Background. While efforts have raised immunization levels in developing countries, high rates of vaccine refusal in both developing and developed countries are causing concern worldwide. We aimed to determine the causes of vaccine refusal among parents refusing or postponing the vaccination of their children.

Methods. This descriptive, cross-sectional study was performed in the Giresun province of Turkey. The study population included families who were unwilling or refused to vaccinate at least one of their children under the scope of the Turkey Enhanced Program of Immunization. Data were obtained during the year 2018 by face-toface interviews with each vaccine hesitant parent (VHP).

Results. Vaccine refusal incidence was 1.2% in the year 2018. In 8 (14.8%) of the children, the vaccination was recorded to be postponed due to health problems, while 46 (85.2%) children were not vaccinated due to parental vaccine refusal. Two-thirds of unvaccinated children were living outside the province center of Giresun. The parents consisted of young adults whose average age was 30.6±6.6 years. VHPs were mostly university graduates (61.1% of mothers-70.3% of fathers). While at least one of the VHPs was a religious official in 24.1%, at least one of the either VHP was a teacher in 20.3%. The most common reasons for vaccine refusal were `fear of vaccine side-effects` (55.6%), and `problems in previous vaccinations` (33.3%). In 44.4 % of refusal cases, no specific reason was stated.

Conclusions. Primary healthcare providers, who are in close contact with parents, have an important role to provide the right health information. Various in-service training can be provided to improve the communication skills of healthcare providers. In these training sessions, besides comprehensive information about vaccines, it should be aimed to provide parents with the ability to understand their concerns, to approach them sensitively and to present the information they need effectively.

Keywords: childhood vaccination, immunization, vaccine hesitant parents, vaccine refusal