The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy

Özlem Kemer Aycan; Sevde Aksu

doi:10.46332/aemj.1871505

The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy

Abstract

Purpose: This cross-sectional analytical study aimed to assess breastfeeding mothers’ attitudes toward childhood vaccination, levels of vaccine hesitancy, and vaccine literacy, and examine the relationships between these variables, as well as associated sociodemographic factors.

Materials and Methods: The study included 120 breastfeeding mothers attending the Pediatric Health and Diseases outpatient clinic at Balikesir Universty between April and May 2025. Data were collected via face-to-face interviews using a sociodemographic questionnaire, the Attitudes Toward Vaccination Scale, the Vaccine Hesitancy Scale, and the Vaccine Literacy Scale.

Results: While 82.5% reported having their children vaccinated, 61.7% experienced partial or complete hesitation.. Mothers of male children had significantly higher total vaccination attitude scores and communicative and critical literacy scores. Participants believing vaccines had no side effects demonstrated more positive attitudes and lower hesitancy levels . Functional literacy was negatively correlated with both hesitancy and negative attitudes (p<0.001). Despite a generally positive view of vaccination, 67.5% believed vaccines have side effects, with autism (82.7%), infertility (80.2%), and fever (86.4%).

Conclusion: Although breastfeeding mothers largely support childhood vaccination, vaccine hesitancy remains common, mainly driven by concerns about misinformation and possible side effects. In our study, higher vaccine literacy particularly at the functional level was unexpectedly linked to less favorable vaccination attitudes and greater hesitancy. This suggests that increased exposure to vaccine-related information does not always lead to greater acceptance and that how information is understood and interpreted may be more important than the amount of information available.

Keywords

Ethical Statement

Approval for this study was obtained from the Clinical Research Ethics Committee of Balikesir University Health Sciences Non-Interventional Ethics Committee (date:11/3/2025,number:2025/133)

References

Plotkin SA, Plotkin SL. The development of vaccines: how the past led to the future. Nat Rev Microbiol. 2011;9(12):889-893. doi: 10.1038/nrmicro2668.
World Health Organization. (2025). Vaccines and immunization. who.int/health-topics/vaccines-and-immunization. Access date:19.12.2025
Trumbo SP, Silver D, Domenti O, et al. Strengthening legal frameworks for vaccination: The experiences of Armenia, Georgia, and Moldova. Vaccine. 2019;37(35):4840-4847. doi: 10.1016/j.vaccine.2018.10.069.
Tan, Ayça Kömürlüoğlu; Yalçin, S. Songül. Childhood Vaccination And Vaccine Hesitancy: A Comparison Between Türkiye And The World. Turk J Pediatr Dis, 2024;18(6):387-395. doi: 10.12956/tchd.1547693.
MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4164. doi: 10.1016/j.vaccine.2015.04.036.
World Health Organization. (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019.
Janiak S, Piszczek E, Buczkowska A, Buczkowski K. Parental Vaccine Hesitancy, Trust in Physicians, and Future Vaccination Intentions: A PACV Cross-Sectional Study. Vaccines (Basel). 2025;13(11):1127. doi: 10.3390/vaccines13111127.
Durmaz N, Suman M, Ersoy M, Örün E. Parents' Attitudes toward Childhood Vaccines and COVID-19 Vaccines in a Turkish Pediatric Outpatient Population. Vaccines (Basel). 2022;10(11):1958. doi: 10.3390/vaccines10111958.

