Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo

mapear as evidências científicas acerca das percepções, crenças, conhecimentos e atitudes de pais ou responsáveis legais de crianças menores de 5 anos quanto à vacinação infantil de rotina.

Métodos:

revisão de escopo, conduzida de acordo com o referencial do JBI. As buscas foram realizadas nas bases PubMed/MEDLINE, Web of Science, Scopus e LILACS. Retornaram 5.535 estudos e foram selecionados 77, que atenderam aos critérios de inclusão.

Resultados:

percepções relacionadas à interação com os profissionais e serviços de saúde, com a organização e estrutura familiar, com a interação social e políticas públicas, crenças culturais, religiosas e pessoais, conhecimentos sobre o calendário vacinal, o processo de vacinação e imunização e fontes de informação são os principais fatores mapeados e que podem influenciar positiva ou negativamente a atitudes dos pais ou responsáveis legais em vacinar crianças.

Conclusões:

os achados permitem identificar fatores relacionados à percepção e crenças dos pais sobre vacinação infantil.

Descritores:
Vacinação; Programas de Imunização; Tutores Legais; Pais; Pré-Escolar

Autoria

Mariana Mesquita de Oliveira Lima Autor Correspondente Mariana Mesquita de Oliveira Lima E-mail: mmos.df@gmail.com

concepção ou desenho do estudo/pesquisa

análise e/ou interpretação dos dados

revisão final com participação crítica e intelectual no manuscrito

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

https://orcid.org/0000-0002-0670-7782

Aline Oliveira Silveira

concepção ou desenho do estudo/pesquisa

análise e/ou interpretação dos dados

revisão final com participação crítica e intelectual no manuscrito

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

https://orcid.org/0000-0003-4470-7529

Ana Paula Sarmento Charão Aureliano

análise e/ou interpretação dos dados

revisão final com participação crítica e intelectual no manuscrito

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

https://orcid.org/0000-0001-9358-2174

Hellen Cristina Costa Rocha

análise e/ou interpretação dos dados

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

https://orcid.org/0009-0002-5867-7826

Luciana Melo de Moura

análise e/ou interpretação dos dados

revisão final com participação crítica e intelectual no manuscrito

Escola Superior de Ciências da Saúde. Brasília, Distrito Federal, BrasilEscola Superior de Ciências da Saúde. Brasília, Distrito Federal, BrasilEscola Superior de Ciências da Saúde. Brasília, Distrito Federal, Brasil

https://orcid.org/0000-0002-4514-2171

Sammya Rodrigues dos Santos

análise e/ou interpretação dos dados

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

https://orcid.org/0009-0004-4981-4475

Autor Correspondente
Mariana Mesquita de Oliveira Lima E-mail: mmos.df@gmail.com

EDITOR CHEFE

Dulce Barbosa

EDITOR ASSOCIADO

Priscilla Broca

SCIMAGO INSTITUTIONS RANKINGS

Universidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, BrasilUniversidade de Brasília. Brasília, Distrito Federal, Brasil

Figuras | Tabelas

Figuras (4)
Tabelas (2)

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Figura 1
Fluxograma do processo de seleção e triagem dos artigos de revisão sistemática segundo método PRISMA(¹⁶16 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Brit Med J [Internet]. 2021[cited 2024 May 20];372(71). Available from: https://www.bmj.com/content/372/bmj.n7112
https://www.bmj.com/content/372/bmj.n711... ), 2024

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Figura 2
Distribuição da produção de artigos mundialmente, 2024

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Quadro 2
Fatores relacionados às percepções, conhecimentos e atitudes dos pais em relação à vacinação, 2024

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Quadro 3
Crenças dos pais sobre a vacinação infantil, 2024

Figura 1 Fluxograma do processo de seleção e triagem dos artigos de revisão sistemática segundo método PRISMA(¹⁶16 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Brit Med J [Internet]. 2021[cited 2024 May 20];372(71). Available from: https://www.bmj.com/content/372/bmj.n7112
https://www.bmj.com/content/372/bmj.n711... ), 2024

Figura 2 Distribuição da produção de artigos mundialmente, 2024

Quadro 2 Fatores relacionados às percepções, conhecimentos e atitudes dos pais em relação à vacinação, 2024

