Survey of Australian Father's Attitudes towards Infant Vaccination: Findings from the Australian Father's Study

Abstract

Objectives: To investigate the attitudes of expectant Australian fathers towards vaccination, and to identify factors which may influence these attitudes.
Methods: Design: A cross-sectional survey study of 407 Australian men with expectant partners, mean age 30.4 (SD 6.7). Outcomes were self reported attitude, level of knowledge and information resources accessed regarding pregnancy related issues. Participant demographics collected included: age, number of children, relationship status, level of education, employment information and smoking status.
Results: Majority (89%) of participants had a positive attitude towards infant vaccination, 9% felt neutral, and 2% had negative attitudes. Positive attitudes towards vaccination were associated with lower self-reported knowledge of pregnancy issues but a higher likelihood of discussing pregnancy issues with health care providers rather than sourcing information from the internet (both p<0.0001).
Conclusion: A majority of Australian expectant fathers have a positive attitude towards infant vaccination. Fathers with negative attitudes to vaccination self-reported higher levels of knowledge. They were more likely to obtain information from the Internet instead of healthcare staff.
Article discussion at:
https://pregnancyandwomenshealth.com

Full text

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ISSN: 2167-1079
Primary Health Care: Open Access
Prosser et al., Primary Health Care 2016, 6:2
http://dx.doi.org/10.4172/2167-1079.1000228
Volume 6 • Issue 2 • 1000228
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
Open Access
Research Article
Survey of Australian Father’s Attitudes towards Infant Vaccination:
Findings from the Australian Father’s Study
Natasha Prosser1, Rodney Petersen2 and Julie Quinlivan1,3*
1Department of Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, WA 6027, Australia
2Women’s and Babies Service, Women’s and Children’s Hospital, North Adelaide, SA 5006, Australia
3Institute for Health Research, University of Notre Dame Australia, Fremantle, 6160, WA, Australia
*Corresponding author: Julie Quinlivan, Department of Obstetrics and
Gynaecology, Joondalup Health Campus, Joondalup, WA 6027, Australia, Tel: 08
9400 9631; Fax : 08 9400 9955; E-mail: Julie.Quinlivan@nd.edu.au
Received June 09, 2016; Accepted June 27, 2016; Published June 30, 2016
Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian Father’s
Attitudes towards Infant Vaccination: Findings from the Australian Father’s Study.
Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
Copyright: © 2016 Prosser N, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Fathers pregnancy; Attitudes, Mixed methods study;
Prospective study; Cohort study; Infant vaccination; Conscientious
objector
Background
Vaccine preventable diseases place a heavy burden on the
community and the introduction of widespread immunization
regimens have resulted in the reduction or eradication of many
diseases, saving millions of lives. It is considered one of the most
signicant contributions to the improvement in global health outcomes
[1-6]. Some protection for non-immunized people may be achieved via
‘herd immunity’, when the majority of the population are vaccinated
thus restricting the spread of disease [7].
Despite the success of immunization programs, many children
still contract vaccine preventable illnesses, some with tragic outcomes
[6,8]. Many of these children were too young to be vaccinated, unable
to receive them for medical reasons or contracted disease as a result
of vaccine failure. However, some parents choose not to vaccinate
their children, citing political, personal or philosophical motives for
declining [9-12]. Other vaccine opponents question the safety, ecacy
and necessity of recommended vaccines [9-12].
While there is literature on parental attitudes to vaccination, there
is a paucity of information on father’s attitudes. Most studies reported
that the mother was the primary source of information [9-12]. Given
fathers play an important role in child rearing and exert inuence on
decision making processes as co-parent, we have sought to explore the
attitudes of expectant fathers towards newborn vaccination.
Methods
Study design
A self-reporting survey of expectant fathers.
Setting
is study was undertaken as part of e Australian Father’s
Study (AFS), a longitudinal study of Australian father’s experiences
of parenthood from the third trimester of their partner’s pregnancy
until 6 weeks post-partum [13,14]. Participants were identied
through the antenatal clinic at Joondalup Health Campus (JHC). JHC
incorporates both public and private hospitals and is located in the
North Metropolitan region of Perth, Western Australia. is study was
reviewed and granted ethics approval by the JHC Human Research
Ethics Committee. Data were collected between 2013 and 2015.
