Introduction and Aim: The number of parents who opted out of vaccine schedule in Turkey are increasing every year. This qualitative study aims to investigate the reasons underlying the attitudes among a group of parents who either hesitate or completely refuse vaccines. To our knowledge no face-to-face interview with Turkish parents was conducted before.

Material and Methods: In this qualitative study, semi structured, in- depth, face-to-face and one-to-one interviews were conducted with parents who met the inclusion criteria. The criteria were as follows: (1) the parents had refused at least one of the childhood vaccinations at the date it has been suggested to them; (2) the child that the parent had not vaccinated must be five years old or younger; and (3) the parents must reside within Istanbul at the time of the interview. Recruitment of the volunteers by convenience and snowball sampling continued until themes were satisfied. 23 parents were interviewed. Interviews lasted for an average of 31 minutes. The maximum duration was 120 minutes and the minimum 13 minutes. An interview form using the health belief model was created with the help of two advisors experienced in qualitative research methodology. The main headings of the interview form were as follows: (1) Perceived susceptibility to infectious diseases; (2) perceived seriousness; (3) undesired effects; (4) perceived effectiveness of childhood vaccines; and (5) external influences. Data were collected between the dates 12.12.2017 -02.19.2018. The interviews were conducted by the author (35, male) who was a medical doctor, a resident in public health department of a university hospital at the time of the interview. The sound records were transcribed verbatim, coded manually and thematically analyzed by the principal author. Research was conducted with the permission of the Ethics Committee of Istanbul Medical Faculty (file number: 2017/1041).

Results: An organic or behavioral disease became a trigger factor for some of the participants to do research on vaccines. Participants have evaluated their decision continuously and started the process during or before pregnancy.

They thought that the ingredients of the vaccines caused irreversible effects in the nervous system and could affect behavior. Participants found it risky to use a vaccine that’s perceived low in efficiency, injected numerous times to the children during the early development phase. They thought they kept the risk of susceptibility to infectious diseases low by creating a hygienic micro environment.

The parents perceived the seriousness of infectious diseases low helped by easy access to modern health services. They intervened by methods they assume “natural”. They considered the immunity derived from vaccines inferior to “natural” immunity derived from infectious diseases, and found injections disrupting the integrity of the body and modern medicine artificial.

The attitude of the healthcare worker increased their distrust to the vaccines.

The commercial interests of the pharmaceutical industry and products of foreign origin becomes of concern to the parents, and the assertion that the uncertainty of the outcomes of science decrease their trust to it. Fatalism and the belief that some ingredients have negative connotations in religion, and the opinion leaders affect parents’ views on vaccines.

Sources of limitations: The duration of a few number of the interviews were notably shorter than the average duration. This situation was observed especially during the interviews with participants from a low socio-economic background. Therefore, the study might lack some insight relating to the reasons behind socio economically disadvantaged participants’ choices. Another limitation was the use of convenience sampling which might compromise the diversity of the participants.

Conclusions and Recommendations

Participants expect satisfactory explanation concerning the ingredients and the long term effects of the vaccines. The realities concerning ingredients, side effects and infectious diseases must be explained to the parents. Claims such as vaccine-autism relationship must be tackled with evidence.

Family physicians play an important part in the critical encounter between physician and patient concerning the declaration of opting out of vaccination. The family physician should be well informed about the facts about the ingredients and possible side effects of vaccines. An insight to the risk perception of the concerned mother acquired from such qualitative studies could be supplied to the family physician to better manage the vaccine hesitancy. Lectures on risk perception of lay people could be incorporated to the curriculum of medical schools.

Cross-sectional quantitative research must be done on a large sample to measure the number of parents who had their children vaccinated but still have an anxiety about the vaccines.

Key words: Vaccine hesitancy, vaccine refusal, qualitative, childhood vaccines, interview, parent

Footnote: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.