Parental Knowledge, Attitudes, and Practices on Pediatric Vaccination in Honduras: Insights and Challenges for Improving Immunization Coverage

Abstract

Vaccines are the second most effective public health intervention after clean water. However, global vaccine coverage has declined in recent years. In 2019, the WHO identified vaccine hesitancy as one of the top ten public health challenges. In Honduras, data from the Expanded Program on Immunization showed a decline in fully vaccinated children under five, from 89% in 2019 to 77% in 2022. Addressing parental concerns, reducing misinformation, and promoting vaccine acceptance are critical responsibilities for health professionals. This descriptive study aimed to assess and analyze parents' knowledge, attitudes, and practices concerning pediatric vaccination. The study was carried out between August and October 2024 in the outpatient departments of four health centers in two regions of Honduras. Data collection was conducted using a structured questionnaire administered by trained medical personnel, who also reviewed vaccination cards to determine their completeness. Visual scales were incorporated to enhance understanding of the Likert scales. The information was analyzed in STATA version 16.1. Frequencies and percentages were calculated for qualitative variables. The study received ethics committee approval. A total of 178 interviews were conducted with parents across four healthcare facilities, with the majority (3/4) being public institutions. Regarding religious affiliation, 61% of parents identified as evangelical, and 30% identified as Catholic. Knowledge: When asked, "What is a vaccine?" only 71% (127/178) of parents provided a correct answer. Additionally, 81% (144/178) believed that receiving vaccines to build "defenses" is better than acquiring immunity through natural infection; 10% (18/178) of parents were uncertain about the best approach. Twelve percent of parents were unsure about vaccine timing, while 75% followed the national vaccination schedule. Notably, when asked about vaccine-preventable diseases included in Honduras vaccination schedule, 30% were unable to provide a correct response. Most parents strongly agreed that vaccines are effective (75.6%), safe (75.9%), and important for community health (72%). Attitudes: Most parents (82.2%) supported mandatory vaccinations, while 45.5% dismissed others' opinions as irrelevant in vaccination decisions. Practices: Among the parents who presented their child's vaccination card during the interview (123/178), 93.5% had a complete immunization record in accordance with the guidelines of the Honduras´ EPI. Healthcare personnel were the main source of vaccine information (92.6%), followed by the internet and social media (30%). Additionally, 19% of parents reported being denied vaccination services at public healthcare facilities. The reasons provided included upper respiratory tract symptoms (35%), fever (38%), and other factors, such as restrictions on opening vaccine vials without additional patients, low weight, and anemia. Forty-one percent of parents expressed interest in receiving more information about vaccines through educational sessions specifically designed for parents. They also emphasized the need to identify reliable sources of information to enhance their knowledge about vaccines. The findings reveal strong trust in vaccines among parents, with high support for their safety, effectiveness, and mandatory implementation, as well as recognition of their community-wide benefits. However, gaps in knowledge and barriers to vaccination access underscore the need for professional communication to sustain vaccine acceptance, reinforce trust in immunization programs, and address these challenges effectively.