









































Pa
ge

 
1



Pa
ge

 
36

 American Journal of  Medical Science
and Innovation (AJMSI)

Parents’ Knowledge, Attitude, and Misconceptions Towards Vaccination Practices for 
Their Children, as Determined by a Cross-Sectional Study in the City of  Nalut, Libya 

Amira Saleh Khalifa Bagni1*, Aminah Issa Masud Aljerbi1, Huda Said Khalefah Askar1, Nada Abdalhakim Ali Warragh1,
Aya Mohammed Essa Alkhamaesi1

Volume 4 Issue 2, Year 2025
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v4i2.5404
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: May 24, 2025

Accepted: June 26, 2025

Published: August 15, 2025

The study aimed to determine the knowledge, attitude, and misconceptions of  parents about 
the practice of  childhood vaccinations. The study followed a descriptive, analytical approach 
in a cross-sectional study of  workers in several schools (middle and high school), in addition 
to those attending the Sidi Khalifa Health Vaccination Center in the city of  Nalut. The 
sample totaled 1,024 participants, and 24 participants were excluded. The questionnaire was 
distributed to the participants in addition to a face-to-face dialogue with the participants. 
The questionnaire consists of  four axes: The first axis talks about the demographic 
characteristics of  the participants, then three axes in order about the wrong beliefs, attitudes, 
and knowledge of  parents about practicing vaccinations for their children. From December 
2022 to July 2023, the study was conducted and the results were analyzed using SPSS. The 
results showed that the average age of  the sample was 25-30 years. The educational level of  
the participants was 609 (60.9%) for those with university degrees. Marital status was divided 
between married (719), divorced (169), and widows (112). There was a correlation between 
the age of  the participants and misconceptions about vaccinations (P-value< 0.05). It was 
also found that the level of  misconceptions was low among the participants. The attitude 
of  the participants towards the practice of  vaccinations was positive 56.80%. It was also 
found that there was a correlation (P-value< 0.05) between the attitude towards practicing 
vaccinations and the educational level of  the participants (36.78%) and their knowledge of  
vaccinations. An association was also found between the marital status of  the participants 
and their tendency to practice vaccinations (X² = 163.815, P = 0.000).

Keywords
Childhood Vaccinations, Direction, 
False Beliefs, Knowledge

1  Department of  Public Health, College of  Medical Technology, Nalut University, Libya
* Corresponding author’s e-mail: bagniamirasaleh4@gmail.com

INTRODUCTION
Immunization is a global success story in the field of  
health. We now have vaccines to prevent more than 
twenty life-threatening diseases, and immunization 
currently prevents between 3.5 million and 5 million 
deaths annually due to diseases such as Diphtheria, 
tetanus, whooping cough, influenza, and measles (WHO, 
2018). The Advisory Committee on Immunization 
Practices recommends routine vaccination of  children 
by age 2, but evidence suggests that only 2% to 26% of  
children receive vaccine doses at age-appropriate times 
(Kurosky et al., 2016). The World Health Organization 
defines vaccine hesitancy as “delay in accepting or 
refusing vaccines despite the availability of  vaccination 
services” It is a complex matter and varies depending on 
time, place, and vaccines. Individuals who are reluctant 
to receive vaccines constitute a heterogeneous group. 
They may reject some vaccines but agree with others. 
They may postpone receiving vaccines or accept them 
according to the recommended schedule while remaining 
unsure (Alsuwaidi et al., 2020). Myths and misinformation 
are among the main factors contributing to parents’ 
reluctance to complete vaccinations for their children. 
Among the widespread beliefs is that the measles vaccine 
causes autism in children. Catching the disease is better 
than facing the side effects of  the vaccine. Natural 
immunity acquired through infection with the disease 

