Immunisation is universally acknowledged as one of the most cost-effective and powerful public health strategies to reduce morbidity and mortality among children. By safeguarding children against life-threatening infectious diseases, immunisation serves not only as a medical intervention but also as a crucial pillar of national health policy. In the Indian context, the Universal Immunisation Programme (UIP) aims to provide equitable vaccine access to all children. However, despite its wide reach and government support, disparities in immunisation coverage remain, often stemming from parents' lack of knowledge and misconceptions about vaccines [1].

Parental awareness is fundamental to the success of immunisation campaigns. Numerous studies in India highlight that a parent's knowledge, attitude, and beliefs about vaccines greatly influence their child’s immunisation status. In a cross-sectional study from South India, over 80% of parents lacked awareness about newer vaccines not included in the national schedule. Misconceptions about vaccine efficacy and fear of side effects were commonly reported, especially among those with lower educational levels [2]. Similarly, in North Karnataka, researchers found that while a majority of mothers were aware of basic vaccines like BCG and Polio, knowledge about other vaccines and their schedules was significantly lower [3].

The gap in parental knowledge is not just a matter of access to services, but also of health literacy. In a Tamil Nadu-based study, although 60% of children were fully immunised, one-fifth of parents expressed doubts about vaccine safety, and a significant number believed that immunisation could cause long-term side effects [4]. These perceptions are influenced by multiple factors, including maternal education, socioeconomic status, and exposure to reliable health information. In fact, studies consistently reveal that higher maternal education levels correlate strongly with better vaccine knowledge and compliance [5].

The knowledge-attitude-practice (KAP) gap is evident across multiple regions. In a recent study in Dehradun, even though 84.5% of parents had average to good knowledge about immunisation, nearly 20% had missed scheduled vaccine doses for their children. The most frequently cited reasons included lack of awareness about the next dose, illness in the family, and unavailability of vaccines at health centres [6]. This indicates that knowledge alone may not always translate into timely vaccination unless supported by systemic infrastructure and reminder mechanisms.

Moreover, in urban slum settings, where healthcare access is more erratic, misinformation and lack of motivation among parents significantly contribute to low immunisation coverage. In a study conducted in Bijapur, only 34.8% of children were fully immunised. The most prominent barrier was lack of information about immunisation schedules, demonstrating the urgent need for grassroots-level health education interventions [7].

Digital and mobile-based awareness campaigns have shown potential in bridging this gap. A study evaluating the Kilkari maternal messaging program in rural Madhya Pradesh found that exposure to mobile-based health messages improved male caregivers’ knowledge and enhanced the timeliness of child vaccination at birth [8]. However, these digital interventions need to be scaled up with local language support and tailored content to maximise their impact.

Despite government efforts like the Mission Indradhanush to improve immunisation coverage, India still has a significant number of unimmunised or partially immunised children. A recent study from Maharashtra identified key factors affecting immunisation uptake, such as maternal education, family income, and birthplace of the child [9]. Similarly, research from Amritsar found a stark contrast between low knowledge and relatively better immunisation practices, pointing toward the impact of institutional support in driving compliance despite knowledge gaps [10].

Given these insights, it becomes imperative to systematically assess the knowledge and perceptions of parents through well-designed questionnaire studies. Such assessments can reveal the nuanced barriers to immunisation uptake and inform targeted public health strategies. Moreover, understanding demographic correlates—such as parental education, occupation, and residence—can help in tailoring communication and outreach efforts.

METHODOLOGY

1. Study Design

This was a cross-sectional observational study using a structured questionnaire to assess the knowledge and perception of parents of under-five children regarding the immunisation schedule.

2. Study Setting

The study was conducted at the Immunisation Clinic of Gulbarga Institute of Medical Sciences (GIMS), Kalaburagi, Karnataka, a tertiary healthcare facility serving both rural and urban populations.

