Enhancing Infant Immunization Rates: Determinants of Complete Routine Vaccination in an Urban Indonesian Primary Health Center

Lutfi Agus Salim; Muthmainnah Muthmainnah; Alif Fatimatuz Zahro; Damai Arum Pratiwi; Ira Nurmala; Chung-Ying Lin; Dini Yulia Restuti; Annisa Clara Salsabila

doi:10.56338/mppki.v8i3.7100

Lutfi Agus Salim Department of Epidemiology Population Biostatistics and Health Promotion Behavioural Science, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
Muthmainnah Muthmainnah Department of Epidemiology, Biostatistics, Population Studies, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
Alif Fatimatuz Zahro Department of Epidemiology, Biostatistics, Population Studies, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
Damai Arum Pratiwi Department of Epidemiology, Biostatistics, Population Studies, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
Ira Nurmala Department of Epidemiology, Biostatistics, Population Studies, and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
Chung-Ying Lin Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan,
Dini Yulia Restuti East Java Provincial Health Office, Surabaya, East Java, Indonesia
Annisa Clara Salsabila Master Student of Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Indonesia

DOI: https://doi.org/10.56338/mppki.v8i3.7100

Keywords: Immunization, Behavior, Maternal, Health Belief Model, Public Health, Good Health, Well-being

Abstract

Introduction: Infant immunization is crucial in reducing mortality and morbidity, aligning with the Sustainable Development Goals (SDGs) to promote health and well-being. In Indonesia, routine immunization for infants aged 0-12 months includes essential vaccines and newer antigens like PCV and Rotavirus. Maternal beliefs significantly influence immunization completion. This study examines factors affecting mothers' decisions regarding complete immunization in the Banyu Urip Health Center area using the Health Belief Model.

Methods: A cross-sectional study was conducted on 86 mothers with infants aged 12-24 months to assess immunization completeness during their first year. The study analyzed the relationship between maternal perceptions, such as susceptibility, severity, benefits, barriers, self-efficacy, and cues to action and immunization behavior.

Results: Findings showed a moderate relationship between perceived susceptibility, severity, barriers, and cues to action with immunization behavior. A strong correlation was observed between perceived benefits, self-efficacy, and participation in complete immunization. Mothers with higher risk perception, awareness of severity, strong belief in benefits, and self-efficacy, along with strong cues to action and fewer barriers, were more likely to ensure full immunization for their infants.

Conclusion: The study highlights the importance of strengthening awareness and reducing barriers to improve immunization rates. Enhancing maternal self-efficacy and addressing perceived obstacles can increase full immunization coverage, ensuring better health outcomes for infants.

References

Isnayni E. Hubungan Karakteristik Ibu dan Peran Keluarga (Inti dan Non Inti) dengan Kelengkapan Imunisasi Dasar pada Bayi di Puskesmas Pucuk Kabupaten Lamongan [Internet]. Universitas Airlangga; 2016 [cited 2023 Nov 3]. Available from: https://repository.unair.ac.id/40046/

Harmasdiyani R. PENGARUH KARAKTERISTIK IBU TERHADAP KETIDAKPATUHAN PEMBERIAN IMUNISASI DASAR LENGKAP PADA ANAK BAWAH DUA TAHUN [Internet]. 2015 [cited 2023 Nov 5]. Available from: https://e-journal.unair.ac.id/JBE/article/download/1670/1287

Kementrian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 12 Tahun 2017 Tentang Penyelenggaraan Imunisasi. 2017.

Rokom. Pencanangan Nasional, Perluasan Imunisasi Inactivated Poliovirus Vaccine (IPV) Dosis kedua [Internet]. 2023 [cited 2023 Nov 4]. Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20230621/1843336/pencanangan-nasional-perluasan-imunisasi-inactivated-poliovirus-vaccine-ipv-dosis-kedua/

Direktorat Pengelolaan Imunisasi. Petunjuk Teknis Pelaksanaan Imunisasi Pneumokokus Konyugasi [Internet]. Jakarta; 2022 [cited 2023 Nov 11]. Available from: https://ebooks.poltekkes-tjk.ac.id/2023/03/20/petunjuk-teknis-pelaksanaan-imunisasi-pneumokokus-konyugasi-pvc/