is better than immunity generated by vaccination, and 
vaccine beliefs have been linked to partial and complete 
incompleteness of  vaccines in Brazil (KallasSilva et 
al., 2025). A study in Saudi Arabia included parents of  
390 children. Factors that were associated with better 
knowledge among parents about vaccinating children 
were young mothers and working mothers, an increase 
in the level of  education of  mothers and fathers, and a 
positive correlation with significance between knowledge 
and the trend towards vaccinating children (Al-Zahrani J, 
2020). Knowledge and trust are contributing factors to 
vaccine acceptance, and a significant decline in childhood 
vaccination has been observed in recent years. One of  
the most important reasons that influence mothers’ 
decision to postpone or avoid vaccinating their children 
is knowledge and confidence in children’s vaccines. This 
is what was revealed by a study evaluating mothers’ 
knowledge and confidence in vaccinating their children 
in Rwanda. In a cross-sectional survey, out of  2,126 
fathers and mothers, the percentage of  those who had 
good knowledge and confidence in vaccinating children 
was 95.5%. The study showed that good knowledge 
and confidence in vaccinating children are linked to 
education, profession, and income (Mbonigaba et al., 
2024). Monthly studies have confirmed that mothers’ 
education and practice of  vaccinations has a positive 
impact on immunization status, and that awareness 



Pa
ge

 
37

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

of  vaccination is much higher among mothers with 
higher education. Negative attitudes from parents, 
such as the mother’s fear of  vaccination, the negative 
effects of  vaccination, and the tendency to abstain from 
vaccination, are also considered obstacles to vaccinating 
the child. According to the survey conducted in Georgia, 
the main reason for abstaining from vaccinations was 
the negative attitude towards vaccination (Verulava et al., 
2019). Evaluating parents’ attitudes toward childhood 
vaccines and determining the prevalence of  vaccination 
reluctance among parents and its relationship to the 
social and demographic characteristics of  the parents. 
This was the goal of  a study conducted in Malaysia. 
A questionnaire was used to collect information and 
conduct a correlation test. It was noted in the results that 
a total of  63 (11.6%) parents was reluctant to vaccinate 
their children. Hesitation was associated with unemployed 
and younger parents who have fewer children. The results 
also showed that the Internet (65.6%) is the main source 
of  information about vaccinations (Azizi et al., 2017). 
The great interest in the debate over vaccinations makes 
it increasingly important to understand how parents make 
the decision to vaccinate their children. Open qualitative 
interviews were conducted for participants that included 
mothers one to three days after giving birth, and then 
they were re-asked three to six months later about their 
practice of  vaccinations. The results addressed three axes: 
attitude towards vaccinations, knowledge of  vaccination, 
and decision-making. It was found that the number of  
mothers who intended to vaccinate their children was 
25. They either agreed to the vaccination, doubted it, or 
accepted the vaccination, but they had great fears. Among 
the results was that there were 8 mothers who did not 
intend to be vaccinated, and they either refused the 
vaccination completely or chose only some vaccines. The 
results also showed that knowledge of  the recommended 
vaccines for children is weak among both vaccinated 
and unvaccinated children, and it was also found that 
they are concerned about the permanent side effects 
of  vaccinations (Benin et al., 2006). 3,924 participants 
were interviewed to find out the response rates to 
vaccinations for their children, which reached 57.9% in 
2003 and 65.0% in 2004. Concern about the safety of  the 
vaccine was an indicator for parents who were unsure, 
disapproving, and late. The results also showed that 
delaying or not getting vaccinated for their children did 
not receive any information or confirmation from the 
health care provider as a main reason (Gust et al., 2008). 
This study was conducted after conducting several field 
visits to several facilities in the city of  Nalut to identify 
a problem for research that focused on the factors that 
would increase or decrease vaccination practice. The aim 
of  the study is to determine the knowledge, attitude, and 
false beliefs of  parents about practicing vaccinations for 
their children among residents of  the city of  Nalut, Libya.

