Public Attitudes and Beliefs Towards Childhood Vaccinations: Urban-Rural Differences and the Other Social Determinant of Health

Year 2023, Volume: 13 Issue: 2, 376 - 384, 15.06.2023

Zeynep Saçıkara , Kübra Sultan Dengiz , Deniz Koçoğlu-tanyer

https://doi.org/10.33808/clinexphealthsci.1124403

Abstract

Objective: The study aimed to compare vaccination attitudes and behaviors of individuals living in rural and urban areas by evaluating the social
determinants of health.
Methods: This research was a secondary analysis study based on two projects examining vaccination attitudes of individuals, which were conducted separately in urban and rural areas. The researches were conducted in a city center and eight rural areas located in the central Anatolia region of Turkey. In total, 1,164 individuals were studied. Multiple regression analysis (enter model) was used for determinants of public attitude toward vaccination.
Results: In urban areas, the rate of awareness of discussions about vaccination and the rate of consideration that vaccination should be a parental decision were higher than in rural areas. According to the public attitude toward vaccination–HBM Scale, the sub-dimensions of perceived susceptibility, perceived severity, and health motivation scores of participants from rural residents were higher than those from urban residents. Regarding the sub-dimension of perceived barriers, participants from urban areas had a higher score. The social determinants of health, such as lack of health insurance, unemployment or low income, difficulty accessing health facilities, conviction that vaccination is a parental decision, moderate/poor economic perception, especially the profession, are effective in vaccine attitude.
Conclusion: This study showed a difference between vaccination attitudes of individuals living in urban and rural areas.

Keywords

attitude, childhood, social determinants, rural, urban, vaccine and vaccine hesitancy

