This document presents a research proposal assessing current approaches to childhood immunization. The study will use a community-based cross-sectional design to examine factors associated with partial immunization of children under five, such as mothers' knowledge, beliefs, religion, and education level. A sample of mothers will be surveyed using random stratified sampling. Correlation analyses will examine relationships between vaccination hesitancy and demographic factors. The results could help identify digital methods for tracking under-vaccinated children and inform future health policy. Limitations include potential recall bias and the time needed for data collection.

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Assessing Current Approaches to Childhood Immunizations
Department of Psychology, Grand Canyon University
PSY-550: Research Methods
Dr. Shari Schwartz
May 19, 2021
Introduction
Immunization is the process in which an individual is protected
against disease, and it is done via vaccination. On the other
hand, vaccination is the action of a vaccine being introduced
into the body to produce immunity to a particular disease. A
vaccine is a product that arouses the immune system of an
individual, thus the production of immunity to a particular
disease. The immunity thus protects the individual from that
disease. Immunity is the protection from a disease that is
infectious. Child immunization is the primary public health
approach in the reduction of child mortality and morbidity.
Assessment of the current approaches that are linked to the
immunization of a child is essential. Globally, primary
immunization is estimated to prevent approximately 2.5 million
childhood deaths annually from tetanus, diphtheria, measles,

2. and pertussis (Dube et al., 2013). Immunization succession is
always accompanied by rejection of public health practices, and
reasons for these have never been straightforward. Some of the
motivations are religious, scientific, or even political. To
reduce the incidence and prevalence of vaccine-preventable
diseases, vaccination programs depend on a high uptake level.
Vaccination offers protection for vaccinated individuals. When
there are high vaccination coverage rates, the indirect protection
rate is stimulated for the overall community (Dube et al.,
2013).Literature Review
Despite this massive use, immunization coverage in countries
still developing has been reported to be still low. If mothers
were educated on the importance of these vaccine services to
their children, all the children would receive immunization as
per the Expanded Program on the Immunization schedule, hence
preventing mortality and morbidity. According to Thapar et al.,
in 2014, approximately an 18.7million children could not get
the third dose of the Diphtheria-Pertussis-Tetanus (DPT3)
vaccine. The total percentage of children who are one year and
below and have to receive their dosses of DPT3 vaccine is seen
as a proxy indicator regarding full immunization. The DPT3
estimates assess the health system performance and measure the
immunization program effectiveness regarding service delivery.
These strategies are thus used in the implementation of
strategies for the elimination and eradication of diseases.
According to Thapar et al., the global coverage for DPT1 and
DPT3 was 90% and 86%, respectively, while that of measles
first dose at 86%.
The above estimates thus do not replicate the seen differences
in vaccine coverage. The coverage of DPT1 and DPT3 varied
from 84% and 76% in Africa and 97% and 94% in the European
countries. In India, the routine has been lower than in the rest of
the countries. Following the 2013 outbreak in Israel, many
parents were reluctant to take their children to vaccinate Oral
Polio Vaccine afterward, and thus, poliomyelitis seemed to be
reoccurring due to this. To attain maximum immunization

3. coverage, the global vaccine action plan (GVAP) asked
countries to try and accomplish 90percent immunization
coverage by 2020 for all vaccines. Out of 194 country members
of the world health organization, only 129 achieved the
coverage goal of GVAP national vaccination. Immunization
coverage in all the world countries has been stable since 2010,
with 85 to 86 percent. Despite the high rate of childhood
vaccination coverage, some estimates hide groups of under-
vaccinated children due to parents' hesitance. In recent years, a
lot has been investigated, and the word vaccine hesitance has
been formed, but evidence that has been found in regards to
factors that link to vaccine hesitance has not been thoroughly
investigated. This research will help adopt a more panoramic
lens so that these factors can be brought into focus and know -
how they look globally.
Many factors are inducing the uptake of vaccines among the
parents of the children. They include the pain, ethnic concerns
of the vaccine, fever, and adverse effects of the vaccines that
come about after a child has been immunized, and most of them
lead to vaccine hesitancy in most countries. The spread of
vaccine fear and ant vaccine has become common, mostly on
online platforms and people. In terms of vaccine policy, vaccine
attitudes and behaviors are differentiated from one another even
though they might be slightly related. Attitudes towards
vaccination may be different from actual behaviors as a mother
who pursues vaccination for both her children, and she may be
displaying pro-vaccine behavior, but at the same time, they may
be hesitant to receive the same vaccines. In such a case, the
mother’s behavior may be that it is just a school requirement
that she is to follow; otherwise, she would not opt to receive the
vaccine if it were not that way. Simultaneously, the attitudes
that drive her to vaccine hesitancy may be due to science,
influence in personalities she trusts, matters of religion, and
skepticism. The primary focus of this proposal is the group of
parents who hold vaccine-hesitant attitudes and exhibit non-
vaccinating behaviors for their children. Parents who refuse

