title: Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review.
abstract: BACKGROUND
  The suboptimal compliance to vaccinations continues to be a major public health problem.
  
  
  METHODS
  We conducted a systematic review (PubMed and Cochrane databases) to evaluate factors associated with suboptimal compliance to vaccinations, focusing on children and adolescents in developed countries. We categorized studies according to whether they used an analytical statistical approach.
  
  
  RESULTS
  We identified 553 potentially relevant articles and evaluated in detail 39 with original data. Factors influencing compliance to vaccinations related to parental-childhood characteristics and healthcare structure-professionals characteristics. Specifically, among the various parental-childhood characteristics studied, non-white race, low socioeconomic status, paying for immunization, lack of health insurance, low parental education, older age of the child, younger maternal age, large family size, late birth order, lack of knowledge about disease and vaccination, negative beliefs/attitudes towards immunization, fear of side-effects/risks/contraindications, not remembering vaccination schedules and appointments, sick child delays, and delayed well child visits were statistically significantly associated with suboptimal compliance. Among healthcare structure-professional characteristics were studied. Skepticism/doubts regarding provided medical information, inadequate support from healthcare providers, lack of available health structures, and problems concerning transportation and accessibility to immunization clinics were statistically significantly associated with suboptimal compliance to vaccination.
  
  
  CONCLUSIONS
  By recognizing and understanding factors associated with suboptimal compliance to vaccinations we can better approach the risk populations and target our efforts at stressing and reinforcing the vital importance of immunizations. Methods to enhance compliance to vaccinations may include reminder calls/mail notification of parents, initiation of health education programs for parents and health professionals, and open communication and trust between care takers of children and physicians.
authors.affiliation: Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. m.falagas@aibs.gr
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
authors.forename: Effie
authors.initials: E
authors.lastname: Zarkadoulia
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019049:Developed Countries; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D010349:Patient Compliance; D011634:Public Health