Parent and Caregiver Willingness for Childhood COVID-19 Vaccination in Urban Uganda: Applying the Behavioral and Social Drivers (BeSD) Framework

Introduction: Vaccinations are widely recognized for protecting children from infectious diseases. During the COVID-19 pandemic, immunization efforts became especially important. Despite these efforts, achieving high vaccine uptake has remained challenging in Uganda, underscoring the need to better understand the factors that influence caregivers’ decisions regarding childhood COVID‑19 vaccination. The acceptability of routine childhood COVID-19 vaccine boosters among parents or caregivers in Uganda remains uncertain. This study examined factors associated with parent/caregiver willingness to vaccinate their children against COVID-19 in an urban immunization clinic in Kampala, Uganda. Methods: We conducted a cross-sectional study among 230 caregivers with children under 59 months of age in an urban postnatal clinic in Kawempe Division, Kampala, Uganda, from June 2023 to July 2023. The outcome was willingness to receive annual routine COVID-19 vaccination for their child. Covariate selection was informed by the World Health Organization (WHO) Behavioral and Social Drivers (BeSD) framework: (i) thoughts and feelings (disease risk perception, confidence in vaccine safety, and benefits), (ii) social processes (family and friend norms), and (iii) practical issues (affordability). Modified Poisson regression identified factors independently associated with willingness to receive routine COVID-19 vaccination for their children. Adjusted prevalence rate ratios (adj. PRR) and 95% confidence intervals (95% CI) were calculated. P-values of <0.05 were considered statistically significant. Among 230 respondents, 83.9% (n = 193) reported willingness to vaccinate their children against COVID-19, with female caregivers aged 15-24 years comprising 51% (n = 117) of our study sample. After controlling for confounders, willingness was higher among those with moderate confidence in vaccine benefits (PRR: 3.07; 95% CI: 1.37-6.85; p = 0.006) and very important confidence in vaccine benefits (PRR: 3.11; 95% CI: 1.41-6.89; p = 0.005), positive family norms (PRR: 1.35; 95% CI: 1.04-1.75; p = 0.022), and intention to vaccinate themselves (PRR: 2.68; 95% CI: 1.18-6.07; p = 0.019). Conclusion: Targeting BeSD factors related to confidence in vaccine benefits, family norms, and parent/caregivers’ vaccination intentions could help address barriers to routine childhood COVID-19 vaccination, potentially improving COVID-19 vaccination rates among urban, healthcare-seeking caregivers in similar study settings.