what is a thematic analysis of the data following? Participants’ responses to the question: How

what is a thematic analysis of the data following? Participants’ responses to the question: How should public health practitioners deal with parents who refuse immunization for their children? Public health practitioners should deal with parents who refuse immunization with respect, professionalism, and an understanding of their reasons for refusal, as these may result from fear created by misinformation about immunization or cultural beliefs. They should provide clear and accurate information about the safety and health benefits of immunization for their children, and address any specific fears the parents may have. This can help parents feel more confident and better understand health benefits of immunizing their children. “Public health practitioners should respond by trying to uncover the root of why parents refuse to immunize their children. For example, if parents refuse immunization because they fear it will cause their children to have other health conditions, I would suggest describing the realities of the disease for which they are refusing immunization. That way, parents might realize the greater risk of not vaccinating their children. I would also suggest that public health practitioners appeal to the data and history of the safety of immunizations. Many parents who are refusing vaccinations for their children have already been vaccinated. Public health practitioners could point out the protection the parents have had from diseases and how the parents do not have whatever they are scared their children will get from the immunizations. Public health practitioners should also focus on getting community leaders and influential people to support immunization openly. If the leaders parents look up to and trust support immunization, hesitant parents may reconsider their stance.” When parents refuse to immunize their children, it is the health practitioners’ job to educate the parents on the importance of vaccinations. Health practitioners should be respectful, acknowledging the parents’ fears and concerns without judgment while educating them with scientifically accurate information about the risks of being unvaccinated. It is also essential to encourage immunization using plain language that the parents can understand and encourage a conversation rather than confrontation, with the goal being to guide the parents towards reconsidering. Additionally, practitioners and offices can offer incentives, flexible vaccination scheduling, mobile clinics, and school visits with the overall goal of increasing accessibility for the parents if that is found to be the general concern. Parental vaccine hesitancy or refusal often stems from the desire to protect their child or to have autonomy over their child’s health choices. The first step in addressing parental concerns surrounding vaccinating their child is to listen to their concerns and feelings to better understand their perspectives. It is essential to acknowledge strong emotions from parents that may arise, which may be due to a multitude of factors such as generational trauma, mistrust of the medical community, misinformation, or political or religious beliefs. The next step is to approach the parent’s concerns gently, providing resources on the benefits of vaccination and guiding them step-by-step through to avoid the appearance of being too aggressive or judgmental. As public health or clinical practitioners, we are often guided by scientific information, specifically concerning vaccinations, and it can be easy to make assumptions or appear judgmental when discussing this information. It is vital to honor and recognize feelings a parent may have when discussing matters and decisions regarding their child’s health in order to foster a trusting relationship with parents. Practitioners should emphasize the risk that their children faces by not immunizing them. They can have informative sessions and an easy website to access, that do not place blame, but emphasize it is pivotal for their child’s health with facts from trusted health sources. They should also include anecdotes of parents who shared the same sentiment but then changed their minds and what led them to the decision. It gives them someone they can relate to. Public health practitioners need to more effectively promote vaccination through careful choices with vaccine promotion campaigns. Many new parents in this era have little knowledge of the virulence of diseases like measles. Showing the reality of the situation may help push parents to worry more about their child’s risk of getting sick. They should also emphasize that many communicable childhood diseases are entirely preventable – show how immunization has drastically decreased incidence of these diseases over the past century. Practitioners speaking one-on-one with skeptical parents should validate their worries rather than shame them. Explain that mistrust in vaccines is understandable given disinformation going around, and that people are always trying to do what’s best for their children, and preventing them from catching and spreading disease is what’s best. Public health practitioners should proceed carefully with parents who refuse immunizations for their children although understanding the reasons behind their refusal is important. For some parents, they may decline vaccines to their children because of religious values, personal experiences, misinformation of side effects, and/or distrust in vaccines. Public health practitioners should provide the parents evidence-based information that address common misconceptions around vaccinations using credible and reliable sources to relay the benefits of vaccines and the risk of preventable diseases. The strategy to handle these situations involve addressing vaccine information respectfully without parents becoming more resistant and remain comfortable with receiving. By maintaining a non-judgmental and educational approach, public health practitioners may be able to encourage parents to choose immunization, thus protecting their children’s health and their community. “I believe parents choose not to vaccinate their children for two main reasons: a lack of education on the benefits of vaccination and misinformation about its potential risks. If public health practitioners want to address vaccine hesitancy among parents, the most effective approach is to listen to their concerns. Understanding their specific fears and misconceptions allows public health officials to provide tailored, empathetic responses. Parents refuse to vaccinate their children for various reasons. Some believe vaccines are poorly studied, others think vaccinations are unnecessary, and some fear that vaccinating their children will do more harm than good. Regardless of the reason, the response must be individualized. It is the responsibility of public health officials to educate parents based on their specific concerns, correct misinformation, and foster an environment of open dialogue, ultimately helping parents make more informed decisions about their children’s health.” All health practitioners can do is make sure parents understand the weight of their decision. No one can force parents to administer any health service without their consent or their children’s. Not only should they be informed on the immunological repercussions associated with unvaccinated individuals, but social repercussions as well. Unless it’s a religious or medical decision, most schools require children to be vaccinated. To willingly not vaccinate children, sets them up to a life full of complications. Freedom