title: Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination.
abstract: OBJECTIVE
  To determine whether a systematic review of qualitative studies can lead to identification of consistent themes across studies, using barriers toward childhood vaccination as an example.
  
  
  METHODS
  We performed a systematic literature search of studies identified in 10 electronic databases. Two independent reviewers selected the relevant abstracts and articles, then extracted information. Content analysis methodology was used to create a coding template for barriers and then to identify how many studies identified specific barriers.
  
  
  RESULTS
  Fifteen studies were included in this overview. Eight studies used semistructured interviews, five used focus groups, and two used both methodologies. Themes fell under four major headings: issues of harm, issues of distrust, access issues, and other issues. Barriers identified in more than half of the studies included concern about the risk of adverse effects, concern that vaccinations are painful, distrust of by those advocating vaccines (including belief in conspiracy), belief that vaccination should not occur when the child has a minor illness, unpleasant staff or poor communication, and lack of awareness of the vaccination schedule.
  
  
  CONCLUSIONS
  Systematically reviewing qualitative studies on barriers to childhood vaccination provided important information on barriers that are consistently identified by parents in several different studies.
authors.affiliation: University of Oxford, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Mills
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Jadad
authors.forename: Cory
authors.initials: C
authors.lastname: Ross
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001290:Attitude; D002648:Child; D003469:Culture; D003627:Data Interpretation, Statistical; D015340:Epidemiologic Research Design; D006801:Humans; D010290:Parents; D014611:Vaccination / Q000523:psychology*