COVID-19 vaccination in children aged 5-11: a systematic review of parental barriers and facilitators in Western countries.

Background: Parental decision-making regarding vaccination, particularly for coronavirus-19 (COVID-19) where significant debate surrounds children aged 5-11, is influenced by various factors. Understanding the motivations behind parents' vaccination choices for their children is crucial for maintaining vaccine uptake, in line with the National Health Service United Kingdom vaccination strategy.

Objectives: The present systematic review aims to identify the barriers and facilitators affecting parents' decisions to vaccinate children aged 5-11 against COVID-19 in Western countries.

Data sources and methods: The first search was conducted using PsychINFO, MEDLINE and Google Scholar in June 2023 with an additional follow-up search a year later in June 2024 for full-text papers focusing on COVID-19 vaccine decision-making among parents or caregivers of children aged 5-11. The language of the included studies was set as English and originating from Western countries specifically examining barriers and facilitators to COVID-19 vaccination, excluding children with chronic conditions. The risk of bias was independently assessed by both authors using the JBI Checklist for Prevalence Studies, with disagreements resolved through discussion.

Results: A total of four cross-sectional questionnaire studies involving a total of 5,812 participants from Western countries (the United States and Europe) were included in the present review. Only 46.35% of parents intended to vaccinate their children aged 5-11 against COVID-19. The primary barriers identified were concerns about side effects and distrust in institutions. Key facilitators included recommendations from healthcare professionals and parents' own COVID-19 vaccination status. Demographic factors including ethnicity and gender showed mixed influence.

Conclusion: Persistent concerns about side effects and institutional distrust have reduced parental intention to vaccinate their children. However, healthcare professionals play an important role in increasing vaccine uptake through recommendations to their patients. Future interventions should focus on equipping healthcare professionals with the necessary tools to effectively promote vaccination and address parental concerns about side effects.