“I didn’t even know humans could get polio … I swear that’s for dogs.” A co-produced, thematic analysis exploring adolescent attitudes to vaccines

Abstract Background Immunisation forms a cornerstone of public health policy. However, uptake rates of routine vaccines offered in adolescence are sub-optimal. In 2023/24, for example, HPV uptake in England, for example, was 72.9% of girls and 67.7% of boys in school year 8 (aged 12 to 13 years), well below the World Health Organization’s goal of achieving 90% coverage by 2030. This presents both individual and public health risks. While much research exists on the attitudes of healthcare workers and parents towards adolescent vaccines, less is heard from adolescents themselves. Methods We worked with over 80 adolescents to co-design, pilot and analyse data for this qualitative thematic analysis of adolescent attitudes towards vaccines. Adolescent collaborators received training in qualitative research methods and thematic analysis and contributed to study design by selecting the interview format, co-developing participant materials and the discussion guide, leading piloting activities with younger adolescents, and contributing to coding, theme development and interpretation of findings. For the study itself, we interviewed 30 adolescents aged 12–17 years living in England. Results Participants were generally in favour of some or all vaccines, with a minority having not received any adolescent vaccines. Five themes were identified: Understanding vaccines, Fear and comfort; Autonomy and control; Information sources and conspiracy theories; and Identity and social norms. Among our participants, vaccine uptake was influenced by perceptions of vaccine preventable diseases and by fear of needles. Decision-making dynamics between parents and adolescents were complex, with autonomy disrupting as well as driving vaccine behaviour. Social media was not a major source of vaccine information for adolescents, with participants expressing disinterest in online vaccine content and implicating adults as the ones engaging with and sharing online vaccine disinformation. Finally, we found that adolescent development impacted vaccine attitudes. Younger participants were more likely to adopt a collective family attitude toward vaccines. Older participants were more able to consider long-term benefits and more likely to have established their own position on vaccines. Conclusions In our study, most participants wanted to be more involved in vaccine decisions; given techniques to manage anxiety about vaccines; better educated about vaccine preventable diseases; and supported in developing the critical thinking skills needed to make informed health decisions.