Vaccine hesitancy among Saudi parents of children in Abha City, Saudi Arabia: a cross-sectional study.

BACKGROUND: Vaccine hesitancy remains an important global public health concern despite the success of childhood immunization programs. Parental concerns regarding vaccine safety, side effects, and misinformation may negatively influence vaccine uptake and contribute to delayed or refused childhood vaccination. This study aimed to assess vaccine hesitancy among Saudi parents in Abha City and identify factors associated with hesitant attitudes toward compulsory childhood vaccination. METHODS: A cross-sectional analytical study was conducted among 382 Saudi parents of children younger than 12 years in Abha City, Saudi Arabia, between 1 January and 30 April 2025. Data were collected using a structured Arabic questionnaire assessing sociodemographic characteristics, vaccine knowledge, attitudes, trust, and vaccination behaviors. A composite vaccine hesitancy score was calculated, and participants with scores ≥11 were classified as having high vaccine hesitancy. Firth penalized logistic regression analysis was performed to identify factors independently associated with high vaccine hesitancy. Data were analyzed using R statistical software version 4.4.3. RESULTS: Most participants demonstrated good awareness regarding compulsory childhood vaccination, with 96.9% reporting familiarity with the national immunization schedule. Although overall vaccine confidence was high, 46.1% of participants reported concerns regarding vaccine side effects, and 35.6% had previously delayed or refused a compulsory vaccine for their child. Overall, 5.2% of participants demonstrated high vaccine hesitancy. Firth penalized logistic regression analysis showed that parents older than 40 years (adjusted OR = 6.62, 95% CI: 1.65-38.89, p = 0.006) and female participants (adjusted OR = 3.41, 95% CI: 1.29-9.98, p = 0.013) were independently associated with high vaccine hesitancy. CONCLUSION: Although vaccine hesitancy was relatively low among Saudi parents in Abha City, concerns regarding vaccine safety and side effects remain common. Targeted educational interventions, effective healthcare communication, and strategies addressing vaccine misinformation are essential to maintain public confidence in childhood immunization programs.