Interação com os profissionais de saúde	Profissionais acolhedores(²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020 https://doi.org/10.1590/S0104-1169201100... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023 https://doi.org/10.1016/j.socscimed.2007... ) e que promovem segurança relacional(⁵⁴54 Carrion ML. An ounce of prevention: identifying cues to (in)action for maternal vaccine refusal. Qual Health Res. 2018;28(14):2183–94. https://doi.org/10.1177/1049732318792505 https://doi.org/10.1177/1049732318792505... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023 https://doi.org/10.1016/j.socscimed.2007... ) são considerados importantes pelos pais para sentirem-se confiantes na vacinação da criança(⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... , ⁷⁸78 Nisar N, Mirza M, Majid Hafeez Qadri. Knowledge, attitude and practices of mothers regarding immunization of one year old child at Mawatch Goth, Kemari town, Karachi. Pakistan J Med Sci [Internet]. 2010[cited 2024 May 20];26(1):183–6. Available from: https://www.cabidigitallibrary.org/doi/full/10.5555/20103088942 https://www.cabidigitallibrary.org/doi/f... ). Profissionais que conversam abertamente e promovem informações claras, completas e acessíveis sobre a vacina (imunológico) e a vacinação infantil e a recomenda promovem a compreensão e influenciam positivamente a decisão dos pais, sendo considerados fontes de informação primária pela maioria(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22 https://doi.org/10.4103/jehp.jehp_687_22... , ¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650 https://doi.org/10.1177/2515135523115265... , ²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ³³33 Mayerová D, Abbas K. Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania. BMC Public Health. 2021;21(1). https://doi.org/10.1186/s12889-021-11724-6 https://doi.org/10.1186/s12889-021-11724... , ³⁷37 Mossey S, Hosman S, Montgomery P, McCauley K. Parents’ experiences and nurses’ perceptions of decision-making about childhood immunization. Can J Nurs Res. 2020;52(4):255-67. https://doi.org/10.1177/0844562119847343 https://doi.org/10.1177/0844562119847343... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/ https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁴¹41 Restivo V, Palmeri S, Bono S, Caracci F, Fiorino GR, Foresta A, et al. Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy. 2020;91:41–7. https://doi.org/10.23750/abm.v91i3-S.9415 https://doi.org/10.23750/abm.v91i3-S.941... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647 https://doi.org/10.1080/21645515.2018.15... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁵⁰50 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486–93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... , ⁵¹51 Šeškutė M, Tamulevičienè E, Levinienè G. Knowledge and attitudes of postpartum mothers towards immunization of their children in a Lithuanian Tertiary Teaching Hospital. Medicina. 2018;54(1):2. https://doi.org/10.3390/medicina54010002 https://doi.org/10.3390/medicina54010002... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239 https://doi.org/10.5742/MEWFM.2018.93239... , ⁵⁹59 Sjogren E, Ask LS, Örtqvist Å, Asp M. Parental conceptions of the rotavirus vaccine during implementation in Stockholm: a phenomenographic study. J Child Health Care. 2017;2;21(4):476-87. https://doi.org/10.1177/1367493517734390 https://doi.org/10.1177/1367493517734390... , ⁶⁰60 Attwell K, Leask J, Meyer SB, Rokkas P, Ward P. Vaccine rejecting parents’ engagement with expert systems that inform vaccination programs. J Bioethic Inquiry. 2016;14(1):65-76. https://doi.org/10.1007/s11673-016-9756-7 https://doi.org/10.1007/s11673-016-9756-... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁶²62 Schollin AL, Hjern A, Lindstrand A, Olen O, Sjogren E, Blennow M, et al. Receiving early information and trusting Swedish child health centre nurses increased parents’ willingness to vaccinate against rotavirus infections. Acta Pediatr. 2017;106(8):1309–16. https://doi.org/10.1111/apa.13872 https://doi.org/10.1111/apa.13872... , ⁶⁵65 Weiss C, Schröpfer D, Merten S. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis. BMC Infect Dis. 2016;16(1). https://doi.org/10.1186/s12879-016-1747-0 https://doi.org/10.1186/s12879-016-1747-... , ⁶⁶66 Negussie A, Kassahun W, Assegid S, Hagan AK. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study. BMC Public Health. 2015;16(1). https://doi.org/10.1186/s12889-015-2678-1 https://doi.org/10.1186/s12889-015-2678-... , ⁶⁸68 Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública. 2015;49. https://doi.org/10.1590/S0034-8910.2015049005149 https://doi.org/10.1590/S0034-8910.20150... , ⁶⁹69 Harvey H, Good J, Mason J, Reissland N. A Q-methodology study of parental understandings of infant immunisation: implications for healthcare advice. J Health Psychol. 2013;20(11):1451–62. https://doi.org/10.1177/1359105313513622 https://doi.org/10.1177/1359105313513622... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20 https://doi.org/10.1186/1471-2431-14-20... , ⁷²72 McCauley MM, Kennedy A, Basket M, Sheedy K. Exploring the choice to refuse or delay vaccines: a national survey of parents of 6- through 23-month-olds. Acad Pediatr. 2012;12(5):375-83. https://doi.org/10.1016/j.acap.2012.06.007 https://doi.org/10.1016/j.acap.2012.06.0... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁶76 Coniglio MA, Platania M, Privitera D, Giammanco G, Pignato S. Parents’ attitudes and behaviours towards recommended vaccinations in Sicily, Italy. BMC Public Health. 2011;11(1). https://doi.org/1471-2458/11/305 https://doi.org/1471-2458/11/305... , ⁷⁸78 Nisar N, Mirza M, Majid Hafeez Qadri. Knowledge, attitude and practices of mothers regarding immunization of one year old child at Mawatch Goth, Kemari town, Karachi. Pakistan J Med Sci [Internet]. 2010[cited 2024 May 20];26(1):183–6. Available from: https://www.cabidigitallibrary.org/doi/full/10.5555/20103088942 https://www.cabidigitallibrary.org/doi/f... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728 https://doi.org/10.1542/peds.2005-1728... , ⁸⁶86 Bigham M, Remple VP, Pielak K, McIntyre C, White R, Wu W. Uptake and behavioural and attitudinal determinants of immunization in an expanded routine infant Hepatitis B Vaccination Program in British Columbia. Can J Public Health. 2006;97(2):90–5. https://doi.org/10.1007/BF03405322 https://doi.org/10.1007/BF03405322... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015 https://doi.org/10.1016/j.vaccine.2004.1... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ), mesmo antes da criança nascer(⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x https://doi.org/10.1111/j.1440-1754.2008... ). Profissionais que exigem a vacinação infantil, porém não promovem a compreensão dos pais sobre os benefícios da imunização, alcançam a completude vacinal, mas não favorecem relações saudáveis com os pacientes(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ⁴¹41 Restivo V, Palmeri S, Bono S, Caracci F, Fiorino GR, Foresta A, et al. Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy. 2020;91:41–7. https://doi.org/10.23750/abm.v91i3-S.9415 https://doi.org/10.23750/abm.v91i3-S.941... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... ). Profissionais que não dedicam tempo o bastante para conversar com os pais sobre a vacinação infantil e o calendário vacinal de forma clara(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁷77 Ba’amer AA. Coverage of and barriers to routine child vaccination in Mukalla district, Hadramout governorate, Yemen. East Mediter Health J [Internet]. 2010 [cited 2024 May 20];16(02):223–7. Available from: https://iris.who.int/handle/10665/117847 https://iris.who.int/handle/10665/117847... , ⁷⁹79 Borràs E, Dominguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A. Parental knowledge of paediatric vaccination. BMC Public Health. 2009;9(1). https://doi.org/10.1186/1471-2458-9-154 https://doi.org/10.1186/1471-2458-9-154... , ⁸³83 Tickner S, Leman PJ, Woodcock A. Factors underlying suboptimal childhood immunisation. Vaccine. 2006;24(49-50):7030–6. https://doi.org/10.1016/j.vaccine.2006.06.060 https://doi.org/10.1016/j.vaccine.2006.0... , ⁸⁴84 Cassell JA, Leach M, Poltorak MS, Mercer CH, Iversen A, Fairhead JR. Is the cultural context of MMR rejection a key to an effective public health discourse? Public Health. 2006;120(9):783–94. https://doi.org/10.1016/j.puhe.2006.03.011 https://doi.org/10.1016/j.puhe.2006.03.0... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ), pouco acessíveis e sensíveis às demandas dos pais(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁵⁴54 Carrion ML. An ounce of prevention: identifying cues to (in)action for maternal vaccine refusal. Qual Health Res. 2018;28(14):2183–94. https://doi.org/10.1177/1049732318792505 https://doi.org/10.1177/1049732318792505... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis https://www.researchgate.net/publication... , ⁶⁰60 Attwell K, Leask J, Meyer SB, Rokkas P, Ward P. Vaccine rejecting parents’ engagement with expert systems that inform vaccination programs. J Bioethic Inquiry. 2016;14(1):65-76. https://doi.org/10.1007/s11673-016-9756-7 https://doi.org/10.1007/s11673-016-9756-... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183 https://doi.org/10.1186/1471-2458-13-118... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020 https://doi.org/10.1590/S0104-1169201100... , ⁷⁵75 Smith PJ, Humiston SG, Marcuse EK, Zhao Z, Dorell CG, Howes C, et al. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the health belief model. Public Health Reports. 2011;126:135–46. https://doi.org/10.1177/00333549111260S215 https://doi.org/10.1177/00333549111260S2... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023 https://doi.org/10.1016/j.socscimed.2007... , ⁸³83 Tickner S, Leman PJ, Woodcock A. Factors underlying suboptimal childhood immunisation. Vaccine. 2006;24(49-50):7030–6. https://doi.org/10.1016/j.vaccine.2006.06.060 https://doi.org/10.1016/j.vaccine.2006.0... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728 https://doi.org/10.1542/peds.2005-1728... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015 https://doi.org/10.1016/j.vaccine.2004.1... , ⁹⁰90 Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents’ perspectives on the MMR immunisation: a focus group study. British J Gen Pract [Internet]. 2001 [cited 2024 May 20];51(472):904–10. Available from: https://bjgp.org/content/51/472/904.short https://bjgp.org/content/51/472/904.shor... , ⁹²92 Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol. 1996;49(6):697–703. https://doi.org/10.1016/0895-4356(96)00007-8 https://doi.org/10.1016/0895-4356(96)000... ), que apresentam comportamento hostil(⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁶⁸68 Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública. 2015;49. https://doi.org/10.1590/S0034-8910.2015049005149 https://doi.org/10.1590/S0034-8910.20150... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... ), que possuem barreira linguística(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... ), que pressionam os pais para vacinarem seus filhos(⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis https://www.researchgate.net/publication... , ⁹⁰90 Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents’ perspectives on the MMR immunisation: a focus group study. British J Gen Pract [Internet]. 2001 [cited 2024 May 20];51(472):904–10. Available from: https://bjgp.org/content/51/472/904.short https://bjgp.org/content/51/472/904.shor... ) ou não indicam a vacinação(³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817 https://doi.org/ 10.5578/ced.202119817... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ), que demonstram conhecimento limitado e discordante sobre o assunto(³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ³⁵35 Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med. 2021;282:114132. https://doi.org/2021.114132 https://doi.org/2021.114132... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁵⁴54 Carrion ML. An ounce of prevention: identifying cues to (in)action for maternal vaccine refusal. Qual Health Res. 2018;28(14):2183–94. https://doi.org/10.1177/1049732318792505 https://doi.org/10.1177/1049732318792505... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728 https://doi.org/10.1542/peds.2005-1728... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ), promovem atrasos e rejeição à imunização das crianças.