MATERIAL AND METHODS
The current study is a cross-sectional study of  the Nalut 

city community of  parents to determine their knowledge, 
attitude, and misconceptions regarding the practice of  
vaccinations for their children. The study was conducted 
for parents with qualifications in the education and health 
sectors in several schools (5 government preparatory and 
secondary educational schools) and the health center 
(Sidi Khalifa) in the region for a sample number of  1,024 
participants in a random manner. 24 participants were 
excluded as a result of  not completing or receiving the 
questionnaire papers from them. The study was conducted 
between December 2022 and July 2023 among parents 
aged 20 to 40 years and above who frequent the health 
center and have a child to be vaccinated in the center’s 
clinics, and among parents working in other sectors such 
as education and other professions. Approval to conduct 
the study was awarded by the Governing Council of  Nalut 
University (NU) during 2022. Use the questionnaire as a 
4-axis study instrument. The first theme addressed the 
participants’ demographic information, which included 
gender, age, educational level, family income, marital 
status, and occupation; the second theme talked about 
misconceptions about vaccinations and included 8 
questions; the third theme included questions about the 
attitude toward practicing vaccinations; and the fourth 
theme related to the knowledge of  vaccinations and 
included 9 direct questions in particular. The results were 
analyzed using the descriptive statistics SPSS (frequencies, 
percentages, and arithmetic mean) to describe the study 
variables. Using the Pearson correlation test and the chi-
square test to find the relationship between the study 
variables considering a value of  P-value > 0.05.

RESULTS AND DISCUSSION
A total of  1,000 participants were in this study, the results 
of  which were analyzed into percentages and frequencies 
of  demographic factors for the participants. As shown in 
Table (1), the number of  males reached 476 (47.6%), and 
the number of  participating females (52.4%) was 524. The 
age of  the participants was between 20 and over 40, with 
the ages between 20 and 25 years reaching 367 participants 
and the ages between 25 and 30 years reaching 207, the 
ages between 30 and 35 years reaching 242 participants, 
and the lowest age of  participation being <40 years (184), 
and the average age among the participants was between 
the ages of  30 and 25 years. The educational level of  the 
participating sample, as shown in Table (1), for university 
degree holders was 609 participants, followed by 156 
participants for secondary school certificate holders, 122 
for preparatory certificate holders, and 25 for primary 
certificate holders, 65 participants had advanced degrees, 
and 23 of  the participants did not enroll in educational 
institutions. The monthly income of  422>1200 Libyan 
dinars per month was 1200-900 Libyan dinars for 343 
participants, 228 of  whom had a share of  900-600 
Libyan dinars during the month. 719 study participants 
were married, 169 participants were divorced, and 112 
participants were widowed.409 of  the participants’ 
jobs were teaching, while 356 participants were state 



Pa
ge

 
38

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

Table 1: Socio Demographic characteristics of  the study participation
Item Demographic variables Freq. (%)
Gender Male 476 47.6%

female 524 52.4%
Age 25-20 367 36.7%

30-25 207 20.7%
35-30 242 24.2%
>40 184 18.4%

Level of  Education Did Not Attend An Educational 23 2.3%
Elementary 25 2.5%
Preparatory 122 12.2%
High School 156 15.6%
Under Undergraduate 609 60.9%
Postgraduate 65 65%

Monthly income 600  - 900 228 22.8%
 900 - 1200  343 34.3%
>1200 429 42.9%

Social situation Married 719 71.9%
Absolutism 169 16.9%
Widower 112 11.2%

Occupation Teacher 409 40.9%
Employe 356 35.6%
Freelance work 103 10.3%
Medical professions 87 8.7%
Other 45 4.5%

Table 2: Determine the relationship between participants’ demographic characteristics and participants’ beliefs about 
vaccinations
Beliefs about vaccinations P. value Correlation coefficient Neuter Disagree  Agree

Do you think that vaccinations weaken a 
child's immune system?

0.317** 134 426 440

Do you think vaccinating children is a 
risk factor for asthma and allergies? 

0.000 0.116** 162 494 344

Do you think vaccinations cause autism? 0.012 0.713 186 445 369
Do you think that vaccinations lead 
to sudden infant death syndrome in 
children?

