Understanding maternal decision-making for self-paid childhood vaccines a qualitative exploration of safety, information, and context

Abstract

Objectives To explore how mothers make decisions regarding self-paid childhood vaccines within real-world family and healthcare contexts, and to elucidate the underlying processes that may explain variability in maternal willingness observed in prior quantitative findings. Methods A qualitative study was conducted using semi-structured, in-depth interviews among biological mothers of children aged 42 days to 3 years attending a preventive healthcare outpatient clinic. Participants were purposively sampled based on prior vaccination experience and willingness to capture diverse decision-making patterns across predefined groups. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis with inductive coding. Data collection proceeded iteratively until thematic saturation was achieved. Results A total of 16 mothers participated. Five themes and fifteen subthemes were identified, capturing key dimensions of maternal decision-making. Mothers navigated multiple and asymmetric information sources, balancing trust in healthcare professionals with independent verification or reliance on social networks. Decision-making followed a safety-first structure, in which perceived safety functioned as a prerequisite before consideration of benefits. Economic considerations were framed as a dynamic tension between immediate financial burden and perceived long-term health value, with cost acting as either a filtering factor or a selective prioritization mechanism. Trust in healthcare providers was constructed through communication quality, while insufficient consultation contributed to uncertainty and increased reliance on informal information sources. System-level factors, including service convenience, digital accessibility, and lack of follow-up support, further shaped decision-making processes. Conclusion Maternal decision-making regarding self-paid childhood vaccines is a dynamic and context-dependent process characterized by safety-first appraisal, information uncertainty, economic evaluation, and communication experiences. Family context influences how these factors are prioritized and negotiated. Strategies to improve uptake should address safety concerns explicitly, enhance accessible information delivery, and strengthen communication and continuity within vaccination services.