4. their children to be vaccinated always defend their positions
based on their beliefs (Girmay and Dadi 2019). Parents have
their reasons for vaccinations; others believe that vaccines will
ruin instead of helping their child, while others believe that
natural immunity is better than an artificial one. According to
Gesser-Edelsburg et al., the risk of the public perception is
based on a dependent context analysis. According to Gesser -
Edelsburg et al., the parents who give full immunization of
other vaccines but fail with oral polio vaccine occurred due to
lack of faith in the health system, reasons particularly to the
polio outbreak concerns related to the safety of the vaccine.
Most mothers believed that their children were to be protected
when given the oral polio vaccine, but it was for society's well-
being in an absolute sense. MethodsParticipants
A sample of mentally stable parents who are 18 to 45 years will
be invited to answer questions linked to immunization-related
intention, beliefs, and even behaviors. These participants will
be selected via the multistage sampling technique. Using
multistage sampling, the population will be divided into groups
then later into subgroups so that the appropriate ones are found.
Several steps will be used to divide the groups to find the target
population. The first step will include a random selection of
seven clusters from the population. A selection of three
households with children less than five years will be performed
randomly. The community health information system (CHIS)
registration log will be used as a sampling frame to select
households with children less than five years. During the
collection of data for the study, if participants will not be found
a home, the researchers will have to go back there the next day
(Etikan and Bala 2017).Apparatus
This study will make use of both primary and secondary data.
The primary data will be collected from personal structured
interviews, which will be given to the mothers. After the
participants have answered, the questions grading will be done
against the predetermined scoring system. Telephone surveys
will also collect data from the target population as trained

5. interviewers will contact probable respondents to gather
information. Demographic and health survey programs will be
used as the secondary data collection data whereby children
who have received immunization fully and partially will be
traced.Procedure
Simple random stratified sampling will be appropriate as it will
ensure particular characteristics that will be represented
proportionately in the sample. A simple random method is a
technique that is to be used to choose the population that is to
test the hypotheses concerning the entire population. This study
will adopt a simple random procedure of mothers from each of
the targeted populations. In general, non-probability sampling
selects any member of the population indiscriminately. The
population will first be defined then a sample size will be
chosen. The lottery method, including the use of a computer
program, will be considered to select the target population
randomly. Data will then be collected from the chosen samples
without bias (Wang et al., 2018).Research Design
A community-based cross-sectional study will be used to
conduct the study. This design will help the researcher collect
and analyze data that is important in addressing the research
question. A comprehensive analysis would provide an overview
of variables, without their existence being determined (Thomas,
2020).Results
The mean and standard deviation of the age of all the mothers
who will participate in the study will be calculated in terms of
years to find the majority who are confined to beliefs and other
factors, thus reluctant to take their children for complete
immunization. The mean age of the children who have not
received complete vaccination due to the mother's hesitance and
those who have received full immunization as per EPI will also
be determined. The mother's level of education will also be
accessed to see whether they are aware of the vaccines their
children should get and the number of doses, thus choosing to
ignore or whether they have no idea at all. The mother's religion
will also be assed that is whether Muslim, Christian, or Hindu.

