A Meta-Ethnographic Review of Factors Relating to Vaccine Hesitancy in the European Parental Population


Lidia Cilcic
University of Warwick
Emily Róisín Reid
University of Warwick


One in ten European children are at risk of contracting a vaccine-preventable disease due to low immunisation coverage. As parents play an important role in the vaccination decision, understanding their perception about inoculations is essential to address the low uptake. The aim of this study was to gain better insight into the factors that influence parental vaccine hesitancy in Europe and to produce a better framework to explain this phenomenon.

This meta-ethnographical review was carried out in April-May 2020 by following Noblit and Hare’s approach. The articles retrieved from relevant medical databases were primary papers written in English, published after 2000 and presenting qualitative data. The appraisal process involved the use of CASP qualitative checklist. ‘Line of argument’ synthesis was used to develop a higher order interpretation.

Thirteen studies were included in the analysis from which five themes were identified: 1) Trust in professionals, institutions, and government, 2) Relationship and communication with healthcare professionals, 3) Perceived minimal threat of the disease, 4) Personal experience, 5) Too young to vaccinate. The meta-ethnographic synthesis revealed how the different themes interact with one another to influence parental choice. Moreover, the duty to protect was showed to play an important role in how these factors are perceived by parents.

 Key messages

This review presents an updated framework explaining vaccine hesitancy in the European parental population. Uptake of childhood immunisations could be encouraged by fostering trustworthy relationships between parents and medical professionals and through clearer messages on the risks of vaccine-preventable diseases.

December 30, 2020