Concept / Theory Development Final Paper















Institutional Affiliation




Aim: The aim of the study will be to assess the attitudes of parents towards children vaccination.

Background: Attitudes towards treatment are likely to influence uptake. All over the world, attitude towards treatment has been worrying such that its acceptance has been prejudiced. To some parents, they have turned to delaying such programs so that the children do get vaccinated. These attitudes in one way or another have been influenced by either culture, beliefs and human feelings.

Design: Concept analysis of the data will be appropriate in getting the opinions of the respondents.

Sources of data: A literature search from books, international health organizations, PubMed and AltHealth databases report on attitudes towards vaccination was used. Recent pieces of literature dated ten years from 2013 were included.

Method: The data will be analyzed using the Walker and Avant’s model. The method includes eight full steps in analyzing the data.

Results: The concept of attitudes on the vaccination of children has the following attributes: Parenting styles, family or home rules, parental supervision and child to parent communication. The experiences are that both positive and adverse attitudes exist among parents. The consequence is that ignoring vaccination or delaying the same would lead to contraction of vaccine-related diseases which are preventable.

Conclusion: Parents’ attitudes towards treatment of children in Saudi Arabia have led to either low or high incidence of illness.

Key Words: Parental attitudes, vaccinate, delay, children

Summary statement

Why is this research or review needed?

  • Different children in different societies report experiencing health complications after vaccination
  • Attitude is a concept that has discouraged many parents towards achieving good things.
  • Nurses can lead in averting the notion that attitudes have created on the health risks of vaccines.

What are the key findings?

  • The attributes of attitudes towards children vaccination can be clarified to assist in understanding the importance of vaccination.
  • The concept of attitudes towards children vaccination has led to the emergence of the need to include it in research, practice and education.


The concept of attitude has been applied widely in various fields such as communication as well as science. The term “attitude” has often resulted in mixed reactions.  A search of the phrase on the internet led to many scholarly articles that discussed different findings in diverse academic fields. In the medical field, nurses have often used the word attitude to do research in health fields concerning vaccination and other treatment methods. The primary use of a concept is to provide researchers with an opportunity to give certain thoughts that relate to a phenomenon under assessment. According to Walker and Avant, concept analysis assists in the process of examining a concept’s essential elements. The method of analysis of a concept of attitude assists in distinguishing related concepts and perhaps gives a difference that may exist. Reviewing, definition and provision of operational definitions are necessary for the study of the attitude concept.


In addition to the definition of the term “attitude,” its measurement has also brought confusion and inconsistencies. A good number of words have been connected and used in measuring attitude and these include beliefs, cultures and feelings (Al-Ayed and Sheik, 2006). Hence, lack of common definition and measurement of the term attitude continues to be an issue (Leask & Danchin, 2017). The concept of attitude towards physical and psychological behavior: vaccination of children before school by delaying the process in some countries. A search for the term attitude in the internet yielded about 392 million results of articles for medical publications. Although many scholarly articles exist on attitudes, the correct definition and measurement remain inconsistent globally.

Some studies have been documented worldwide and particularly in developing countries implying a positive attitude of parents towards vaccination. Al-Zahrani (2013) conducted research in Saudi Arabia on the parental knowledge and their attitude with regards to treatment and also the impacts on protection exercise. Immunization of the children through immunization against communicable diseases has proved to be the most efficient strategy to lower overall morbidity as well as mortality among younger population (Al-Zahrani, 2013). High level of vaccination coverage must be fundamentally maintained to achieve a high standard of this treatment strategy.

According to the study carried out by Al-Zahrani, the results indicated that many parents had positive attitudes towards vaccination. The knowledge received from health professionals was however not significant for the protection of the children. Apart from parental attitudes, treatment of children is also affected by the social and economic status of the parents. Besides, low education also plays a role delaying full implementation of treatment (Al-Zahrani, 2013). Therefore, it can be argued that lack of vaccination has caused the death of many millions of children.

The concept of parental attitudes towards treatment can be explored in two different directions. The first is positive and also negatives views. The positive attitudes have over and again been associated with the willingness of the parents to avail their children for vaccination. The variations that are brought by the difference in the negative and positive attitudes are as a result of unreliable information sources for treatment. As the need to vaccinate children goes unmet due to the opposing views of parents, many children get exposed to health care environment that only facilitate poor health and hence delaying the necessary treatment. If parents might be suspicious of the risks of the program, they get additional information from the physicians. Other sources of information which can be sued as a guide are television, radio, internet and newspapers. The actual understanding of how to motivate parents to have a positive attitude towards vaccination is crucial in reducing health complications on children. There are many sources which have been documented to show the positivity of many parents towards vaccination.

