Determinants of vaccine hesitancy among caregivers of children in rural South India: a comprehensive cross-sectional framework analysis

Abstract

Background: Vaccine hesitancy-the delay in acceptance or refusal of immunization despite availability-poses an important challenge to immunization programmes. This study investigated the behavioral pattern and determinants of vaccine hesitancy among caregivers of children in rural South India using the WHO-SAGE Vaccine Hesitancy framework. Methods: A descriptive cross-sectional questionnaire-based survey was conducted among 360 caregivers registered in Anganwadi demographic records in Zaheerabad, Raichur, over a three-month period from June 2025 to August 2025. The structured questionnaire assessed caregiver characteristics, childhood vaccination profiles and behavioral variables mapped to SAGE domains. Pearson's chi-square test was used for categorical associations. Results: Safety concerns were the most frequently reported reason for hesitancy (30.0%, n=108), followed by lack of awareness (25.0%, n=90). Hesitancy was concentrated in HPV (n=121), COVID-19 (n=112) and PCV (n=98), while routine EPI vaccines accounted for 29 responses. Significant associations were observed for primary hesitancy reason (χ²=132.381, p<0.001), vaccine type (χ²=33.785, p<0.001) and SAGE domain (χ²=55.445, p<0.001). Conclusions: Vaccine hesitancy in this setting was predominantly product-specific and associated with safety concerns, awareness gaps and confidence-related factors. Communication-focused, context-specific interventions may help improve vaccine confidence and acceptance.