PARENTS PERCEPTION, EXPERIENCES AND DECISION MAKING REGARDING CHILDREN IMMUNIZATION AGED 0-5 YEARS IN RURAL AREAS OF BAHAWALPUR, PUNJAB, PAKISTAN

Abstract

Background: Childhood immunization remains one of the most effective public health interventions for reducing morbidity and mortality among children under five years of age. Despite the availability of free vaccination services under Pakistan’s Expanded Program on Immunization (EPI), immunization coverage in rural areas continues to be suboptimal. Parents’ perceptions, lived experiences, sociocultural beliefs, and access-related challenges play a decisive role in shaping immunization decisions for vulnerable children. Objective: This study aimed to explore parents’ perceptions, experiences, and decision-making processes regarding childhood immunization among children aged 0–5 years in rural areas of Bahawalpur, Punjab, Pakistan. Methodology: A qualitative study design was employed using in-depth, semi-structured interviews. Twenty-seven parents of children aged 0–5 years were purposively selected from three rural communities in Bahawalpur. Data were collected through audio-recorded interviews conducted in local languages and analyzed using Braun and Clarke’s thematic analysis framework. Results: The analysis revealed eight major themes influencing parental decision-making: positive perceptions of vaccination, limited knowledge of immunization schedules, the role of religion and cultural beliefs, accessibility and satisfaction with immunization services, logistical and systemic barriers, concerns regarding minor side effects, influence of education and media, and community-driven suggestions for improvement. Most parents viewed immunization as a life-saving and religiously acceptable practice and expressed trust in healthcare workers. However, gaps in detailed knowledge, inconsistent service delivery, misinformation from isolated religious sources, and access barriers contributed to delayed or missed vaccinations. Conclusion: Parents in rural Bahawalpur generally demonstrated positive attitudes toward childhood immunization, supported by religious acceptance and trust in healthcare services. Nonetheless, persistent challenges related to knowledge gaps, service accessibility, and misinformation hinder optimal immunization coverage. Strengthening community-based education, improving service delivery, and engaging trusted religious and community leaders are essential strategies to enhance childhood immunization uptake in rural Pakistan.