Decoding the Factors Influencing Parental Vaccine Decision-Making: Insights from Saudi Arabia on COVID-19 Vaccination for Children-Lessons for Future Pandemics.

Background: In Gulf nations such as Saudi Arabia, where COVID-19 vaccination is optional, parental decision-making regarding vaccinating children is critical. Understanding the psychological factors that drive these decisions can shape future vaccination strategies. Methods: Between November 2021 and January 2022, a cross-sectional, web-based validated survey was conducted using chain-referral (snowball) sampling across multiple social media platforms. A total of 2176 parents residing in Saudi Arabia with children aged 5-18 years participated. The 5C psychological antecedents (confidence, complacency, constraints, calculation, and collective responsibility) were assessed. Multinomial logistic regression was employed to determine factors influencing parental decision-making across three child age groups: 5-11 years only, 12-18 years only, and both age ranges (5-18 years). Results: Overall, 77.9% of parents agreed to receive all scheduled doses of the COVID-19 vaccine themselves, while 58.6% agreed to vaccinate children aged 12 years or older, and only 41.9% agreed to vaccinate children younger than 12 years. Fathers were significantly more likely to accept vaccination [Odds ratio (OR) = 17.48, p = 0.01] compared to mothers, who showed higher reluctance (OR = 15.08, p = 0.01). Having a child aged 5-11 years increased reluctance threefold (OR = 3.16, p = 0.01). Parents who believed that returning to school was safe showed increased vaccine acceptance (OR = 4.32, p = 0.01). Confidence and collective responsibility were the strongest positive predictors of vaccine acceptance, particularly for younger children, with OR estimates of 1.23-1.53 for confidence and 1.33-2.13 for collective responsibility. Conversely, extensive information seeking (calculation) was associated with lower acceptance (OR = 0.09, p = 0.03). A history of COVID-19 hospitalization among family or friends was significantly associated with increased parental reluctance (p = 0.03). Conclusions: This study identifies key psychological and demographic factors influencing parental decisions regarding COVID-19 vaccination for children. Building parental confidence and fostering collective responsibility are essential for increasing vaccination rates, particularly among parents of younger children aged 5-11 years. Healthcare authorities should address vaccine safety concerns, provide clear and accurate information, and tailor strategies to parents who remain hesitant.