Date of Conferral





Public Health


Marylou Gutierrez


Low immunization in Nigeria is associated with high prevalence of childhood diseases. The purpose of this qualitative phenomenological study was to describe caregivers' perceptions of routine immunization of their children ages 24 to 36 months. Caregivers' attitudes, cultural beliefs, and knowledge regarding immunization were examined. The health belief model was used to guide study. Interviews were conducted with 5 caregivers of fully immunized and 5 caregivers of partially and nonimmunized children. Digital recordings were analyzed using NVivo 10 to identify themes and subthemes. Attitudes of caregivers with fully immunized children included both perceived barriers (distance to health center, lack of information) and perceived benefits (vaccine safety and effectiveness), whereas caregivers with incomplete vaccinations reported multiple transportation-related barriers. Cultural beliefs were limited to religious beliefs and emerged as a theme among both caregiver groups, where full vaccination associated with Christian beliefs and lack of vaccination with belief in traditional healers. Caregivers' knowledge associated with full vaccination included cues to action (information from nurses and reminders by others) and self-efficacy (kept vaccination cards ready and prepared for vaccination day), and incomplete vaccination associated with lack of reminders and preparation. Perceived severity, susceptibility, and benefits were associated with full vaccination status, while lack of perceived severity, susceptibility, cues to action, and self-efficacy constituted barriers to vaccination. Social change implications include education on disease severity, susceptibility, and vaccination safety, and expanding transportation, access to vaccination centers, and religious outreach programs to increase immunization of Nigerian children.