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Asian Journal of Healthy and Science

p-ISSN: 2980-4302

e-ISSN: 2980-4310

Vol. 3 No. 2 February 2024

FACTORS INFLUENCING PARENTS' DECISION TO IMMUNIZE

CHILDREN

Zenitha Meida Sari

, Inggit Luthfia Zahra

, Raihandi Putra

, Yenny Purnama

Stefanie

, Inayaturrahmaniyah bin Tahir

1,4

Selaras Public Hospital Cisauk,Tangerang, Indonesia

Babelan Public Hospital, Bekasi, Indonesia

Jatinegara Primary Health Care, Indonesia

Bunda Aliyah Public Hospital, Indonesia

Asistant of Indonesian Pediatric Society, Indonesia

Zenithameida88@gmail.com, inggitlzhr@gmail.com, raihandi_p@yahoo.co.id,

purnamayenny454@gmail.com, stefani2997@gmail.com,

iinrahmaniah@gmail.com

Abstract

Immunization has an important role as a preventive measure for various disease

risks. Immunization is carried out to strengthen the body's defense system so that it

is immune to attacks from various causes of disease. However, some mothers as

parents have their own concerns about having their children immunized. The aim of

this research is to determine the factors that influence parents' decisions to immunize

their children. The method used in this research is literature review with a qualitative

approach. The data analysis used is Miller and Hubber analysis, namely by data

reduction, data presentation, and drawing conclusions. The research results show

that maternal education and knowledge, family support, support from immunization

officers, social media and the internet, and perceptions of child vulnerability. The

research results show that maternal education and knowledge, family support,

support from immunization officers, social media and the internet, as well as

perceptions of children's vulnerabilities are factors that can influence parents'

decisions to immunize their children

Keywords: Child; Immunization; Parental Decision

INTRODUCTION

Basic immunization in children is very important to strengthen the body's

defense system so that it is immune to germs. Protecting infants from various risks of

disease through immunization is the responsibility of parents and local health

workers (CN & Chrismilasari, 2020)

Immunization is an effort to increase a person's immunity actively against a

disease, so that if one day exposed to the disease will not get sick or only experience

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mild illness (Safitri, 2019). Vaccines contain viruses that have been paralyzed.

Vaccines contain viruses or bacteria that are killed or attenuated, and do not cause

illness or put a person at risk for complications (Kharin et al., 2021). Protecting

various risks of disease through immunization is the responsibility of parents and

local health workers (CN & Chrismilasari, 2020).

However, according to data from the Indonesian Ministry of Health in 2023,

there is an increase in the percentage of immunization coverage. The percentage of

infants aged 0-11 months who received Complete Basic Immunization (IDL) was

92.7%, the percentage of infants aged 12-24 months who received further

immunization under two years (baduta) was 93.2%, the percentage of infants aged 0-

11 months who received PCV immunization until the second dose was 90.6%, while

the percentage of children aged grade 6 Elementary School (SD) who had received

further immunization included 1 dose of DT immunization, 1 dose of Measles-

Rubella immunization and 2 doses of TD immunization as much as 91% (Kemenkes,

2023). This shows an increase in immunization coverage, although it shows that

coverage is still not 100%.

Currently, there are still many false assumptions about immunization that

develop in society and many are concerned about the risks of some vaccines. In this

case, especially the role of the mother becomes very important because the closest

person to the baby and who mainly takes care of the baby is the mother (Hartaty &

Menga, 2019). Efforts to overcome the low immunization rate are by conducting

basic immunization counseling training activities for health cadres in the place with

the cermah method, discussion, question and answer, simulation, demonstration,

regarding basic immunization in infants and toddlers (Yani, 2023).

Previous research conducted by Rachmah et al., (2022) stated that there are 2

factors that influence and parents to carry out complete basic immunization for their

children, namely internal and external factors. Where internal factors are factors that

are in the scope of individual parents themselves, namely age, education, work,

knowledge, family support, perception and reminding. External factors that are

external factors such as information received by parents both from counseling by

health workers and from the role of community leaders, the distance of the house to

the location of services, the composition of vaccines, and the availability of vaccines.