Conhecimentos sobre vacinação infantil	Pais que têm conhecimento sobre o calendário de vacinação infantil(²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ²⁸28 Oli AN, Ogwaluonye UC, Onubogu CU, Ozumba AF, Agbaenyi OH, Okeke KN, et al. Public Knowledge and Opinion on Childhood Routine Immunizations in Two Major Cities of Anambra State, Nigeria. J Multidiscip Healthcare. 2021;14:247–57. https://doi.org/10.2147/JMDH.S279397 https://doi.org/10.2147/JMDH.S279397... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ⁴¹41 Restivo V, Palmeri S, Bono S, Caracci F, Fiorino GR, Foresta A, et al. Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy. 2020;91:41–7. https://doi.org/10.23750/abm.v91i3-S.9415 https://doi.org/10.23750/abm.v91i3-S.941... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647 https://doi.org/10.1080/21645515.2018.15... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666 https://doi.org/10.1080/21645515.2019.16... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239 https://doi.org/10.5742/MEWFM.2018.93239... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20 https://doi.org/10.1186/1471-2431-14-20... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020 https://doi.org/10.1590/S0104-1169201100... , ⁷⁸78 Nisar N, Mirza M, Majid Hafeez Qadri. Knowledge, attitude and practices of mothers regarding immunization of one year old child at Mawatch Goth, Kemari town, Karachi. Pakistan J Med Sci [Internet]. 2010[cited 2024 May 20];26(1):183–6. Available from: https://www.cabidigitallibrary.org/doi/full/10.5555/20103088942 https://www.cabidigitallibrary.org/doi/f... , ⁸⁷87 Matsumura T, Nakayama T, Okamoto S, Ito H. Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan. BMC Public Health. 2005;5(1). https://doi.org/10.1186/1471-2458-5-59 https://doi.org/10.1186/1471-2458-5-59... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ) e a doença imunoprevenível(⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020 https://doi.org/10.32725/kont.2019.020... , ⁶⁵65 Weiss C, Schröpfer D, Merten S. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis. BMC Infect Dis. 2016;16(1). https://doi.org/10.1186/s12879-016-1747-0 https://doi.org/10.1186/s12879-016-1747-... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023 https://doi.org/10.1016/j.socscimed.2007... ), sabem onde podem ter acesso à vacinação(⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647 https://doi.org/10.1080/21645515.2018.15... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... ) e consideram que os benefícios da vacinação superam os riscos das reações adversas(¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650 https://doi.org/10.1177/2515135523115265... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. 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BMC Infect Dis. 2016;16(1). https://doi.org/10.1186/s12879-016-1747-0 https://doi.org/10.1186/s12879-016-1747-... , ⁸⁰80 Logullo P, Carvalho HB, Saconi R, Massad E. Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J. 2008;126(3):166–71. https://doi.org/10.1590/S1516-31802008000300006 https://doi.org/10.1590/S1516-3180200800... , ⁸⁷87 Matsumura T, Nakayama T, Okamoto S, Ito H. Measles vaccine coverage and factors related to uncompleted vaccination among 18-month-old and 36-month-old children in Kyoto, Japan. BMC Public Health. 2005;5(1). https://doi.org/10.1186/1471-2458-5-59 https://doi.org/10.1186/1471-2458-5-59... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ), sobre o imunobiológico(²²22 Sapriadi S, Kasnawi T, Syukur M, Kamaruddin SA. Factors Related to the Parental Decision in Conducting Measles-Rubella Vaccination to the Children in South Sulawesi, Indonesia. Univ J Public Health. 2022;10(5):448–54. https://doi.org/10.13189/ujph.2022.100502 https://doi.org/10.13189/ujph.2022.10050... , ³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817 https://doi.org/ 10.5578/ced.202119817... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/ https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239 https://doi.org/10.5742/MEWFM.2018.93239... , ⁶²62 Schollin AL, Hjern A, Lindstrand A, Olen O, Sjogren E, Blennow M, et al. Receiving early information and trusting Swedish child health centre nurses increased parents’ willingness to vaccinate against rotavirus infections. Acta Pediatr. 2017;106(8):1309–16. https://doi.org/10.1111/apa.13872 https://doi.org/10.1111/apa.13872... , ⁶⁶66 Negussie A, Kassahun W, Assegid S, Hagan AK. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study. BMC Public Health. 2015;16(1). https://doi.org/10.1186/s12889-015-2678-1 https://doi.org/10.1186/s12889-015-2678-... )/processo de imunização(²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817 https://doi.org/ 10.5578/ced.202119817... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20 https://doi.org/10.1186/1471-2431-14-20... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ), sobre onde e quando se vacinar(⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... ) ou sobre os benefícios da imunização(²⁸28 Oli AN, Ogwaluonye UC, Onubogu CU, Ozumba AF, Agbaenyi OH, Okeke KN, et al. Public Knowledge and Opinion on Childhood Routine Immunizations in Two Major Cities of Anambra State, Nigeria. J Multidiscip Healthcare. 2021;14:247–57. https://doi.org/10.2147/JMDH.S279397 https://doi.org/10.2147/JMDH.S279397... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... ) apresentam limitações para vacinar completamente seus filhos.
Acesso aos serviços de saúde de forma universal e gratuita	Vacinação infantil gratuita(⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183 https://doi.org/10.1186/1471-2458-13-118... , ⁷⁸78 Nisar N, Mirza M, Majid Hafeez Qadri. Knowledge, attitude and practices of mothers regarding immunization of one year old child at Mawatch Goth, Kemari town, Karachi. Pakistan J Med Sci [Internet]. 2010[cited 2024 May 20];26(1):183–6. Available from: https://www.cabidigitallibrary.org/doi/full/10.5555/20103088942 https://www.cabidigitallibrary.org/doi/f... , ⁸⁰80 Logullo P, Carvalho HB, Saconi R, Massad E. Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J. 2008;126(3):166–71. https://doi.org/10.1590/S1516-31802008000300006 https://doi.org/10.1590/S1516-3180200800... ) e ofertada próxima ao domicílio(²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... ), sem necessidade de esperar por longos períodos(²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... ), são considerados fatores que impulsionam a imunização dos menores. Serviços de vacinação inacessíveis(²⁴24 Akman N, Yildiz A. Evaluation of mothers opinions on routine childhood vaccinations. J Pediatr Infect. 2022;16(4):253–9. https://doi.org/10.5578/ced.20229605 https://doi.org/10.5578/ced.20229605... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... ), com pouca segurança(⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... ), de baixa qualidade(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... ), que encontram-se fechados na maioria do tempo(⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666 https://doi.org/10.1080/21645515.2019.16... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... ), onde a vacina está indisponível(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁶⁶66 Negussie A, Kassahun W, Assegid S, Hagan AK. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study. BMC Public Health. 2015;16(1). https://doi.org/10.1186/s12889-015-2678-1 https://doi.org/10.1186/s12889-015-2678-... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁷77 Ba’amer AA. Coverage of and barriers to routine child vaccination in Mukalla district, Hadramout governorate, Yemen. East Mediter Health J [Internet]. 2010 [cited 2024 May 20];16(02):223–7. Available from: https://iris.who.int/handle/10665/117847 https://iris.who.int/handle/10665/117847... ), localizados longe das residências dos pais(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22 https://doi.org/10.4103/jehp.jehp_687_22... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666 https://doi.org/10.1080/21645515.2019.16... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020 https://doi.org/10.1590/S0104-1169201100... , ⁷⁷77 Ba’amer AA. Coverage of and barriers to routine child vaccination in Mukalla district, Hadramout governorate, Yemen. East Mediter Health J [Internet]. 2010 [cited 2024 May 20];16(02):223–7. Available from: https://iris.who.int/handle/10665/117847 https://iris.who.int/handle/10665/117847... ), com longas filas de espera(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772 https://doi.org/10.36948/ijfmr.2023.v05i... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ⁴⁰40 Haroune V, King L. Factors contributing to parental “vaccine hesitancy” for childhood immunisations. Nurs Child Young People. 2020;32(4):20-5. https://doi.org/10.7748/ncyp.2020.e1269 https://doi.org/10.7748/ncyp.2020.e1269... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁵⁰50 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486–93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x https://doi.org/10.1111/j.1440-1754.2008... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ) e com horários que não atendem às necessidades dos pais(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ), são considerados empecilhos para a vacinação infantil.
Dinâmica e padrões de organização familiar	Pais que se programam dentro da rotina familiar para levarem seus filhos para se vacinarem apresentam cadernetas de vacinação mais completas(³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... ). Pais que possuem vários afazeres e esquecem(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ) ou não têm tempo para levar os filhos para se vacinarem(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772 https://doi.org/10.36948/ijfmr.2023.v05i... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ³³33 Mayerová D, Abbas K. Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania. BMC Public Health. 2021;21(1). https://doi.org/10.1186/s12889-021-11724-6 https://doi.org/10.1186/s12889-021-11724... , ⁴⁰40 Haroune V, King L. Factors contributing to parental “vaccine hesitancy” for childhood immunisations. Nurs Child Young People. 2020;32(4):20-5. https://doi.org/10.7748/ncyp.2020.e1269 https://doi.org/10.7748/ncyp.2020.e1269... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁵⁰50 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486–93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... , ⁵⁵55 Yunitasari E, Nastiti AA, Hasan WD, Yusuf A, Nugroho HSW. Factors associated to infant vaccination in Madurese, Indonesia. Indian J Public Health Res Develop. 2018;9(10):364. https://doi.org/10.5958/0976-5506.2018.01370.0 https://doi.org/10.5958/0976-5506.2018.0... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis https://www.researchgate.net/publication... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁷³73 Favin M, Steinglass R, Fields R, Banerjee K, Sawhney M. Why children are not vaccinated: a review of the grey literature. Int Health. 2012;4(4):229–38. https://doi.org/10.1016/j.inhe.2012.07.004 https://doi.org/10.1016/j.inhe.2012.07.0... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020 https://doi.org/10.1590/S0104-1169201100... , ⁷⁷77 Ba’amer AA. Coverage of and barriers to routine child vaccination in Mukalla district, Hadramout governorate, Yemen. East Mediter Health J [Internet]. 2010 [cited 2024 May 20];16(02):223–7. Available from: https://iris.who.int/handle/10665/117847 https://iris.who.int/handle/10665/117847... , ⁸³83 Tickner S, Leman PJ, Woodcock A. Factors underlying suboptimal childhood immunisation. Vaccine. 2006;24(49-50):7030–6. https://doi.org/10.1016/j.vaccine.2006.06.060 https://doi.org/10.1016/j.vaccine.2006.0... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ) e não se envolvem(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751 https://doi.org/10.7759/cureus.19751... , ²⁹29 Terzi Ö, Gülen EN, Dündar C. The causes of parental vaccine refusal: results of a survey from Giresun, Turkey. Turkish J Pediatr. 2021; 63(4):618. https://doi.org/10.24953/turkjped.2021.04.009 https://doi.org/10.24953/turkjped.2021.0... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... ) para desempenhar a atividade apresentam dificuldades em manter a caderneta de vacinação em dia. Famílias que mudam de estado(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... , ⁶⁶66 Negussie A, Kassahun W, Assegid S, Hagan AK. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case – control study. BMC Public Health. 2015;16(1). https://doi.org/10.1186/s12889-015-2678-1 https://doi.org/10.1186/s12889-015-2678-... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ) ou de consultório médico(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... ) encaram dificuldades em vacinar seus filhos.