3. Study Duration

Data collection was carried out over six months, from September 2024 to February 2025, covering routine immunisation sessions and ensuring a steady participant flow.

4. Participants – Inclusion/Exclusion Criteria

Parents or caregivers of under-five children visiting the clinic and consenting to participate were included. Those who refused consent or were unable to respond meaningfully were excluded.

5. Sampling Method

Convenience sampling was used, enrolling eligible parents present at the clinic during the data collection period.

6. Sample Size

A total of 100 parents were enrolled, based on clinic footfall and study feasibility within the specified duration.

7. Study Groups

No intervention or control groups were created. Participants were later grouped by demographic variables during data analysis.

8. Study Parameters

The study assessed knowledge of immunisation schedules, vaccine names, side effects, and perceptions regarding safety and importance of vaccines.

9. Study Procedure

Eligible participants were informed, consented, and given a questionnaire in their preferred language. Each interview took about 15–20 minutes.

10. Data Collection

Data were collected using a pre-tested structured questionnaire through interviews. Responses were recorded on paper and digitised for analysis.

11. Data Analysis

Data were analysed using SPSS software. Descriptive statistics and inferential tests like Chi-square and ANOVA were applied with significance at p < 0.05.

12. Ethical Considerations

Ethical approval was obtained. Informed consent was taken from each participant, ensuring confidentiality and voluntary participation throughout the study.

RESULTS

1. Age-wise Distribution of Children

The majority (72%) of children receiving immunization were aged 1–5 years, indicating higher attendance for booster doses in later stages of the immunization schedule. This highlights the importance of early reminders for timely infant vaccination (Table 1).

Table 1: Age-wise Distribution of Children

Graph 1: Age-wise Distribution of Children

2. Parental Perception of Vaccine Safety

A high proportion (81%) of parents believed vaccines are safe, reflecting overall positive attitudes toward immunization in the community (Table 2).

Table 2: Parental Perception of Vaccine Safety

Graph 2: Parents’ Opinion on the Safety of Vaccines

3. Parental Adherence to Vaccination Schedule

90% of parents reported following the immunization schedule, indicating strong program compliance and effective health service delivery (Table 3).

Table 3: Parental Adherence to Vaccination Schedule

Graph 3: Compliance with Vaccination Schedule Among Parents

4. Parental Trust in Healthcare Workers Regarding Immunization

An overwhelming 95% of parents expressed trust in healthcare workers, emphasizing their vital role in promoting vaccine acceptance (Table 4).

Table 4: Parental Trust in Healthcare Workers Regarding Immunization

Graph 4: Level of Trust in Healthcare Workers Among Parents

5. Belief That Vaccines Cause Side Effects vs. Immunization Status of Previous Child

Although 67% believed vaccines cause side effects, this perception did not significantly affect immunization completion, indicating that side effect concerns may not be a major deterrent (Table 5).

Table 5: Belief That Vaccines Cause Side Effects vs. Immunization Status of Previous Child

Graph 5: Perceived Side Effects and Immunization Status

DISCUSSION

This study explored parents’ knowledge, perception, and adherence related to childhood immunization in an Indian setting. The results demonstrate a generally favorable outlook on immunization among parents, with strong trust in healthcare workers and high compliance rates, aligning well with prior Indian studies.

Firstly, the age-wise distribution shows that 72% of children attending immunization services were aged 1–5 years. This finding is consistent with the study by Jayaraj et al. (2023), which reported that while children are generally vaccinated, delays in early infant immunization remain common due to lack of timely reminders and awareness [4]. This highlights the need for improving outreach in the first year of life.

Secondly, 81% of parents in this study believed vaccines are safe. This mirrors findings from Parvathy Devi et al. (2022), where 98.1% of parents acknowledged vaccine safety and disease prevention benefits [11]. Similarly, a study by Akunuri & Dayal (2016) also noted overall positive attitudes but emphasized that concerns about side effects and lack of knowledge about optional vaccines persisted [2].