0.000 0.0325** 170 448 382

Do you think that the MMR measles 
vaccine, when received, causes 
meningitis?

0.000 0.256** 222 467 311

Misconceptions about vaccinations included several 
questions in particular, the answers of  the participants, 
which amounted to 440 (44%) participants, about the 
belief  that vaccinations weaken the infant’s immune 
system, and also the belief  that vaccinations cause autism 
369 (36.9%). We find that 382 (38.2%) of  the participants 
believe that vaccinations lead to sudden infant death 
syndrome, believe that the side effects of  the vaccine are 

serious 252 (25.2%) believe that vaccinating children is a 
risk factor for asthma and allergies. This is what (Table 
2) showed. The results of  the correlation test between 
parents’ beliefs about vaccinations and the ages of  the 
participants had a fairly ideal positive relationship, as all 
variables were statistically significant at the significance 
level of  P value > 0.05 (Table 2). 

employees in various sectors, 366 had self-employment, and 103 participants were medical professionals (Table 1).



Pa
ge

 
39

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

Do you think the side effects of  the 
vaccine are serious?

0.002 0.098** 299 449 252

Do you think vaccinations are safe? 0.000 0.248** 172 355 473

Most of  the beliefs among the participants were correct 
about vaccinations, with an acceptable percentage of  
44.09%. However, despite this, it turns out that there 
are wrong beliefs among the participants. We find that 

Figure 1: shows the Level of  beliefs among participants

the percentage of  55.91% was for the two options: agree 
and neutral. Which shows a negative trend towards the 
practice of  vaccinations among participants.
The tendency of  participants practicing vaccinations 
for their children takes a positive direction among 
most participants, and this is evident from their 
positive answers, with good and somewhat satisfactory 
percentages. When participants are asked about their 
trust in health care service providers, we find it at an 
acceptable rate of  68.5%. Giving the vaccine at the 
specified time was also satisfactory at a rate of  54%. Not 
delaying the vaccination date beyond the recommended 
schedule was also accepted at a rate of  57.1%. Delaying 
the vaccine date was 56.6%. As for selecting or choosing 
the vaccinations given to children, it was 52.2%. It is also 
clear that there is a correlation between the participants’ 
tendency to practice vaccinations for their children and 
the educational level of  the participants, as p-value values 
were p-value > 0.05. Table (3)

Table 3: shows the participants’ tendency to practice vaccinations for their children and its relationship to the 
participants’ educational level
The attitudes towards practicing 
vaccinations

P. value No Correlation Coefficient Yes

Do you have confidence in healthcare 
providers?

685 
68.5%

0315
31.5%

0.002 0.097**

Do you give vaccines to your child on 
time?

540
54.0%

460
46.0%

0.000 0.145**

Have you ever delayed your child's 
vaccination?

566
56.6%

434
43.4%

0.000 1.171**

Do you follow the recommended 
vaccination schedule?

571
57.1%

429
42.9%

0.008 0.087**

Is it okay to choose and select 
vaccinations?

478
47.8%

522
52.2%

0.013 0.078*

We can summarize the participants’ attitude toward 
practicing vaccinations as positive for most (56.80%), 
compared to those who have no attitude or tendencies 
toward vaccinating their children (43.20%). This is due 
to reasons that may be related to the level of  educational 
knowledge about vaccinations (Figure 2).

Figure 2: Participating parents’ attitudes towards vaccine 
practices

When measuring the cognitive educational level of  
participants regarding vaccinations, it was found that it 
is knowledge acceptable to parents. When asked about 
natural immunity, it is better than vaccination with a 
vaccine. Yes, was the answer given by 626 (62.6%). The 
participants’ knowledge of  the human papillomavirus 
(HPV) vaccine protects the future from cancer. Their 
knowledge was somewhat satisfactory, 593 (59.3%). 
Through the results of  testing the correlation between 
vaccination practice and the educational level of  the 
participants, it is clear that there is a correlation at p-value 
> 0.05 (Table 4).
The level of  knowledge about vaccinations among the 
participants was calculated and found to be somewhat 
acceptable (62.92%) compared to the level of  knowledge 
among the participants. Their beliefs and educational 
level prevent them from practicing vaccination (37.08%). 



