Knowledge, Attitudes, and Practices of Antenatal Women Regarding Vaccination, and Determinants of Vaccination Acceptance: A Mixed-Methods Study

Abstract

Background/Objectives: Vaccination is the most important way to prevent infection-related morbidity and mortality, but delays in the acceptance or refusal of vaccines despite the availability of vaccination services can adversely affect health outcomes. Methods: This is a cross-sectional congruent parallel mixed-methods study exploring vaccine-related knowledge, attitudes and practices and factors associated with vaccine acceptance or hesitancy. A validated questionnaire was used to collect responses from pregnant women. Results: A total of 326 women participated in the study. The majority of women were over 30 years old, educated, had higher incomes, and had been pregnant before. Of the participants, 94.7% had adequate knowledge of vaccine services, 64% relied on more than one source of information, and the majority (89%) relied on information from doctors. In total, 93.5% held a positive attitude towards vaccination, and the majority accepted it. A total of 159 (48.7%) self-reported a moderate to strong vaccine hesitancy (VH). Qualitative analysis showed that those who had strong VH expressed mistrust, social media information, safety concerns regarding newer vaccines, and religious beliefs as influencing factors. Factors significantly affecting VH were education, household income, adequate knowledge, and appropriate attitude. Other factors were knowledge gaps, perceived necessity, distrust, and belief in natural immunity. Hesitancy positively correlated with being a homemaker and being parous, but the difference was not statistically significant. Conclusions: This study reveals a population with generally favorable vaccine attitudes and high vaccination intentions, alongside significant underlying hesitancy. Knowledge gaps exist, and healthcare professionals remain the most trusted information source. Addressing the identified barriers through evidence-based, culturally sensitive, and community-engaged strategies will be essential for maintaining high vaccination coverage and preventing future outbreaks.