ABSTRACT
Microarray patches (MAPs) are an emerging, needle-free vaccination technology with potential to improve vaccine uptake and acceptability. A cross-sectional online survey was conducted to assess parents’ perceptions of MAP safety, usability, and acceptability for themselves and their children. Participants were parents of children aged ≤18 y residing in Australia, Canada, the United Kingdom, or New Zealand. Responses were recorded on a 7-point Likert scale. Descriptive statistics and paired t-tests were used for analysis. A total of 102 parents participated (mean age = 40.7 y, SD = 10.6), predominantly from Canada (59.8%) and Australia (35.3%). Parents rated MAP vaccination as safe and effective (mean = 5.13; 95% CI: 4.83–5.43), easy to use (mean = 5.51; 95% CI: 5.26–5.77), and acceptable (mean = 5.43; 95% CI: 5.18–5.68). Respondents preferred MAPs over traditional needle and syringe (N&S) methods for themselves and their children, particularly citing benefits for those with needle-related anxiety. Parents expressed stronger preferences for healthcare provider administration for children compared to themselves. MAP self-administration was also viewed positively. Participants indicated greater willingness to pay more for their child to receive the MAP vaccination compared to themselves. Findings suggest that parents perceive MAPs as a safe, usable, and acceptable alternative to N&S vaccination for themselves and their children.
KEYWORDS: Parents, microarray patch, vaccination, immunization, usability, acceptability
Introduction
Microarray patches (MAPs) are a new needle-free delivery platform under development. Much of the current research on MAPS is focused on healthy adults,1 with a recent phase 1/2 trial using measles-rubella MAPs demonstrating equivalent immunogenicity with no serious adverse events.2 Studies in adults have demonstrated reduced pain, the potential for self and lay administration, no risk of needle-stick injuries, no need for vaccine reconstitution, and a reduction in clinical waste.3–5 Another considerable advantage is the enhanced thermostability of MAPs that could improve logistics, thus increasing vaccine accessibility. However, there is limited literature on MAP vaccination in parents and children. This study aimed to examine parents’ perceptions of MAP vaccination, specifically safety, efficacy, usability, and acceptability. Where applicable, we also examine the differences in parents’ perceptions of MAP vaccination for themselves compared to their child or children.
Methods
Study design
This was part of a wider project to validate the Microarray Patch for Vaccination (MAPVac) Scale to measure the perceived safety, usability, and acceptability of MAPs for vaccination across Australia, Canada, the United Kingdom, and New Zealand.6 Participants were eligible to complete the parent survey if they had at least one child 18 y old or younger and were their guardian or legal representative. Each survey response represented a unique adult participant; however, it is possible that more than one parent of the same child participated in the study. For the purposes of this study, the term ‘parents’ was used to refer to all respondents. For the purposes of this study, the term ‘parents’ was used to refer to all respondents. Digital advertisements were shared via social media and online newsletters. All participants were invited to review a study information sheet, which included the instructions for use, and to watch a brief video demonstrating how a MAP is administered. The example used was the High-Density Microarray Patch currently under development by Vaxxas. The one-page information sheet, supported by images, described the MAP application process, its stage of development, potential benefits and limitations, and possible side effects (e.g., erythema). This study was approved by the Western Sydney Local Health District Human Ethics Committee (ref: 2023/ETH00705).
Data collection
We adapted the validated MAPVac Scale7 tailoring toward parents. Twelve parents assisted with scale adaptation using interviews. The scale comprised 20 items, seven of which directly compared the parent’s perspective of experiencing MAPs and that of their child. Each survey item was recorded using a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree).
Statistical analysis
Mean scores and 95% confidence intervals (CIs) were reported. Where applicable, paired t-tests were conducted for parent responses on their perceptions of themselves versus their child/ren. Stata 18 was used for statistical analyses.
