Factors underlying parental decisions about combination childhood vaccinations including MMR: a systematic review

Vaccine. 2010 Jun 11;28(26):4235-48. doi: 10.1016/j.vaccine.2010.04.052. Epub 2010 May 14.


Suboptimal childhood vaccination uptake results in disease outbreaks, and in developed countries is largely attributable to parental choice. To inform evidence-based interventions, we conducted a systematic review of factors underlying parental vaccination decisions. Thirty-one studies were reviewed. Outcomes and methods are disparate, which limits synthesis; however parents are consistently shown to act in line with their attitudes to combination childhood vaccinations. Vaccine-declining parents believe that vaccines are unsafe and ineffective and that the diseases they are given to prevent are mild and uncommon; they mistrust their health professionals, Government and officially-endorsed vaccine research but trust media and non-official information sources and resent perceived pressure to risk their own child's safety for public health benefit. Interventions should focus on detailed decision mechanisms including disease-related anticipated regret and perception of anecdotal information as statistically representative. Self-reported vaccine uptake, retrospective attitude assessment and unrepresentative samples limit the reliability of reviewed data - methodological improvements are required in this area.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Child, Preschool
  • Choice Behavior*
  • Decision Making*
  • Developed Countries
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Measles-Mumps-Rubella Vaccine / administration & dosage
  • Parents / psychology*
  • Vaccination / psychology*
  • Vaccines, Combined / administration & dosage


  • Measles-Mumps-Rubella Vaccine
  • Vaccines, Combined