Pa
ge

 
40

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

Table 4: shows the relationship between the educational level of  participants and their knowledge of  vaccinations.
Parent participants’ knowledge of  
vaccinations

P. Value No Correlation Coefficient Yes

Are you aware that vaccines are extracts that 
contain microbes like bacteria and viruses?

679
67.9%

321
32.1%

0.000 0.155**

Is natural immunity superior to vaccination 
with a vaccine?

626
62.6%

374
37.4%

0.000 0.137**

Can a child receive a vaccination if  they have 
a fever?

626
62.6%

374
37.4%

0.000 0.133**

Did you know that vaccines have eradicated 
many deadly diseases like smallpox and 
tetanus from the world?

676
67.6%

324
32.4%

0.011 0.081*

It's important to vaccinate your child against 
diseases that no longer exist, did you know?

611
61.1%

389
38.9%

0.001 0.109**

Did you know that your child is given multiple 
doses of  the same type?

594
59.4%

406
40.6%

0.000 0.127**

Are you aware that the papillomavirus vaccine 
prevents cervical cancer?

593
59.3%

407
40.7%

0.000 0.114**

Table 5 : The relationship between the marital status of  parents and their tendency to practice vaccinations.

Marital status
Attitude of  parents to practice vaccination

X² P. Value
Yes     No

Married 26.7% 45.2% 163.815 0.000
Absolutism 9.92% 6.98%
Widower 6.58% 4.62%
Total 43.2% 56.8%

The level of  knowledge among the participants can be observed in Figure (3).

Figure 3: The level of  Knowledge of  parental participants about vaccinations

The practice of  vaccination is influenced by the marital 
status of  the participants. According to the chi-square 
test, the marital status of  participants is a significant factor 
in their tendency to practice vaccinations (X² = 163.815, 
P = 0.000). Most married people have a somewhat weak 
positive tendency to practice vaccinations, with a weak 

percentage of  45.2%, followed by divorced people with 
6.98% and widows with 4.62%. As for the negative trend 
for married people, 26.7%; divorced people, 9.92%; 
and widows, 6.58%. Through these percentages, we can 
say that marital status has an impact on the practice of  
vaccinations.



Pa
ge

 
41

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

Discussion
The study was conducted to determine the knowledge, 
attitude, and misconceptions of  parents regarding the 
practice of  vaccinations for their children. Demographic 
characteristics of  study participants in a sample of  1,000 
participants, including 476 (47.6%) males and 524 (52.4%) 
females, whose average age ranges between 25 and 35 
years. The level of  false beliefs was weak, 36.72%, while 
correct beliefs were also weak 44.05%. When determining 
the relationship between the ages of  the study participants 
and their misconceptions about vaccinations, it was 
found that there was a significant relationship between 
the study variables (P value > 0.05), and this result was 
consistent with the study (Facciola et al., 2019). In which 
it was stated that vaccinations are negatively related to the 
age of  the parents, we also note agreement with a study 
(Borras et al., 2009). Which showed that the highest rate 
of  vaccination coverage is linked to the aging mothers and 
their increased knowledge of  vaccinations. The results of  
the study also showed that 62.92% have knowledge about 
vaccinations, unlike 37.08%, who do not have specific 
knowledge about vaccinations These results contradicted 
the recent study, which showed that 23.26% of  parents 
did not have specific information about vaccinations. 
The level of  misconceptions was close to the results of  
a study (Giambi et al., 2018). Which showed that safety 
concerns are the main reason for refusing vaccination 
or boycotting vaccination compared to the current 
study, where beliefs that vaccinations are safe (47.3%), 
and this result is consistent with the study (McKee & 
Bohannon, 2016). The results also showed a relationship 
between the participants’ knowledge about vaccinations 
and the participants’ educational level (p-value > 0.05). 
This result was consistent with (Kalok et al., 2020) and 
this result was also consistent with (Alyami et al., 2018) 
Which showed that higher education has an impact and 
is linked to a commitment to practicing vaccinations. The 
positive trend in vaccination practice was low at 56.80% 
among the participants, and the negative trend was also 
low at 43.20%. These results were consistent with the 
results of  the study (Hak et al., 2005). The results also 
showed that there is a significant relationship between 
the marital status of  the participants and their practice of  
vaccinations (P value > 0.05), which is consistent with the 
study (Luman et al., 2003).

