Health literacy, awareness and referral patterns of mothers in childhood vaccination: a cross-sectional study in Iran

Vaccination of children is one of the most effective strategies for preventing preventable infectious diseases in childhood. Additionally, successful control of these diseases requires timely vaccination. This study aimed to determine maternal health literacy, awareness of the importance of timely immunization and the referral patterns of Iranian mothers for the immunization of their children. This cross-sectional study was conducted among 250 mothers attending health centers using a multi-stage cluster sampling approach. Health centers were considered as clusters, from which two clusters and subsequently two comprehensive health service centers within each cluster were randomly selected. Eligible mothers attending these centers were then recruited. Data were collected using validated questionnaires, including demographic information, health literacy (s-TOFHLA), and awareness of the importance of timely vaccination. After confirming the validity and reliability of the tools, the data were analyzed with SPSS version 22. Descriptive statistics were applied alongside Chi-square, Kruskal-Wallis, and correlation tests to examine associations. Mothers’ awareness of timely vaccination was moderate (12.73 ± 2.04), and the mean health literacy score was 85.2 ± 11.8. Only 40.8% reported regular vaccination visits. Awareness significantly increased with maternal age (highest rank mean in > 30 years: 135.6, p < 0.001) and education (highest in bachelor’s degree or higher: 138.9, p = 0.002), while employed mothers showed the highest awareness levels compared with housewives and self-employed mothers (rank mean 147.7, p < 0.001). Birth order was not significantly related to awareness (p = 0.769). Regular vaccination visits were more common among mothers who received information from physicians or health centers (72.5%, p = 0.011) and among mothers older than 30 years (49%, p = 0.046). Although mothers with adequate health literacy and first-born children had higher rates of regular visits, these associations were not statistically significant. Maternal age, education, occupation, and information sources play an important role in vaccination awareness and adherence. Targeted educational and community-based interventions to improve maternal health literacy and awareness may enhance timely vaccination and reduce the impact of misinformation.