Vaccine hesitancy and its determinants among refugee parents resettled in Aotearoa New Zealand

Figures & data

Table 1. Sociodemographic characteristics of participants (n = 178).

	Number	Valid Percent
Parent
Father	99	56%
Mother	69	39%
Other	9	5%
Missing	1
First-born status
Yes	90	51%
No	86	49%
Missing	2
Age
18–24	12	7%
25–34	49	28%
35–44	61	35%
45+	55	31%
Missing	1
Family type
Couple	130	73%
Single parent	23	13%
Extended family	19	11%
Other	4	2%
Missing	1
Number of children
One	47	27%
Two	51	29%
Three and above	76	44%
Missing	4
Religion
Christian	83	47%
Muslim	91	51%
Other	3	2%
Missing	1
Educational level
No qualification	7	4%
Primary	7	4%
Secondary	40	23%
Trade/Vocational	39	22%
University	82	47%
Missing	3
Household income, NZ$
< $25,000	29	18%
$25,001– $50,000	58	35%
$50,001 – $75,000	52	31%
> $75001	27	16%
Missing	12
Duration in NZ
< 1 year	2	1%
2–4 years	22	12%
5–9 years	44	25%
>10 years	109	62%
Missing	1
Region of origin
Africa	123	70%
Asia	15	9%
Middle East	31	18%
Other*	6	3%
Missing	3

*Other = Pacific/Ocenia region, Europe, Latin America and Caribbean and North America. NZ$ = New Zealand dollar.

Table 2. Internal consistency of PACV surveys in different languages.

	Reliability score			N of Items
	Number	Cronbach’s Alpha	Cronbach’s Alpha (Standardised Items)
English PACV	109	0.76	0.77	15
Somali PACV	10	0.89	0.89	15
Oromo PACV	18	0.62	0.64	14*
Arabic PACV	17	0.58	0.53	15
Combined PACV	154	0.77	0.77	15

*The Oromo PACV was only 14 items because there was no variation in the responses to Q14.

Table 3. Responses to PACV survey items (n = 178).

Question Number	PACV Questions		Response		No. (%)
1	Have you ever delayed having your child get a vaccine (not including seasonal flu or swine flu (H1N1)vaccines) for reasons other than illness or allergy? *		Yes		34 (21)
			No		131 (79)
			Don’t know		13
2	Have you ever decided not to have your child get a vaccine (not including seasonal flu or swine flu (H1N1)vaccines) for reasons other than illness or allergy? *		Yes		19 (12)
			No		142 (88)
			Don’t know		17
3	How sure are you that following the recommended vaccination schedule is a good idea for your child?Please answer on a scale of 0 to 10, where 0 is Not at all sure and 10 is Completely sure.		0 – 5		29 (17)
			6 – 7		30 (18)
			8 – 10		110 (65)
			Missing		9
4	Children get more vaccines than are good for them.		Agree		102 (58)
			Disagree		27 (15)
			Unsure		48 (27)
			Missing		9
5	I believe that many of the illnesses that vaccines prevent are severe.		Agree		137 (79)
			Disagree		22 (12)
			Unsure		15 (9)
			Missing		4
6	It is better for my child to develop immunity by getting sick than to get a vaccine.		Agree		45 (26)
			Disagree		82 (47)
			Unsure		46 (27)
			Missing		5
7	It is better for children to get fewer vaccines at the same time.		Agree		60 (35)
			Disagree		52 (30)
			Unsure		61 (35)
			Missing		5
8	How concerned are you that your child might have a serious side effect from a vaccine?		Concerned		83 (47)
			Not concerned		77 (44)
			Unsure		16 (9)
			Missing		2
9	How concerned are you that any one of the childhood vaccines might not be safe?		Concerned		75 (43)
			Not concerned		72 (42)
			Unsure		26 (15)
			Missing		5
10	How concerned are you that a vaccine might not prevent the disease?		Concerned		69 (40)
			Not concerned		71 (41)
			Unsure		32 (19)
			Missing		6
11	If you had another infant today, would you want him/her to get all the recommended vaccines?		Yes		151 (85)
			No		16 (6)
			Don’t know		11 (9)
			Missing		0
12	Overall, how hesitant (uncertain) about childhood vaccines would you consider yourself to be?		Hesitant		43 (24)
			Not hesitant		113 (65)
			Unsure		20 (10)
			Missing		2
13	I trust the information I receive about vaccines.		Agree		146 (83)
			Disagree		19 (11)
			Unsure		12 (7)
			Missing		1
14	I am able to openly discuss my concerns about vaccines with my child’s doctor.		Agree		149 (86)
			Disagree		13 (8)
			Unsure		12 (7)
			Missing		4
15	All things considered, how much do you trust your child’s doctor? Please answer on a scale of0 to 10, where 0 is Do not trust at all and 10 is Completely trust		0 – 5		18 (12)
			6 – 7		30 (19)
			8 – 10		107 (69)
			Missing		23

Highlighted responses indicate hesitancy; Q1–Q15 responses were collapsed from 5 into 3 categories; *don’t know in Q1 and Q2 excluded as missing data.

