Understanding rotavirus vaccine acceptance in Indonesia: a WHO BeSD-based exploration of parents' and religious leaders' perspectives in three provinces

Abstract

Background Disparities in rotavirus vaccine uptake in Indonesia persist despite its national implementation, yet, the community-level determinants of vaccination remain underexplored. Understanding the behavioural and social factors influencing vaccination decisions is essential for developing interventions that improve vaccine uptake in the community. Methods A qualitative study was conducted using the World Health Organization Behavioural and Social Drivers (WHO BeSD) framework. Data were collected between May and December 2025 through five focus group discussions and 24 in-depth interviews with parents and religious leaders in Yogyakarta, Bali, and the Moluccas. Participants were purposively sampled to capture diverse experiences and perspectives. Data were analysed using a deductive thematic approach guided by the four BeSD domains: Thinking and Feeling, Social Processes, Motivation, and Practical Issues. Results Seventy-one participants (61 parents and 10 religious leaders) took part in the study. Overall acceptance of rotavirus vaccination was high and driven by trust in vaccine benefits and confidence in health services. Within the Thinking and Feeling domain, participants recognised the severity of diarrhoeal disease and the protective value of vaccination, although concerns about adverse effects and limited access to information remained, particularly in rural areas. Social Processes generally supported vaccine uptake through health workers' recommendations, community endorsement, and support from religious leaders. Most mothers reported autonomy in vaccination decision-making, although gender-related influences persisted in some households. Motivation to vaccinate was strengthened by the desire to protect children from severe illness. Under Practical Issues, participants described vaccination services as accessible through primary healthcare facilities but highlighted the need for improved information dissemination and more reliable vaccine availability in remote areas. Conclusions Improving vaccine literacy, strengthening service delivery, and addressing practical barriers are critical to increasing complete rotavirus vaccination uptake. Tailored communication and engagement of parents, religious leaders, and community stakeholders may further enhance vaccine acceptance and uptake across diverse Indonesian settings.