Muklati & Rokhaidah, (2020) explained that factors that affect parental compliance

in immunizing diphtheria in toddlers include age, education level, employment

status, knowledge, attitudes, beliefs and family support.

Unlike previous studies, the update to this study is to deepen the explanation

of the factors that influence parents' decisions in immunization. The importance of

immunization is as a preventive effort to avoid various diseases that can be prevented

by immunization (PD3I). However, some parents have various concerns if

immunization is carried out so that the low immunization rate in Indonesia. Thus,

the purpose of this study is to determine the factors that influence parents' decision

to immunize.

RESEARCH METHODS

This research uses literature review method with qualitative approach. Literature

review is to provide a framework related to new findings and previous findings to

identify indications of the progress of the results of a study through comprehensive

research and interpretation results from literature related to certain topics in which

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identify research questions by searching and analyzing relevant literature using a

systematic approach (Sumartiningsih & Prasetyo, 2019). While qualitative is defined

as a strategy for finding meaning, understanding, concepts, characteristics,

symptoms, symbols and descriptions of a phenomenon, focused and multimethod,

natural and holistic, prioritizing quality, using several ways, and presented

narratively in scientific research (Sidiq et al., 2019).

The data analysis used is a simplified approach. The articles used are focused on

original empirical research articles or research articles that contain the results of actual

observations or experiments where there are abstracts, introductions, methods,

results, and discussions of research.

The article search strategy uses databases available on Google Scholar and

Pubmed. The keywords in finding articles are parental decisions, and immunizations.

The stages taken in the simplified approach analysis include summarizing each critical

review of the literature. Obtained search results of 17,500 articles with the keyword

Factors Influencing parents to Immunize Children then determine the strengths and

weaknesses of literature and to see the relationship between one literature and

another (Sidiq et al., 2019)

RESULT AND DISCUSSION

As a result of a literature review of 10 articles obtained, researchers found factors

that influence parents' decisions to immunize children.

Table 1 Result of a Literature Review of 10 Articles Obtained

Researcher Name

Research Title

Research Results

(Hadisuyatmana

et al., 2019)

Factors Influencing

Mothers’ Intention

to Immunize

Children Younger

than Five Years of

Age in West Borneo:

a Cross-Sectional

Study

Mothers' intentions are influenced by

suggestions from family members,

which indicate that their decision-

making capacity is limited and

dependent on other family members.

Further investigation is needed to

uncover the underlying reasons for non-

compliance.

(Callaghan et al.,

2019)

Parent psychology

and the decision to

delay childhood

vaccination

The decision by parents to delay

vaccinating children is an important

public health issue associated with

conspiratorial thinking and needle

sensitivity.

(Mustamu &

Markus, 2019)

Parents

Determination

Factors Influencing

Incomplete Basic

Immunization for

Infants in Sorong

City, West Papua

Province.

Number of children, support of

immunization officers, distance to

immunization sites, and behaviors that

contribute to immunization

incompleteness.

(Febriastuti et al.,

2014)

Parental

Compliance in

Providing Basic

Most mothers have a moderate

perception of the completeness of

immunization due to control belief and

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Immunization

Completeness to

Infants 4-11 Months

perceived belief that is lacking in

compliance with immunization

completeness. Good perception has an

effect on increasing parental

compliance in providing basic

immunization to infants. Most mothers

have not too high intentions towards

the completeness of immunization.

Good intentions have an effect on

increasing parental compliance in

providing basic immunization to

infants.

(Mauidhah et al.,

2021)

Parent Psychology

and The Decision to

Delay Childhood

Vaccination

Factors that can affect compliance in

the provision of complete basic

immunization are modification factors

consisting of age, gender, ethnicity,

socioeconomic and knowledge.