CONCLUSION
Through this study, we find that most participants 
practice vaccinations for their children, but these 
practices are not without factors that cause abstention 
or delay in fully covering vaccinations for children. 
One of  these factors is the spread of  misconceptions 
about vaccinations, which include concerns about the 
safety of  vaccines. The educational level was also linked 
to the practice of  vaccinations, which included the 
hesitation and lack of  commitment of  participants to 
giving vaccinations on time and selecting vaccinations. 
Family stability also has an effective role in the practice 

of  vaccinations. The determinants of  the study were the 
participants’ indifference to completing the questionnaire 
form, which led to the deletion of  a number of  them, 
and the community’s lack of  acceptance by helping this 
research spread and measure awareness and enhance its 
importance in dissemination.
This study recommends conducting future, more 
comprehensive and in-depth studies of  the study sample, 
to precisely find out what are the reasons leading to the 
lack of  vaccination coverage for children and the decline 
in society’s tendency to practice vaccinations. We also 
recommend that part of  the educational curriculum 
include lessons dedicated to vaccinations to correct 
the misconceptions entrenched in the minds of  some 
people about vaccinations, and there is no objection to 
conducting educational courses for married or about-
to-marry parents about the importance of  practicing 
vaccinations.

REFERENCES
Alsuwaidi, A. R., Elbarazi, I., Al-Hamad, S., Aldhaheri, 

R., Sheek-Hussein, M., & Narchi, H. (2020). (Vaccine 
hesitancy and its determinants among Arab parents:                                        
a cross-sectional survey in the United Arab Emirates. 
Human vaccines & Immunotherapeutics, 16(12), 3163-
3169 https://www.tandfonline.com/doi/full/10.108
0/21645515.2020.1753439

Alyami, A. R., Alhashan, G. M., Nasser, I. A., Alyami, S. R., 
Al Mardhamah, N. H., Alyami, M. H., ... & Alanazi, A. 
M. (2018). (Knowledge, beliefs and practices of  parents 
towards childhood. The Egyptian Journal of  Hospital 
Medicine, 70(1), 1-7. https://ejhm.journals.ekb.eg/
article_11499_42cf55fa991df8022428fba6298bf70e.
pdf

Al-Zahrani, J. (2020). (Knowledge, attitude and practice 
of  parents towards childhood vaccination. Majmaah 
Journal of  Health Sciences, 1(1), 23-23. https://www.
mjhs-mu.org/index.php?mno=287964

Azizi, F. S. M., Kew, Y., & Moy, F. M. (2017). (Vaccine 
hesitancy among parents in a multi-ethnic country, 
Malaysia. Vaccine, Science Direct, 35(22), 2955-2961 
https://www.sciencedirect.com/science/article/abs/
pii/S0264410X17304723

Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. 
D., & Holmboe, E. S. (2006). (Qualitative analysis 
of  mothers’ decision-making about vaccines for 
infants:   the importance of  trust. American Academy 
of  Pediatrics, 117(5), 1532-1541 org/pediatrics/article-
abstract/117/5/1532/70005/Qualitative-Analysis-
of-Mothers-Decision-Making

Borràs, E., Domínguez, À., Fuentes, M., Batalla, J., 
Cardeñosa, N., & Plasencia, A. (2009). (Parental 
knowledge of  pediatric vaccination. BMC 
Public Health, 9, 1-7. https://link.springer.com/
article/10.1186/1471-2458-9-154

