title: Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children.
abstract: To investigate the relationship between parents' health literacy and decision-making regarding child vaccinations.
  
  
  
  A cross-sectional survey was conducted among 731 parents of children aged 3-4 years. Functional, communicative, and critical health literacy (HL), knowledge, beliefs, reliability of the vaccine's information resources, and vaccine's attitudes were measured. Attitudes included three types: pro-vaccine attitudes, anti-vaccine attitudes, and attitudes regarding mandatory vaccination. Path analysis was conducted to explore direct and indirect associations of compliance with childhood vaccinations and HL.
  
  
  
  Communicative HL has a significant negative direct association with compliance with vaccinations (ß=-0.06, p<0.05). High functional and critical HL have significant negative indirect associations with vaccinations through parents' attitudes regarding vaccines. Higher levels of perception of reliability of informal information resources are associated with non-compliance.
  
  
  
  The results indicate that parents with high functional, communicative, and critical HL are more at risk of not vaccinating their children. The results are contrary to expectations in which people with high HL adopt more positive health behaviors.
  
  
  
  Public health professionals may need more sophisticated communication methods to transfer messages regarding vaccines to parents in order to prevent decline in vaccine coverage rates, taking into account levels of trust and health literacy.
authors.affiliation: Public Health Department, Tel-Aviv Yafo Municipality, Israel; School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel. Electronic address: anatamit@post.tau.ac.il.
authors.forename: Anat
authors.initials: A
authors.lastname: Amit Aharon
authors.affiliation: Public Health Department, Tel-Aviv Yafo Municipality, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Nehama
authors.affiliation: School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel; Ministry of Health, Hifa District, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Rishpon
authors.affiliation: School of Public Health, Faculty of Welfare and Health Studies, Haifa University, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Baron-Epel
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002675:Child, Preschool; D003142:Communication; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012189:Retrospective Studies; D014611:Vaccination / Q000523:psychology*
keywords: Autonomy in decision-making; Childhood vaccinations; Perception of control