(Lafnitzegger &

Gaviria-Agudelo,

2022)

Vaccine Hesitancy in

Pediatrics

Social media and the internet have been

described as key elements that can

negatively influence parental decision-

making regarding vaccines. The next

focus is to explain effective

interventions that can be implemented

by health care providers. Non-

confrontational and open discussions,

as well as a trusting and strong

relationship between parents and health

care providers, seem to create a strong

foundation for vaccine acceptance.

(Hobani &

Alhalal, 2022)

Factors Related to

Parents’ Adherence

to Childhood

Immunization

A linear combination of perceived

infectious disease severity, perceived

susceptibility of their children,

perceived benefits of immunization,

perceived fewer barriers to

immunization, immunization-related

cues to action, and self-efficacy

predicted immunization nonadherence

rates (F(11.220) = 2.595, p <0.001) and

explained 12% of the variance.

However, only perceptions of child

vulnerability, perceptions of

inhibitions, and self-efficacy

independently predicted parental

disobedience.

(Hasibuan &

Ginting, 2023)

Factors Affecting

Maternal

Compliance with

Basic Immunization

Factors affecting immunization

compliance are education, knowledge,

and family support.

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for Infants Aged 0-12

Months in Kampong

Blang Village and

Pageu Village, Blang

Bintang District,

Aceh Besar Regency

in 2020

(Park et al., 2023)

Parental Factors

Affecting Decision

to Vaccinate Their

Daughters against

Human

Papillomavirus

Parents' perceived knowledge and

perceived risk had a significant impact

on their decision to vaccinate their

daughters with the HPV vaccine.

Parents who have a strong belief that

the HPV vaccine is safe in terms of side

effects are 10 times more likely to decide

to vaccinate their daughters with the

HPV vaccine. Parental factors including

HPV-related behaviors and health

awareness were found to be associated

with parents' decisions to vaccinate

their daughters against HPV. To

increase the use of HPV vaccine at the

age of 12, it is necessary to increase

parental awareness about HPV through

public communication supported by

scientific evidence.

(Maemunah et al.,

2023)

Factors Affecting the

Completeness of

Basic Immunization

in Infants at

Posyandu Dewi

Sartika, Malang City

The results of the study can be

concluded that there are 7 factors that

are significantly related to the

completeness of basic immunization in

infants at Posyandu Dewi Sartika,

Malang City. These factors are

occupation, knowledge, attitude,

education, experience, health

information and age.

The purpose of development in the health sector is to reduce morbidity and

death rates due to diseases, both infectious and non-communicable diseases, among

others, through improving health, and disease prevention (preventive). One of the

preventive measures in improving public health status is immunization (Lestari et al.,

2019). The Indonesian Ministry of Health implements the Immunization

Development Program (PPI) in children in an effort to reduce the incidence of

diseases that can be prevented by immunization (PUTRI, 2021).

Immunization is an effort to reduce child morbidity and mortality, but there are

still many children who have not received immunization (Rahmatina & Erawati,

2021). The participation of mothers, and the support of all components of society are

very important in the success of immunization programs. It should be emphasized

that immunization of infants and children not only provides prevention of these

children but will have a much wider impact because it will prevent widespread

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transmission with an increase in the level of immunity in general in the community

(Loriana & Mustaming, 2018). Based on the results of the literature review , the factors

that influence parents' decision to immunize are as follows.

1. Mother's Education and Knowledge

In his research, Saudah (2023) stated that maternal education affects

immunization compliance. Education has a very important role in determining

human quality, with education humans will obtain knowledge and information.

The knowledge and information obtained will certainly affect a person's

compliance. In addition, the higher a person's level of education, the more quality

of life he will have and the higher one's level of education, the higher his

understanding.

Supported by the results of research by Maemunah, N., Susmini, &;

Tuanany, N. (2023) which states that one of the 7 factors that influence parents'

decisions to immunize is parental education. Parental knowledge about certain

diseases is the main reason for immunization. The decision of parents to

immunize their children is influenced by the information obtained about the

immunization so that parents have good knowledge (Arista et al., 2021).

