Vaccination & Preventive Care Across Traditions

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician or nurse: Benefits, risks and ingredients, answered honestly.
• Pharmacist: Ingredients, side effects and where to get vaccinated, where pharmacists vaccinate.
• Community health worker: Practical access and follow-up, where such roles exist.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Canada, Ethiopia, Pakistan, Philippines, Italy, Australia, Brazil, Chile, Paraguay, Peru and Uruguay, Lebanon, France. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Secondary source:

Read in a summary of the source, not the source itself.

Policy, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Availability not verified:

Whether this is available today was not checked.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

• Global · Guidance · 2022

  WHO's 2022 BeSD guidance defines practical issues, including access barriers, as a driver of vaccination separate from motivation, which covers intentions, willingness and hesitancy.

  Limits: Guidance, not outcomes

  What others could learn: A care team can ask separately whether a person is unsure, has questions about safety, hears different things from others, or simply cannot get to a vaccination visit. The framework keeps practical barriers distinct from hesitancy so they are not mistaken for it.

  Conditions, limits and source

  Conditions that matter:

  Designed for programme-level data gathering (surveys, interviews, local adaptation) rather than the clinic visit. Using it needs trained interviewers, ethics review and a plan to act on findings. Individual clinicians would have to translate the domains into their own questions.

  Cannot be inferred:

  Does not show that any clinic-level question set changes uptake. Does not describe any country's results. The survey and interview items in the annexes are not reproduced here and nothing here is a measurement instrument.

  Limits:

  Framework and measurement guidance, not an evaluation of conversations or outcomes. The tools are population surveys and interview guides. The guidance says the drivers it measures are specific to vaccination and do not directly include broader influences such as literacy, political views and socio-economic status, which its qualitative tools can explore.

  Source: World Health Organization, Behavioural and social drivers of vaccination: tools and practical guidance for achieving high uptake (Glossary, 'BeSD framework domains', printed p. vii (PDF p. 9); framework in Section 1, Fig. 1). Where: Global. Population: People deciding whether to be vaccinated, and the immunization programmes that serve them. Published 2022-05-20; retrieved 2026-10-11.

• Canada · Measured outcome · 2018

  In a Quebec quasi-experimental study, infants of mothers who received one motivational-interviewing vaccination session on the postpartum ward had higher vaccine coverage at 3, 5 and 7 months than comparison infants.

  What others could learn: A short session that invites a parent to voice concerns and explore their own ambivalence, timed before the first routine infant dose, was followed by modestly higher on-time coverage. The authors attribute this to a respectful, non-judging exchange; the study did not test which element mattered.

  Conditions, limits and source

  Conditions that matter:

  Staff trained in motivational interviewing, about 20 minutes per family, a postpartum stay long enough to hold the session, and a regional immunization registry to measure results. Mothers had to speak French or English; those needing acute care were excluded.

  Cannot be inferred:

  Not evidence that motivational interviewing works with parents who firmly refuse vaccines. Not a randomized result. Effect sizes are modest and from one region and schedule. A separate follow-up (PMID 30457421) exists and was not used for this record.

  Limits:

  Not randomized: the comparison group was mothers not approached. The 3.2, 4.9 and 7.3 point gains are per-protocol; intention-to-treat gains were 2.7, 3.8 and 5.7 points. The comparison group had more cesarean births, more neonatal admissions and more mothers with earlier children, which the authors say may have shrunk the effect. The registry lacks children who moved away. The session was delivered by research assistants, not routine clinic staff. Mothers were not selected for hesitancy.

  Source: BMC Public Health (Gagneur et al.), A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study (Abstract, Results; design in Methods ('Study design', 'Intervention')). Where: Canada (Quebec, Eastern Townships). Population: Mothers aged 18 or over giving birth at one university hospital, and their newborns: 1,140 intervention and 1,249 comparison. Published 2018-06-28; retrieved 2026-10-11.

• Ethiopia · Reported experience · 2026

  In a 2024 qualitative study in eight districts of Ethiopia's Amhara, Oromia and Somali regions, participants at all sites frequently cited poor service delivery, including a lack of compassionate and respectful care, as a barrier.

  What others could learn: Caregivers and leaders named how people are treated at vaccination sessions alongside distance and fear of side effects. A care team could ask about the last visit, waiting, respect and how side effects were explained before assuming a knowledge gap. The study also reports engaging religious and community leaders and fathers as a promising practice in Oromia.