Morniroli D, Consales A, Riverso L, et al. Post-partum Hospital Stay and Mothers' Choices on Breastfeeding and Vaccines: A Chance We Should Not Miss. Front Public Health. 2021;9:625779. doi: 10.3389/fpubh.2021.625779.
Badua AR, Caraquel KJ, Cruz M, Narvaez RA. Vaccine literacy: A concept analysis. Int J Ment Health Nurs. 2022;31(4):857-867. doi: 10.1111/inm.12988.
Arriaga M, Francisco R, Nogueira P, et al. Health Literacy in Portugal: Results of the Health Literacy Population Survey Project 2019-2021. Int J Environ Res Public Health. 2022;19(7):4225. doi: 10.3390/ijerph19074225.
Şahin AN, Şimşek A. Mothers’ attitudes toward measles vaccination and vaccine hesitancy: A cross-sectional study. YIU J Health Sci. 2025;6(3):106-113. doi: 10.51261/yiu.2025.1805352.
Akarsu, Özlem; US, Mahmut Caner. The Effect of Parental Vaccine Literacy Level and Attitudes on COVID19 Vaccination Decisions for Children Aged 5-11 Years: A Cross-sectional Study. Journal of Child. 2023; 23(3):243-250. doi: 10.26650/jchild.2023.1344596.
Özümit, Didem; Sari, Hatice Yıldırım. Adaptation of the Attitudes Towards Vaccination Scale into Turkish, examination of its validity and reliability. J Pediatr Infect. 2021;5(3):167-176. doi: /10.5578/ced.20219720.
Cvjetkovic SJ, Jeremic VL, Tiosavljevic DV. Knowledge and attitudes toward vaccination: A survey of Serbian students. J Infect Public Health. 2017;10(5):649-656. doi: 10.1016/j.jiph.2017.05.008.
Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: The development of a survey tool. Vaccine. 2015;33(34):4165-4175. doi: 10.1016/j.vaccine.2015.04.037.
Aslan KT, Ay P, Kaş D, et al. Adaptation and validation of the Turkish version of the vaccine hesitancy 5 point Likert Scale. Hum Vaccin Immunother. 2021;17(12):5176-5182. doi: 10.1080/21645515.2021.1953347.
Amit 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 Couns. 2017;100(4):768-775. doi: 10.1016/j.pec.2016.11.016
Yorulmaz, Deniz S.; Kocoglu-Tanyer, Deniz. A Vaccine Literacy Scale For Childhood Vaccines: Turkish Validity And Reliability Vaccine Literacy Scale. J Public Health. 2024;32(5):855-863. doi: 10.1007/s10389-023-01878-5
Ghasemi A, Zahediasl S. Normality tests for statistical analysis: a guide for non-statisticians. Int J Endocrinol Metab. 2012;10(2):486-489. doi: 10.5812/ijem.3505.
Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9(8):1763-1773. doi: 10.4161/hv.24657
Larson HJ, Jarrett C, Eckersberger E, Smith DM, Paterson P. Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012. Vaccine. 2014;32(19):2150-2159. doi: 10.1016/j.vaccine.2014.01.081
Evsile S, Celep G, Duran AP, Bahadır A, Memiş K, Davvara M, Kılıç N, Çayır S, Akıncı S. Evaluation of attitudes and behaviors of families with children aged 0-24 months about childhood vaccines. J Curr Pediatr. 2025;23(2):126-33. doi: /10.4274/jcp.2025.21447
Didem HY, Ülfiye Ç, Miraç Ç, Safiye TS, Pelin SS, Cem YA, et al. The frequency and determinants of vaccine hesitancy among parents of preschool and kindergarten students in Edirne central district. J Pediatr Nurs. 2024;74:e38-e44. doi: 10.1016/j.pedn.2023.11.002.
Turan FD. Parents’ attitudes toward childhood vaccines included in the national immunization program: The Aksaray sample. J Public Health Nurs. 2022;4(3):239-250. doi: 10.54061/jphn.1183177.
Michel JP, Goldberg J. Education, Healthy Ageing and Vaccine Literacy. J Nutr Health Aging. 2021;25(5):698-701. doi: 10.1007/s12603-021-1627-1.
Facciolà A, Visalli G, Orlando A, et al. Vaccine hesitancy: An overview on parents' opinions about vaccination and possible reasons of vaccine refusal. J Public Health Res. 2019;8(1):1436. doi: 10.4081/jphr.2019.1436.
Anwar M, Faisal A, Jawed K, Yousuf A, Shaikh I. Association Between Maternal Literacy and Child Immunization According to the Expanded Program on Immunization Schedule in a Primary Health Care Center of a Squatter Settlement in Karachi. Cureus. 2023;15(8):e43608. doi: 10.7759/cureus.43608.
Heraclides A, Kouvari K. Health literacy in relation to vaccine hesitancy: Systematic review of observational studies. Eur J Public Health. 2025;35(Suppl 4):ckaf161.1475. doi: 10.1093/eurpub/ckaf161.1475.
V Casigliani, G Arzilli, D Menicagli, G Scardina, P L Lopalco, Vaccine hesitancy and Health Literacy: we need to change our paradigm. Eur J Public Health. 2020;30(5): ckaa165.032. doi: 10.1093/eurpub/ckaa165.032.
Lamot M, Kirbiš A. Understanding Vaccine Hesitancy: A Comparison of Sociodemographic and Socioeconomic Predictors with Health Literacy Dimensions. Vaccines (Basel). 2024;12(10):1141. doi: 10.3390/vaccines12101141.
Demirtaş MS, Yaman Artunç N. Mothers’ Perspectives on Childhood Vaccination Programmes after the COVID-19 Pandemic and Subsequent News/Rumours About Vaccination. Turkish J Pediatr Dis. 2024;18(6):348-354. doi: 10.12956/tchd.1462728.
Galagali PM, Kinikar AA, Kumar VS. Vaccine Hesitancy: Obstacles and Challenges. Curr Pediatr Rep. 2022;10(4):241-248. doi: 10.1007/s40124-022-00278-9.
Güdücüoğlu, Hüseyin; Berktaş, Mustafa; Yaman, Görkem. Thiomersal and Autism. Ankem Journal, 2011;25(1):62-69. doi: 10.5222/ankem.2011.62.
Duran R, Çalbayram N. Attitudes of healthcare professionals regarding vaccines and influencing factors: A cross-sectional study. J Pediatr Nurs. 2024;79:e148-e153. doi: 10.1016/j.pedn.2024.10.013.