Formal, non-formal, and informal education can influence a person in

making decisions and behaving, with education a person can increase intellectual

maturity, so that they can make decisions in action (Senewe et al., 2017). Included

in determining the decision to immunize.

2. Family Support

Hadisuyatmana, S., Krisnana, I., &; Sipahutar, M. A. (2019) stated that

mothers' intentions are influenced by suggestions from family members, which

indicates that their capacity to make decisions is limited and depends on other

family members.

The family is the smallest part of society consisting of the head of the family

and other family members who live in one house because of blood relations and

marriage ties, so that there is interaction between family members with other

family members, if one of the family members gets health problems, it will affect

other family members. So that the family is the focus of strategic health services

because the family has a major role in maintaining the health of all family

members, and family problems are interrelated, the family can also be a place for

decision making in health care (Rahmawati &; Umbul, 2014).

3. Immunization Officer Support

Lafnitzegger, A., Agudelo, C. G. (2022) stated that non-confrontational and

open discussions, as well as a trusting and strong relationship between parents and

health care providers, seem to create a strong foundation for vaccine acceptance.

Health workers can strive to provide services and explanations to patients

professionally in order to provide good service and explanation of patient needs.

In addition, the support of health worker services has an important role to increase

maternal knowledge in meeting immunization needs. A health worker has a role

as an educator (Widaningsih, 2022). It is expected that health workers will

increase the knowledge and attitudes of mothers who do not comply with

immunization of their children, among others, with more intensive counseling

(Ridwan &; Legiran, 2015).

4. Social Media and the Internet

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Social media and the internet have been described as key elements that can

negatively influence parental decision-making regarding vaccines (Lafnitzegger,

A., Agudelo, C. G. 2022).

The popularity of social media has been identified as one reason for growing

parental anxiety about the safety of vaccines for children. The internet is one of

the important tools for many people to find information, support health services,

and share health knowledge, opinions, and experiences (Nainggolan & Senewe,

2020). Fear of side effects after vaccination or often referred to as Post-

Immunization Adverse Events (KIPI) is also a scourge for parents who doubt the

effectiveness and efficacy of vaccines. They say that previously healthy children

became ill after vaccination. Vaccination hesitancy is also often associated with

conspiracy theories. Conspiracy theories are widely spread through social media

(Rahmawati & Umbul, 2014).

5. Perception of Children's Vulnerability

(Hobani & Alhalal, 2022) stated that children's perceptions of vulnerability,

perceptions of obstacles, and self-efficacy independently predict parental non-

compliance in immunizing their children.

Concerns about MR immunization side effects are related to parents'

perceptions that there are obstacles in MR immunization. In addition, the

emergence of worry due to immunization side effects is also related to previous

experiences experienced by parents regarding the history of immunization to their

children (Pugliese-Garcia et al., 2018).

Mothers have perceptions: their children are vulnerable to PD3I if not

immunized; these diseases are dangerous because they can cause death and

disability; Immunization is useful because it is a form of prevention so that

children do not get sick and do not experience health problems after

immunization; although there are obstacles to immunization during the pandemic

due to fear of contracting COVID-19, besides having to deliver, different health

facility procedures during the pandemic and delays in service providers, as well as

children's health conditions (Wahyuni & Hadi, 2022).

Various diseases can attack the body regardless of age and gender, but in fact

it shows that it affects children more than adults due to the relatively weak

resistance of the body compared to adults. So the need for preventive efforts, one

of which is by immunization. However, some factors that influence parents'

decisions to immunize children are maternal education and knowledge, family

support, immunization officer support, social media and the internet, and

perceptions of children's vulnerability.

CONCLUSION

Based on the results of the literature review, it was found that the goal of health

development is expected to reduce morbidity and death rates due to disease. One of

the preventive efforts in order to improve health is by immunization. However, there

are still many children who have not received immunization, and factors that

influence parents' decisions to immunize children are maternal education and

knowledge, family support, support from immunization officers, social media and

the internet, and perceptions of children's vulnerability.

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