A comprehensive analysis of the parental attitude towards children vaccination will be conducted using the Walker and Avant method (Cronin, Ryan and Coughlan, 2010). The method occurs in 8-steps. According to Cronin, Ryan and Coughlan (2010), Walker and Avant’s method is an attractive method for concept analysis because it assists in establishing the clarity of a concept. For example, the vaccination is a health process which needs clarification so as to convince more parents to understand the method. Cronin, Ryan and Coughlan (2010) argue that the analysis of this dilemma would reduce the ambiguity in the benefits of the process.

Within the healthcare sector, there are behavioral concepts which concern understanding a health situation and the illness experiences (Hasanain and Jan 2002). Therefore, the concept analysis by Walker and Avant method is suitable in ensuring that parents genuinely understand vaccination. On the underlying situation, the aim of this approach will take place in two folds. First and foremost, the process will define parental attitude and vaccination. Secondly, this approach will consider vaccination to be carried out in mixed parental attitudes. In particular, the concept of parental attitude will be given consideration as to whether treatment could be promoted further to improve the care of the children. The use of concept analysis will help in the identification of characteristics of the parents and the attributes of vaccination with the aim of achieving clarity. However, Cronin, Ryan and Coughlan (2010), asserts that the method is time-consuming and thus needs rigorous approach at all the stages.

Data Sources

An academic search of AltHealth, PubMed, EBSCO and CINAHLwere used in which keyword such as attitudes were used as the keyword. Additional searching of the data was also done through Google scholar for whom the topic was keyed in as attitude. The results in published articles, peer-reviewed articles and journals for the years between 2002 and 2013 were included. Studies which addressed the issue of l attitudes were selected for further evaluation. On the other hand, the articles which did not address the topic were ignored. Additional journals and articles which did not have any direct link with the issue were only selected due to the supporting information which they included.

A wide range of references were obtained from the first search. Addition and omission criteria were used in the process to review the abstracts of the articles and 25 studies papers proved beneficial and worth inclusion for analysis. The thematic analysis of the materials which was conducted led to results included below. The materials included the concept analysis methods, Walker & Avant, cross-sectional studies and literature reviews. The table below contains the samples of the articles used in the study of parental attitudes towards children vaccination.

Table 1: Literature Reviewed









Uses of the concept


Concept analysis is an essential approach in assessing the concept of attitudes. A number of literatures have been used as the sources of data used in the analysis and therefore, their adequacy as well as appropriateness must be taken into consideration during assessment. Ryan and Coughlan (2010) argue that correct definitions of the key words used during the research is important and should be done in the first case so as to narrow down the research based on the aims of the investigation. Attitudes can be interpreted differently depending on the target of a study. Cultural perceptions of many people have implied many definitions for the term as opposed to medical definition. For instance, the influence of attitudes on the personality of the children is significant and hence can be felt on the behaviors of the children at later stages. Due to the negative attitudes on the children vaccination, some of them end up growing with the wrong notion that vaccination could be having harmful effects on them. Therefore, personal beliefs play a significant role in the development of a child’s personality. As a result, parental attitudes comprise the social influence that children experience during early days of growth.  In essence, parental attitudes are the involvement of the parent in a child’s decision-making process. Parental attitudes have different attributes which would influence the environment of a child and actions as well. These characteristics include parenting styles, family or home rules, parental supervision and child to parent communication among others.

Finally, vaccination is the process of administering antigenic material to the body to stimulate immunity system of an individual and protect the body from the pathogen. Vaccines prevent morbidity from external infection and after vaccination, herd immunity may be witnessed. Vaccination is an important strategy in the prevention of common diseases in children. Despite the significant role of vaccines in the treatment of illness, reduction in mortality as a result of immunizations has not only drama between children and parents but has also remained controversial. Despite the role that vaccines play in human health, there are also reasons why most people and societies at large have remained suspicious of vaccines. Many parents argue that vaccines are counter-natural that exposes one to diseases. Cite. Additionally, many parents believe that vaccination violates the will of God. Moreover, mandatory vaccination policies amount to violation personal liberty. Recently, many assumptions like autism have been regarded as one of the latest manifestation.