  Conditions, limits and source

  Conditions that matter:

  Findings come from areas with hard-to-reach communities, infrequent sessions, staff shortages and, in places, conflict or drought. Counseling time and supervision for vaccinators would be needed. Involving leaders depends on local relationships and on the caregiver wanting it.

  Cannot be inferred:

  Not representative of Ethiopia or of the regions as a whole. Does not show that respectful care or leader engagement raises coverage. Says nothing about what any faith requires. Participants' beliefs are reported as beliefs, not as facts or doctrine.

  Limits:

  Participants at village level were selected by health extension workers and community leaders, which may bias selection. Most data collectors were male, which may have affected openness. The authors note fieldwork coincided with Ramadan, which made some interviews hard to arrange. Barriers were reported, not ordered by importance or measured.

  Source: PLOS Global Public Health (Zewdie et al.), Barriers to and enablers of childhood immunization uptake in Ethiopia's Amhara, Oromia, and Somali Regions: A multi-perspective qualitative study (Results, 'Barriers to immunization uptake', 'Universal supply-side barriers'). Where: Ethiopia (Amhara, Oromia and Somali regions, eight districts). Population: Caregivers of zero-dose, under-immunized and fully immunized children; community, religious and traditional leaders; health workers. Published 2026-06-05; retrieved 2026-10-11.

• Pakistan · Reported experience · 2025

  Frontline polio workers in high-risk areas of one Pakistani city reported that some households refused the vaccine from visit fatigue and fear of surveillance, and others to draw attention to more pressing unmet needs.

  Limits: Abstract only

  What others could learn: Some refusal at the door may reflect visit fatigue, fear of surveillance or unmet needs rather than a view about the vaccine. Workers proposed fewer, better contacts and added services (food, medicines, primary care, sanitation). A care team could ask what else a household needs before repeating information.

  Conditions, limits and source

  Conditions that matter:

  Needs a programme able to reduce touchpoints and bundle services, which means funding beyond vaccination. Security risks for workers are noted in the abstract. Staff need time and standing to listen and to refer.

  Cannot be inferred:

  Not representative of Pakistan or of polio refusal everywhere. Does not show that fewer visits or added services raise uptake; they are workers' suggestions. Does not describe the beliefs of any religious or ethnic group.

  Limits:

  Abstract only. Accounts come from frontline workers, not from the households themselves. The city is not named in the abstract. The abstract does not give counts for each reason.

  Source: Global Public Health (Majidulla et al.), Engage less, provide more: Community health workers' perspectives on how to overcome opposition to polio vaccination in Pakistan (Abstract, Results (abstract only; full text not retrieved)). Where: Pakistan (super high risk union councils of one major city). Population: Frontline polio workers (171 teams) serving households in super high risk union councils; households are described through the workers' accounts. Published 2025-02-11; retrieved 2026-10-11.

• Philippines · Reported experience · 2023

  After interviews and a focus group with 41 parents and health workers in Pasay City, authors suggest the Dengvaxia controversy may reduce measles vaccine confidence and that lack of transparency played a crucial role.

  Limits: Abstract only

  What others could learn: Past vaccine events may shape how parents see a different vaccine. A care team could ask what a parent has heard and lived through before giving information. The abstract notes the clinic waiting room as a place where parents share experiences; it does not test any response.

  Conditions, limits and source

  Conditions that matter:

  Requires staff willing to discuss a politically charged episode, up-to-date factual answers, and time. Trust here is tied to national events outside the clinic's control.

  Cannot be inferred:

  Not evidence of how much the controversy changed measles coverage. Not representative of the Philippines. Does not show that transparency or waiting-room measures restore trust.

  Limits:

  Abstract only. One city. Linking the controversy to measles hesitancy is the authors' interpretation within a social-drama framework, not a measured effect. Participant numbers by group are not given in the abstract.

  Source: Journal of Public Health (Miras et al.), 'I was terrified for my child': understanding the link between the Dengvaxia controversy and the measles vaccine hesitancy in Pasay City, Philippines (Abstract, Conclusion (abstract only; full text not retrieved)). Where: Philippines (Pasay City). Population: Parents and health care workers in one city (41 participants). Published 2023-11-29; retrieved 2026-10-11.

