COVID | Free Full-Text | Associations between Socio-Demographic Characteristics and Maternal Attitudes towards Childhood Vaccination in Cyprus—A Cross-Sectional Survey
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1. Introduction
Childhood vaccination uptake is a growing public health concern. Especially during the COVID-19 pandemic, existing research has shown a decline in routine childhood vaccination uptake. Specifically, the uptake of vaccines against measles, mumps, rubella, tetanus, diphtheria, pertussis, polio, and pneumococcal disease dropped significantly [1]. Several factors impacted this, including the reduced access to immunization services during the pandemic [2] and parental COVID-19 infection, which caused the delay of childhood vaccination [3].
Parental vaccine hesitancy has been previously known to result in vaccination delay or avoidance, even prior to the COVID-19 pandemic [4,5,6]. Despite the proven efficacy and safety of vaccines, negative attitudes and concerns among parents can affect childhood vaccination uptake [7,8,9,10,11,12], with the immunization status of children often being associated with that of their parents [13]. Various factors influence parental decisions to vaccinate their children, including their socio-demographic status, parental perceptions about vaccines, their educational level, and others [8,14,15,16,17,18,19]. Public health authorities around the world should consider parental vaccine hesitancy as a possible threat to society. In the recent past, epidemics of vaccine-preventable diseases were observed; therefore it is crucial to study parental health literacy, attitudes, and perceptions about vaccines [20].
Vaccination acceptance is a complex and variable phenomenon worldwide, necessitating country-specific research. Recent research identified Cypriots as less hesitant compared to residents of other countries [21]. However, there are concerns about potential delays in adhering to the childhood vaccination schedule in Cyprus [22]. The lack of compliance with the vaccination schedule may increase the occurrence of vaccine-preventable diseases. Unfortunately, the available literature on parental attitudes and beliefs towards childhood vaccination in Cyprus is limited. Previous research among healthcare professionals in Cyprus has indicated negative attitudes towards childhood COVID-19 vaccination [23]. This highlights the need for further investigation to better understand the specific factors that influence maternal attitudes towards childhood vaccination in Cyprus.
Given that mothers often oversee their children’s vaccination schedule, this study aims to explore the associations between socio-demographic characteristics and maternal attitudes towards childhood vaccination at the beginning of the COVID-19 pandemic in Cyprus. Understanding maternal attitudes towards childhood vaccination during this period provides valuable insights into the factors that influence vaccination decision making. By examining how socio-demographic factors shape maternal attitudes, this research will offer valuable insights into the specific barriers and concerns that may affect vaccine acceptance in different groups. Additionally, this research serves as a baseline for future studies, allowing for a comparison of maternal attitudes towards childhood vaccination before and after the COVID-19 pandemic. Ultimately, the findings will contribute to the development of effective public health strategies tailored to specific socio-demographic contexts in Cyprus, with the goal of improving childhood vaccination rates and preventing vaccine-preventable diseases.
4. Discussion
The current investigation represents the first attempt to assess maternal attitudes and beliefs towards childhood vaccination in Cyprus. Our findings revealed an overall positive attitude towards children’s access to all vaccinations provided by the NVP (89.3%), belief in vaccine-mediated protection from serious and potentially fatal diseases (90.1%), awareness of possible adverse reactions from some vaccines (84.1%), acknowledgment that the benefits of vaccination outweigh the potential risks (86.6%), and recognition of the usefulness of vaccines (91.4%). Socio-demographic factors, particularly marital status, single-parent status, and employment status were found to have a significant impact on maternal attitudes and perceptions regarding childhood vaccination.
According to the findings of our study, the majority of mothers believed that all vaccinations recommended by the NVP should be given to their children, a finding that is consistent with another study in Greece [26]. Moreover, we found that mothers in Cyprus do not think natural childhood illness is preferable to vaccination, which is in agreement with another study that examined vaccine hesitancy in the United Arab Emirates [27]. On the other hand, our results revealed that mothers disagreed that a large number of vaccines can have a negative impact on children’s immune systems, a finding that is in contrast with a study in Saudi Arabia, in which 37% of participants believed that vaccines at the same time have no effects on the immune systems of children [28]. A strong relationship between neutral and negative vaccination attitudes has been associated with vaccination omission in the literature [29,30,31]. The current study identified neutral attitudes towards vaccination safety and effectiveness, long-term vaccination-related problems, vaccination with new vaccines, and vaccine commercial profiteering. It is possible to hypothesize that parents with neutral attitudes are more likely to change their perceptions; hence, targeting those could influence vaccination coverage in Cyprus. Neutral parental attitudes may change towards positive or negative attitudes after, so public health authorities should intervene using appropriate interventions to affirm that parental attitudes change to desire direction.