General definition of attitude

The next phase in Walker and Avant method will identify and define attitude and the characteristics of the concept of attitude.  Attitude is a term which has its origin from Italy. An internet search of the term attitude gives 392 million results that cut across many scholarly fields. An attitude is a noun that has many synonyms. By definition, attitude implies to the way of thinking as well as feeling towards something and especially one that is shown in an individual’s behavior. Another definition of attitude is a truculent behavior that is resentful or rather antagonistic in nature. It also applies to the position of a human body that imply to the mental state. Despite the existence of many definitions, only few that relates to health can be included and will be useful in this study.  The description of the qualities, in this case, provides room for detecting the occurrence of the attitudes. Upon completion of the definition of the attitude, the following attributes of parental attitudes were identified: 1) parenting styles, 2) family or home rules and 4) child to parent communication. Nonetheless, additional subthemes were determined for each variable. The figure below is a summary of original definitions themes and the subthemes



Parenting styles

Parenting styles are the primary variable of parenting attitudes.  Parenting style is defined as a standard psychological strategy that parents used to rear their children (Rhee et al., 2006). Rhee et al. (2006) assert that parenting styles are divided into authoritative, permissive, authoritarian and neglectful with each component having different characteristics and triggering different reaction to the environment.

Authoritarian Parenting Style

The authoritarian parenting style is where either of the parent’s set-up rules that children should follow with no exception (Ingram, 2011). Under this parenting style, the kids never make mistakes because of fear of punishment and hence they do not get involved in problems that need issue solving. As a result, parents expect that their children follow the ruled at all times with no mistake. According to Ingram (2011), mental training is the best therapy and supervisor for children.

Permissive parenting style

 Permissive parenting style is another parenting style that can influence the behavior or character of children towards vaccination. Permissive parenting is a type of parental style that is marked by low demands and high responsiveness (Johnson and Kelley, 2011). The parents tend to more loving than correcting and hence provide little guidelines as well as rules. The parents expect no mature character from their children but are friendlier than a parental figure. In other terms, this type of parental style is also called permissive parenting (Johnson and Kelley, 2011). The main benefit of this parenting style is that it does not allow confrontations and performs more of nurturing of the child.

Authoritative parenting style

Piko and Balázs (2012) define authoritative parenting style as a kind of parenting which sets high expectations for the children, gives resources and also supports the needs of the parents. Such parenting style does encourage their children, listen to them, allow expression of opinions and encourage them to discuss available options (Piko and Balázs (2012). However, there are limits as well as consequences of the bad behavior of a child. The visual figure showcases the characteristics of a child and the parent under authoritative parenting style. The parent is in a posture which suggests instructive while the parent is in a listening attitude.

Neglectful parenting style

Neglectful Style is another parenting style that does not consider hand-holding and child guidance (Garcia and Gracia, 2009). It is often neglectful and a kind of dismissive parenting style and therefore undemanding toward a child. In other words, it is also called uninvolved parenting style (Garcia and Gracia, 2009). Neglectful parenting style characterizes Parents’ needs and hence ignores the wants of the child. Barth (2009), affirm that this kind of parenting style results to the following characteristics: Disconnect, loneliness, academic problems and behavioral problem. There are numerous characteristics of this type of parenting. These features include emotional detached from the children, no supervision, little love, intentionally avoid interaction with a child and are always overwhelmed by their issues.

Home or family rules

The house rules are orders in the family that makes every member of the family behave in the right manner (Ramirez et al., 2011). The control is essential in a family set-up because it strives to balance whatever one needs to get and respect for others’ needs. Also, the rules are also useful in that they make teenagers and the adolescents to feel safe.  According to Ramirez et al. (2011), the rules are “situational,” “ground,” “don’t” and “do” rules.

Situational rules

These are rules which consider a particular context of the event and the place of occurrence (Ramirez et al., 2011). They are accurate for only a given situation. For instance, the situational rule may apply while traveling in a car, visiting a different persons’ house, using a computer and when shopping just to mentions a few.

The “Do” rules

The “Do” rules are known to be teaching tools. They commonly used in various situations to guide the behavior of a child in a positive manner (Butler, Joyce and Pike, 2008). The examples of such rules are: sit down and eat, speak politely, wear a seatbelt, be gentle and be at home by curfew time among others.

