Peer-reviewed article
Integrating vaccine hesitancy into the health belief model: additive effects on parental decision-making for child RSV vaccination.
Hyunji Park, Huso Yi, Minah Park ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined what influences parents' decisions about vaccinating young children against respiratory syncytial virus (RSV) in South Korea. Researchers surveyed 402 parents and used statistical modeling to test how parents' knowledge, beliefs, and vaccine hesitancy affect their intention to vaccinate. The findings show that vaccine hesitancy is a distinct factor that should be understood separately from other beliefs, and that addressing parents' concerns about vaccine barriers and improving communication with healthcare providers could increase vaccination acceptance.
Key points
- 17% of surveyed parents in South Korea reported no intention to vaccinate their children against RSV
- RSV knowledge indirectly influenced vaccination intention through health belief constructs including perceived susceptibility and cues to action (β = 0.15, p < 0.001)
- Cues to action most strongly predicted vaccination intention (β = 0.31, p < 0.001)
- Perceived barriers most strongly predicted vaccine hesitancy (β = 0.73, p < 0.001)
- Incorporating vaccine hesitancy as a distinct construct improved the model's explanatory power and stability
Limitations
The study is cross-sectional and based on parental self-report in one country, so it cannot demonstrate causation or generalize findings to other populations or cultures. The findings reflect intentions rather than actual vaccination behavior.
Abstract
BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of respiratory infections in young children. With pediatric RSV vaccines in late-stage clinical evaluation, understanding how parental perceptions and vaccine hesitancy (VH) shape vaccination intentions is critical for achieving high vaccination coverage and maximizing public health benefits. This study applied the Health Belief Model (HBM) to identify factors influencing vaccination intentions and examined VH as a distinct outcome alongside vaccination intention within the HBM framework. METHODS: A survey of 402 parents of children aged ≤ 5 years in South Korea assessed RSV knowledge, HBM constructs, and VH. Structural equation modeling (SEM) was used to test two models: (1) an HBM-only model examining pathways from knowledge to vaccination intention mediated by HBM constructs and (2) an extended HBM–VH model specifying both vaccination intention and VH as parallel outcomes. RESULTS: Overall, 17% of parents reported no intention to vaccinate their children against RSV. At the bivariate level, RSV knowledge, HBM constructs, and VH were all significantly associated with vaccination intention. In the HBM-only SEM, perceived susceptibility and cues to action mediated the relationship between RSV knowledge and intention. In the extended HBM–VH model, RSV knowledge was indirectly associated with vaccination intention through HBM constructs (β = 0.15, p < 0.001). Vaccination intention was most strongly associated with cues to action (β = 0.31, p < 0.001), whereas VH was most strongly associated with perceived barriers (β = 0.73, p < 0.001). CONCLUSIONS: Incorporating VH improved the model’s stability and explanatory power. VH represents a distinct construct within the HBM, and its inclusion enhances understanding of parental decision regarding vaccination. Strengthening provider training to address hesitancy and improving parent–provider communication may further promote vaccine acceptance.