Estrutura familiar	Famílias com pais casados, onde existe apoio social familiar ampliado e comunitário ou estrutura familiar conjunta(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22 https://doi.org/10.4103/jehp.jehp_687_22... , ³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5 https:doi.org/10.1186/s12889-021-11466-5... , ⁵⁰50 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486–93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... , ⁵⁵55 Yunitasari E, Nastiti AA, Hasan WD, Yusuf A, Nugroho HSW. Factors associated to infant vaccination in Madurese, Indonesia. Indian J Public Health Res Develop. 2018;9(10):364. https://doi.org/10.5958/0976-5506.2018.01370.0 https://doi.org/10.5958/0976-5506.2018.0... ) e que o número de filhos é menor(³⁰30 Voo JYH, Lean QY, Ming LC, Md. Hanafiah NH, Al-Worafi YM, Ibrahim B. Vaccine knowledge, awareness and hesitancy: a cross sectional survey among parents residing at Sandakan District, Sabah. Vaccines. 2021;9(11):1348. https://doi.org/10.3390/vaccines9111348 https://doi.org/10.3390/vaccines9111348... ), favorecem a diminuição da hesitação vacinal/recusa vacinal. Mães que passaram por depressão pós-parto(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... ) e/ou não contam com o apoio familiar(⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... ), dentro do sistema patriarcal(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772 https://doi.org/10.36948/ijfmr.2023.v05i... , ³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817 https://doi.org/ 10.5578/ced.202119817... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... ) ou são mães solteiras(³³33 Mayerová D, Abbas K. Childhood immunisation timeliness and vaccine confidence by health information source, maternal, socioeconomic, and geographic characteristics in Albania. BMC Public Health. 2021;21(1). https://doi.org/10.1186/s12889-021-11724-6 https://doi.org/10.1186/s12889-021-11724... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... ) e possuem mais filhos(²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁴24 Akman N, Yildiz A. Evaluation of mothers opinions on routine childhood vaccinations. J Pediatr Infect. 2022;16(4):253–9. https://doi.org/10.5578/ced.20229605 https://doi.org/10.5578/ced.20229605... , ³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4 https://doi.org/10.1186/s12889-020-09169... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17 https://doi.org/10.4103/ijph.IJPH_397_17... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/ https://www.ncbi.nlm.nih.gov/pmc/article... ) enfrentam dificuldades em vacinar seus filhos.
Interações sociais	Tradição familiar(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ⁶⁸68 Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública. 2015;49. https://doi.org/10.1590/S0034-8910.2015049005149 https://doi.org/10.1590/S0034-8910.20150... ), influência de amigos e parentes(²²22 Sapriadi S, Kasnawi T, Syukur M, Kamaruddin SA. Factors Related to the Parental Decision in Conducting Measles-Rubella Vaccination to the Children in South Sulawesi, Indonesia. Univ J Public Health. 2022;10(5):448–54. https://doi.org/10.13189/ujph.2022.100502 https://doi.org/10.13189/ujph.2022.10050... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378 https://doi.org/10.2147/PHMT.S295378... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647 https://doi.org/10.1080/21645515.2018.15... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807 https://doi.org/10.3390/ijerph16101807... , ⁵⁸58 Alshammari TM, Subaiea GM, Hussain T, Moin A, Yusuff KB. Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study. Vaccine. 2018;36(1):23-8. https://doi.org/10.1016/j.vaccine.2017.11.050 https://doi.org/10.1016/j.vaccine.2017.1... , ⁶²62 Schollin AL, Hjern A, Lindstrand A, Olen O, Sjogren E, Blennow M, et al. Receiving early information and trusting Swedish child health centre nurses increased parents’ willingness to vaccinate against rotavirus infections. Acta Pediatr. 2017;106(8):1309–16. https://doi.org/10.1111/apa.13872 https://doi.org/10.1111/apa.13872... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20 https://doi.org/10.1186/1471-2431-14-20... , ⁹⁴94 Lakhani AD, Morris RW, Morgan M, Dale C, Vaile MS. Measles immunisation: feasibility of a 90% target uptake. Arch Dis Childhood. 1987;62(12):1209–14. https://doi.org/10.1136/adc.62.12.1209 https://doi.org/10.1136/adc.62.12.1209... ) e celebridades(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... ) a favor da vacinação são considerados fatores motivadores para vacinar crianças menores de 5 anos. A influência negativa de amigos, familiares(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338 https://doi.org/10.1080/21645515.2022.21... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772 https://doi.org/10.36948/ijfmr.2023.v05i... , ³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817 https://doi.org/ 10.5578/ced.202119817... , ³⁷37 Mossey S, Hosman S, Montgomery P, McCauley K. Parents’ experiences and nurses’ perceptions of decision-making about childhood immunization. Can J Nurs Res. 2020;52(4):255-67. https://doi.org/10.1177/0844562119847343 https://doi.org/10.1177/0844562119847343... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/ https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020 https://doi.org/10.32725/kont.2019.020... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074 https://doi.org/10.1016/j.vaccine.2017.1... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis https://www.researchgate.net/publication... , ⁶⁸68 Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública. 2015;49. https://doi.org/10.1590/S0034-8910.2015049005149 https://doi.org/10.1590/S0034-8910.20150... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183 https://doi.org/10.1186/1471-2458-13-118... , ⁷⁹79 Borràs E, Dominguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A. Parental knowledge of paediatric vaccination. BMC Public Health. 2009;9(1). https://doi.org/10.1186/1471-2458-9-154 https://doi.org/10.1186/1471-2458-9-154... , ⁸³83 Tickner S, Leman PJ, Woodcock A. Factors underlying suboptimal childhood immunisation. Vaccine. 2006;24(49-50):7030–6. https://doi.org/10.1016/j.vaccine.2006.06.060 https://doi.org/10.1016/j.vaccine.2006.0... ) e líderes religiosos(²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772 https://doi.org/10.36948/ijfmr.2023.v05i... , ⁵⁵55 Yunitasari E, Nastiti AA, Hasan WD, Yusuf A, Nugroho HSW. Factors associated to infant vaccination in Madurese, Indonesia. Indian J Public Health Res Develop. 2018;9(10):364. https://doi.org/10.5958/0976-5506.2018.01370.0 https://doi.org/10.5958/0976-5506.2018.0... ) ou políticos^{(^44,55)} em relação à vacinação infantil dificulta a aceitação da prática pelos pais.
Políticas públicas sociais e de saúde – direitos sociais da criança – direito à vida e a saúde – e estrutura/funcionamento dos programas de vacinação	Pais que concordam e confiam na política de imunização do Ministério da Saúde do país estão mais dispostos a vacinar seus filhos com as vacinas do calendário local(¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650 https://doi.org/10.1177/2515135523115265... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006 https://doi.org/10.3390/vaccines10010006... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/ https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0 https://doi.org/10.1186/s12889-018-6338-... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647 https://doi.org/10.1080/21645515.2018.15... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666 https://doi.org/10.1080/21645515.2019.16... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239 https://doi.org/10.5742/MEWFM.2018.93239... , ⁶³63 Ababu Y, Braka F, Teka A, Getachew K, Tadesse T, Michael Y, et al. Behavioral determinants of immunization service utilization in Ethiopia: a cross-sectional community-based survey. Pan African Med J. 2017;27. https://doi.org/10.11604/pamj.supp.2017.27.2.10635 https://doi.org/10.11604/pamj.supp.2017.... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20 https://doi.org/10.1186/1471-2431-14-20... ). A obrigatoriedade da vacinação infantil no país(³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ⁴¹41 Restivo V, Palmeri S, Bono S, Caracci F, Fiorino GR, Foresta A, et al. Knowledge and attitudes of parents after the implementation of mandatory vaccination in kindergartens of Palermo, Italy. 2020;91:41–7. https://doi.org/10.23750/abm.v91i3-S.9415 https://doi.org/10.23750/abm.v91i3-S.941... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020 https://doi.org/10.32725/kont.2019.020... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... ) ou para o ingresso da criança na vida escolar auxilia na elevação das taxas de vacinação(¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650 https://doi.org/10.1177/2515135523115265... , ²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002 https://doi.org/10.1016/j.acap.2022.10.0... , ³⁷37 Mossey S, Hosman S, Montgomery P, McCauley K. Parents’ experiences and nurses’ perceptions of decision-making about childhood immunization. Can J Nurs Res. 2020;52(4):255-67. https://doi.org/10.1177/0844562119847343 https://doi.org/10.1177/0844562119847343... , ⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x https://doi.org/10.1111/j.1440-1754.2008... ). Pais que apoiam governos(⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695 https://doi.org/10.33546/bnj.695... ) e líderes que são a favor da vacinação infantil(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22 https://doi.org/10.4103/jehp.jehp_687_22... ) consideram a vacinação como importante para a saúde da criança. Pais que consideram o programa nacional de imunização local como completo(⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183 https://doi.org/10.1186/1471-2458-13-118... ) não concordam em vacinar seus filhos com vacinas novas, enquanto que pais que percebem o calendário vacinal como rígido(⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958 https://doi.org/10.1111/jocn.13958... , ⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013 https://doi.org/10.1590/1413-81232014201... ) apresentam resistência em segui-lo. Pais que são contrários à lei da obrigatoriedade vacinal no país(³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062 https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060 https://doi.org/10.1016/j.vaccine.2019.0... , ⁶⁸68 Barbieri CLA, Couto MT. Decision-making on childhood vaccination by highly educated parents. Rev Saúde Pública. 2015;49. https://doi.org/10.1590/S0034-8910.2015049005149 https://doi.org/10.1590/S0034-8910.20150... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183 https://doi.org/10.1186/1471-2458-13-118... ) possuem descrença no governo, nas agências reguladoras(³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346 https://doi.org/10.1080/21645515.2021.19... , ⁵⁰50 Syiroj ATR, Pardosi JF, Heywood AE. Exploring parents’ reasons for incomplete childhood immunisation in Indonesia. Vaccine. 2019;37(43):6486–93. https://doi.org/10.1016/j.vaccine.2019.08.081 https://doi.org/10.1016/j.vaccine.2019.0... ) e no programa de imunização local^{(^{39,47,52,60,63,67,79,82,90})}, não sendo adeptos à prática de vacinação infantil.