Participants
Expectant fathers, who were the acknowledged father of the child,
were recruited via the pregnant mother on her attendance at antenatal
clinic aer 20 weeks gestation. Recruiters were qualied medical
practitioners or midwives aliated with the AFS. e mother’s consent
for the father’s participation was sought and participants were provided
an information brochure outlining the requirements of involvement
to enable informed consent to enter the trial to be given. Individual
consent was obtained from each participant. Exclusion criteria were:
pregnancy complicated by known foetal anomaly, fathers with limited
Abstract
Objective: To investigate the attitudes of expectant Australian fathers towards vaccination, and to identify factors
which may inuence these attitudes.
Methods: A cross-sectional survey study of 407 Australian men with expectant partners, mean age 30.4 (SD
6.7). Self reported attitude, level of knowledge and information resources accessed regarding pregnancy related
issues. Participant demographics collected included: Age, number of children, relationship status, level of education,
employment information and smoking status.
Results: Majority (89%) of participants had a positive attitude towards infant vaccination, 9% felt neutral and 2%
had negative attitudes. Positive attitudes towards vaccination were associated with lower self-reported knowledge
of pregnancy issues but a higher likelihood of discussing pregnancy issues with health care providers rather than
sourcing information from the internet (both p<0.001).
Conclusion: A majority of Australian expectant fathers have a positive attitude towards infant vaccination. Fathers
with negative attitudes to vaccination self-reported higher levels of knowledge. They were more likely to obtain
information from the Internet instead of healthcare staff.
Implication for public health: Including fathers in health discussion with knowledgeable health care providers may
result in increased vaccine uptake.

Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian Father’s Attitudes towards Infant Vaccination: Findings from the Australian
Father’s Study. Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
Page 2 of 5
Volume 6 • Issue 2 • 1000228
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
English language abilities, not acknowledged as biological parent
status.
Data sources
is mixed methods study was a predened sub-study of the AFS
collected between January and July 2014. e number of new antenatal
bookings in this recruitment period was 981. is is a longitudinal
study of Australian men who are the acknowledged father of the
unborn child of their pregnant partner. Data were collected via a self-
reported questionnaire consisting of demographic details including:
age, country of birth, living arrangements with the mother, employment
status, education level, other children, and smoking status [13,14]. A
Likert scale was used to assess attitudes to infant vaccination and a
self- reported level of knowledge about pregnancy issues. In addition,
participants were asked to explain their attitude toward vaccination via
an open-ended question. Qualitative information was extracted from
written comments. ree questionnaires were administered in the
antenatal period to be lled in six weeks prior to birth (Q1), immediately
post partum (Q2) and six weeks post partum (Q3). Overall return rate
of questionnaires following consent is 79% with individual return rates
of 85%, 79% and 73% for Q1, Q2 and Q3 respectively. e data for the
vaccination study comes from Q1.
Variables
Participant responses from the Likert scale regarding attitudes to
vaccination were assigned as either ‘Positive’, ‘Neutral’ or ‘Negative’ for
analysis.
Bias
Potential sources of bias in this self-reported study are information
bias, selection bias, non-response bias, and response bias. Attempts
to minimise these sources of bias included: Extended data collection
period, standard response forms, de-identied and condential
respondent surveys.
Sample size
e primary hypothesis was that education would positively
inuence attitudes towards infant vaccination. Fathers with a positive
attitude towards infant vaccination would have undertaken more
formal years of education compared to those with a negative or neutral
attitude. We estimated 80% of fathers with a positive attitude would
have 12 or more years of education, whereas only 30% of fathers with
a neutral or negative attitude would have this degree of education.
Assuming two samples, with alpha error of 0.05, beta of 0.2 and power
of 80%, then 22 expectant fathers with negative or neutral attitude
towards vaccination were required to test the hypothesis.
Given the percentage of 12-15 month-olds fully vaccinated in
Australia ranges from a high of 92.3% to a low of 86.2%, and rates of
specic conscientious objection ranged from 0% to 7.1% across dierent
Medicare Local catchment areas, we estimated 6% of expectant fathers
might have a negative or neutral attitude towards vaccination [15,16].
We therefore recruited 407 expectant fathers into the vaccination study.
Statistical analysis
Statistical analysis was performed using Minitab® (version 16,
University of Melbourne). Dierence in attitudes to vaccinations was
assessed using Chi Square test or Fisher Exact test if cell size was less
than 5. Responses to the open-ended questions were assessed using
inductive content analysis. Responses were independently read by the
principal researchers and an abstraction process used to summarize and
conceptualize the overall meaning and implications of the comments.
