Acceptance-related barriers
| Concerns and beliefs | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=19) |
| Concern about vaccine safety | Perceived short-term and longer-term harm caused by vaccines, beliefs that vaccines are unhealthy, concern over vaccine ingredients. | 14 |
| Lack of trust in government, vaccines or providers | Mistrust of those involved in vaccine delivery and policy. Perceived influence of stakeholders on decision making, eg, ‘medical community does not understand adverse events’.40 | 14 |
| Preference for natural immunity/belief in benefit of disease | Belief that natural immunity, rather than immunity from vaccines, is better. Belief that ‘illness strengthens child’s immune system’.31 | 8 |
| Concern that vaccines compromise immune system | Belief that vaccines overload the immune system or impair the body’s natural immunity. | 7 |
| Alternative beliefs about health | Belief in immune system variation, the ability to control a child’s exposure to pathogens and anthroposophic ideas about disease prevention. | 6 |
| Concern vaccines delivered too young | Belief that vaccines are provided when children are too young and not robust. | 6 |
| Belief in personal choice | Prioritisation of parent’s right to choose re: vaccination. | 5 |
| Concern about combined injections | Belief that combination vaccines are harmful for example, ‘parents perceive overload of antigens’.18 | 5 |
| Concern about number of vaccines | Belief that children receive too many injections, too many vaccines, eg, ‘multiple vaccinations are unsafe’.31 | 5 |
| Lack of self-efficacy or perceived behavioural control | Lack of perceived behavioural control or capacity to take their child to receive vaccines, including isolation/lack of empowerment of women. | 5 |
| Concern about autism | Personal experience of autism or belief that vaccines cause autism. | 4 |
| Conspiracy beliefs | Belief in conspiracy theories about vaccination. | 4 |
| Concern about pain | Concern with injection site pain. | 3 |
| Anticipated regret | Anticipated guilt or regret of vaccinating a child, or inability to forgive oneself if vaccine side-effects occurred. | 2 |
| Concern about schedule | Desire for flexibility to adapt a vaccine schedule to a child. | 1 |
| General concern (unspecified) | Concerns about vaccination, including parents’ general worry or anxiety. | 1 |
| Health perceptions and experiences | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=22) |
| Perceived contraindications | Perception that child has a contraindication on appointment day, eg, ‘vaccines will be harmful if the child is sick’.15 | 10 |
| Perception that disease is not severe or child is not susceptible | Low perceived risk of infection or severity of illness. | 10 |
| Allergy or adverse event experience | Concern about potential allergy, previous traumatic or adverse vaccine experiences. | 9 |
| Perception that vaccines are not effective | Low perceived effectiveness of vaccines, concern with quality of vaccines. | 9 |
| Complementary and complementary medicine use | Preference for alternative healthcare for example, homeopathy. | 7 |
| Personal objections to vaccination | Resistance, objection or disagreement with vaccines, for example, ‘not believing in’ vaccines or ‘opposition to the use of animals in vaccine development’.14 | 6 |
| Previous vaccination decision | History of delayed, missed or declined vaccinations. | 6 |
| Needle phobia | Child or parent fear of needles. | 2 |
| Previous/current health behaviours | History of failure to engage with health services, baby health checks, eg, ‘refusal of health checks’.34 | 2 |
| Knowledge and information | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=22) |
| Lack of knowledge about diseases and/or vaccines | Insufficient knowledge of what vaccines are or the importance of receiving all vaccine doses. | 11 |
| Insufficient information | Insufficient quantity and quality of information. | 9 |
| Lack of knowledge or awareness of schedule | Insufficient knowledge about the vaccination schedule or vaccine doses, for example, eligibility requirements or remembering the vaccine schedule. | 6 |
| Misleading information from media | Over-reliance on information from the media, adverse media publicity and inadequate or poorly targeted mass media messaging. | 6 |
| Dissatisfaction with information | Information not adequate in terms of amount, content or delivery. | 4 |
| Lack of knowledge or awareness of services | Unawareness of vaccination services, clinic location or timing. | 4 |
| Lack of awareness or understanding of vaccination responsibility | Uncertainty and confusion over responsibility for arranging the vaccinations. | 3 |
| Forgetting that immunisation was due | Not remembering appointments or the schedule. | 3 |
| Inaccurate or inappropriate information | Conflicting information or information not appropriate to education level. | 3 |
| Misleading information identified through personal information seeking | Engagement in personal research and alternate information seeking behaviour, perception that ‘vaccine research is vital but inadequate’.14 | 3 |
| Social or family influence | ||
| Barrier | Explanation of barrier | Reviews reporting the barrier (n=22) |
| Social or family pressure | Normative beliefs, subjective norms, social judgement, influence from social networks or cultural pressure, family members, community members, organised groups or institutions and media and the internet. | 13 |
| Religious beliefs | Religious objection to vaccination. | 9 |
| Lack of social responsibility | Disinclination to vaccinate for the benefit of wider society, viewing vaccinating for community protection as an unwelcome obligation. | 5 |
| Family structure, roles and values | Family roles positioning vaccination as a ‘feminised task’,39 discriminatory values such as a gender preference. | 2 |
| Traditional or cultural beliefs | Traditional beliefs or customs, magico-religious factors or sorcery as social dimension of illness. | 2 |