Kementrian Kesehatan Republik Indonesia. Petunjuk Teknis Pemberian Imunisasi Rotavirus (RV) [Internet]. Jakarta; 2023 [cited 2023 Nov 11]. Available from: https://ayosehat.kemkes.go.id/buku-petunjuk-teknis-pemberian-imunisasi-rotavirus-rv

Direktorat Jenderal Pencegahan dan Pengendalian Penyakit Kementrian Kesehatan Republik Indonesia. Laporan Kinerja 2022 Direktorat Pengelolaan Imunisasi [Internet]. 2023 [cited 2023 Nov 11]. Available from: http://p2p.kemkes.go.id/wp-content/uploads/2023/03/Laporan-Kinerja-Direktorat-Jenderal-P2P-Tahun-2022.pdf

Kaur G, Danovaro-Holliday MC, Mwinnyaa G, Gacic-Dobo M, Francis L, Grevendonk J, et al. Routine Vaccination Coverage — Worldwide, 2022. MMWR Morb Mortal Wkly Rep. 2023 Oct 27;72(43):1155–61.

Nandi A, Shet A. Why vaccines matter: understanding the broader health, economic, and child development benefits of routine vaccination. Hum Vaccin Immunother. 2020 Aug 2;16(8):1900–4.

Riza Y. Model Perceived Behaviour Berbasis Pengembangan Health Belief Model dengan Pendekatan Stepwise WHO terhadap Perilaku Preventif Penyakit Jantung pada Peserta Bpjs Kesehatan Mandiri. [Surabaya]: Universitas Airlangga; 2022.

Musa Ibrahim A, Ismail Onoruoiza S, Musa A, Dangani Umar B, Sherif Kunle Y. Using Health Beliefs Model as an Intervention to Non Compliance with Hypertension Information among Hypertensive Patient. IOSR Journal Of Humanities And Social Science (IOSR-JHSS [Internet]. 2015;20(9):11–6. Available from: www.iosrjournals.org

Wagner AL, Boulton ML, Sun X, Mukherjee B, Huang Z, Harmsen IA, et al. Perceptions of measles, pneumonia, and meningitis vaccines among caregivers in Shanghai, China, and the health belief model: A cross-sectional study. BMC Pediatr. 2017 Jun 12;17(1).

Esposito S, Principi N, Cornaglia G. Barriers to the vaccination of children and adolescents and possible solutions. Vol. 20, Clinical Microbiology and Infection. Blackwell Publishing Ltd; 2014. p. 25–31.

Bandura A. Self Efficacy – The Exercise of Control (Fifth Printing, 2002). New York: Freeman & Company; 1997.

Anies. Ensiklopedia Penyakit. Yogyakarta: PT. Kanisius; 2016.

Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Vol. 2, Health Education Monographs. 1974.

Puri YE, Murti B, Demartoto A. Analysis of the Effect of Maternal Perception on Completeness of Child Immunization Status with Health Belief Model. Journal of Health Promotion and Behavior [Internet]. 2016;01(03):211–22. Available from: http://www.thejhpb.com/index.php?journal=thejhpb&page=article&op=view&path%5B%5D=29&path%5B%5D=32

He L, Liao QY, Huang YQ, Feng S, Zhuang XM. Parents’ perception and their decision on their children’s vaccination against seasonal influenza in Guangzhou. Chin Med J (Engl). 2015;128(3):327–41.

Hobani F, Alhalal E. Factors related to parents’ adherence to childhood immunization. BMC Public Health. 2022 Dec 1;22(1).

Hanifa A. Determinan Kepatuhan Imunisasi Dasar Balita Pada Masa Pandemi Covid-19 Berdasarkan Health Belief Model [Internet]. [Surabaya]: Universitas Airlangga; 2022 [cited 2023 Nov 5]. Available from: http://ir.unair.ac.id/uploaded_files/temporary/DigitalCollection/ZDdkYThkM2NlNjczY2EzMzQ2ZjIzNjkwOGI1OWVjNGIyNmIwMGYyMA==/index.html

Fadl N, Elbarazi I, Saleeb MRA, Youssef N, Shaaban R, Ghazy RM. Parental intention to vaccinate children against seasonal influenza in the Eastern Mediterranean region: A cross-sectional study using the health belief model. Hum Vaccin Immunother. 2023;19(2).