Open coding was performed to maximize the number of headings in
order to describe all aspects of the content [17].
Results
Participants
407 expectant fathers were recruited into the vaccination study.
Descriptive data
e demographic characteristics of the study participants are
summarised in Table 1. Of the 407 Fathers included in the study,
the mean age was 30.4 years, (SD 6.7). Of these, 147 (41%) indicated
Australia was not their country of birth, a gure higher than the average
Australian overseas born general population (28.5%) [18]. Most men
reported that they were living with the mother of the child (94.1%) and
had achieved an education level of year 12 or higher (82.5%). Nearly
10% of the fathers reported they were unemployed or in retraining. Of
those who were employed, 66.3% worked more than 40 h per week.
Outcome data
Table 2 summarises demographic details, vaccination knowledge,
and information sources regarding pregnancy issues by attitude towards
vaccination. e majority of participants had a positive attitude towards
infant vaccination (N=357, 89%). However, 9% (N=35) of fathers had
a neutral and 2% (N=8) a negative attitude. Seven participants did not
indicate their attitude to vaccination and were treated as missing data
(not included in table).
e key nding was that fathers with neutral and negative attitudes
towards infant vaccination reported self-assessed higher levels of
knowledge of vaccination issues (p=0.01 and <0.001 respectively).
ese same men also reported they were more likely to have gained
their knowledge from the Internet than from a healthcare professional
(both p<0.001).
Qualitative data
Of the 357 men with positive attitudes to vaccination, 66 commented
on their beliefs, the main themes identied were: Vaccination as
Variable Australian Fathers Study
N=407
Age in years Mean (Std. Dev.) 30.4 (6.7)
Country of birth N (%)
Australia
Overseas
227 (56%)
180 (44%)
Relationship living arrangements N (%)
Living with mother
Not living with mother
383 (94.1%)
17 (4.2%)
Level of education N (%)
Less than 12 years of school
12 years of school or more
65 (16%)
336 (82.5%)
Employment N (%)
Not currently employed
Yes and work locally
Yes and y in y out worker
39 (9.6%)
296 (72.7%)
65 (16%)
Hours worked each week
Less than one hour a week
1-15 h per week
16-40 h per week
More than 40 h per week
16 (4%)
5 (1.2%)
108 (26.5%)
270 (66.3%)
First time father N (%)
Yes
No
210 (51.5%)
195 (48%)
Table 1: Demographics of study cohort.

Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian Father’s Attitudes towards Infant Vaccination: Findings from the Australian
Father’s Study. Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
Page 3 of 5
Volume 6 • Issue 2 • 1000228
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
medical advancement, health benets, anger towards those who
do not immunise and the importance of high rates of vaccination.
No participants who reported neutral feelings towards vaccinations
commented on their viewpoint. Of the 8 participants with a negative
attitude towards vaccinations, all commented on their decisions, with
the main themes identied being: risks of vaccination, persecution, and
the redundancy of vaccinations.
Advancement of modern medicine
A number of respondents commented that they believed
vaccinations were a demonstration of the progress of medicine and a
sign of an advanced society. One participant wrote:
“I’m going to make sure my child is vaccinated. When you think back
how entire families were wiped out, in the old cemeteries and such, I mean
why you wouldn’t vaccinate your child. ey are progress.”
Another participant wrote:
“Vaccines are one of the wonders of modern medicine.”
Health benets
Many expectant fathers felt that vaccinations were essential and
saved lives and unvaccinated children were at risk.
“Everyone knows vaccines save lives. ose parents who don’t
vaccinate their children put all other children at risk.”
Another father discussed the risk versus benet of vaccinations
“e side eects listed are pretty mild – sore arm, irritable for a few
hours. e benets are huge. It can save your child’s life or stop them
getting deaf or brain damaged. I know the baby’s not here yet but already
I feel very strongly protective. I will do anything to reduce the risk of my
child being hurt.”
Anger towards those who did not vaccinate
A common theme expressed by some fathers was anger towards
people who did not vaccinate their children because it placed their own
child at increased risk.