Facciolà, A., Visalli, G., Orlando, A., Bertuccio, M. 
P., Spataro, P., Squeri, R., ... & Pietro, A. D. (2019). 
(Vaccine hesitancy: An overview on parents’ opinions 



Pa
ge

 
42

https://journals.e-palli.com/home/index.php/ajfst

Am. J. Food. Sci. Technol. 4(2) 36-42, 2025

about vaccination and possible reasons of  vaccine 
refusal. Journal of  public health research, 8(1), jphr-2019.
https://journals.sagepub.com/doi/full/10.4081/
jphr.2019.1436

Giambi, C., Fabiani, M., D’Ancona, F., Ferrara, L., 
Fiacchini, D., Gallo, T., ... & Rota, M. C. (2018). 
(Parental vaccine hesitancy in Italy–results from 
a national survey. Vaccine, 36(6), 779-787 https://
www.sciencedirect.com/science/article/abs/pii/
S0264410X17318376

Gust, D. A., Darling, N., Kennedy, A., & Schwartz, B. 
(2008). (Parents with doubts about vaccines: which 
vaccines and reasons why. American Academy of  
Pediatrics, 122(4), 718-725. https://publications.aap.
org/pediatrics/article-abstract/122/4/718/71378/
Parents-With-Doubts-About-Vaccines-Which-
Vaccines

Hak, E., Schönbeck, Y., De Melker, H., Van Essen, G. 
A., & Sanders, E. A. (2005). (Negative attitude of  
highly educated parents and health care workers 
towards future vaccinations in the Dutch childhood 
vaccination program. Vaccine, 23(24),  3103-3107. 
https://www.sciencedirect.com/science/article/abs/
pii/S0264410X05001143

Kallas-Silva, L., Couto, M. T., Soares, M. E. M., 
Ferreira-Silva, S. N., & Avelino-Silva, V. I. (2025). 
(Myths and misinformation associated with vaccine 
incompleteness: A survey study. Patient Education and 
Counseling, 131, 108556.https://www.sciencedirect.
com/science/article/abs/pii/S0738399124004233

Kalok, A., Loh, S. Y. E., Chew, K. T., Aziz, N. H. A., Shah, 

S. A., Ahmad, S., ... & Mahdy, Z. A. (2020). Vaccine 
hesitancy towards childhood immunization amongst 
urban pregnant mothers in Malaysia. Vaccine, 38(9), 
2183-2189. https://www.sciencedirect.com/science/
article/abs/pii/S0264410X20300694

Luman, E. T., McCauley, M. M., Shefer, A., & Chu, 
S. Y. (2003). (Maternal characteristics associated 
with vaccination of  young children. American 
Academy of    Pediatrics, 111(Supplement_1),1215-1218.  
https://publications.aap.org/pediatrics/article-
abstract/111/Supplement_1/1215/28596/Maternal-
Characteristics-Associated-With

Mbonigaba, E., Yu, F., Reñosa, M. D. C., Cho, F. N., 
Chen, Q., Denkinger, C. M., ... & Chen, S. (2024). 
Knowledge and trust of  mothers regarding childhood 
vaccination in Rwanda. BMC Public Health, 24(1), 
1067. https://link.springer.com/article/10.1186/
s12889-024-18547-1

McKee, C., & Bohannon, K. (2016). (Exploring the 
reasons behind parental refusal of  vaccines. The 
journal of  pediatric pharmacology and therapeutics, 21(2),  
104-109. https://jppt.kglmeridian.com/

Verulava, T., Jaiani, M., Lordkipanidze, A., Jorbenadze, 
R., & Dangadze, B. (2019). (Mothers’ knowledge and 
attitudes towards child immunization in Georgia.
The Open Public Health Journal, 12, 232-237. https://
eprints.iliauni.edu.ge/9099/

WHO. (2018). World Health Organization. Vaccines and 
immunization.https://www.who.int/health-topics/
vaccines-and-immunization#tab=tab_1


