---
title: "Knowledge Predicts Parental Vaccine Hesitancy in Infants: Cross-Sectional Study from Piauí, Brazil"
id: "pubmed-42710148"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42710148"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42710148/"
doi: "10.1016/j.vaccine.2026.129127"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Knowledge Predicts Parental Vaccine Hesitancy in Infants: Cross-Sectional Study from Piauí, Brazil
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42710148
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42710148/)
- **DOI:** [10.1016/j.vaccine.2026.129127](https://doi.org/10.1016%2Fj.vaccine.2026.129127)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Investigators conducted a cross-sectional analytical study in Piauí, Brazil, with 452 parents or guardians of children in the first year of life, selected by cluster sampling and interviewed at home in 2025. - The research team used an adapted, previously validated questionnaire; **knowledge** was measured using six questions and categorized as low, moderate, or high. - **Vaccine hesitancy** was defined as at least one response compatible with any of five dimensions: confidence, complacency, convenience, communication, or context. - The cohort skewed to younger infants: 78.5% were aged zero to six months; most parents/guardians were female (88.5%) and non-White (82.7%). - Moderate knowledge was most common (55.8%); high knowledge occurred in 35.4% of respondents. - Overall hesitancy occurred in 31.4% of parents/guardians; hesitancy specific to the **COVID-19 vaccine** was 25.2%, while 6.2% related to other routine childhood vaccines. - Adjusted logistic regression showed higher odds of hesitancy among parents of children aged seven to 12 months (aOR 2.16; p = 0.002). - Higher education was associated with lower odds of hesitancy (aOR 0.79; p = 0.038); high **knowledge** was independently associated with reduced hesitancy (aOR 0.39; p = 0.015). - Authors concluded that greater parental understanding of vaccine-preventable diseases, safety, and expected reactions correlated with better vaccine adherence during the first year of life. - The study was cross-sectional; the source did not report longitudinal follow-up, vaccination uptake verification, or detailed item-response distributions for the knowledge questions.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 8. # Knowledge as a predictor of parental vaccine hesitancy during children's first year of life [Malena Gonçalves Almeida](https://pubmed.ncbi.nlm.nih.gov/?term=Almeida+MG&cauthor_id=42710148)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-1 "Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. Electronic address: malena.almeida@aluno.fiocruz.br."), [Beatriz Fátima Alves de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=Alves+de+Oliveira+BF&cauthor_id=42710148)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-2 "Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil."), [Eugênio Barbosa de Melo Júnior](https://pubmed.ncbi.nlm.nih.gov/?term=de+Melo+J%C3%BAnior+EB&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Ana Raisla de Araújo Rodrigues](https://pubmed.ncbi.nlm.nih.gov/?term=de+Ara%C3%BAjo+Rodrigues+AR&cauthor_id=42710148)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-4 "Department of Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Nelson Flecha Lugo](https://pubmed.ncbi.nlm.nih.gov/?term=Lugo+NF&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Paulo de Tarso Moura Borges](https://pubmed.ncbi.nlm.nih.gov/?term=Moura+Borges+PT&cauthor_id=42710148)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-5 "Department of Specialized Medicine, Federal University of Piauí, Teresina, PI, Brazil."), [Antonio Rosa de Sousa Neto](https://pubmed.ncbi.nlm.nih.gov/?term=de+Sousa+Neto+AR&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Telma Maria Evangelista de Araújo](https://pubmed.ncbi.nlm.nih.gov/?term=Evangelista+de+Ara%C3%BAjo+TM&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#full-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil.") Affiliations Expand ### Affiliations * 1 Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. Electronic address: malena.almeida@aluno.fiocruz.br. * 2 Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. * 3 Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil. * 4 Department of Nursing, Federal University of Piauí, Teresina, PI, Brazil. * 5 Department of Specialized Medicine, Federal University of Piauí, Teresina, PI, Brazil. * PMID: **42710148** * DOI: [ 10.1016/j.vaccine.2026.129127 ](https://doi.org/10.1016/j.vaccine.2026.129127) Free article Item in Clipboard # Knowledge as a predictor of parental vaccine hesitancy during children's first year of life Malena Gonçalves Almeida et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42710148/) . 