Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Mary K. Barger, PhD, MPH, RN, CNM, FACNM, Chairperson; Mary Jo Clark, PhD, RN, PHN, Committee Member; Eileen K. Fry-Bowers, PhD, JD, RN, CPNP, Committee Member


childhood immunization, vaccines, social ecological model, parents, standardized instrument


The success of childhood immunizations has led to a decrease in the visibility of the morbidity and mortality of vaccine-preventable diseases. Parents are questioning the validity and safety of vaccines resulting in significantly increasing numbers of underimmunized and unvaccinated children throughout the country. The purpose of this dissertation was to explore the perceptions of barriers to immunizations in parents with children, birth to 12 months of age presenting for a well-child or vaccinations-only visit to one of two pediatric primary care clinics located in San Diego County. The social ecological model was used to guide this dissertation. A cross-sectional, descriptive correlational study was conducted using the standardized instrument, Searching for Hardships and Obstacles To Shots (SHOTS), to measure parental barriers to childhood immunizations, delivered as a self-administered questionnaire in a web-based survey format. A response rate of 90.8% resulted in a total of 129 participant surveys being examined. Data were analyzed using descriptive and nonparametric inferential statistics. Study findings suggested that participants had considerable differences in overall perceptions of barriers to childhood immunizations. The SHOTS instrument construct contributing to the highest median scores across barriers to immunizations was ‘perceived concerns about childhood vaccines’. The lowest median scores were related to ‘perceived access issues'. These results suggested that participants perceived more barriers as concerns about vaccinations rather than issues of access to them. Furthermore, SHOTS scores suggested that for most parents, importance of immunizations was not considered a barrier to getting their child vaccinated. Participants’ responses to social ecological immunization-related survey items showed parental barriers to childhood immunizations are complex and influenced by more than intrapersonal (parent’s attitudes and beliefs about immunizations) factors. The findings of this study validate the need for tailored vaccine education and health policy interventions for this population. Nurses in pediatric clinics, preschools, and community health centers are in a unique position to develop innovative vaccine education programs and to advocate for health care policy interventions to ameliorate barriers related to concerns and promote immunization in this vulnerable population.

Document Type

Dissertation: Open Access



Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.