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

Katrina F. Brown*, J. Simon Kroll, Michael Hudson, Mary Ramsay, John Green, Susannah J. Long, Charles A. Vincent, Graham Fraser, Nick Sevdalis

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

266 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)4235-4248
Number of pages14
Issue number26
Publication statusPublished - 11 Jun 2010

Bibliographical note

Funding Information:
This review was funded by a Health Protection Agency Ph.D. studentship in Behavioural Science. The funder had no role in the conduct of the review or the decision to submit the paper for publication. The Clinical Safety Research Unit is affiliated with the Centre for Patient Safety and Service Quality at Imperial College Healthcare NHS Trust which is funded by the National Institute of Health Research.


  • Decision-making
  • Immunization
  • MMR
  • Parents
  • Vaccination


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