# Bridging the knowledge gap: Thai parents’ perspectives on dengue infection and its vaccination and the need for targeted promotion

## TL;DR

Thai parents have good general knowledge of dengue but lack specific vaccine details, with complacency being a key barrier to vaccine acceptance.

## Contribution

The study identifies complacency as a significant predictor of dengue vaccine acceptance among Thai parents using the 4C model.

## Key findings

- Parents showed high general vaccination attitudes but intermediate dengue vaccine knowledge.
- Complacency was the strongest correlate of dengue vaccine acceptance.
- Only 9.75% of parents had vaccinated their children against dengue.

## Abstract

Dengue infection is endemic in Thailand, with children being the most impacted group. Various measures, including the dengue vaccine (recently recommended in Thailand since 2017 for Dengvaxia and 2023 for Qdenga), have been implemented to prevent and manage the disease. However, the rate of infection among Thai children is still high. This study explored Thai parents’ knowledge and attitudes toward dengue infection and its preventive vaccine, guided by the 4C Model for vaccine hesitancy.

This cross-sectional study employed a questionnaire survey, utilizing five investigator-developed instruments. Survey items were grouped into the components of the 4C Model. Data analysis involved descriptive, Pearson’s correlations, and Binary Logistic Regression statistics.

Among 400 participating parents in this study, high positive attitudes toward general childhood vaccination (mean score = 41.18/60) and a high level of dengue infection knowledge (mean score = 9.08/12) were observed. Common prevention methods included destroying larval breeding sites and mosquito bite prevention. Most parents viewed dengue infection as a serious disease (mean score = 7.65/10), perceiving impacts like children’s school absenteeism (93%) and parental work time off (80.75%). Regarding government management of dengue, a substantial proportion (~35%) expressed no opinion. Parents exhibited an intermediate level of dengue vaccine knowledge (mean score = 5.06/10), with most unaware of its effectiveness or complex recommendations. Most (63.5%) expressed dengue vaccine acceptance, with 9.75% having vaccinated their children and 59.56% planning to do so. All 4C model components except Calculation were weakly but significantly correlated with parents’ dengue vaccine acceptance, with Complacency being the strongest (r = -.149, p = .05). Only Complacency independently predicted dengue vaccine acceptance among Thai parents (OR=0.897, p = .031).

This study provides insights into Thai parents’ understanding of dengue and its vaccine in children. Findings offer a basis for developing targeted public health campaigns and communication strategies to promote dengue vaccine use in children, and to inform public policy on vaccine affordability.

Dengue infection remains a significant global health challenge, particularly affecting children in endemic regions like Thailand. While vaccines offer a crucial tool for prevention, their impact depends heavily on public acceptance. This study explores Thai parents’ understanding and attitudes towards dengue vaccination, using the established 4C model to identify influencing factors.

We found that despite a general awareness of dengue and vaccine availability, many parents lacked detailed knowledge about the vaccine’s specifics, such as its complex recommendations, effectiveness, or cost. Crucially, a sense of complacency regarding dengue’s threat emerged as the strongest factor influencing vaccine acceptance. Interestingly, even parents working as healthcare providers showed lower vaccination intentions for their own children.

These findings are vital for both scientists and the public, including a countrywide policy for vaccine implementation in the Expanded Program on Immunization (EPI). They illuminate key barriers to vaccine uptake in a real-world setting, suggesting that effective public health campaigns, especially healthcare providers’ advice, must go beyond basic information provision. By understanding specific concerns, addressing financial barriers, and countering complacency, public health initiatives can be better tailored to increase dengue vaccine acceptance, ultimately enhancing disease control and improving child health in affected communities.