Abstract
BACKGROUND: The COVID-19 vaccination has played a crucial role in combating the pandemic, yet vaccine hesitancy remains a significant barrier to achieving herd immunity. This challenge is particularly pronounced in specific cultural and geographic contexts. Understanding the reasons for parental reluctance to vaccinate their children is essential for developing effective public health strategies. This study aimed to assess the attitudes of parents with unvaccinated children aged 5-12 years toward COVID-19 vaccination and to explore their reasons for not vaccinating their children, despite having access to vaccination programs, in Tabriz, Iran. METHOD: This cross-sectional study, conducted between March and August 2022 in Tabriz. A random sample of 400 parents was selected from five healthcare centers using a cluster sampling method in conjunction with the Iranian SIB system. To gather data, a questionnaire was developed based on a comprehensive literature review and interviews with local parents. The questionnaire's content validity was established through expert review, and its internal consistency reliability was assessed, yielding a Cronbach's alpha of 0.85, indicating good reliability. Statistical analysis was performed using one-way ANOVA, chi-square, and Fisher's exact tests to explore associations between demographic factors and vaccine hesitancy. Multiple logistic regression was employed to identify significant predictors of parents' reluctance to vaccinate their children. Additionally, the reasons for unwillingness were reported for hesitant and unwilling parents and compared using the chi-square test. RESULT: Out of 400 parents of unvaccinated children, 263 parents (65.8%) were definitely unwilling, 21 (5.3%) were hesitant, and 116 (29.0%) were accepting to vaccinate their children against COVID-19. The analysis revealed that parents of children with underlying diseases were more hesitant or unwilling to vaccinate (OR = 1.77, (95% CI: (0.93, 3.42), P-value = 0.07). Additionally, mothers were more hesitant or unwilling than fathers (OR = 2.24, 95% CI: (1.42, 3.53), P-value = 0.001). The top three concerns among the unwilling and hesitant parents were the side effects of COVID-19 vaccination for children (reported by over 81.0%), the perception that vaccination could decrease the disease process (over 46.0%), and the lack of valid information about the side effects (above 42.9%). Furthermore, an important reason for unwillingness among unwilling parents was a lack of trust in the available vaccines (40.5%). CONCLUSION: Parents' willingness to vaccinate their children against COVID-19 in Tabriz was low, primarily due to concerns about the potential side effects of the vaccine. To address this issue, culturally sensitive public health campaigns should be designed that specifically target these concerns and involve trusted community figures. These initiatives could help reduce vaccine hesitancy, particularly among mothers and parents of children with underlying health conditions.