through “some kind of evolution as far as how I felt about it because I didn’t do a ton of research before I had kids.”
Outside of physicians and the internet, participants reported discussing vaccinations with their family and friends and other social entities. Casey even cited “physicians and coworkers” as the primary two entities with whom they discussed vaccines. David said they talked with their friends and spouse about vaccines. They report discussing people in their larger social network that plan to not vaccinate their children and the participant reports that they have conversations about that so that they can try to understand. Fred reported discussing vaccines with their mother who is “a nurse and she even did a little paper about the chemicals in the vaccines and the things that build up in your system.”