• Italy · Policy · 2021

  A 2021 descriptive analysis reports Italy's first-dose measles coverage fell from 90.4% in 2013 to 85.3% in 2015, then rose to 94.4% in 2019, after Law 119/2017 expanded mandatory vaccines from four to ten.

  Limits: Secondary source · Policy, not outcomes · Availability not verified

  What others could learn: Where vaccination is tied to a legal requirement, families may arrive because of a rule rather than a decision. A clinician could state the requirement plainly and still ask what worries the family. The paper reports administrative penalties for hesitant or refusing parents; it does not study how that affects what families tell clinicians.

  Conditions, limits and source

  Conditions that matter:

  Needs a national schedule, regional services able to verify records, school-level enforcement and penalties. The paper notes regional differences in organization and compliance timing.

  Cannot be inferred:

  Does not show parents' views, trust or experience of the mandate, or whether coverage gains persisted. Not transferable to countries with different services or legal systems. Does not compare countries.

  Limits:

  Secondary description. The law text was not retrieved because Italian government hosts were unreachable, so the paper's one-sentence account of school admission (all children under 16 must show proof) is not used here; other summaries distinguish exclusion at ages 0 to 6 from fines at ages 6 to 16. The 2017 outbreak and a national plan coincided with the law and the design cannot isolate the law's effect. Regional data differ.

  Source: Human Vaccines & Immunotherapeutics (Sindoni et al.), Effect of the mandatory vaccination law on measles and rubella incidence and vaccination coverage in Italy (2013-2019) (Abstract, Results; see also Measles vaccination coverage, National level). Where: Italy. Population: Children in Italy covered by national and regional surveillance and coverage reports. Published 2021-08-04; retrieved 2026-10-11.

• Australia · Reported experience · 2017

  Many of 26 GPs and nurses interviewed in two New South Wales regions about parents who decline vaccination found it helpful to first ask permission, ask open-ended questions or respectfully challenge a belief before offering information.

  Limits: Service as described

  What others could learn: Experienced providers reported opening with permission and open questions, listening respectfully, and protecting the relationship so the topic can be revisited. A clinic could write down which parent concerns were raised and keep the door open instead of treating one visit as the test.

  Conditions, limits and source

  Conditions that matter:

  Needs longer appointments and communication training; the authors say junior staff may need more guidance. Exemption paperwork at the time added a bureaucratic role for clinicians, which has since changed.

  Cannot be inferred:

  Does not show these approaches change vaccination status. Not representative of Australian providers. Parent views are not reported. Exemption policy described has since changed and is not current law.

  Limits:

  Provider self-reports, not observed consultations, and the authors say they do not measure behavior. Nurses were under-represented. Some providers also described dismissing concerns or using fear appeals; those are reported, not endorsed. Exemption rules described changed after 2015.

  Source: BMC Pediatrics (Berry et al.), When parents won't vaccinate their children: a qualitative investigation of Australian primary care providers' experiences (Results, 'Explore and inform' (Table 1 gives example wording)). Where: Australia (New South Wales, two regions). Population: 26 general practitioners, community nurses and practice nurses (17 GPs, 9 nurses). Published 2017-01-17; retrieved 2026-10-11.

• Brazil, Chile, Paraguay, Peru and Uruguay · Reported experience · 2021

  In influenza vaccine focus groups in urban South America, participants in some risk groups in Uruguay and Brazil said doctors differ on recommending the vaccine, which raised doubts about its safety.

  What others could learn: When people hear conflicting advice from different clinicians, doubt can shift from the clinician to the vaccine. A team could agree a consistent message, ask what the person has heard from others, and say plainly where guidance differs.

  Conditions, limits and source

  Conditions that matter:

  Needs shared protocols across prescribers and pharmacists, and time to ask about earlier advice. The authors link trust to health-system context and the supply of information.

  Cannot be inferred:

  Does not compare countries. Does not show how common conflicting advice is. Not evidence about childhood vaccines or other regions. Does not show that aligned messages raise uptake.

  Limits:

  Authors state results cannot be generalized to urban populations across countries. Recruitment differed by country. Focus groups may suppress views that differ from the majority. Influenza vaccine, not childhood schedules. Participants' accounts of what doctors said were not checked.