Quadro 3 Crenças dos pais sobre a vacinação infantil, 2024

Crenças que inibem a vacinação infantil

Vacinação como uma ação que causa dor e sofrimento(⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17
https://doi.org/10.4103/ijph.IJPH_397_17... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958
https://doi.org/10.1111/jocn.13958... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020
https://doi.org/10.1590/S0104-1169201100... , ⁸⁰80 Logullo P, Carvalho HB, Saconi R, Massad E. Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J. 2008;126(3):166–71. https://doi.org/10.1590/S1516-31802008000300006
https://doi.org/10.1590/S1516-3180200800... ), trauma(³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/
https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015
https://doi.org/10.1016/j.vaccine.2004.1... ), sobrecarga imunológica(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378
https://doi.org/10.2147/PHMT.S295378... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751
https://doi.org/10.7759/cureus.19751... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346
https://doi.org/10.1080/21645515.2021.19... , ³⁴34 Wagner AL, Shotwell AR, Boulton ML, Carlson BF, Mathew JL. Demographics of vaccine hesitancy in Chandigarh, India. Front Med. 2021;7. https://doi.org/10.3389/fmed.2020.585579
https://doi.org/10.3389/fmed.2020.585579... , ⁴⁰40 Haroune V, King L. Factors contributing to parental “vaccine hesitancy” for childhood immunisations. Nurs Child Young People. 2020;32(4):20-5. https://doi.org/10.7748/ncyp.2020.e1269
https://doi.org/10.7748/ncyp.2020.e1269... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁴⁴44 Bianco A, Mascaro V, Zucco R, Pavia M. Parent perspectives on childhood vaccination: how to deal with vaccine hesitancy and refusal? Vaccine. 2019;37(7):984-90. https://doi.org/10.1016/j.vaccine.2018.12.062
https://doi.org/10.1016/j.vaccine.2018.1... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020
https://doi.org/10.32725/kont.2019.020... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695
https://doi.org/10.33546/bnj.695... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074
https://doi.org/10.1016/j.vaccine.2017.1... , ⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183
https://doi.org/10.1186/1471-2458-13-118... , ⁷⁵75 Smith PJ, Humiston SG, Marcuse EK, Zhao Z, Dorell CG, Howes C, et al. Parental delay or refusal of vaccine doses, childhood vaccination coverage at 24 months of age, and the health belief model. Public Health Reports. 2011;126:135–46. https://doi.org/10.1177/00333549111260S215
https://doi.org/10.1177/00333549111260S2... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023
https://doi.org/10.1016/j.socscimed.2007... , ⁸⁴84 Cassell JA, Leach M, Poltorak MS, Mercer CH, Iversen A, Fairhead JR. Is the cultural context of MMR rejection a key to an effective public health discourse? Public Health. 2006;120(9):783–94. https://doi.org/10.1016/j.puhe.2006.03.011
https://doi.org/10.1016/j.puhe.2006.03.0... , ⁸⁹89 Bardenheier B, Yusuf H, Schwartz B, Gust D, Barker L, Rodewald L. Are parental vaccine safety concerns associated with receipt of Measles-Mumps-Rubella, Diphtheria and Tetanus Toxoids With Acellular Pertussis, or Hepatitis B Vaccines by Children? Arch Pediatr Adolesc Med. 2004;158(6):569–75. https://doi.org/10.1001/archpedi.158.6.569
https://doi.org/10.1001/archpedi.158.6.5... , ⁹⁰90 Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents’ perspectives on the MMR immunisation: a focus group study. British J Gen Pract [Internet]. 2001 [cited 2024 May 20];51(472):904–10. Available from: https://bjgp.org/content/51/472/904.short
https://bjgp.org/content/51/472/904.shor... ), riscos à saúde da criança(¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650
https://doi.org/10.1177/2515135523115265... , ²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338
https://doi.org/10.1080/21645515.2022.21... , ²²22 Sapriadi S, Kasnawi T, Syukur M, Kamaruddin SA. Factors Related to the Parental Decision in Conducting Measles-Rubella Vaccination to the Children in South Sulawesi, Indonesia. Univ J Public Health. 2022;10(5):448–54. https://doi.org/10.13189/ujph.2022.100502
https://doi.org/10.13189/ujph.2022.10050... , ²³23 Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: a cross-sectional study. Vaccines. 2021;10(1):6. https://doi.org/10.3390/vaccines10010006
https://doi.org/10.3390/vaccines10010006... , ²⁴24 Akman N, Yildiz A. Evaluation of mothers opinions on routine childhood vaccinations. J Pediatr Infect. 2022;16(4):253–9. https://doi.org/10.5578/ced.20229605
https://doi.org/10.5578/ced.20229605... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772
https://doi.org/10.36948/ijfmr.2023.v05i... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378
https://doi.org/10.2147/PHMT.S295378... , ²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751
https://doi.org/10.7759/cureus.19751... , ²⁹29 Terzi Ö, Gülen EN, Dündar C. The causes of parental vaccine refusal: results of a survey from Giresun, Turkey. Turkish J Pediatr. 2021; 63(4):618. https://doi.org/10.24953/turkjped.2021.04.009
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Crenças em falsas contraindicações para se vacinar(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22
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Crenças na imunidade adquirida naturalmente ser melhor do que a vacinação(²⁴24 Akman N, Yildiz A. Evaluation of mothers opinions on routine childhood vaccinations. J Pediatr Infect. 2022;16(4):253–9. https://doi.org/10.5578/ced.20229605
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Experiências ruins de vacinação com filhos mais velhos(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
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https://doi.org/10.1080/21645515.2022.21... , ²⁹29 Terzi Ö, Gülen EN, Dündar C. The causes of parental vaccine refusal: results of a survey from Giresun, Turkey. Turkish J Pediatr. 2021; 63(4):618. https://doi.org/10.24953/turkjped.2021.04.009
https://doi.org/10.24953/turkjped.2021.0... , ³⁵35 Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med. 2021;282:114132. https://doi.org/2021.114132
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Crenças de que seu filho é muito novo para ser vacinado, baseando-se em crenças culturais(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346
https://doi.org/10.1080/21645515.2021.19... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/
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https://doi.org/10.1016/j.vaccine.2004.1... ) que a mãe foi imunizada na gestação(⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015
https://doi.org/10.1016/j.vaccine.2004.1... ) e não necessita vacinar seu filho, que não está suscetível a contrair a doença imunoprevenível(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
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https://doi.org/10.1016/0895-4356(96)000... ), que podem controlar o curso delas confiando na qualidade do sistema de saúde local, e que crianças não imunizadas não representam perigo para a comunidade(³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817
https://doi.org/ 10.5578/ced.202119817... ).