Positive attitude
N=357 (87.7%)
Neutral attitude
N=35
(8.6%)
Negative attitude
N=8
(2%)
Age Mean (SD)
p-value 30.43 (6.7) 30.14 (6.8)
0.55
29.85 (5.0)
0.21
Country of birth N (%)
Australia
Overseas
p-value
210 (59%)
147 (41%)
14 (40%)
21 (60%)
0.03
3 (37.5%)
5 (62.5%)
0.28
Relationship with mother of baby N (%)
Living with mother
Not living with mother
p-value
338 (94.7%)
17 (4.7%)
35 (100%)
0 (0%)
0.38
6 (75%)
2 (25%)
0.06
Level of education N (%)
Less than 12 years of school
12 years of school or more
p-value
60 (16.8%)
296 (82.9%)
4 (11.4%)
31 (88.6%)
0.63
1 (12.5%)
7 (87.5%)
1.00
ATSI Race N (%)
Yes
No
p-value
55 (15.4%)
301 (84.3%)
8 (23%)
27 (77%)
0.24
1 (12.5%)
7 (87.5%)
1.00
Employment type N (%)
Not currently employed
Yes and work locally
Yes and y in y out worker
p-value
31 (8.7%)
264 (74%)
61 (17%)
8 (23%)
25 (71%)
2 (6%)
0.015
2 (25%)
5 (62.5%)
0 (0%)
0.13
Hours worked per week N (%)
0-1 h a week
1-40 h per week
40+ h per week
p-value
13 (4%)
104 (28.5%)
239 (67%)
3 (9%)
6 (17%)
26 (74%)
0.45
2 (25%)
2 (25%)
3 (37.5%)
0.23
Smoker N (%)
Yes
No
p-value
92 (25.8%)
262 (73.4%)
5 (14%)
30 (86%)
0.15
4 (50%)
3 (37.5%)
0.08
First time father N (%)
Yes
No
p-value
188 (53%)
165 (46%)
18 (51%)
17 (49%)
0.86
2 (25%)
5 (62.5%)
0.26
Self-assessed knowledge of vaccination
Likert scale 0-10 Mean (Std Dev)
p-value 6.6 (1.7) 7.7 (0.9)
0.01
9.2 (0.2)
<0.0001
Source of knowledge N (%)
* Healthcare staff
* Internet
* Friends and family
* Other
p-value
254 (71.2%)
23 (6.4%)
65 (18.2%)
15 (4.2%)
15 (43%)
18 (51%)
2 (6%)
0 (0%)
0.001
0 (0%)
7 (87.5%)
1 (12.5%)
0 (0%)
<0.0001
Table 2: Differences between fathers with positive versus neutral or negative attitudes toward infant vaccination.

Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian Father’s Attitudes towards Infant Vaccination: Findings from the Australian
Father’s Study. Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
Page 4 of 5
Volume 6 • Issue 2 • 1000228
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
“I read abut (sic) a baby that died cause a mother took her
unvaccinated child to day care. at’s crazy. If not vaccinated you (sic)
kid can die. If that happened to me I’d want those parents to pay. Maybe
they should go to prison or something because really, they’ve killed that
child by their actions.”
is theme was also reected by expectant fathers with a positive
attitude towards vaccination whose partners, the baby’s mother, had
a negative attitude. Two participants in this situation wrote detailed
comments about their frustration that hospital sta ignored them
because the mother’s views carried greater weight. In one case where
the mother had signed a “Refusal of vaccination” form the father wrote:
“Why should my child be put at risk because we disagree about this?
Why does her opinion matter more than my own? I want Hepatitis B
and Vitamin K injections at birth. She thinks they are dangerous. Father’s
opinions and values don’t count. We are ignored – even when we are the
one saying and doing the right thing and agreeing with the doctors. I was
so angry that the midwife ignored me I had to leave the room”
Another father who separated from his partner aer enrolling in
the study wrote in his questionnaire:
“She’s bitter about me leaving and taking it out on our baby. She
knows I want him to have all the needles and tests. I asked the hospital
to give them but they said only the mother can say so. Why is that the
case? I mean, why is her word worth more than mine? It’s my baby as
much as it is hers. I just want what is best for my baby. She just wants
to hurt me.”
Importance of high vaccination rates
Another common theme addressed was the importance of high
vaccination rates in protecting the community. One participant wrote:
“You need most people to have injections so everyone is safe. Babies
are only safe if everyone is injections (sic).”
Risks of vaccination
In the sub-group of fathers with a negative attitude towards
vaccination, one theme was that the risks of vaccination outweighed
benets. One participant wrote:
“e absolute risk of our child contracting a disease is very low. e
risks of vaccination disease such as autism and ADD are high.”