Supporting Institution

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Project Number

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Thanks

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References

• UNDG. Socio-economic impact of Ebola virus disease in west African countries: A call for national and regional containment, recovery and prevention. Published [February 2015]. Updated [01 August 2016]. Accessed: [07 March 2022]. https://www.undp.org/africa/publications/socio-economic-impact-ebola-virus-disease-west-africa
• Newall A, Jit M, Hutubessy R. Are current cost-effectiveness thresholds for low-and middle-income countries useful? Examples from the world of vaccines. Pharmacoeconomics. 2014;32(6):525-531 DOI: 10.1007/s40273-014-0162-x
• Plotkin S. History of vaccination. Pnas. 2014;111(34):12283-12287 DOI: 10.1073/pnas.1400472111
• WHO. European Immunization Agenda 2030. Published [February 2021]. Accessed: [07 March 2022] https://www.who.int/europe/initiatives/the-european-immunization-agenda-2030
• Whitney CG, Zhou F, Singleton J, Schuchat A. Benefits from immunization during the vaccines for children program era—United States, 1994–2013. Mmwr. 2014;63(16):352-355
• Roush S, Murphy T, Group V-PDTW. Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States. JAMA. 2007;298(18):2155-2163 DOI:10.1001/jama.298.18.2155
• McGovern M, Canning D. Vaccination and all-cause child mortality from 1985 to 2011: Global evidence from the demographic and health surveys. Am J Epidemiol. 2015;182(9):791–798 DOI: 10.1093/aje/kwv125
• Avcı E. Çocukluk dönemi aşılarına ilişkin karşılaştırmalı bir analiz: Amerika Birleşik Devletleri ve Türkiye. Özgürlük Araştırmaları Derneği. 2017;1(1):5-30. http://ozgurlukarastirmalari.com/oad~rapor_cocukluk-donemi-asilari-abd-ve-turkiye (Turkish)
• WHO. Immunization. Published [December 2019]. Accessed: [07 March 2022]. https://www.who.int/features/factfiles/immunization/en/.
• WHO. Measles – European Region. Published [06 May 2019]. Accessed: [07 September 2022]. https://www.who.int/emergencies/disease-outbreak-news/item/2019-DON140
• Larson H, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, Schuster M, MacDonald N, Wilson G. Measuring vaccine hesitancy: the development of a survey tool. Vaccine 2015;33(34):4165-4175 DOI:10.1016/j.vaccine.2015.04.037
• Soysal G, Akdur R. Investigating vaccine hesitancy and refusal among parents of children under five: a community-based study. J Curr Pediatr. 2022;20(3):339-348 DOI:10.4274/jcp.2022.01488
• Newcomer SR, Freeman RE, Wehner BK, Anderson SL, Daley MF. Timeliness of early childhood vaccinations and undervaccination patterns in Montana. Am J Prev Med. 2021;61(1):e21-e9 DOI:10.1016/j.amepre.2021.01.038
• Dube E, Vivion M, MacDonald NE. Vaccine hesitancy, vaccine refusal and the anti-vaccine movement: influence, impact and implications. Expert Rev Vaccines. 2015;14(1):99-117 DOI:10.1586/14760584.2015.964212
• Dube E, Gagnon D, Ouakki M, Bettinger JA, Witteman HO, MacDonald S, Fisher W, Saini V, Greysonet D. Measuring vaccine acceptance among Canadian parents: A survey of the Canadian Immunization Research Network. Vaccine 2018;36(4):545-552 DOI:10.1016/j.vaccine.2017.12.005
• Salmon DA, Dudley MZ, Glanz JM, Omer SB. Vaccine hesitancy: causes, consequences, and a call to action. Vaccine 2015;49(6):391-398 DOI: 10.1016/j.amepre.2015.06.009
• Enkel SL, Attwell K, Snelling TL, Christian HE. ‘Hesitant compliers’: Qualitative analysis of concerned fully-vaccinating parents. Vaccine 2018;36(44):6459-6463 DOI:10.1016/j.vaccine.2017.09.088
• Armstrong K, Berlin M, Schwartz JS, Propert K, Ubel PA. Barriers to influenza immunization in a low-income urban population. Am J Prev Med. 2001;20(1):21-25 DOI:10.1016/s0749-3797(00)00263-4
• Gualano M, Bert F, Voglino G, Buttinelli E, D'Errico M, De Waure C, Giovanni D, Fantini M, Giuliani A, Marranzano M, Massanotti G, Massimi A, Nante N, Pennino F, Squeri R, Stefanati A, Signorelli C, Siliquini R. Attitudes towards compulsory vaccination in Italy: Results from the NAVIDAD multicentre study. Vaccine 2018;36(23):3368-3374 DOI:10.1016/j.vaccine.2018.04.029
