The State of Parents’ Knowledge About COVID-19 Vaccination in Children

Prerequisites and approaches for raising the willingness to vaccinate in Germany

Vaccinating underage children against SARS-CoV-2 can contribute to preventing (long term) illnesses in children (1), to reducing the spread of the virus, and to accelerating herd immunity in the long term (2). Whether parents have their child vaccinated also depends on how well informed they are about COVID-19 vaccination for children and how they deal with this information (3). Their health literacy—that is, their ability to find information, to understand it, to assess it, and to reach a decision based on it, is crucial in this setting. We compared representative collected statements from parents to assess their own knowledge and health literacy regarding COVID-19 vaccination in children with statements of adults without children regarding COVID-19 vaccination in general. We formulate initial starting points for communicating more effectively with parents and motivating them to have their children vaccinated.

Methods

The Federal Centre for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BZgA) carried out a representative survey regarding COVID-19 vaccination in children from 7 September to 5 October 2021 (n=1500 parents of underage children in Germany). The data were collected in computer assisted telephone interviews (CATI) with a dual frame approach, as well as in online surveys (computer assisted personal interviews, CAWI) from an actively recruited pool of persons who had consented to participation in online surveys (online access panel, Norstat). Simultaneously, persons without underage children (aged 16–65 years; n=1464) were questioned about COVID-19 vaccination in general.

In the survey of parents, data were collected of their own assessment of how well informed they were and of their ability to find information on COVID-19 vaccination in children, understand this information, evaluate it, and come to a vaccination decision on the basis—this was done on the basis of the dimensions of the validated construct health literacy (4). The persons without underage children were asked the same questions, but relating to COVID-19 vaccination in general. In addition to the parents’ vaccination status, the parental need for information on COVID-19 vaccination in children and preferred information channels for this purpose were included in the analyses, as were communications with pediatricians or general practitioners. The statistical significance of between-group differences in the frequency data were analyzed by using the overlap of the 95% confidence intervals. We used contingency tables for complex samples, which were calculated for weighted data. The data were weighted according to the distribution of age, sex, education status, and federal state of all parents in Germany.

Results

In the parent sample, 1216 parents were vaccinated (81%) and 284 parents (19%) were unvaccinated.

Subjective state of knowledge and health literacy regarding vaccination in general and regarding childhood vaccination

Of the parents in the survey, almost half (48%) reported that they were (very) well informed about COVID-19 vaccination in children; a quarter (24%) felt very (very) poorly informed. Persons without underage children reported notably more often (81%) that they were (very) well informed and notably more rarely (5%) (very) poorly informed—but this was regarding COVID-19 vaccination in general. Parents also assessed their own health literacy—the ability to find information, understand it, evaluate it, and reach a decision regarding COVID-19 vaccination in children on that basis—as much lower than did persons without children regarding COVID-19 vaccination in general (Table 1).

Table 1

Subjective perception of knowledge and health literacy regarding COVID-19 vaccination of persons without underage children and parents of underage children (vaccinated and unvaccinated)

Subjective state of knowledge and health literacy in vaccinated versus unvaccinated parents

Compared with vaccinated parents, unvaccinated parents felt notably more rarely (very) well and more often (very) poorly informed regarding COVID-19 vaccination in children. We saw no differences in estimating health literacy between unvaccinated and vaccinated parents (Table 1).

Information needs and preferred information channels of vaccinated and unvaccinated parents

Vaccinated and unvaccinated parents name the same topics on which they would like further information, but in a slightly different order. This is information on side effects, safety, possible long-term sequelae of COVID-19 vaccination in children, and duration and effectiveness of vaccine protection (Table 2). Furthermore, they prefer similar information channels: medical staff was mentioned most often as the information source, but at the time of the survey, half (46% of vaccinated parents, 58% of unvaccinated parents) had not yet discussed vaccinating their children with a pediatrician or GP. Further preferred information channels are the websites of public health institutions (for example, the Federal Ministry of Health, Robert Koch-Institute, Federal Centre for Health Education), of health insurance companies or health authorities (Table 2). About two thirds of parents whose children attend school or nursery think it is necessary that those institutions also provide information on vaccinating children.

Table 2

Information needs and preferred information channels of parents of underage children (vaccinated versus unvaccinated); proportions of agreement in per cent

Discussion

The recommendations of Germany’s Standing Committee on Vaccination (STIKO) and study results of the efficacy and safety of the COVID-19 vaccine in children have become available only recently. For this reason, parents consider themselves underinformed about COVID-19 vaccination in children; they assess their health literacy as low and their need for information as great. This should be tackled in a targeted fashion so as to enable parents to reach an informed decision, jointly with their children, in favor of or against COVID-19 vaccination. This is especially—but not exclusively—the case for educating unvaccinated parents. Pediatricians and GPs, but also teaching staff and (school) healthcare workers have an important active role in this setting because they are widely accepted as information sources (4). Targeted attention/appeals, sharing information, support when sourcing information, and invitations to parents to talk can be effective. Existing materials to support these multipliers should therefore be widely distributed and extensively publicized in primary care and multipliers in the education system.

Carolin Muschalik, Boris Orth, Christina Merkel, Freia de Bock, Ursula von Rüden

Bundeszentrale für gesundheitliche Aufklärung, Referat Q3 – Evaluation, Methoden, Forschungsdaten, Köln ([e-mail])

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 9 December 2021, revised version accepted on 31 January 2022.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Muschalik C, Orth B, Merkel C, de Bock F, von Rüden U: The state of parents’ knowledge about COVID-19 vaccination in children—prerequisites and approaches for raising the willingness to vaccinate in Germany.

Dtsch Arztebl Int 2022; 119: 226–7. DOI: 10.3238/arztebl.m2022.0127

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