Another participant agreed
“ere are 100s of studies that show a link between vaccines and
poor outcomes for children. Papers about autism, nerve damage, immune
damage, cancer and death (sic). I mean you risk killing your child just
to supposedly keep it safe from disease, but you give it a disease instead.
Even if you don't get a bad event, the needles hurt your child and cause
them to suer.”
Persecution
Some participants felt that people who conscientiously objected to
immunization where being unfairly punished for their choices.
“e government overstate this issue and try to make you feel guilty
following your own free will.”
“Now the government penalises parents like us. We have to ll in
extra forms for childcare. Just because we have gone to the trouble to look
into it ourselves and not be mindless numbers we get penalized.”
Redundancy of vaccines
One participant reected on the necessity of vaccinations.
“…vaccines are not needed anymore. e disease’s they protect against
have basically disappeared. One paper said no cases of diphtheria had
been seen in the world for decades so why do you need a vaccine against
it”.
Discussion
is paper evaluates the attitudes of Australian fathers towards
vaccinations and factors that may be associated with particular attitudes
to vaccination.
We found that the majority of fathers in the survey were supportive
of infant and childhood vaccinations, while a small proportion
demonstrated a neutral (9%) or negative (2%) attitude.
Participants with a neutral or negative attitude towards vaccination
felt they were better informed about vaccination compared to fathers
with a positive attitude, self-reporting higher levels of knowledge
(p=0.01 and p<0.001 respectively). However, while there was social,
nancial and educational parity across the groups, fathers with neutral
and negative attitudes were more likely to use the Internet as a source of
knowledge rather than a health care professional (both p<0.001).
Vaccinations have made a signicant contribution to the global
health picture yet despite their success; there has been a notable decline
in voluntary uptake. eir very success may well have contributed to
the reduction in uptake secondary to a newfound complacency toward
vaccine-preventable diseases. Disease is no longer present as a reminder to
vaccinate, thus the perceived risk of the severity of diseases is low [9,11,19].
Consumer condence in vaccines can also challenge uptake, with
concern for safety and side eects driving a reluctance to vaccinate.
Adverse publicity in the media has previously raised questions about
safety, ecacy and side eect proles result in lack of trust by some
parents [10,11,20,21]. Some studies have suggested that socioeconomic
factors such as level of education and income were more important
than parental perceptions in vaccination uptake by parents [11,12,22].
Our study did not reect this, with no statistically signicant dierence
in education and employment outcomes between fathers with positive,
neutral or negative attitudes (p>0.05).
Conict can arise where there are two opposing, yet strongly held
opinions with regards to the health care decisions of the child. Fathers
may feel disregarded by perinatal sta and thus excluded from a unied
parental team when the wishes of the mother take preference over those
of the father.
Overwhelmingly, fathers reported that benets of protection against
disease outweighed side eects and chose to endorse vaccination. ese
fathers were more likely to accept advice on vaccination from health
care providers [10-12,20].
Limitations
is study has several limitations due to its self-reporting design,
which may introduce response and non-response bias. However, this
is limited by the adequate sample size to obtain information on fathers
with neutral and negative attitudes. is study was undertaken in a
single public hospital in Perth, Western Australia, which may reduce
the generalizability of the results. is study does not link attitudes with
actual vaccine uptake and may not dierentiate between partial uptake
or late vaccine adaptors.

Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian Father’s Attitudes towards Infant Vaccination: Findings from the Australian
Father’s Study. Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
Page 5 of 5
Volume 6 • Issue 2 • 1000228
Primary Health Care
ISSN: 2167-1079 PHCOA, an open access journal
Conclusion
is paper emphasises the importance for health professionals to
be able to provide up to date information in the face of vast quantities
of material available for public consumption on the Internet. eir
role as a reliable source of information should not be underestimated.
Where possible, involving fathers in discussions around the benets of
vaccinations may help to increase vaccination rates.
Acknowledgement
The AFS is registered at the Australian and New Zealand Clinical Trials
Registry with the number ACTRN 12613001273774 and the trial website is located
at http://australianfathersstudyresearchtrial.weebly.com
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Citation: Prosser N, Petersen R, Quinlivan J (2016) Survey of Australian
Father’s Attitudes towards Infant Vaccination: Findings from the Australian
Father’s Study. Primary Health Care 6: 228. doi:10.4172/2167-1079.1000228
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