Parental compliance with the vaccination schedule was found to be 90% in this study, echoing results from Jelly et al. (2023), where although knowledge was not perfect, the majority of parents ensured their children were vaccinated on time [6]. High adherence despite knowledge gaps may reflect the success of healthcare worker outreach and routine reminders.

Trust in healthcare providers was also high at 95%, supporting earlier findings by Patil et al. (2018), where doctors were identified as the primary and most trusted information source [1]. This reinforces the importance of leveraging health workers in community sensitization efforts.

Interestingly, while 67% of parents believed vaccines might cause side effects, this did not significantly influence immunization rates, suggesting that awareness of mild side effects does not necessarily translate to hesitancy—an encouraging sign compared to other studies where fear of adverse effects led to delays or refusals (Kaur, 2018) [10].

CONCLUSION

The study highlights that while parental concerns about vaccine side effects exist, they do not significantly deter immunisation uptake when supported by trust in healthcare providers. High levels of adherence and positive attitudes reflect the success of public health interventions at the grassroots level. Nevertheless, to achieve universal immunisation, continuous education, timely reminders, and infrastructure strengthening—especially in early infancy—remain essential. The findings underscore the importance of community-centric strategies to close the knowledge-practice gap and ensure timely, complete vaccination for all children.

REFERENCES

1. Patil R, Maheshwari D, Patel B. Knowledge and awareness of parents about universal immunization program and optional vaccines: a cross-sectional study in Central India. Indian J Basic Appl Med Res. 2018;7(2):585-593.
2. Akunuri S, Dayal A. What do parents think? Knowledge and awareness about newer vaccines: a cross-sectional study in South Indian city. Int J Contemp Pediatr. 2016;3(4):1301-1306.
3. John N, John N, Midhunya JV, Doddayya H. Child immunization: knowledge among mothers in a North Karnataka hospital. J Drug Deliv Ther. 2022;12(1):n.p.
4. Jayaraj J, Ganesan S, Geminiganesan S. Knowledge, attitude and practices regarding immunization among parents with children in the age group 12 to 24 months. Int J Community Med Public Health. 2023;10(5):1892-1896.
5. Panchal R, Gaikwad A. Assessment of knowledge and barriers regarding immunization among parents visiting the paediatric OPD. J Nurs Sci Pract. 2015;5(1):29-33.
6. Jelly P, Jeenwal N, Wadhwa N, Kumari N, Kumari P, Mathur P, et al. Knowledge, attitude, compliance and barriers of immunization among parents of under-five children. Int J Afr Nurs Sci. 2023;20:100608.
7. Angadi MM, Jose AP, Udgiri R, Masali KA, Sorganvi V. A study of knowledge, attitude and practices on immunization of children in urban slums of Bijapur city, Karnataka, India. J Clin Diagn Res. 2013;7(12):2803-2806.
8. Chakraborty A, Mohan D, Scott K, Sahore A, Shah N, Kumar N, et al. Does exposure to health information through mobile phones increase immunisation knowledge, completeness and timeliness in rural India? BMJ Glob Health. 2021;6(6):e005489.
9. Rane SS, Shinde AA, Mhaske SN. Factors affecting parent’s awareness regarding paediatric immunization: a cross sectional study. VIMS Health Sci J. 2023;9(2):n.p.
10. Kaur G. An exploratory study to assess the knowledge and practices regarding immunization among mothers of infants attending pediatric OPD of Bebe Nanaki Mother and Child Care Centre, Guru Nanak Dev Hospital, Amritsar. Asian J Nurs Educ Res. 2018;8(3):379-384.
11. Devi P, Manohar S, Lavanya R, Pasupathy S. Knowledge, Attitude and Practices on Childhood Immunisation among Parents Attending Paediatric OPD at a Tertiary Care Centre, Kanchipuram District, Tamil Nadu, India. Indian J Neonatal Med Res. 2022;10(1):PO10–4.