The “Don’t” rules

The don’t rules is a kind of control which guide a child not to do whatever is wrong. The control is useful in that it makes a child avoid being victims of the unfortunate circumstances. Additionally, the don’t rule nurtures a child to have a good behavior. For example, don’t spit, don’t beg for things while in the supermarket and don’t urinate on the floor.

Ground rules

The “ground” rules are rules which apply every place. Even though children might be the target of the “ground” laws, they also apply to everybody in the family. Examples of such rules are being polite and never hurt one another.

Child to parent communication

The communication between the parent and the child is an important aspect of parenting skill. Parenting is so enjoyable if such relationship is positive. Positive parenting approach is necessary regardless whether the child is a teenager. A positive approach to parenting builds self-esteem and mutual respect (Riesch, Anderson and Krueger, 2006). Excellent communication would require that the parent is available to his or her child and listen to the children. Riesch, Anderson and Krueger (2006), assert that healthy child to parental communication prevents behavior of a child that would increase his or her health risks. In essence, improving a child to parent communication assists in mitigation of common risks and consequently, nurtures the behavior of a child. The parents to children negative communication about vaccination will only develop lifetime negative attitude towards such health practices. On the other hand, effective communication between the parents and the child will make that use of the vaccine is taken as important so as to avert the chances of common illness. The child to parent communication is characterized by the following elements: Active listening and close communication.

Active listening

Active listening is an essential aspect of a parent to child communication. It is the ability and willingness to listen to a child’s demand or message (Riesch, Anderson and Krueger, 2006). Being an active listener implies the best understanding of another person. Verbal, as well as non-verbal, are important aspects of a parent to child communication to which attention must be paid. The parent to child communication influences the parental attitudes.

Friendly interface

A warm and thus a healthy relationship with a child need regular communication. Frequent and constant communication puts parents in a better position of knowing the needs of the children. Besides, this creates room and opportunity of listening to the children. The friendly interface does not have schedules but can take place at any time either dinner, on telephone, bedtime and through letters. Riesch, Anderson and Krueger (2006), argue that parents must create a friendly environment for communication that would encourage children to take up instructions. A friendly environment encourages an attitude that would make a child understand into detail, the assumptions and facts about vaccination.

Identification of a model case

The next step in the Walker and Avant method of concept analysis is the identification of a case model (Walker and Avant, 2011).  An example case is an exemplar of concept analysis which describes and includes the defined attributes. It assists in knowing the internal structure of the concept in use and hence helps in clarifying the underlying meaning of the issue (Gillespie, Chaboyer and Wallis, 2007; Walker and Avant, 2011).

Identify Antecedents and Consequences

Antecedents and consequences make the next step in Walker and Avant’s method. The identification of the antecedents as well as consequences is useful in refining the definition of attributes. Antecedents are events that take place before the main event. In the case of attitude as a concept, many theorists argue that acquisition of attitude occurs through experiences during cognitive learning. Old experiences are the main contributors of attitude at the time of its occurrence. Concerning this study, some events will occur and remain hidden to a child before the intervention of the parents’ attitudes. On the other hand, consequences are events that occur after the concept. The antecedents, in this case, are the implications of the parents’ attitudes towards the vaccination of the children. The result is that a child will have ears towards vaccination. Consequently, this may lead to high incidences of diseases that relate to a lack of immunization. Conversely, positive attitude of the parents towards will support healing programs and hence furthering healing. In essence, attitude progresses over the years when an individual acquires additional knowledge and experience. However, attitude also remains dependent on culture but can change over time as well as space.


The identification of a model case and other additional cases assist in defining and refining of attributes of the concept of attitude. The following case shown below is given as an example of giving the best fitting attribute.

Model Case

A child who has not started schooling learns that his parent has negative attitudes towards vaccination and learns that his father often delays the program. The child later believes that being vaccinated is unsafe and might make him develop health complications. The model case demonstrates a real life situation of the feeling of parents towards vaccination and further shows the defining attributes: belief, culture, feeling and assessment of the concept.

Borderline Case

A mother starts to take her child for immunization. When her husband realized about this secret arrangement, he decides to discourage the wife by talking about disabilities such as autism due to vaccination. The mother decides to abandon child protection through vaccination so as to please the husband and restore peace in the house. The case above is an example of the borderline case contains most attributes of the concept of attitude. However, not all the attributes are covered in this case. The situation may make the mother of the child and the child too to believe that vaccination causes alleged problems like autism and this will discourage future vaccination. Her decision to abandon treatment too is influenced by beliefs, cultures and feelings towards vaccination.