• MacDougall DM, Halperin BA, Langley JM, McNeil SA, MacKinnon-Cameron D, Li L, Halperin S. Knowledge, attitudes, beliefs, and behaviors of pregnant women approached to participate in a Tdap maternal immunization randomized, controlled trial. Hum Vaccin Immunother. 2016;12(4):879-885 DOI:10.1080/21645515.2015.1130193
• Saitoh A, Nagata S, Saitoh A, Tsukahara Y, Vaida F, Sonobe T, Kamiya H, Naruse T, Murashima S. Perinatal immunization education improves immunization rates and knowledge: A randomized controlled trial. Prev Med. 2013;56(6):398-405 DOI:10.1016/j.ypmed.2013.03.003
• Weiner JL, Fisher AM, Nowak GJ, Basket MM, Gellin BG. Childhood immunizations: First-time expectant mothers’ knowledge, beliefs, intentions, and behaviors. Am J Prev Med. 2015;49(6):426-434 DOI:10.1016/j.amepre.2015.07.002
• Jeihooni AK, Hidarnia A, Kaveh MH, Hajizadeh E, Askari A. Effects of an osteoporosis prevention program based on health belief model among females. Nurs Midwifery Stud. 2015;4(3): e26731 DOI:10.17795/nmsjournal26731
• Jones CJ, Smith H, Llewellyn C. Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review. Health Psychol Rev. 2014;8(3):253-269 DOI:10.1080/17437199.2013.802623
• Masoudiyekta L, Rezaei-Bayatiyani H, Dashtbozorgi B, Gheibizadeh M, Malehi AS, Moradi M. Effect of education based on health belief model on the behavior of breast cancer screening in women. Asia Pac J Oncol Nurs. 2018;5(1):114-120 DOI:10.4103/apjon.apjon_36_17
• O'connor PJ, Martin B, Weeks CS, Ong L. Factors that influence young people's mental health help‐seeking behaviour: a study based on the Health Belief Model. J Adv Nurs. 2014;70(11):2577-2587 DOI:10.1111/jan.12423
• Hayden J.Introduction to health behavior theory. 4th ed. USA. Canada Jones and Barlett Publishers. 2009.
• Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: Development of a measure assessing the 5C psychological antecedents of vaccination. PloS one 2018;13(12):e0208601 DOI:10.1371/journal.pone.0208601
• Skinner CS, Tiro J, Champion VL. Background on the health belief model. Health behavior: Theory, research, and practice. 5th ed. Jossey Bas. 2015
• Dyda A, King C, Dey A, Leask J, Dunn AG. A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination. BMC Public Health 2020;20(1):1-8 DOI:10.1186/s12889-020-09327-8
• WHO. Social determinants of health. Published [22 Jenuary 2021]. Accessed: [07 March 2022]. https://apps.who.int/gb/ebwha/pdf_files/EB148/B148_R2-en.pdf
• Francis MR, Nohynek H, Larson H, Balraj V, Mohan VR, Kang G, Nuorti J. Factors associated with routine childhood vaccine uptake and reasons for non-vaccination in India:1998–2008.Vaccine 2018;36(44):6559-6566 DOI:10.1016/j.vaccine.2017.08.026
• Mendel-Van Alstyne JA, Nowak GJ, Aikin AL. What is ‘confidence’and what could affect it?: A qualitative study of mothers who are hesitant about vaccines. Vaccine 2018;36(44):6464-6472 DOI:10.1016/j.vaccine.2017.09.007
• Okoli GN, Abou-Setta AM, Neilson CJ, Chit A, Thommes E, Mahmud SM. Determinants of seasonal influenza vaccine uptake among the elderly in the United States: A systematic review and meta-analysis. Gerontol Geriatr Med. 2019;5:(1):5-12 DOI:10.1177/2333721419870345
• Smits C, Toelsie J, Eersel M, Krishnadath I. Equity in health care: an urban and rural, and gender perspective; the suriname health study. Aims Public Health 2018;5(1):1-12 DOI:10.3934/publichealth.2018.1.1
• Asuman D, Ackah CG, Enemark U. Inequalities in child immunization coverage in Ghana: Evidence from a decomposition analysis. Health Econ Rev. 2018;8(1):9-15 DOI:10.1186/s13561-018-0193-7
• Yaya S, Uthman OA, Okonofua F, Bishwajit G. Decomposing the rural-urban gap in the factors of under-five mortality in sub-Saharan Africa? Evidence from 35 countries. BMC Public Health 2019;19(1):616 DOI:10.1186/s12889-019-6940-9
• Sowe A, Johansson K. Disentangling the rural-urban immunization coverage disparity in The Gambia: A fairlie decomposition. Vaccine 2019;37(23):3088-3096 DOI:10.1016/j.vaccine.2019.04.062