Details

Primary Language

English

Subjects

Infectious Diseases, Social Epidemiology

Journal Section

Research Article

Authors

Özlem Kemer Aycan ^*
0000-0002-2462-0939
Türkiye

Sevde Aksu
0000-0001-7749-8474
Türkiye

Publication Date

August 31, 2026

Submission Date

January 25, 2026

Acceptance Date

April 22, 2026

Published in Issue

Year 2026 Volume: 10 Number: 2

DOI

https://doi.org/10.46332/aemj.1871505

IZ

https://izlik.org/JA87TP38WT

Cite

RIS / Bibtex

APA

Kemer Aycan, Ö., & Aksu, S. (2026). The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy. Ahi Evran Medical Journal, 10(2), 223-233. https://doi.org/10.46332/aemj.1871505

AMA

1.Kemer Aycan Ö, Aksu S. The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy. Ahi Evran Med J. 2026;10(2):223-233. doi:10.46332/aemj.1871505

Chicago

Kemer Aycan, Özlem, and Sevde Aksu. 2026. “The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy”. Ahi Evran Medical Journal 10 (2): 223-33. https://doi.org/10.46332/aemj.1871505.

EndNote

Kemer Aycan Ö, Aksu S (August 1, 2026) The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy. Ahi Evran Medical Journal 10 2 223–233.

IEEE

[1]Ö. Kemer Aycan and S. Aksu, “The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy”, Ahi Evran Med J, vol. 10, no. 2, pp. 223–233, Aug. 2026, doi: 10.46332/aemj.1871505.

ISNAD

Kemer Aycan, Özlem - Aksu, Sevde. “The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy”. Ahi Evran Medical Journal 10/2 (August 1, 2026): 223-233. https://doi.org/10.46332/aemj.1871505.

JAMA

1.Kemer Aycan Ö, Aksu S. The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy. Ahi Evran Med J. 2026;10:223–233.

MLA

Kemer Aycan, Özlem, and Sevde Aksu. “The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy”. Ahi Evran Medical Journal, vol. 10, no. 2, Aug. 2026, pp. 223-3, doi:10.46332/aemj.1871505.

Vancouver

1.Özlem Kemer Aycan, Sevde Aksu. The Relationship Between Breastfeeding Mothers’ Attitudes Toward Vaccination, Vaccine Hesitancy, and Vaccine Literacy. Ahi Evran Med J. 2026 Aug. 1;10(2):223-3. doi:10.46332/aemj.1871505