Table 4. Association between sociodemographic factors and vaccine hesitancy.

		Hesitant	Non-Hesitant	Bivariate Analysis		Multivariate Analysis
Factor		No.	No.	UOR (95% CI)	P	AOR (95% CI)	P
First-born status
Yes		13	77	1.35 (0.61, 3.01)	0.45
No		16	70	REF
Age 18–34		21	89	1.68 (0.609, 4.63)	0.60
35+		17	99	REF
Religion
Christian		9	74	REF	0.16
Muslim		19	72	2.17 (0.92, 5.11)
Other**		1	2	4.11 (0.34, 49.99)
Education
No qualification		2	5	3.70 (0.62, 22.27)	0.08	4.69 (0.45,48.90)	0.04*
Primary		3	4	6.94 (1.31, 36.68)		8.97 (1.48,54.33)
Secondary		9	31	2.69 (0.95, 7.60)		2.91 (1.02,8.29)
Tertiary		14	107	REF		REF
Duration in NZ
<9 years		14	54	0.90 (0.238, 3.374)	0.21
>10 years		15	94	REF
Source of information ***
Official †		18	115	REF	0.03*	REF	0.045*
Media †		6	12	3.20 (1.07,9.58)		4.87 (1.36, 17.38)
Personal †		4	7	3.65 (0.97,13.74)		2.25 (0.32, 15.85)
Household income, NZ$
< $25,000		6	23	1.15 (0.31,4.31)	0.67
$25001– $50,000		11	47	1.03 (0.32,3.33)
$50001 – $75,000		6	46	0.57 (0.16, 0.09)
> $75001		5	22	REF

Note. NA: Not applicable; UOR: unadjusted odds ratio; AOR: adjusted odds ratio; * Significant result, p < .05; **Other: Hindu, Buddhist, Atheist, and other religion.

*** only 162 participants with single primary source of information were included; † Official: health professionals and brochure; Media: mass media (tv and radio). social media, internet (google); Personal: family and friends, community, and other. NZ$ = New Zealand dollar

Table 5. Respondents’ comments pertaining to childhood vaccines and vaccination services (n = 24).

Participant Number	Comments about childhood vaccines and vaccination services
R9	Vaccination is highly important for all kids in the world.
R12	I am not sure how important having child vaccine is. it is very hard to see when your child cried during vaccine.
R20	Vaccination is vital for our children to prevent them from disabilities or untimely death.
R38	In opinion vaccinations affect the behavior of children.
R47	The health care system fails to adequately care and support those who are nonwhite, this in turn creates a significant doubt and mistrust of the health care providers and professionals. Racism and discrimination are the main reasons for refugees to be blatantly subjugated to mistreatment and poorer health outcomes and experiences. To put it bluntly, you can’t trust those who mistreat you when you are vulnerable and at their mercy for help and support. Hence the surge of anti vaccination sentiments amongst refugees.
R51	Be natural as much as possible
R55	People come to New Zealand from different part of the world mainly under Quota Refuge and some people from some countries may not know well the value of vaccination and they should be taught well at the reception center.
R56	Vaccination is necessary for children … . But there are some vaccinations that may have side effects, negatively affect children’s abilities such as speech and comprehension.
R62	There are many children in the world who are far from getting access for vaccines and they lived healthy life, that makes me to think twice about vaccines.
R71	Vaccines can prevent polio, measles, and all diseases, this is important for children because the child cannot tell the signs and symptoms of pains.
R72	I believe that childhood vaccination has reduced infant mortality rate significantly.
R74	I believe that childhood vaccinations have reduced infant mortality rate significantly as in the case of Africa.
R76	There are rumors from community friends that some vaccines cause mental illnesses to children later in their life, and they are giving examples of some children they know they were normal until they had vaccine.
R85	I do agree with childhood vaccination, and it is important for our children
R88	I believe that Vaccination can save many children death and disability. More research and health education can help to improve refuge familys health.
R90	I believe the safety and efficiency of vaccines is not satisfying looking at how much the world developed.
R111	Additional vaccines needs to be added, for example COVID 19 vacines
R113	Health professionals must give the parents the right information of the benefit and side-effects of the vaccination
R128	More education for parents during the prenatal follows up in the language those parents understand.
R137	I agree with children’s vaccination
R140	Further investigation should be done on vaccines before it is given and affects the future of the children
R141	The side-effects (a possibe harms of vaccines) should be explained to the parents
R145	COVID has shown the importance of vaccine.
R165	I’m not sure how this vaccination important to my children every single winter they are sick even when travel to home country (Africa), where is the importance of this vaccine