  Source: PLOS ONE (Gonzalez-Block et al.), Influenza vaccination hesitancy in large urban centers in South America. Qualitative analysis of confidence, complacency and convenience across risk groups (Results, 'Confidence: Trust in the system' (country comparison paragraph)). Where: Brazil, Chile, Paraguay, Peru and Uruguay (urban focus groups). Population: Pregnant women, mothers of children under 6, adults with risk factors, and adults aged 60 or over (middle-class urban residents). Published 2021-08-12; retrieved 2026-10-11.

• Lebanon · Measured outcome · 2020

  In a 2019 national survey of 2,785 parents in Lebanon, better patient-physician communication was associated with higher knowledge, better attitudes and better practice regarding children's vaccination.

  What others could learn: A clinic could treat the vaccine conversation as part of care: ask parents what they know and what worries them, and ask how they found the discussion. Here, communication quality and knowledge moved together; whether improving communication changes uptake needs an intervention study.

  Conditions, limits and source

  Conditions that matter:

  Interviews in Arabic by trained staff. The authors describe measles coverage below the 95% target in 2018 (82% first dose, 63% second dose), some vaccines being voluntary and usually not covered by the ministry of public health, and about 29% of respondents having no insurance. Better practice was linked to education and to having insurance.

  Cannot be inferred:

  Does not show that better communication causes better vaccination practice, or how Lebanese physicians communicate. Does not show current coverage or practice. Describes these respondents only; it is not a statement about any community, sect or religion in Lebanon.

  Limits:

  Cross-sectional, so the direction of association is unknown. Knowledge, attitude, practice and communication are all parent self-report. Reliability of the knowledge, attitude and practice scales was modest in the authors' own report, and correlations between communication and each outcome were small to moderate. Parents with intellectual disability or dementia were excluded. Data are from before COVID-19. Items are not reproduced here.

  Source: BMC Public Health (Matta P, El Mouallem R, Akel M, Hallit S, Fadous Khalife MC); PMC open access, Parents' knowledge, attitude and practice towards children's vaccination in Lebanon: role of the parent-physician communication (Abstract, Results). Where: Lebanon. Population: Parents (fathers, mothers or both) of children aged 1 month to 15 years; 2,785 of 3,500 questionnaires returned (about 80%); 63% women, 51% university educated. Published 2020-09-22; retrieved 2026-10-11.

• France · Measured outcome · 2023

  In a randomized trial of 733 mothers in two maternity wards in south-eastern France, a motivational interview by trained midwives lowered vaccine hesitancy measures and raised intention to vaccinate more than a leaflet, measured during the postpartum hospital stay.

  What others could learn: Where staff time allows, a trained, non-judgmental conversation that starts by listening to a parent's concerns can be tested against written information alone. Effects here were largest for the most hesitant and least educated mothers, which suggests asking who benefits rather than assuming one effect.

  Conditions, limits and source

  Conditions that matter:

  Midwives completed a 5.5-hour e-learning course and a 2.5-day workshop with role-play over about 2 months, received a 66-page information guide and a debriefing, then held interviews of 10 to 30 minutes with mothers and partners the day after birth. France had required most childhood vaccines since 2018. The validated hesitancy questionnaire is named in the abstract; its items are not reproduced here.

  Cannot be inferred:

  Does not show that motivational interviewing raises actual infant vaccination, or that the effect lasts or transfers to settings without trained midwives, mandates or maternity-ward contact. Not evidence about hesitancy in any religious or ethnic group.

  Limits:

  Measured attitudes and intentions rather than actual vaccination, and the second questionnaire followed the intervention within the hospital stay, so a Hawthorne effect is possible, which the authors discuss. The control was a leaflet, not usual conversation. The absolute net change was modest (5.8 points on a 100-point measure). Mothers' initial intention was slightly higher in the control arm. Fewer mothers than planned were included; the authors advise caution in generalizing to other European countries. A separate paper reports follow-up at about 7 months (PMID 41628064); it was not used here.

  Source: Eurosurveillance (Verger P, Cogordan C, Fressard L, et al.); PMC open access, A postpartum intervention for vaccination promotion by midwives using motivational interviews reduces mothers' vaccine hesitancy, south-eastern France, 2021 to 2022: a randomised controlled trial (Abstract, Results (VH is vaccine hesitancy; VI is vaccination intention; D-I-D is difference-in-difference)). Where: France (south-eastern France, two maternity hospitals). Population: Mothers who had given birth the previous day (733 included in the intention-to-treat analysis). Published 2023-09-21; retrieved 2026-10-11.

• The sourced examples include guidance, measured outcome, reported experience, policy. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.