Sentimento de vergonha e crítica relacionado à pobreza pelas mães(³⁹39 Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub-Saharan Africa: a systematic review. BMC Public Health. 2020;20(1). https://doi.org/10.1186/s12889-020-09169-4
https://doi.org/10.1186/s12889-020-09169... , ⁴⁹49 Ridad GS. Barriers to adherence to expanded program on immunization among parents in Lanao del Norte, Philippines. Belitung Nurs J. 2019;5(1):16–22. https://doi.org/10.33546/bnj.695
https://doi.org/10.33546/bnj.695... ).

Crenças em métodos alternativos para proteger as crianças contra as doenças imunopreveníveis(⁷⁹79 Borràs E, Dominguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A. Parental knowledge of paediatric vaccination. BMC Public Health. 2009;9(1). https://doi.org/10.1186/1471-2458-9-154
https://doi.org/10.1186/1471-2458-9-154... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015
https://doi.org/10.1016/j.vaccine.2004.1... ), como amor(⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... ), amamentação(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817
https://doi.org/ 10.5578/ced.202119817... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/
https://pubmed.ncbi.nlm.nih.gov/32147978... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060
https://doi.org/10.1016/j.vaccine.2019.0... , ⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183
https://doi.org/10.1186/1471-2458-13-118... ), alimentação(²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772
https://doi.org/10.36948/ijfmr.2023.v05i... , ³⁵35 Çelik K, Turan S, Üner S. I’m a mother, therefore I question”: parents’ legitimation sources of and hesitancy towards early childhood vaccination. Soc Sci Med. 2021;282:114132. https://doi.org/2021.114132
https://doi.org/2021.114132... , ⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... , ⁷¹71 Harmsen IA, Mollema L, Ruiter RA, Paulussen TG, Melker HE, Kok G. Why parents refuse childhood vaccination: a qualitative study using online focus groups. BMC Public Health. 2013;13(1). https://doi.org/10.1186/1471-2458-13-1183
https://doi.org/10.1186/1471-2458-13-118... , ⁸²82 Casiday RE. Children’s health and the social theory of risk: insights from the British measles, mumps and rubella (MMR) controversy. Soc Sci Med. 2007;65(5):1059–70. https://doi.org/10.1016/j.socscimed.2007.04.023
https://doi.org/10.1016/j.socscimed.2007... ), homeopatia(⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... ), produtos fitoterápicos(³¹31 Atasever BN, Sayar S, Sabanci M, Gür AB, Karakoç H. Vaccine rejection for parents with babies of 0-24 months: solution recommendations for causes and reduction. J Pediatr Infect. 2021;15(2):e97–102. https://doi.org/ 10.5578/ced.202119817
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https://doi.org/2021.114132... , ³⁸38 Fridman E, Peretz-Aizenman L, Azab AN. The Barriers to Neonatal Hepatitis B Vaccination in Israel: a prospective study. PubMed [Internet]. 2020[cited 2024 May 20];22(3):148–53. Available from: https://pubmed.ncbi.nlm.nih.gov/32147978/
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https://doi.org/ 10.5578/ced.202119817... ).

Crenças religiosas que afirmam que a vacinação causa malefícios para a saúde das crianças, considerando um pecado(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
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https://doi.org/10.13189/ujph.2022.10050... , ²⁵25 Mohd Z, Norrafizah J, Mohamad M, Manimaran K. Alternative Practices of Vaccination among Parents in Selangor, Malaysia. Int J Multidiscip Res. 2023;5(6). https://doi.org/10.36948/ijfmr.2023.v05i06.8772
https://doi.org/10.36948/ijfmr.2023.v05i... , ²⁹29 Terzi Ö, Gülen EN, Dündar C. The causes of parental vaccine refusal: results of a survey from Giresun, Turkey. Turkish J Pediatr. 2021; 63(4):618. https://doi.org/10.24953/turkjped.2021.04.009
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https://doi.org/10.1016/j.vaccine.2019.0... , ⁵⁵55 Yunitasari E, Nastiti AA, Hasan WD, Yusuf A, Nugroho HSW. Factors associated to infant vaccination in Madurese, Indonesia. Indian J Public Health Res Develop. 2018;9(10):364. https://doi.org/10.5958/0976-5506.2018.01370.0
https://doi.org/10.5958/0976-5506.2018.0... , ⁶¹61 Kurup L, He HG, Wang X, Wang W, Shorey S. A descriptive qualitative study of perceptions of parents on their child’s vaccination. J Clin Nurs. 2017;26(23-24):4857–67. https://doi.org/10.1111/jocn.13958
https://doi.org/10.1111/jocn.13958... , ⁶³63 Ababu Y, Braka F, Teka A, Getachew K, Tadesse T, Michael Y, et al. Behavioral determinants of immunization service utilization in Ethiopia: a cross-sectional community-based survey. Pan African Med J. 2017;27. https://doi.org/10.11604/pamj.supp.2017.27.2.10635
https://doi.org/10.11604/pamj.supp.2017.... , ⁶⁴64 Aharon A, Nehama H, Rishpon S, Baron-Epel O. Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children. Patient Educ Counsel. 2017;100(4):768–75. https://doi.org/10.1016/j.pec.2016.11.016
https://doi.org/10.1016/j.pec.2016.11.01... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728
https://doi.org/10.1542/peds.2005-1728... )

