Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada

Hum Vaccin Immunother. 2019;15(1):113-120. doi: 10.1080/21645515.2018.1509647. Epub 2018 Sep 11.


Background: Vaccine hesitancy (VH) is a growing problem. The first step in addressing VH is to have an understanding of who are the hesitant individuals and what are their specific concerns. The aim of this survey was to assess mothers' level of vaccine hesitancy and vaccination knowledge, attitudes, and beliefs.

Methods: Mothers of newly-born infants in four maternity wards in Quebec (Canada) completed a self-administered questionnaire. The questionnaire included items to assess VH and intention to vaccinate. VH scores were calculated using the Parents Attitudes about Childhood Vaccines (PACV) survey. Multivariate logistic regression was performed to determine variables associated with intention to vaccinate (OR; 95% CI).

Results: Overall, 2645 questionnaires were included in this analysis and 77.5% of respondents certainly intended to vaccinate their infant at 2 months of age. Based on the PACV 100-point scale, 56.4% of mothers had a 0 to ˂30 score (low level of VH); 28.6% had a 30 to ˂50 and 15.0% had a score of 50 and higher (high level of VH).The main determinants of mothers' intention to vaccinate were the perceived importance of vaccinating infants at 2 months of age (OR = 9.2; 5.9-14.5) and a low score of VH (OR = 7.4; 5.3-10.3).

Discussion: Although the majority of mothers held positive attitudes toward vaccination, a large proportion were moderately or highly vaccine hesitant. Mothers' level of VH was strongly associated with their intention to vaccinate their infants, showing the potential detrimental impact of VH on vaccine uptake rates and the importance of addressing this phenomenon.

Keywords: attitudes; beliefs; determinants; immunization; knowledge; vaccine hesitancy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Hospitals, Maternity
  • Humans
  • Infant
  • Intention
  • Mothers / education
  • Mothers / psychology*
  • Patient Acceptance of Health Care*
  • Quebec
  • Surveys and Questionnaires
  • Vaccination / psychology*
  • Vaccination Refusal / psychology
  • Vaccines / administration & dosage
  • Young Adult


  • Vaccines

Grant support

This study was funded by the Fonds de recherche du Québec – Santé and the ministère de la Santé et des services sociaux du Québec. The funding sources had no involvement in any part of the study.