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BMC Public Health. 2012; 12: 408.
Published online Jun 6, 2012. doi:  10.1186/1471-2458-12-408
PMCID: PMC3434025
How orthodox protestant parents decide on the vaccination of their children: a qualitative study
Wilhelmina L M Ruijs,corresponding author1,2 Jeannine L A Hautvast,1 Giovanna van IJzendoorn,2 Wilke J C van Ansem,1 Koos van der Velden,1 and Marlies EJL Hulscher3
1Department of Primary and Community Care, Academic Collaborative Centre AMPHI, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands
2Municipal Health Service GGD Rivierenland, J.S. de Jongplein 2, 4001 WG, Tiel, The Netherlands
3Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525EZ, Nijmegen, The Netherlands
corresponding authorCorresponding author.
Wilhelmina L M Ruijs: h.ruijs/at/elg.umcn.nl; Jeannine L A Hautvast: j.hautvast/at/elg.umcn.nl; Giovanna van IJzendoorn: vanijzendoorn/at/ggd.regiorivierenland.nl; Wilke J C van Ansem: vanansem/at/ivo.nl; Koos van der Velden: j.vandervelden/at/elg.umcn.nl; Marlies EJL Hulscher: m.hulscher/at/iq.umcn.nl
Received March 1, 2012; Accepted June 6, 2012.
Abstract
Background
Despite high vaccination coverage, there have recently been epidemics of vaccine preventable diseases in the Netherlands, largely confined to an orthodox protestant minority with religious objections to vaccination. The orthodox protestant minority consists of various denominations with either low, intermediate or high vaccination coverage. All orthodox protestant denominations leave the final decision to vaccinate or not up to their individual members.
Methods
To gain insight into how orthodox protestant parents decide on vaccination, what arguments they use, and the consequences of their decisions, we conducted an in-depth interview study of both vaccinating and non-vaccinating orthodox protestant parents selected via purposeful sampling. The interviews were thematically coded by two analysts using the software program Atlas.ti. The initial coding results were reviewed, discussed, and refined by the analysts until consensus was reached. Emerging concepts were assessed for consistency using the constant comparative method from grounded theory.
Results
After 27 interviews, data saturation was reached. Based on characteristics of the decision-making process (tradition vs. deliberation) and outcome (vaccinate or not), 4 subgroups of parents could be distinguished: traditionally non-vaccinating parents, deliberately non-vaccinating parents, deliberately vaccinating parents, and traditionally vaccinating parents. Except for the traditionally vaccinating parents, all used predominantly religious arguments to justify their vaccination decisions. Also with the exception of the traditionally vaccinating parents, all reported facing fears that they had made the wrong decision. This fear was most tangible among the deliberately vaccinating parents who thought they might be punished immediately by God for vaccinating their children and interpreted any side effects as a sign to stop vaccinating.
Conclusions
Policy makers and health care professionals should stimulate orthodox protestant parents to make a deliberate vaccination choice but also realize that a deliberate choice does not necessarily mean a choice to vaccinate.
Keywords: Decision-making, Immunization, Minority group, Religion, Religious objections to vaccination, Vaccination
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