| Summary: | The recent decline in early childhood vaccination has been attributed to negative parental attitudes about immunisation. Vaccinations are a common cause of acute infant pain, although the impact of infant pain expression upon vaccination uptake is not well understood. Theoretical models of infant pain propose that care-giver behaviours may regulate pain expression, although previous findings have been inconclusive. Understanding care-giver beliefs, and the relationship between care-giver and infant behaviours during immunisation, may help to identify effective soothing strategies and develop interventions targeting parental concerns. This thesis examines a number of factors associated with the role of the care-giver in infant immunisation uptake and pain expression. First, two systematic reviews, summarise evidence regarding the efficacy of uptake interventions and parental beliefs about immunisation. Second, the relationship between infant pain expression, care-giver behaviour and vaccine uptake is explored using a prospective cohort study. Finally, the hierarchical nature of parental viewpoints and their relation to vaccine uptake is examined using Q-methodology. Whilst care-givers determine immunisation uptake, findings from the thesis suggest that their influence on infant pain expression may be minimal. Instead, the speed at which vaccines are administered, and the offer of a pacifier during injections may reduce pain expression. Whilst parents have complex views about vaccination, the views of immunising parents are dominated by the notion that vaccination provides the best protection from disease. Implications of the findings are discussed in terms of clinical practice, vaccine policy and future interventions promoting confidence in vaccine efficacy to target vaccine-hesitancy.
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