Assessing the role of parental knowledge, attitudes, and practices in childhood immunization: a global review of determinants and health outcomes

Parental knowledge, attitudes, and perceptions (KAP) significantly influence childhood immunization uptake. Rising concerns about vaccine hesitancy over the past decade have underscored the need to better understand these factors globally. This study synthesizes evidence on how parental KAP impacts childhood vaccination coverage across diverse socioeconomic and geographic contexts. A narrative review was conducted using literature published between 2014 and 2024. Sources included peer-reviewed journals, reports from global health agencies, and national surveys accessed via PubMed, Scopus, WHO databases, and regional studies. Keywords included “childhood,” “knowledge,” “attitudes,” “perception,” “parents,” and “immunization.” Findings reveal considerable variation in parental KAP across countries. Higher educational attainment and income levels were generally associated with more positive vaccination attitudes. In contrast, limited knowledge, misinformation from non-medical sources, gender-based beliefs, and safety concerns contributed to vaccine hesitancy in lower-income settings. Notably, fears related to vaccine side effects, preference for single-dose schedules, and mistrust of pharmaceutical companies were common barriers. Improving parental KAP is critical to advancing global childhood immunization efforts. Tailored interventions, particularly those enhancing health education, provider communication, and community engagement, are necessary to address context-specific barriers and improve vaccine uptake.