<b>Behavioural Determinants Influencing Parental Decisions on Childhood Vaccination in District Peshawar</b>

Background: Childhood vaccination is a critical public health intervention that prevents morbidity and mortality from vaccine-preventable diseases, yet suboptimal uptake remains a challenge in many low- and middle-income countries including Pakistan. Parental attitudes and behaviors play a pivotal role in determining vaccination coverage, with behavioral determinants increasingly recognized as key contributors to vaccine hesitancy. Objective: To examine behavioral, educational, and structural determinants influencing parental decisions regarding childhood vaccination in District Peshawar, Khyber Pakhtunkhwa, Pakistan. Methods: A cross-sectional observational study was conducted from January to March 2025 among 380 parents attending selected health facilities in District Peshawar. Participants completed a structured, interviewer-administered questionnaire assessing socio-demographic characteristics, behavioral attitudes, and system-level factors associated with vaccination compliance. Associations were analyzed using chi-square tests and multivariable logistic regression to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: Among participants, 89.7% reported lack of information as a key barrier and 12.6% reported prior adverse vaccine-related events. Non-compliance was significantly associated with illiteracy (AOR 1.80, 95% CI 1.01–3.22) and rural residence (AOR 3.05, 95% CI 1.66–5.62). Vaccine unavailability (24.5%) and lack of trained vaccinators (87.1%) emerged as prominent structural barriers despite high overall support for vaccination (91.3%). Conclusion: Both behavioral and structural factors significantly influence parental vaccination decisions in this setting. Interventions must address parental knowledge gaps and strengthen rural healthcare infrastructure to improve immunization coverage equitably.