of decision does not equate freedom of consequences. In extreme cases, were parents are knowingly making decisions that are harming and putting their children at risk, health practitioners may report the parents to Child Protective Services (CPS). From there, CPS will assess the situation and determine if any abuse has taken place. In situations where parents refuse to vaccinate their children, public health professionals should collect data on vaccination barriers by talking to parents in different communities about why they may not want to vaccinate their children (i.e. poll parents, talk with pediatricians, etc.). Then, targeted public health campaigns can be disseminated depending on whether vaccine hesitations are determined to result from misconstrued views, health literacy issues, or something else altogether. It is important for public health practitioners to have cultural competency when dealing with different populations. Parents who refuse to immunize their children most likely lack health literacy or are misinformed about vaccinations. Public health practitioners should try to speak to the parents and try to understand where their hesitancy comes from. Public health practitioners should try to ease parents’ concerns by providing them with evidence and discussing the adverse health outcomes that may arise from not being vaccinated. Public health practitioners should speak with community leaders to make it easier to gain parents’ trust. “When parents decline to vaccinate their children, public health professionals should respond with compassion, knowledge, and openness. Practitioners should listen to their concerns and try to understand the reason they are reluctant, whether it is due to personal experiences, cultural beliefs, or inaccurate information. Clear, evidence based information regarding the safety and effectiveness of vaccines can help dispel myths and build confidence. Furthermore, it’s critical to emphasize the advantages of vaccination for the community at large as well as for the child, stressing how vaccinations safeguard populations at risk and prevent disease that is fatal. Encouraging vaccination can also be accomplished by involving faith based organizations, community leaders, and other reliable sources. Creating an informed and transparent conversation that empowers parents to make decisions based on facts rather than fear is the ultimate objective.” Public practitioners should strongly provide their recommendations for immunization while respecting individual autonomy. The approach should be educational, not coercive, offering scientifically backed reasons for why immunization is critical for children’s health and the well being of the community. Practitioners can present real life examples or case studies to demonstrate the potential consequences of not immunizing children. It is important to facilitate open, non-judgmental communication, allowing parents to voice their concerns while addressing any misconceptions they may have. Building trust through empathetic and respectful conversation is key to fostering a positive relationship with parents where advice regarding immunization would be more easily accepted. To address the concern of parents refusing to vaccinate their children, public health practitioners should focus on increasing education and disseminating information through resources that such parents can trust. Most parents that refuse to vaccinate their children were fear-mongered or fed false information about the development of and impact of vaccines. Correct information about vaccines should be explained in clear, digestible language and even involve visuals so parents are more likely to understand the information. This information must go through the proper communication channels and be announced by people/agencies that these parents trust. Most of these parents are not fond of the central government or scientists. Thus, having this information spread to places where they frequent (i.e. childrens’ schools, grocery stores, community centers, online social media platforms, country/community clubs) may be more effective. “Public health practitioners need to address vaccine hesitancy with empathy and clear communication. Many parents refuse vaccines not because they oppose science but due to fear-mongering and misinformation, which have been amplified by social media and political divides. The current administration’s handling of public health has struggled to bridge this gap, as past policies have made vaccines a political issue rather than a public health priority. Misinformation spreads easily among those with limited healthcare access, deepening distrust. To combat this, public health efforts must focus on education, accessibility, and rebuilding trust in medical recommendations. My Vietnamese parents are pro-vaccine, but my mom is hesitant about the flu shot (she didn’t like my sister and I getting it for a long time) because it’ll make us sick and fear-mongering. Now, “”important”” figures like RFK Jr. and groups pushing “medical freedom” make people second-guess vaccines, feeding distrust. The current political climate doesn’t help, as vaccine debates are more about ideology than health. For people like my mom, it’s not about rejecting science but about feeling in control of her health decisions. Addressing hesitancy means tackling misinformation while understanding personal experiences and fears.” “Public health practitioners should address this by conducting informational sessions in communities with high rates of immunization refusal. To identify these areas, a nationwide cross-sectional survey can be used to gather data on parents’ concerns and reasons for opting out of vaccinations. These sessions should be structured around addressing common misconceptions, highlighting the risks of not immunizing children, and providing evidence-based information in an accessible manner. Trusted community figures, such as well-known doctors, religious leaders, and local advocates, should be involved to foster trust and credibility. Additionally, these sessions should feature parents who previously opposed immunization but later changed their stance, allowing them to share personal experiences and what led them to reconsider. This approach helps hesitant parents relate to others who were once in their position, making the discussion more persuasive. The sessions should be designed to educate rather than blame, creating a supportive environment where parents feel comfortable asking questions. Clear guidance should also be provided for those who decide to vaccinate their children, ensuring they have the necessary resources and assistance to take the next steps.” “Public health practitioners should prioritize communication with the parents. It is important to understand what exactly the parents think about vaccination and what their concerns are to be able to provide clear information about the benefits of immunization; and if necessary, provide proof/evidence of the effects of immunization. Furthermore, in some societies, it is important to build trust between practitioners and families. Involving trustworthy community leaders (religious leaders, mayors, head of community) in educating the community could be extremely helpful when trying to sensibilize parents about immunizations. It is also very important to get to the ‘target’ parents in order to have a tailored approach when engaging with them. There is so much misinformation and disinformation about healthcare and vaccines in particular, therefore practitioners should emphasize educating them about immunization.”

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