Contrary Case

In a study carried out by Andre and his colleagues in the year 2008, vaccination proved to reduce incidences of diseases attack, disability and death in many children not only in the developing countries but worldwide. The study demonstrates that actually, vaccination is not associated with any harmful effects such as autism. The study did not rely on the societal beliefs, cultures and traditional feelings.

Empirical Referents

The last step in the Walker and Avant’s method in analyzing the concept of parental attitudes is the identification of empirical referents. The empirical referents help in the definition of the attributes’ measurements (Walker and Avant, 2011). Therefore, the empirical referents are the elements that one will use in assessing the attitudes towards a given phenomenon. The empirical referents serve the same purpose are the subthemes which are components of the central themes. Because parental attitudes interact with a child’s behavior, measurements such as parents’ satisfaction and the reaction of a child concerning beliefs and effects of vaccination may be ideal for assessment of the concept. The response encounter can be measured through observation and interview of the children perceived to be victims of vaccination.


Importance of results

The concept of attitudes towards a given phenomenon can immediately improve the underlying perception of a given situation. The concept can further shade light on the beliefs, cultural stands and feelings that people have on immunization. The attitudes consist of three attributes that can be used to validate the theory of vaccination on children.

Implications for Theory

The effects of vaccines on the children’s health remain a theory update. While many claims that vaccination may cause autism, there is no scientific evidence to support the allegation. The claims have been dependent on the cultural and religious beliefs which have continued to affect the health of the children. The attributes in this concept consist of elements that are unique to healthcare theory that stands to be developed further. Currently, there is no tool that can assist in measuring attitude, however, researchers are at liberty to build more elaborate tool that touches on belief, culture and feeling as attributes of attitude.


Parental attitudes towards children vaccination have affected many children positively and negatively. The delaying of the program has led to increased incidences of diseases. Nonetheless, promotion of the program among the children has lowered the rates of common diseases that are related to vaccination such as polio. Therefore, treatment should be promoted at all cost despite the objection by the church. The concept should be used in nursing, education and research to improve the long the beliefs.

Recommendations for Healthcare Education

The healthcare education must be enhanced to include conventional vaccination procedures and the importance. The basic training should cover the basic information that regards myths of protection. Further. The diversity of opinions concerning the possible beliefs that can divert the minds of the children and therefore creation unnecessary panic and fear should be addressed at an earlier stage. The integrated education should also include case studies with parental attitudes influencing the vaccination of children. Currently, they are unprepared to deal with treatment claims and behavioral changes of the children that are affected by the various parental styles. The above concept analysis is useful as it gives in-depth information concerning parental attitudes towards the vaccination of children. Additional, the education curriculum should be made inclusive of the possible consequences of the lack of vaccination. Indeed, lack of immunization is not only unlawful in Saudi Arabia but also lead high incidences of disabilities. For instances, there has been many cases of polio infection which has caused a lot of invalidities.

Recommendations for Nursing Practice

The nursing sector should adopt a method that is sensitive to the cultural and religious beliefs. More often than not, the society has been very suspicious of the effects of vaccination of children. The suspicious has been accelerated and facilitated by a stand of the cultural beliefs in the society. All the attributes of the parental attitudes towards vaccination of children should be integrated into the nursing practice in Saudi Arabia. The nursing practices, therefore, should be broader to enlighten the common challenges that nurses face during their professional practice. It is true that nurses might face some opposition from the society and even the parents themselves. The training should aim at instilling skills on the nurses on how to deal the emerging rebellion for such practices. Nurses working in either public or private must lead by example by ensuring that the notion of parental attitudes on the vaccines does not hinder the aim of the program. Besides nursing practices, the advanced nursing practices are also capable of managing the public dilemma and convincing more of the public members to embrace the free medical approach and reduce the incidences of diseases manifestations and spread. Advanced nursing practice is capable of proving proper guideline and facts for the public who have developed a negative attitude towards vaccination.

Recommendations for Nursing Research

The medical research plays a significant role in the management of the diseases and also manages the common belief that the public has had for a long time. Maintaining a positive attitude towards the vaccine is of utmost significance so that we do not contribute to the perception that vaccination has adverse effects on the children. The research should come up with robust findings on the confusion of whether the vaccine causes adverse effects on the children or not.  The concept of parental attitude towards the children vaccination by allowing it could serve as a future topic for research in other developing countries in the world.












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