Gilbert NL, Gilmour H, Wilson SE, Cantin L. Determinants of non-vaccination and incomplete vaccination in Canadian toddlers. Hum Vaccin Immunother. 2017 Jun 3;13(6):1447–53.

Du M, Deng J, Yan W, Liu M, Liang W, Niu B, et al. Mpox vaccination hesitancy, previous immunisation coverage, and vaccination readiness in the African region: a multinational survey. EClinicalMedicine. 2025 Feb;80:103047.

Gundogdu Z, Yendur Sezer O. Changing Parental Attitudes Towards Rotavirus Vaccine. Cureus. 2023 Feb 23;

MacDonald NE, Butler R, Dubé E. Addressing barriers to vaccine acceptance: an overview. Hum Vaccin Immunother. 2018 Jan 2;14(1):218–24.

Chen CH, Chiu PJ, Chih YC, Yeh GL. Determinants of influenza vaccination among young Taiwanese children. Vaccine. 2015;33(16):1993–8.

Han K, Zheng H, Huang Z, Qiu Q, Zeng H, Chen B, et al. Vaccination coverage and its determinants among migrant children in Guangdong, China. BMC Public Health. 2014 Feb 26;14(1).

Jung M. The effect of maternal decisional authority on children’s vaccination in East Asia. PLoS One. 2018 Jul 1;13(7).

Nurmala I, Li CY, Pertiwi ED, Devi YP, Muthmainnah M, Rachmayanti RD. The Correlation between Self-Efficacy, Grade, and Sex on the Intention to Participate in Peer-Education Activities in Drug Abuse Prevention Dear Editor-in-Chief [Internet]. Vol. 51, Iran J Public Health. 2022. Available from: https://creativecommons.org/licenses/by-nc/4.0/

Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: Thematic analysis of parents and healthcare workers’ perceptions. Vol. 18, Human Vaccines and Immunotherapeutics. Taylor and Francis Ltd.; 2022.

Lamorte W. Behavioral Change Models : The Health Belief Model. Boston: Boston University; 2016.

Chen MF, Wang RH, Schneider JK, Tsai CT, Dah-Shyong Jiang D, Hung MN, et al. Using the health belief model to understand caregiver factors influencing childhood influenza vaccinations. J Community Health Nurs. 2011;28(1):29–40.

Kirtland KA, Raghunathan T, Patel Murthy B, Li J, White K, Gibbs-Scharf L, et al. Estimating vaccination coverage for routinely recommended vaccines among children aged 24 months and adolescents aged 13 through 17 years using data from immunization information systems in the United States. Vaccine. 2022 Dec;40(52):7559–70.

Hwang J, Shah D V. Health Information Sources, Perceived Vaccination Benefits, and Maintenance of Childhood Vaccination Schedules. Health Commun. 2019;34(11):1279–88.

Noh JW, Kim YM, Akram N, Yoo KB, Park J, Cheon J, et al. Factors affecting complete and timely childhood immunization coverage in Sindh, Pakistan; A secondary analysis of crosssectional survey data. Vol. 13, PLoS ONE. Public Library of Science; 2018.

Ghweeba M, Lindenmeyer A, Shishi S, Abbas M, Waheed A, Amer S. What predicts online health information-seeking behavior among egyptian adults? a cross-sectional study. J Med Internet Res. 2017;19(6).

Azelya T, Andiani P, Hariastuti I, Devi YP. Relationship between Media Access and Social Support with Contraception Plans in East Java, Indonesia. Vol. 16, Indian Journal of Forensic Medicine & Toxicology. 2022.

Kim YM, Haq ZU, Soomro J, Sultana Z, Faizunnisa A, Agha S. Case Study: Effects of a Media Campaign on Breastfeeding Behaviors in Sindh Province, Pakistan. World Health Popul. 2015 Dec 30;16(2):39–45.

Ames HMR, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: A synthesis of qualitative evidence. Vol. 2017, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2017.