Parental decision-making regarding childhood vaccination in Chile: a qualitative study

Parental decision-making regarding childhood vaccination is a complex process shaped by multiple individual, social, and contextual factors that vary across settings. These dynamics have become increasingly complex in the post–COVID-19 context, characterized by heightened public scrutiny of vaccines and mandates, evolving forms of trust alongside growing institutional skepticism, and greater exposure to conflicting and rapidly changing information environments. Chile represents an analytically relevant case for examining these dynamics, given its historically high childhood immunization coverage and a strong National Immunization Program that includes a broad set of mandatory vaccines. This study used a qualitative design to explore parental vaccination decision-making in Chile. A total of 74 parents from three regions of Chile participated in focus groups or semi-structured interviews. Data were analyzed using Template Analysis, guided by sensitizing concepts related to individual, social, and contextual factors outlined in the interview and focus group guides, and remaining open to inductively emerging patterns from participants’ accounts. To examine variation in how parents articulated and justified their decisions, participants were grouped into three vaccination orientations: accepting, hesitant, and selective. No participants reported complete rejection of all childhood vaccines. Six key factors shaping parental vaccination decision-making were identified: (1) medical and public health system expertise, (2) institutional mandates, (3) social circle influences, (4) information environments, (5) experiential and emotional factors, and (6) structural constraints. Although many parents expressed strong trust in healthcare professionals and public health institutions, compliance with mandatory vaccines did not necessarily reflect full confidence in vaccination policies. Among selective parents in particular, adherence to required vaccines often reflected pragmatic conformity to institutional rules rather than active endorsement. Additionally, selective uptake appeared to be shaped not only by hesitancy but also by access-related constraints, particularly for vaccines outside the national immunization schedule. This study highlights the importance of distinguishing between compliance, confidence, and access in highly regulated immunization contexts. The findings have implications for public health communication and immunization policy, particularly in settings where mandatory and non-mandatory vaccines coexist.