Crenças que promovem a vacinação infantil

Vacinar a criança é um dever(⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647
https://doi.org/10.1080/21645515.2018.15... , ⁶⁷67 Couto MT, Barbieri CLA. Cuidar e (não) vacinar no contexto de famílias de alta renda e escolaridade em São Paulo, SP, Brasil. Ciênc Saúde Coletiva. 2015;20(1):105–14. https://doi.org/10.1590/1413-81232014201.21952013
https://doi.org/10.1590/1413-81232014201... , ⁶⁹69 Harvey H, Good J, Mason J, Reissland N. A Q-methodology study of parental understandings of infant immunisation: implications for healthcare advice. J Health Psychol. 2013;20(11):1451–62. https://doi.org/10.1177/1359105313513622
https://doi.org/10.1177/1359105313513622... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020
https://doi.org/10.1590/S0104-1169201100... , ⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x
https://doi.org/10.1111/j.1440-1754.2008... ) e um cuidado parental para poupar seus filhos da dor, do sofrimento e dos impactos de longo prazo na saúde em decorrência das doenças imunopreveníveis(²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ²¹21 Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: thematic analysis of parents and healthcare workers’ perceptions. Human Vac Immunother. 2022;18(6). https://doi.org/10.1080/21645515.2022.2137338
https://doi.org/10.1080/21645515.2022.21... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378
https://doi.org/10.2147/PHMT.S295378... , ³⁷37 Mossey S, Hosman S, Montgomery P, McCauley K. Parents’ experiences and nurses’ perceptions of decision-making about childhood immunization. Can J Nurs Res. 2020;52(4):255-67. https://doi.org/10.1177/0844562119847343
https://doi.org/10.1177/0844562119847343... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17
https://doi.org/10.4103/ijph.IJPH_397_17... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis
https://www.researchgate.net/publication... , ⁶⁹69 Harvey H, Good J, Mason J, Reissland N. A Q-methodology study of parental understandings of infant immunisation: implications for healthcare advice. J Health Psychol. 2013;20(11):1451–62. https://doi.org/10.1177/1359105313513622
https://doi.org/10.1177/1359105313513622... , ⁸⁹89 Bardenheier B, Yusuf H, Schwartz B, Gust D, Barker L, Rodewald L. Are parental vaccine safety concerns associated with receipt of Measles-Mumps-Rubella, Diphtheria and Tetanus Toxoids With Acellular Pertussis, or Hepatitis B Vaccines by Children? Arch Pediatr Adolesc Med. 2004;158(6):569–75. https://doi.org/10.1001/archpedi.158.6.569
https://doi.org/10.1001/archpedi.158.6.5... ).

Vacinar protege tanto a criança do adoecimento grave e mortalidade(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22
https://doi.org/10.4103/jehp.jehp_687_22... , ¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650
https://doi.org/10.1177/2515135523115265... , ²⁴24 Akman N, Yildiz A. Evaluation of mothers opinions on routine childhood vaccinations. J Pediatr Infect. 2022;16(4):253–9. https://doi.org/10.5578/ced.20229605
https://doi.org/10.5578/ced.20229605... , ²⁶26 GebreEyesus FA, Tarekegn TT, Amlak BT, Shiferaw BZ, Emeria MS, Geleta OT, et al. Knowledge, attitude, and practices of parents about immunization of infants and its associated factors in Wadla Woreda, North East Ethiopia, 2019. Pediatr Health, Med Ther. 2021;12:223–38. https://doi.org/10.2147/PHMT.S295378
https://doi.org/10.2147/PHMT.S295378... , ²⁸28 Oli AN, Ogwaluonye UC, Onubogu CU, Ozumba AF, Agbaenyi OH, Okeke KN, et al. Public Knowledge and Opinion on Childhood Routine Immunizations in Two Major Cities of Anambra State, Nigeria. J Multidiscip Healthcare. 2021;14:247–57. https://doi.org/10.2147/JMDH.S279397
https://doi.org/10.2147/JMDH.S279397... , ³²32 Musa S, Kulo A, Habersaat KB, Skrijelj V, Smjecanin M, Jackson C. A qualitative interview study with parents to identify barriers and drivers to childhood vaccination and inform public health interventions. Hum Vac Immunother. 2021;1–11. https://doi.org/10.1080/21645515.2021.1923346
https://doi.org/10.1080/21645515.2021.19... , ³⁴34 Wagner AL, Shotwell AR, Boulton ML, Carlson BF, Mathew JL. Demographics of vaccine hesitancy in Chandigarh, India. Front Med. 2021;7. https://doi.org/10.3389/fmed.2020.585579
https://doi.org/10.3389/fmed.2020.585579... , ³⁷37 Mossey S, Hosman S, Montgomery P, McCauley K. Parents’ experiences and nurses’ perceptions of decision-making about childhood immunization. Can J Nurs Res. 2020;52(4):255-67. https://doi.org/10.1177/0844562119847343
https://doi.org/10.1177/0844562119847343... , ⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁴³43 Dubé È, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother. 2018;15(1):113-20. https://doi.org/10.1080/21645515.2018.1509647
https://doi.org/10.1080/21645515.2018.15... , ⁴⁵45 Napolitano F, Adou A, Vastola A, Angelillo IF. Rotavirus infection and vaccination: knowledge, beliefs, and behaviors among parents in Italy. Int J Environ Res Public Health. 2019;16(10):1807. https://doi.org/10.3390/ijerph16101807
https://doi.org/10.3390/ijerph16101807... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020
https://doi.org/10.32725/kont.2019.020... , ⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666
https://doi.org/10.1080/21645515.2019.16... , ⁵¹51 Šeškutė M, Tamulevičienè E, Levinienè G. Knowledge and attitudes of postpartum mothers towards immunization of their children in a Lithuanian Tertiary Teaching Hospital. Medicina. 2018;54(1):2. https://doi.org/10.3390/medicina54010002
https://doi.org/10.3390/medicina54010002... , ⁵³53 Bhattacherjee S, Dasgupta P, Mukherjee A, Dasgupta S. Vaccine hesitancy for childhood vaccinations in slum areas of Siliguri, India. Indian J Public Health. 2018;62(4):253. https://doi.org/10.4103/ijph.IJPH_397_17
https://doi.org/10.4103/ijph.IJPH_397_17... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239
https://doi.org/10.5742/MEWFM.2018.93239... , ⁵⁸58 Alshammari TM, Subaiea GM, Hussain T, Moin A, Yusuff KB. Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study. Vaccine. 2018;36(1):23-8. https://doi.org/10.1016/j.vaccine.2017.11.050
https://doi.org/10.1016/j.vaccine.2017.1... , ⁵⁹59 Sjogren E, Ask LS, Örtqvist Å, Asp M. Parental conceptions of the rotavirus vaccine during implementation in Stockholm: a phenomenographic study. J Child Health Care. 2017;2;21(4):476-87. https://doi.org/10.1177/1367493517734390
https://doi.org/10.1177/1367493517734390... , ⁶⁵65 Weiss C, Schröpfer D, Merten S. Parental attitudes towards measles vaccination in the canton of Aargau, Switzerland: a latent class analysis. BMC Infect Dis. 2016;16(1). https://doi.org/10.1186/s12879-016-1747-0
https://doi.org/10.1186/s12879-016-1747-... , ⁶⁹69 Harvey H, Good J, Mason J, Reissland N. A Q-methodology study of parental understandings of infant immunisation: implications for healthcare advice. J Health Psychol. 2013;20(11):1451–62. https://doi.org/10.1177/1359105313513622
https://doi.org/10.1177/1359105313513622... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20
https://doi.org/10.1186/1471-2431-14-20... , ⁸⁰80 Logullo P, Carvalho HB, Saconi R, Massad E. Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J. 2008;126(3):166–71. https://doi.org/10.1590/S1516-31802008000300006
https://doi.org/10.1590/S1516-3180200800... , ⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x
https://doi.org/10.1111/j.1440-1754.2008... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728
https://doi.org/10.1542/peds.2005-1728... , ⁸⁶86 Bigham M, Remple VP, Pielak K, McIntyre C, White R, Wu W. Uptake and behavioural and attitudinal determinants of immunization in an expanded routine infant Hepatitis B Vaccination Program in British Columbia. Can J Public Health. 2006;97(2):90–5. https://doi.org/10.1007/BF03405322
https://doi.org/10.1007/BF03405322... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015
https://doi.org/10.1016/j.vaccine.2004.1... , ⁹⁰90 Evans M, Stoddart H, Condon L, Freeman E, Grizzell M, Mullen R. Parents’ perspectives on the MMR immunisation: a focus group study. British J Gen Pract [Internet]. 2001 [cited 2024 May 20];51(472):904–10. Available from: https://bjgp.org/content/51/472/904.short
https://bjgp.org/content/51/472/904.shor... ) quanto a comunidade(¹⁹19 Sahoo SS, Parida SP, Singh AK, Palepu S, Sahoo DP, Bhatia V. Decision-making in childhood vaccination: vaccine hesitancy among caregivers of under-5 children from a tertiary care institution in Eastern India. Ther Adv Vac Immunother. 2023;11. https://doi.org/10.1177/25151355231152650
https://doi.org/10.1177/2515135523115265... , ²⁰20 Hsu C, Evers S, Ibrahim A, Patricia M, Throne P, Melton M, et al. Sometimes Your Heart Says “I Don’t Know”: insights from parents of undervaccinated children. 2023;23(1):57–67. https://doi.org/10.1016/j.acap.2022.10.002
https://doi.org/10.1016/j.acap.2022.10.0... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020
https://doi.org/10.32725/kont.2019.020... , ⁴⁷47 Romijnders KAGJ, van Seventer SL, Scheltema M, van Osch L, Vries H, Mollema L. A deliberate choice? exploring factors related to informed decision-making about childhood vaccination among acceptors, refusers, and partial acceptors. Vaccine. 2019;37(37):5637-44. https://doi.org/10.1016/j.vaccine.2019.07.060
https://doi.org/10.1016/j.vaccine.2019.0... , ⁵²52 Giambi C, Fabiani M, D’Ancona F, Ferrara L, Fiacchini D, Gallo T, et al. Parental vaccine hesitancy in Italy: results from a national survey. Vaccine. 2018;36(6):779–87. https://doi.org/10.1016/j.vaccine.2017.12.074
https://doi.org/10.1016/j.vaccine.2017.1... , ⁵⁶56 Hatoková M, Masaryk R, Túnyiová M. How Slovak mothers view child vaccination: focus group analysis. Czechoslovak Psychol[Internet]. 2018 [cited 2024 May 20];62(2):101–18. Available from: https://www.researchgate.net/publication/325286630_How_slovak_mothers_view_child_vaccination_Focus_group_analysis
https://www.researchgate.net/publication... , ⁷⁹79 Borràs E, Dominguez À, Fuentes M, Batalla J, Cardeñosa N, Plasencia A. Parental knowledge of paediatric vaccination. BMC Public Health. 2009;9(1). https://doi.org/10.1186/1471-2458-9-154
https://doi.org/10.1186/1471-2458-9-154... ), e é uma decisão tomada sem estresse, onde os comportamentos da criança indicativos de sofrimento são encarados com naturalidade(⁵¹51 Šeškutė M, Tamulevičienè E, Levinienè G. Knowledge and attitudes of postpartum mothers towards immunization of their children in a Lithuanian Tertiary Teaching Hospital. Medicina. 2018;54(1):2. https://doi.org/10.3390/medicina54010002
https://doi.org/10.3390/medicina54010002... , ⁶⁹69 Harvey H, Good J, Mason J, Reissland N. A Q-methodology study of parental understandings of infant immunisation: implications for healthcare advice. J Health Psychol. 2013;20(11):1451–62. https://doi.org/10.1177/1359105313513622
https://doi.org/10.1177/1359105313513622... , ⁷⁴74 Figueiredo GLA, Pina JC, Tonete VLP, Lima RAG, Mello DF. Experiences of families in the immunization of Brazilian children under two years old. Rev Latino-Am Enfermagem. 2011;19(3):598–605. https://doi.org/10.1590/S0104-11692011000300020
https://doi.org/10.1590/S0104-1169201100... ) e as injeções múltiplas como necessárias e não prejudiciais(²⁷27 Saeed R, Hashmi I. Pakistan ranks third globally with the most unvaccinated children: is the impact of parental perception and attitude on immunization an essential contributing factor to an unsuccessful vaccination coverage? Cureus. 2021;13(11). https://doi.org/10.7759/cureus.19751
https://doi.org/10.7759/cureus.19751... , ⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666
https://doi.org/10.1080/21645515.2019.16... , ⁵¹51 Šeškutė M, Tamulevičienè E, Levinienè G. Knowledge and attitudes of postpartum mothers towards immunization of their children in a Lithuanian Tertiary Teaching Hospital. Medicina. 2018;54(1):2. https://doi.org/10.3390/medicina54010002
https://doi.org/10.3390/medicina54010002... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239
https://doi.org/10.5742/MEWFM.2018.93239... , ⁸³83 Tickner S, Leman PJ, Woodcock A. Factors underlying suboptimal childhood immunisation. Vaccine. 2006;24(49-50):7030–6. https://doi.org/10.1016/j.vaccine.2006.06.060
https://doi.org/10.1016/j.vaccine.2006.0... , ⁹¹91 Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ [Internet]. 1999[cited 2024 May 20];77(3):224–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2557613/
https://www.ncbi.nlm.nih.gov/pmc/article... ).