2026 Oct 24:92:129127. doi: 10.1016/j.vaccine.2026.129127. Epub 2026 Sep 8. ### Authors [Malena Gonçalves Almeida](https://pubmed.ncbi.nlm.nih.gov/?term=Almeida+MG&cauthor_id=42710148)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-1 "Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. Electronic address: malena.almeida@aluno.fiocruz.br."), [Beatriz Fátima Alves de Oliveira](https://pubmed.ncbi.nlm.nih.gov/?term=Alves+de+Oliveira+BF&cauthor_id=42710148)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-2 "Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil."), [Eugênio Barbosa de Melo Júnior](https://pubmed.ncbi.nlm.nih.gov/?term=de+Melo+J%C3%BAnior+EB&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Ana Raisla de Araújo Rodrigues](https://pubmed.ncbi.nlm.nih.gov/?term=de+Ara%C3%BAjo+Rodrigues+AR&cauthor_id=42710148)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-4 "Department of Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Nelson Flecha Lugo](https://pubmed.ncbi.nlm.nih.gov/?term=Lugo+NF&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Paulo de Tarso Moura Borges](https://pubmed.ncbi.nlm.nih.gov/?term=Moura+Borges+PT&cauthor_id=42710148)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-5 "Department of Specialized Medicine, Federal University of Piauí, Teresina, PI, Brazil."), [Antonio Rosa de Sousa Neto](https://pubmed.ncbi.nlm.nih.gov/?term=de+Sousa+Neto+AR&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil."), [Telma Maria Evangelista de Araújo](https://pubmed.ncbi.nlm.nih.gov/?term=Evangelista+de+Ara%C3%BAjo+TM&cauthor_id=42710148)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42710148/#short-view-affiliation-3 "Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil.") ### Affiliations * 1 Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. Electronic address: malena.almeida@aluno.fiocruz.br. * 2 Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. * 3 Graduate Program in Nursing, Federal University of Piauí, Teresina, PI, Brazil. * 4 Department of Nursing, Federal University of Piauí, Teresina, PI, Brazil. * 5 Department of Specialized Medicine, Federal University of Piauí, Teresina, PI, Brazil. * PMID: **42710148** * DOI: [ 10.1016/j.vaccine.2026.129127 ](https://doi.org/10.1016/j.vaccine.2026.129127) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Objective:** To analyze knowledge about childhood vaccination as a predictor of vaccine hesitancy among parents or guardians of children in the first year of life. **Methods:** This cross-sectional analytical study was conducted in Piauí, Brazil, with 452 parents or guardians of children in the first year of life, selected by cluster sampling. Data were collected in 2025 through household interviews using an adapted and previously validated form. Knowledge was assessed using six questions and classified as low, moderate, or high. Vaccine hesitancy was defined as at least one response compatible with any dimension: confidence, complacency, convenience, communication, or context. Descriptive and inferential analyses were performed. Logistic regression was used with vaccine hesitancy as a dichotomous dependent variable (yes/no), estimating crude and adjusted odds ratios with 95% confidence intervals and a 5% significance level in the final model. **Results:** Most children were aged zero to six months (78.5%) and were male (52.2%). Most parents or guardians were female (88.5%) and had non-White race/skin color (82.7%). Moderate knowledge was most frequent (55.8%), followed by high knowledge (35.4%). Overall vaccine hesitancy occurred in 31.4% of parents or guardians, with 25.2% specific to the COVID-19 vaccine and 6.2% related to other vaccines in the childhood immunization schedule. Parents or guardians of children aged seven to 12 months had higher odds of vaccine hesitancy (aOR: 2.16; p = 0.002), whereas higher education (aOR: 0.79; p = 0.038) and high knowledge (aOR: 0.39; p = 0.015) were associated with lower odds of hesitancy. **Conclusion:** Vaccine hesitancy among parents or guardians of children in the first year of life was substantial and mainly related to COVID-19 vaccination. Lower odds among those with high knowledge and higher education reinforce that understanding childhood vaccination, especially vaccine-preventable diseases, safety, and expected reactions, is important for vaccine adherence during this period. **Keywords:** Infant; Knowledge; Parents; Vaccination hesitancy; Vaccination refusal. Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Parental hesitancy and refusal toward routine childhood vaccination after the COVID-19 vaccination period: a cross-sectional study. ](https://pubmed.ncbi.nlm.nih.gov/42286487/) Eliaçık OE, Çöme O, Günvar T.Eliaçık OE, et al.BMC Prim Care. 2026 Jun 12;27(1):310. doi: 10.1186/s12875-026-03418-y.BMC Prim Care. 2026.PMID: 42286487Free PMC article. * [ Factors associated with parental literacy and hesitancy toward pediatric vaccination. ](https://pubmed.ncbi.nlm.nih.gov/40604612/) Zheng Y, Frew PM, Wang D, Eiden AL.Zheng Y, et al.BMC Public Health. 2025 Jul 2;25(1):2201. doi: 10.1186/s12889-025-23410-y.BMC Public Health. 2025.PMID: 40604612Free PMC article. * [ Characteristics of Vaccine-Hesitant and Nonhesitant Parents in Italy: A Cross-Sectional Study. ](https://pubmed.ncbi.nlm.nih.gov/41662273/) Magi CE, Poliani A, Campoli A, Marcomini I, Villa G, Bambi S, Rasero L, Iovino P, Longobucco Y.Magi CE, et al.Nurs Res. 2026 Jul-Aug 01;75(4):E216-E224. doi: 10.1097/NNR.0000000000000890. Epub 2026 Feb 9.Nurs Res. 2026.PMID: 41662273Free PMC article. * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ COVID-19 vaccination hesitancy in pediatrics: a systematic review. ](https://pubmed.ncbi.nlm.nih.gov/41998754/) Amanat N, Hosseini SH, Habibisaravi R, Omrani MG.Amanat N, et al.Syst Rev. 2026 Apr 18;15(1):179. doi: 10.1186/s13643-026-03110-3.Syst Rev. 2026.PMID: 41998754Free PMC article. 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