Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article


Doctor of Philosophy




Donelle, Lorie


Background: Routine childhood vaccines are an important part of maintaining childhood health and preventing the spread of disease. Parents are responsible for making decision for their children regarding vaccines, but some parents have concerns over vaccine safety, necessity, and hesitate to have their children vaccinated. Parents are looking for vaccine information to support their decision-making and are often accessing information online, but their digital health literacy levels are unknown. COVID-19 has highlighted the importance of vaccines in reducing morbidity and mortality of infectious diseases. However, there is concern over increasing levels of parents’ vaccine hesitancy affecting routine childhood and COVID-19 vaccine uptake.

Aim: The purpose of this study was to investigate parents’ vaccine decisions (across the continuum from vaccine hesitant to vaccine acceptance) as a function of information seeking patterns, health literacy, digital health literacy, trust, vaccine attitudes and beliefs, and the impact of COVID-19 vaccine campaigns.

Methods: A sequential explanatory mixed methods design was utilized. Quantitative data was collected first, in the form of an online survey, followed by semi-structured interviews using the videoconferencing platform Zoom. A qualitative descriptive methodological approach guided the qualitative portion of the study. Quantitative data were analyzed using descriptive statistical analysis and multiple linear regression modelling, qualitative data were analyzed with an inductive thematic approach.

Results: 219 participants completed the survey and 19 participants were interviewed. Most parents in this study have high digital health literacy skills and use a variety of vaccine information sources. We identified through quantitative and qualitative analysis that trust is important factor in vaccine acceptance. 23% participants in this study were less likely to vaccinate their children with routine childhood vaccines since the pandemic. In making COVID-19 vaccine decisions, parents conducted risk assessments and noted fear as a contributing factor to their decisions with protection of vulnerable adults and children being motivations for vaccination. Our study also identified waning trust in large government institutions and public health authorities throughout the pandemic.

Summary for Lay Audience

Parents have the responsibility of making decision for their children surrounding routine childhood and COVID-19 vaccines. Childhood vaccines are an important part of keeping children healthy and controlling the spread of disease. Parents require accurate and accessible information and often look online for vaccine information. While there is accurate information online, there is also false information, making it hard to tell what information one should use to make these important decisions.

The purpose of this study was to understand how parents make decisions about vaccines, particularly routine childhood vaccines and COVID-19 vaccines. We used an online survey to ask parents about their thoughts on vaccines, including those who choose to have their children vaccinated and those who refuse all vaccines. We asked parents what affected their vaccine decision making including; where they look for vaccine information, if they can understand and use the information they find, how they feel about childhood vaccines and their specific beliefs about vaccines, who they trust to give them vaccine information, how the pandemic impacted their decisions about routine and COVID-19 vaccines, and if they accept or decline vaccines in general. We also interviewed parents to better understand their vaccine decisions, particularly about COVID-19 and their thoughts about routine vaccines.

Most parents reported that they can understand the information they find online. When looking at factors that impact parents’ decision to choose vaccination, trust in healthcare providers, trust in the vaccine, and trust in the process of regulating vaccines were all important. After the pandemic, 23% of parents in our study reported they were less likely to have their child vaccinated with routine vaccines. Parents reported that they considered the risks and benefits of the COVID 19 vaccine versus the risk of COVID infection. Fear impacted their decision, parents wanted to protect their children and others as a reason to have their child vaccinated. Trust was an important factor in deciding whether to have their children vaccinated with a COVID-19 vaccine. It was important to trust their healthcare provider and the people in authority sending messages about vaccines.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Available for download on Wednesday, April 30, 2025