• Zeng D, You W, Mills B, Alwang J, Royster M, Anson-Dwamena R. A closer look at the rural-urban health disparities: Insights from four major diseases in the Commonwealth of Virginia. Soc Sci Med. 2015;140(1):62-68 DOI:10.1016/j.socscimed.2015.07.011
• Wagner AL, Boulton ML, Sun X, Mukherjee B, Huang Z, Harmsen IA, Ren J, Zikmund-Fisher B. Perceptions of measles, pneumonia, and meningitis vaccines among caregivers in Shanghai, China, and the health belief model: A cross-sectional study. BMC Pediatrics 2017;17(1):143-150 DOI:10.1186/s12887-017-0900-2
• Kürtüncü M, Alkan I, Bahadır Ö, Arslan N. Zonguldak’ın kırsal bir bölgesinde yaşayan çocukların aşılanma durumu hakkında annelerin bilgi düzeyleri. Ejovoc. 2017;1(1):8-16 (Turkish)
• Özkan Ö, Çatıker A. Bolu il merkezindeki çocukların aşılılık durumları ve engelleri. STED. 2006;15(10):171-178 (Turkish)
• Kocoglu‐Tanyer D, Dengiz KS, Sacikara Z. Development and psychometric properties of the public attitude towards vaccination scale–health belief model. J Adv Nurs. 2020;76(6):1458-1468 DOI:10.1111/jan.14349
• Mathieu P, Gautier A, Raude J, Goronflot T, Launay T, Debin M, Guerrisi C, Turbelin C, Hanslik T, Jestin C, Colizza V, Blanchon T, Rossignol L. Population perception of mandatory childhood vaccination programme before its implementation, France, 2017. Euro Surveill. 2019;24(25):1900053 DOI:10.2807/1560-7917.ES.2019.24.25.1900053
• Chow MYK, Danchin M, Willaby HW, Pemberton S, Leask J. Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: a national online survey. Aust Fam Physician. 2017;46(3):145-151
• Opel DJ, Taylor JA, Zhou C, Catz S, Myaing M, Mangione-Smith R. The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: a validation study. JAMA Pediatri. 2013;167(11):1065-1071 DOI:10.1001/jamapediatrics.2013.2483
• Fatiregun AA, Okoro AO. Maternal determinants of complete child immunization among children aged 12–23 months in a southern district of Nigeria. Vaccine 2012;30(4):730-736 DOI:10.1016/j.vaccine.2011.11.082
• Rozbroj T, Lyons A, Lucke J. Psychosocial and demographic characteristics relating to vaccine attitudes in Australia. Patient Educ Couns. 2019;102(1):172-179 DOI:10.1016/j.pec.2018.08.027
• WHO. Review of social determinants and the health divide in the WHO european region: Copenhagen: WHO regional office for europe; 2014. Published [May 2014]. Accessed:[15 March 2022] https://apps.who.int/iris/bitstream/handle/10665/108636/9789289000307-eng.pdf?sequence=1&isAllowed=y
• Dunn AG, Surian D, Leask J, Dey A, Mandl KD, Coiera E. Mapping information exposure on social media to explain differences in HPV vaccine coverage in the United States. Vaccine 2017;35(23):3033-3040 DOI:10.1016/j.vaccine.2017.04.060
• Meadows CZ, Tang L, Liu W. Twitter message types, health beliefs, and vaccine attitudes during the 2015 measles outbreak in California. Am J Infect Control. 2019; 47(11):1314-1318 DOI:10.1016/j.ajic.2019.05.007
• Abadura SA, Lerebo WT, Kulkarni U, Mekonnen ZA. Individual and community level determinants of childhood full immunization in Ethiopia: A multilevel analysis. BMC Public Health. 2015;15(1):972-980 DOI:10.1186/s12889-015-2315-z
• Potvin L, Jones CM. Twenty-five years after the Ottawa Charter: The critical role of health promotion for public health. Can J Public Health 2011;102(4):244-458 DOI:10.1007/BF03404041
• Eid A, Mohammed Z, AlMatar M, AlGadeeb J, Khawaja R. Knowledge and beliefs of immunization during pregnancy among reproductive age women in saudi arabia. Egypt J Hosp Med. 2018;70(12):2121-2126 DOI:10.12816/0045039
• Williams WW. Surveillance of vaccination coverage among adult populations—United States, 2014. Mmwr Surveillance Summaries 2016;65(1):1-36
• Himelboim I, Xiao X, Lee DKL, Wang MY, Borah P. A social networks approach to understanding vaccine conversations on twitter: Network clusters, sentiment, and certainty in hpv social networks. Health Commun. 2020:35(5):607-615 DOI:10.1080/10410236.2019.1573446
• Kumar D, Chandra R, Mathur M, Samdariya S, Kapoor N. Vaccine hesitancy: understanding better to address better. Isr J Health Policy Res. 2016;5(1):2-10 DOI:10.1186/s13584-016-0062-y