Crença religiosa de que a vacinação não é proibida pela religião(⁴⁸48 Singh HKB, Badgujar VB, Yahaya RS, Abd Rahman S, Sami FM, Badgujar S, et al. Assessment of knowledge and attitude among postnatal mothers towards childhood vaccination in Malaysia. Hum Vaccin Immunother. 2019;15(11):2544–51. https://doi.org/10.1080/21645515.2019.1612666
https://doi.org/10.1080/21645515.2019.16... , ⁵⁷57 Bamatraf FF, Jawass MA. Knowledge and attitude towards childhood immunization among parents in Al-Mukalla, Yemen. World Fam Med J. 2018;16(2):24–31. https://doi.org/10.5742/MEWFM.2018.93239
https://doi.org/10.5742/MEWFM.2018.93239... ) e é apoiada por líderes religiosos(¹⁸18 Goruntla N, Akanksha K, Lalithaasudhaa K, Pinnu V, Jinka D, Bhupalam P, et al. Prevalence and predictors of vaccine hesitancy among mothers of under-five children: a hospital-based cross-sectional study. J Educ Health Promot. 2023;12(1):34–4. https://doi.org/10.4103/jehp.jehp_687_22
https://doi.org/10.4103/jehp.jehp_687_22... ) motiva os pais a vacinarem seus filhos.

Experiências bem-sucedidas na vacinação de filhos mais velhos(³⁶36 Galadima AN, Zulkefli NAM, Said SM, Ahmad N. Factors influencing childhood immunisation uptake in Africa: a systematic review. BMC Public Health. 2021;21(1). https:doi.org/10.1186/s12889-021-11466-5
https:doi.org/10.1186/s12889-021-11466-5... , ⁴⁶46 Cintulová LL. The impact of the emotions that frame mothers’ decision-making about the vaccination of toddlers. Kontakt. 2019;21(2):189-96. https://doi.org/10.32725/kont.2019.020
https://doi.org/10.32725/kont.2019.020... , ⁵⁵55 Yunitasari E, Nastiti AA, Hasan WD, Yusuf A, Nugroho HSW. Factors associated to infant vaccination in Madurese, Indonesia. Indian J Public Health Res Develop. 2018;9(10):364. https://doi.org/10.5958/0976-5506.2018.01370.0
https://doi.org/10.5958/0976-5506.2018.0... , ⁷⁰70 Qutaiba BAO, Bahari MB, Al-Qazaz HK, Salih MR, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14(1). https://doi.org/10.1186/1471-2431-14-20
https://doi.org/10.1186/1471-2431-14-20... , ⁸¹81 Tarrant M, Thomson N. Secrets to success: a qualitative study of perceptions of childhood immunisations in a highly immunised population. J Paediatr Child Health. 2008;44(10):541–7. https://doi.org/10.1111/j.1440-1754.2008.01334.x
https://doi.org/10.1111/j.1440-1754.2008... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728
https://doi.org/10.1542/peds.2005-1728... , ⁸⁸88 Maayan-Metzger A, Kedem-Friedrich P, Kuint J. To vaccinate or not to vaccinate—that is the question: why are some mothers opposed to giving their infants hepatitis B vaccine? Vaccine. 2005;23(16):1941–8. https://doi.org/10.1016/j.vaccine.2004.10.015
https://doi.org/10.1016/j.vaccine.2004.1... ) e a crença na vacinação como “norma cultural”(⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... , ⁸⁵85 Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of mothers’ decision-making about vaccines for infants: the importance of trust. Pediatr. 2006;117(5):1532–41. https://doi.org/10.1542/peds.2005-1728
https://doi.org/10.1542/peds.2005-1728... ) influenciam positivamente a vacinação dos filhos mais novos.

Crença pessoal em considerar a vacinação como necessária por parte de pais que costumam viajar constantemente(⁴²42 McNeil DA, Mueller M, MacDonald S, McDonald S, Saini V, Kellner JD, et al. Maternal perceptions of childhood vaccination: explanations of reasons for and against vaccination. BMC Public Health. 2019;19(1). https://doi.org/10.1186/s12889-018-6338-0
https://doi.org/10.1186/s12889-018-6338-... ).

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Crenças e atitudes de pais ou responsáveis legais sobre a vacinação infantil: revisão de escopo

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[1] Autor Correspondente
Mariana Mesquita de Oliveira Lima E-mail: mmos.df@gmail.com