title: The role of religious leaders in promoting acceptance of vaccination within a minority group: a qualitative study.
abstract: BACKGROUND
  Although childhood vaccination programs have been very successful, vaccination coverage in minority groups may be considerably lower than in the general population. In order to increase vaccination coverage in such minority groups involvement of faith-based organizations and religious leaders has been advocated. We assessed the role of religious leaders in promoting acceptance or refusal of vaccination within an orthodox Protestant minority group with low vaccination coverage in The Netherlands.
  
  
  METHODS
  Semi-structured interviews were conducted with orthodox Protestant religious leaders from various denominations, who were selected via purposeful sampling. Transcripts of the interviews were thematically analyzed, and emerging concepts were assessed for consistency using the constant comparative method from grounded theory.
  
  
  RESULTS
  Data saturation was reached after 12 interviews. Three subgroups of religious leaders stood out: those who fully accepted vaccination and did not address the subject, those who had religious objections to vaccination but focused on a deliberate choice, and those who had religious objections to vaccination and preached against vaccination. The various approaches of the religious leaders seemed to be determined by the acceptance of vaccination in their congregation as well as by their personal point of view. All religious leaders emphasized the importance of voluntary vaccination programs and religious exemptions from vaccination requirements. In case of an epidemic of a vaccine preventable disease, they would appreciate a dialogue with the authorities. However, they were not willing to promote vaccination on behalf of authorities.
  
  
  CONCLUSIONS
  Religious leaders' attitudes towards vaccination vary from full acceptance to clear refusal. According to orthodox Protestant church order, local congregation members appoint their religious leaders themselves. Obviously they choose leaders whose views are compatible with the views of the congregation members. Moreover, the positions of orthodox Protestant religious leaders on vaccination will not change easily, as their objections to vaccination are rooted in religious doctrine and they owe their authority to their interpretation and application of this doctrine. Although the dialogue with religious leaders that is pursued by the Dutch government may be helpful in controlling epidemics by other means than vaccination, it is unlikely to increase vaccination coverage.
authors.affiliation: Academic Collaborative Centre AMPHI, Dpt of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EZ Nijmegen, The Netherlands. h.ruijs@elg.umcn.nl.
authors.forename: Wilhelmina L M
authors.initials: WL
authors.lastname: Ruijs
authors.forename: Jeannine L A
authors.initials: JL
authors.lastname: Hautvast
authors.forename: Said
authors.initials: S
authors.lastname: Kerrar
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.forename: Marlies E J L
authors.initials: ME
authors.lastname: Hulscher
mesh_terms: D005260:Female; D006293:Health Promotion; D006801:Humans; D007857:Leadership; D008297:Male; D032541:Mass Vaccination / Q000208:ethnology*; D008913:Minority Groups; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D024382:Professional Role; D033303:Protestantism; D036301:Qualitative Research