6. The mother's monthly income will also be assessed to see
whether they lack funds for taking them to an immunization
facility. The mother’s antenatal clinic books will be assessed to
determine whether they attended all the visits as required and if
so, they received the tetanus vaccine and whether they gave
birth in a health facility. This will determine whether the health
care providers gave the mothers enough convincing information
about the importance of being immunized. All of this
information will help the researcher assess whether the
participants have enough knowledge of their child's
immunization.
The correlation will be used to see if there is a relationship
between the mother's age and vaccine hesitance. The
relationship between the mother’s religion, level of education,
and beliefs will be correlated with vaccination hesitance. The
Pearson’s coefficient will be used to demonstrate the correlation
between the two variables. A correlation coefficient of +1 will
show a perfect correlation, while a zero correlation will show
no relationship exists. IBM SPSS and strata program will be
used to make this analysis which will show whether correlation
will exist or not. A t table will then be used to compare the
calculated t value with that of the critical t value to identify the
statistical significance.Discussion
The immunization program's success relies on high vaccine
uptake rates and vaccination coverage. Maintenance of high
vaccination coverage has resulted in effective control of
diseases that can be prevented through vaccination. This study
will access the current approaches to childhood immunization
and the factors associated with partial immunization of children
below five years. If the results obtained will be significant, they
will provide a clue in the future if the same thing happens to
someone else. If the same thing happens in a different place
globally, the public will use the results to take proper
preventive measures to protect themselves. Ethical Issues
The research will follow the APA ethical guidelines, including
informed consent, debriefing statement, deception, and

7. obtaining IRB permission. Verbal informed consent will be
attained from every participant before the process of data
collection begins. The participants will be given a complete
description of the hypotheses to be tested, the procedures to
follow them, and other relevant information regarding the study.
Ethical clearance will be acquired from the Institutional Review
Board (IRB), and a permission letter to carry out the research
will be obtained from the University. Participants will fully be
educated about the main goals and objectives of the study, and
they will be assured that all the data they provide will remain
confidential.Study Limitations
Limitations are the design characteristics that will influence or
affect the interpretation of the findings of the research. Despite
getting evidence that might be important, limitations such as
follow-up on the effects of the health system factors that might
influence immunization uptake might be hard to access,
including the number of available, logistics, and the health care
personnel. Mothers not remembering all the events that
happened since the child was born is another limitation that
might occur, especially when they do not have the immunization
cards used. The amount of time needed to conduct the study is
another limitation experienced in a cross-sectional study. Much
time is needed to gather all the information. Conclusion
Future studies regarding the health conditions caused when a
child does not receive full immunization will arise after this
study. If the study finds out that most of these mothers are
reluctant to take their children for full immunization, various
studies might be carried out in the future. Those studies will
identify the digital technology used to track those mothers who
do not take their children to the hospital.Time Frame
Activities
1
2
3
4
5

8. 6
7
Acceptance of the research proposal
Talks with representatives in the study area
Research tools development
Training of interviewees
Pilot study

9. Data collection
Data entry
Analysis
Information to community and authorities

10. Proposal Budget
ITEM
AMOUNT
Student Benefits
$50
Education fees
$80
Supplies
$100
Training fees
$200
Instrument fees
$150
Traveling fees
$300
Other expenses
$500
TOTAL
$1380
References
Dubé, E., Laberge, C., Guay, M., Bramadat, P., Roy, R., &
Bettinger, J. A. (2013). Vaccine hesitancy: an overview. Human
vaccines & immunotherapeutics, 9(8), 1763-1773.
Dubé, E., Vivion, M., Sauvageau, C., Gagneur, A., Gagnon, R.,
& Guay, M. (2016). "Nature does things well; why should we
interfere?" Vaccine hesitancy among mothers. Qualitative
Health Research, 26(3), 411-425.
Etikan, I., & Bala, K. (2017). Sampling and sampling
methods. Biometrics & Biostatistics International Journal, 5(6),
00149.
Gesser-Edelsburg, A., Shir-Raz, Y., & Green, M. S. (2016).
Why do parents who usually vaccinate their children hesitate or

11. refuse? General good vs. individual risk. Journal of Risk
Research, 19(4), 405-424.
Girmay, A., & Dadi, A. F. (2019). Full immunization coverage
and associated factors among children aged 12-23 months in
hard-to-reach areas of Ethiopia. International Journal of
pediatrics, 2019.
Thapar, R., Kumar, N., Surendran, P., Shahdiya, A., Mahendran,
V., Ramesh, R, & Kumar, A. (2021). Vaccine hesitancy among
mothers of under-five children in Coastal South India: a
facility-based cross-sectional study. F1000Research, 10(186),
186.
Thomas, L. (2020, May 8). What is a cross-sectional study?
Retrieved from https://www.scribbr.com/methodology/cross-
sectional-study/
Wang, N., Gao, X., & Li, J. (2018). Random sampling for fast
face sketch synthesis. Pattern Recognition, 76, 215-227.