We reported that single mothers were more likely to have unfavorable attitudes towards childhood vaccinations. This finding was similar to a study in the United Arab Emirates that investigated the beliefs and attitudes of parents about childhood vaccination [27], in contrast to a study in Malaysia where single parents were more likely to vaccinate their children [32]. Apart from this, we found that mothers who completed only secondary education had significantly more prevalent unfavorable vaccination attitudes, which is in disagreement with a study in Israel that identified parents with a low educational level as less vaccine hesitant [33]. On the other hand, that finding is in agreement with a study that identified a lower vaccination acceptance among lower-educated mothers [34]. Furthermore, we reported that unfavorable attitudes about childhood vaccination were more prevalent among mothers with low or no income. Similarly, as before, this finding was in contrast with the study that examined the parents’ perceptions of childhood immunization in Israel, where higher compliance rates about vaccination were reported among those with an average level of income [33].
While we reported some associations between educational level, income status, and age with mothers’ attitudes about childhood vaccination, these findings should be interpreted cautiously due to their lack of statistical significance. Previous studies have shown that a mother’s education significantly impacts vaccination status, with those who have completed higher education exhibiting greater vaccination awareness and a higher likelihood of fully vaccinating their children [35,36,37]. Although our study did not find a statistically significant association between educational level and mothers’ attitudes about childhood vaccination, it is worth noting that higher education in mothers was associated with more positive vaccination attitudes [38,39]. Similarly, our study did not reveal a statistically significant association between income status and mothers’ attitudes towards childhood vaccination. However, it is important to highlight that our study did not find trends among income status categories regarding mothers’ attitudes, which were included in the study. In contrast to our findings, numerous studies have shown that pediatric vaccination coverage is low in middle-income countries, highlighting the significant influence of income status as a determinant of vaccination attitudes, uptake, and knowledge, with mothers who have low or no income often displaying negative attitudes toward vaccination [40,41,42,43]. Furthermore, although previous studies have reported that a mother’s age affects her attitudes related to childhood vaccination [31,44,45], our study did not find a statistically significant association between the age of the mother and the majority of attitudes included in the study.
This study has some limitations that should be acknowledged. This was a cross-sectional study and was limited by non-random, online sampling that limits our study’s representativeness. Furthermore, because the data were gathered through self-reported surveys, there is a risk of misreporting and recall bias. The latter, on the other hand, is less of an issue because it is inherent in all sorts of attitude evaluation studies. In addition, causal inferences cannot be drawn due to the study design. Lastly, beliefs and attitudes were measured after vaccination; hence, some of these may have been influenced by the vaccination experiences.
Several implications arose from the current study that could impact future public health strategies in Cyprus. We noted that mothers possess a heterogeneous population of humans with different attitudes and perceptions towards childhood vaccination. The identified influential factors may help the government authorities understand the determinants of vaccine hesitancy among mothers in Cyprus. It is well established that public health maintenance requires specific interventions to achieve higher vaccination compliance. Targeting groups of mothers based on their socio-demographic and economic characteristics may help them attain those levels. A lack of trust in new vaccines was observed in our study, raising intriguing questions regarding the nature and extent of vaccine hesitancy. Previous research in Italy, even before the COVID-19 pandemic, identified hesitation towards new vaccines [46], and a study in England revealed parental preference for new vaccines to be given separately [47]. New vaccine trust may be influenced by trust in medical providers and government authorities, while previous experience and disease severity could affect new vaccine acceptance [47,48]. During and after the COVID-19 pandemic, parental attitudes towards new vaccines may have been influenced by heightened uncertainty, resulting in neutral attitudes towards them [26]. In our research, only 7% were positive about the vaccination of their children after the release of new vaccines. Our study’s low levels of new vaccine acceptance raise questions about future vaccination uptake, such as the COVID-19 vaccine. It is therefore suggested that a follow-up study concentrating on new vaccination trust among mothers in Cyprus be conducted.
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