"Your child will have a bird brain!": Vaccination choices and stigma among vaccine enquirers in Sweden: A qualitative study.

Background: Substantial research has explored reasons for vaccination delay or refusal. However, little attention has been paid to the process and implications of the choices. The aim of this research was to understand parent's vaccination choices and implications of their choices through the lens of the concept of stigma and health behaviours.

Methods: This is a qualitative study drawing on five focus group discussions and 17 in-depth interviews. Data was collected in an area South of Stockholm that has experienced lower rates of vaccination and is home to some people who are partly inspired by anthroposophical values. The data was analysed following reflexive thematic analysis.

Results: (1) Vaccine enquirers make an informed decision about their vaccination choices. They negotiate different sources, question science, ask for more information and are largely content with their decision. (2) Values and norms influence vaccination decisions; these include anthroposophical health beliefs, and they partly influence the way in which risk is balanced. Trust influences vaccination decisions but trust expresses itself in complex ways. (3) Vaccination related stigma; expressed through fear of being labelled, conflicts with family and friends, feeling lonely with the decision, and avoidance to discuss vaccination choice. (4) Vaccination related stigma was found in the healthcare setting too, expressed by participants working in the health system as well as parents who experienced disrespect and labelling when expressing vaccine choices or seeking healthcare with an unvaccinated child. Participants describe their community as a safe haven where different vaccination choices are respected.

Conclusion: The study found that vaccine enquirers are individuals who make an active choice to delay or decline vaccination. They are not uncertain or hesitant but rather consider themselves well-informed. The study also found different forms of stigma related to vaccination choices. Further research may be helpful to understand implications of vaccination related stigma on health and other vaccination decisions.