Group members: Shahmeer shaheen, Yusia Gill, Afaq ahmad, and M Noor
ABSTRACT
Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccines despite their availability, poses a significant challenge to global and national immunization efforts. In Pakistan, vaccine uptake remains suboptimal due to widespread misinformation, concerns regarding vaccine safety, religious and cultural beliefs and low levels of institutional trust. Nurses as frontline healthcare providers and trusted members of the community are uniquely positioned to influence vaccination decisions through patient education counseling, and sustained engagement. However, empirical evidence examining their role in addressing vaccine hesitancy within the Pakistani context remains limited. This study examined the role of nurses in promoting vaccine acceptance, identified barriers encountered in addressing vaccine hesitancy, assessed nurse led communication and trust building strategies, and developed evidence-based recommendations to enhance vaccination uptake in Quetta, Pakistan. A convergent parallel mixed-methods design was employed. Quantitative data were collected using structured questionnaires from 66 registered nurses involved in vaccination services and 66 vaccine hesitant adults while qualitative data were obtained through semi structured interviews with a purposively selected subset of participants from both groups. Quantitative data were analyzed using descriptive statistics, correlation analysis and multiple regression modeling, whereas qualitative data were analyzed thematically following Braun and Clarke’s six phase framework. Integration of findings occurred during the interpretation phase to enable triangulation. The majority of nurses (88%) reported active involvement in vaccine counseling and education; however only 52% had received formal training in managing vaccine hesitancy. Nurses who reported receiving training and institutional support demonstrated significantly higher confidence in addressing hesitant individuals (p < .001). Among vaccine hesitant adults fear of vaccine side effects (76%), misinformation from social media (61%), and distrust in health institutions (58%) were the most frequently reported contributors to hesitancy. Healthcare providers particularly nurses were identified as the most trusted source of vaccine related information, with 68% of participants reporting high levels of trust. Notably, 82% of hesitant participants indicated that nurse led counseling either positively changed their vaccination decision or strengthened their intention to vaccinate. Qualitative findings further revealed distinct patterns of hesitancy related to informational gaps, social influence, and authority based concerns. Overall, nurses play a pivotal role in promoting vaccine acceptance by acting as trusted communicators and intermediaries between healthcare systems and communities. Despite their substantial influence, gaps in specialized training, heavy workloads, and limited institutional support constrain their effectiveness. Strengthening nurse focused communication training ensuring protected time for patient counseling, and implementing culturally tailored educational interventions are essential strategies for improving vaccination uptake in Pakistan and similar low- and middle-income settings.
Keywords: Vaccine hesitancy; nursing role; vaccine acceptance; health communication; Pakistan; mixed-methods research
The author studies at College of Nursing Christian Hospital Quetta, Affiliated with Bolan University of Medical and Health Sciences
