Childhood influenza vaccination barriers in Australia – key findings summary

This page summarises key findings from the National Vaccination Insights project survey of a nationally representative cohort of 2,000 parents. The aim of the study was to understand the barriers to uptake of influenza vaccine among children under 5 years of age.

Jump to section

• Vaccine Barriers Assessment Tool (VBAT)
• Most common influenza vaccination barriers
• Influenza vaccination barriers associated with not intending parents
• Influenza vaccination barriers associated with financial stress
• Influenza vaccination barriers associated with where parents live

Vaccine Barriers Assessment Tool (VBAT)

The VBAT measures acceptance and access barriers. These barriers can be further grouped according to the following domains:

• thinking and feeling 
• practical issues 
• social influences.

These categories are informed by the World Health Organization Behavioural and Social Drivers of Vaccination (BeSD) framework.
 

Acceptance and access barriers to childhood influenza vaccination, as measured by the VBAT^*

* For more information on the development and validation of the VBAT, see Kaufman J, Tuckerman J, Bonner C, et al. Development and validation of the Vaccine Barriers Assessment Tool for identifying drivers of under-vaccination in children under five years in Australia. Human Vaccines & Immunotherapeutics 2024;20:2359623.

Most common influenza vaccination barriers

The most common influenza vaccination barriers parents (n=2,000) reported were as follows:

• more than 6 in 10 (66.0%) parents reported the acceptance barrier of feeling distressed when thinking about vaccinating their child against influenza (see the ‘Acceptance barriers: thinking-feeling’ graph below)
   
• more than 1 in 10 (15.5%) parents reported the acceptance barrier that they would not feel guilty if their unvaccinated child got influenza (see the ‘Acceptance barriers: thinking-feeling’ graph below)
   
• more than 1 in 10 (15.7%) parents reported the access barrier that they do not prioritise their child’s influenza vaccination over other things (see the ‘Access barriers: practical’ graph below)
   
• around 1 in 10 (10.5%) parents reported the access barrier that they cannot afford costs associated with vaccinating their child against influenza (see the ‘Access barriers: practical’ graph below)
   
• almost 1 in 10 (9.9%) parents reported the acceptance barrier that people close to them do not support influenza vaccination (see the ‘Acceptance barriers: social influences’ graph below).
   

Percentage of parents reporting influenza vaccination barriers – overall and by intention to vaccinate

Acceptance barriers: thinking-feeling

Access barriers: practical

Acceptance barriers: social influences

Influenza vaccination barriers associated with not intending parents

The barriers significantly associated with not intending parents (i.e. parents who did not intend to vaccinate their young child against influenza)* were found to be a mix of access and acceptance barriers. These barriers^** were:

• not prioritising their child's influenza vaccination appointment over other things: 
  • 54.7% of not intending parents vs 6.1% of intending parents reported this barrier, a 48.6 percentage-point difference (95% confidence interval [CI]: 41.9%, 55.3%)
     
• not feeling guilty if their unvaccinated child got influenza: 
  • 54.3% of not intending parents vs 7.5% of intending parents reported this barrier, a 46.8 percentage-point difference (95% CI: 40.2%, 53.5%)
     
• not believing that influenza vaccines protect others in the community: 
  • 43.8% of not intending parents vs 3.4% of intending parents reported this barrier, a 40.4 percentage-point difference (95% CI: 33.8%, 47.1%)
     
• not believing influenza vaccines are safe for their child: 
  • 41.1% of not intending parents vs 2.5% of intending parents reported this barrier, a 38.6 percentage-point difference (95% CI: 32.1%, 45.0%)
     
• not believing influenza vaccines are effective for preventing influenza: 
  • 39.7% of not intending parents vs 3.0% of intending parents reported this barrier, a 36.6 percentage-point difference (95% CI: 30.2%, 43.1%)
     
• people close to them not supporting influenza vaccination: 
  • 37.2% of not intending parents vs 4.6% of intending parents reported this barrier, a 32.7 percentage-point difference (95% CI: 26.2%, 39.2%)
     
• not being able to afford costs associated with vaccinating their child against influenza: 
  • 22.7% of not intending parents vs 7.5% of intending parents reported this barrier, a 15.2 percentage-point difference (95% CI: 9.5%, 20.9%)
     

^* Of the parents surveyed, 15.0% (n=299/2,000) did not intend to vaccinate their child against influenza in time for the influenza season and 74.3% (n=1,486/2,000) were intending. Parents who were unsure (10.8%, n=215/2,000) were not included in this analysis.

^** Barriers are listed in order of strength of association with not intending parents. This is measured as the percentage-point difference between the percentage of parents who did not intend to vaccinate their child against influenza reporting the barrier and the percentage of parents who were intending to vaccinate their child against influenza reporting the barrier.

Influenza vaccination barriers associated with financial stress

Significantly more parents experiencing financial stress reported the following access and acceptance barriers to childhood influenza vaccination than parents not experiencing financial stress:^*

• not believing influenza vaccines are safe for their child:
  • 11.3% of parents experiencing financial stress vs 7.0% of parents not experiencing financial stress reported this barrier, a 4.3 percentage-point difference (95% CI: 1.3%, 7.4%) 
     
• not believing influenza vaccines are effective for preventing the disease:
  • 12.4% of parents experiencing financial stress vs 8.4% of parents not experiencing financial stress reported this barrier, a 4.0 percentage-point difference (95% CI: 0.8%, 7.2%)
     
• not being able to afford the costs associated with vaccinating their child against influenza: 
  • 15.4% of parents experiencing financial stress vs 7.9% of parents not experiencing financial stress, a 7.4 percentage-point difference (95% CI: 4.0%, 10.8%).
     

^* Of the parents surveyed, 36.3% (n=726/2,000) reported experiencing financial stress vs 63.7% (n=1,274/2,000) who did not report experiencing financial stress. Experiencing financial stress was defined as indicating two or more response options to the following question: ‘Since January 2023, did any of the following happen to you because of a shortage of money?’ Response options were: ‘Could not pay electricity, gas or telephone bills on time’; ‘Could not pay the mortgage or rent on time’; ‘Pawned or sold something’; ‘Went without meals’; ‘Was unable to heat home’; ‘Asked for financial help from friends or family’; ‘Asked for help from welfare/community organisations’. 

Influenza vaccination barriers associated with where parents live

Significantly more parents living in metropolitan-regional areas^* (15.9%) reported that they do not prioritise influenza vaccination over other things compared with parents living in rural-remote areas (9.8%), a 6.1 percentage-point difference (95% CI: 1.5%, 10.7%).
 

^* Of the parents surveyed, 90.3% (n=1,806/2,000) lived in metropolitan-regional areas and 9.7% (n=194/2,000) lived in rural-remote areas.

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