Table 2

Acceptance-related barriers

Concerns and beliefs
BarrierExplanation of barrierReviews reporting the barrier (n=19)
Concern about vaccine safetyPerceived 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 providersMistrust of those involved in vaccine delivery and policy. Perceived influence of stakeholders on decision making, eg, ‘medical community does not understand adverse events’.4014
Preference for natural immunity/belief in benefit of diseaseBelief that natural immunity, rather than immunity from vaccines, is better. Belief that ‘illness strengthens child’s immune system’.318
Concern that vaccines compromise immune systemBelief that vaccines overload the immune system or impair the body’s natural immunity.7
Alternative beliefs about healthBelief 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 youngBelief that vaccines are provided when children are too young and not robust.6
Belief in personal choicePrioritisation of parent’s right to choose re: vaccination.5
Concern about combined injectionsBelief that combination vaccines are harmful for example, ‘parents perceive overload of antigens’.185
Concern about number of vaccinesBelief that children receive too many injections, too many vaccines, eg, ‘multiple vaccinations are unsafe’.315
Lack of self-efficacy or perceived behavioural controlLack of perceived behavioural control or capacity to take their child to receive vaccines, including isolation/lack of empowerment of women.5
Concern about autismPersonal experience of autism or belief that vaccines cause autism.4
Conspiracy beliefsBelief in conspiracy theories about vaccination.4
Concern about painConcern with injection site pain.3
Anticipated regretAnticipated guilt or regret of vaccinating a child, or inability to forgive oneself if vaccine side-effects occurred.2
Concern about scheduleDesire 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
BarrierExplanation of barrierReviews reporting the barrier (n=22)
Perceived contraindicationsPerception that child has a contraindication on appointment day, eg, ‘vaccines will be harmful if the child is sick’.1510
Perception that disease is not severe or child is not susceptibleLow perceived risk of infection or severity of illness.10
Allergy or adverse event experienceConcern about potential allergy, previous traumatic or adverse vaccine experiences.9
Perception that vaccines are not effectiveLow perceived effectiveness of vaccines, concern with quality of vaccines.9
Complementary and complementary medicine usePreference for alternative healthcare for example, homeopathy.7
Personal objections to vaccinationResistance, objection or disagreement with vaccines, for example, ‘not believing in’ vaccines or ‘opposition to the use of animals in vaccine development’.146
Previous vaccination decisionHistory of delayed, missed or declined vaccinations.6
Needle phobiaChild or parent fear of needles.2
Previous/current health behavioursHistory of failure to engage with health services, baby health checks, eg, ‘refusal of health checks’.342
Knowledge and information
BarrierExplanation of barrierReviews reporting the barrier (n=22)
Lack of knowledge about diseases and/or vaccinesInsufficient knowledge of what vaccines are or the importance of receiving all vaccine doses.11
Insufficient informationInsufficient quantity and quality of information.9
Lack of knowledge or awareness of scheduleInsufficient knowledge about the vaccination schedule or vaccine doses, for example, eligibility requirements or remembering the vaccine schedule.6
Misleading information from mediaOver-reliance on information from the media, adverse media publicity and inadequate or poorly targeted mass media messaging.6
Dissatisfaction with informationInformation not adequate in terms of amount, content or delivery.4
Lack of knowledge or awareness of servicesUnawareness of vaccination services, clinic location or timing.4
Lack of awareness or understanding of vaccination responsibilityUncertainty and confusion over responsibility for arranging the vaccinations.3
Forgetting that immunisation was dueNot remembering appointments or the schedule.3
Inaccurate or inappropriate informationConflicting information or information not appropriate to education level.3
Misleading information identified through personal information seekingEngagement in personal research and alternate information seeking behaviour, perception that ‘vaccine research is vital but inadequate’.143
Social or family influence
BarrierExplanation of barrierReviews reporting the barrier (n=22)
Social or family pressureNormative 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 beliefsReligious objection to vaccination.9
Lack of social responsibilityDisinclination to vaccinate for the benefit of wider society, viewing vaccinating for community protection as an unwelcome obligation.5
Family structure, roles and valuesFamily roles positioning vaccination as a ‘feminised task’,39 discriminatory values such as a gender preference.2
Traditional or cultural beliefsTraditional beliefs or customs, magico-religious factors or sorcery as social dimension of illness.2