title: A qualitative systematic review of factors influencing parents' vaccination decision-making in the United Kingdom.
abstract: BACKGROUND
  High uptake of vaccinations is crucial for disease prevention. Although overall uptake of childhood immunisations is high in the United Kingdom (UK), pockets of lower uptake remain. Novel systematic methods have not been employed when reviewing the qualitative literature examining parents' vaccination decisions.
  
  
  OBJECTIVE
  We aimed to conduct a qualitative systematic review of studies in the UK to understand factors influencing parental decisions to vaccinate a child.
  
  
  METHODS
  On 12/2/14 we searched PsycINFO, MEDLINE, CINAHL plus, Embase, Social Policy and Practice and Web of Science for studies using qualitative methods and reporting reasons why parents in the UK had or had not immunised their child. Participant quotes and authors' interpretations of qualitative data were extracted from the results of articles. Thematic synthesis was used to develop higher-order themes (conducted in 2015).
  
  
  RESULTS
  34 papers were included. Two types of decision-making had been adopted: non-deliberative and deliberative. With non-deliberative decisions parents felt they had no choice, were happy to comply and/or relied on social norms. Deliberative decisions involved weighing up the risks and benefits, considering others' advice/experiences and social judgement. Emotions affected deliberative decision-making. Trust in information and vaccine stakeholders was integral to all decision-making. Practical issues affected those who intended to vaccinate.
  
  
  CONCLUSIONS
  Parents adopted two different approaches to decision-making about childhood vaccinations. By understanding more about the mechanisms underpinning parents' vaccination behaviour, in collaboration with vaccine stakeholders, we can better design interventions to enhance informed uptake.
authors.affiliation: Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Forster
authors.affiliation: Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Lauren
authors.initials: L
authors.lastname: Rockliffe
authors.affiliation: Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Chorley
authors.affiliation: Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Laura A V
authors.initials: LA
authors.lastname: Marlow
authors.affiliation: Institute of Child Health, UCL, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Helen
authors.initials: H
authors.lastname: Bedford
authors.affiliation: Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom.
authors.forename: Samuel G
authors.initials: SG
authors.lastname: Smith
authors.affiliation: Health Behaviour Research Centre, UCL, Gower Street, London WC1E 6BT, United Kingdom.
authors.forename: Jo
authors.initials: J
authors.lastname: Waller
keywords: Parents; Patient Acceptance of Health Care; Thematic synthesis; Vaccination