Results
Participant demographics
In total 102 parents completed the MAPVac Scale. Respondents’ ages ranged from 25–80 y old, with a mean of 40.7 (SD = 10.6), with most identifying as female (n = 80, 78.4%) followed by male (n = 21, 20.6%). Most were living in Canada (n = 61, 59.8%), followed by Australia (n = 36, 35.3%) and the United Kingdom (n = 5, 4.9%). There were no parents from New Zealand. Twenty-three (22.5%) respondents identified as Indigenous. Among participants, 41 reported having two children (40.2%), 40 having one child (39.2%), 20 having three children (19.6%), and one having four children (1.0%). Demographic information is displayed in Table 1.
Table 1.
Participant demographics.
| Trait | Value | Participants (n = 102) % (n) |
|---|---|---|
| Gender | Female | 78.4 (80) |
| Male | 20.6 (21) | |
| Prefer not to answer/Not stated | 1.0 (1) | |
| Age range in years | 25–80 (mean = 40.7, SD = 10.6) | |
| Number of children | One | 39.2 (40) |
| Two | 40.2 (41) | |
| Three or more | 20.6 (21) | |
| Country of residence | Canada | 59.8 (61) |
| Australia | 35.3 (36) | |
| United Kingdom | 4.9 (5) | |
| Indigenous | Yes | 22.5 (23) |
| No | 77.5 (79) | |
| Prefer not to answer/Not stated | 7.8 (8) | |
| Education | High school Year 10–12 | 4.9 (5) |
| Apprenticeship /College Diploma | 16.7 (17) | |
| Undergraduate degree | 46.1 (47) | |
| Postgraduate degree | 32.4 (33) | |
| Other | 1.0 (1) | |
| Employment status | Full-time | 71.6 (73) |
| Part-time | 79.6 (20) | |
| Other | 4.9 (5) | |
| Occupation | Human health and social work activities | 35.3 (36) |
| Professional, scientific and technical activities | 13.7 (14) | |
| Administrative and support service activities | 9.8 (10) | |
| Information and communication | 6.9 (7) | |
| Manufacturing | 6.9 (7) | |
| Education | 5.9 (6) | |
| Other | 21.6 (22) |
Note: SD, standard deviation.
Survey findings
With combined means for each survey domain, parents perceived MAP vaccination to be safe and effective (m = 5.13, 95% CI: 4.83–5.43), easy to use (m = 5.51, 95% CI: 5.26–5.77), and acceptable (m = 5.43, 95% CI: 5.18–5.68). Descriptive statistics are detailed in Table 2. t-tests are detailed within the text.
Table 2.
Mean scores, standard deviations, and 95% confidence intervals of survey items comparing parents’ responses.
| Scale Item for Parent | Mean | SD | 95% CI | Scale Item for Child | Mean | SD | 95% CI |
|---|---|---|---|---|---|---|---|
| Domain 1: Safety and Efficacy | |||||||
| 1. ‘I think the vaccine patch would be safer than a needle and syringe’ | 5.12 | 1.34 | 4.85–5.38 | ||||
| 2. ‘I think there will be more side effects with a vaccine patch than needle and syringe’ (R) | 3.38 | 1.54 | 3.08–3.69 | ||||
| 3. ‘I believe the vaccine patch will be more painful than an injection’ (R) | 2.58 | 1.44 | 2.29–2.87 | ||||
| 4. ‘I think the vaccine patch could reduce needle-stick injuries (accidental puncture of the skin by a needle)’ | 5.57 | 1.42 | 5.29–5.86 | ||||
| 5. a) ‘I think self-administration of a vaccine patch in a clinic would be safe for myself’ | 5.33 | 1.53 | 5.03–5.63 | 5. b) ‘I think administration of a vaccine patch by a healthcare provider in a clinic would be safe for my child’ | 5.90 | 1.25 | 5.66–6.15 |
| 6. a) ‘I think self-administration of a vaccine patch at home without supervision would be safe for myself’ | 4.75 | 1.85 | 4.39–5.12 | 6. b) ‘I think administration of a vaccine patch at home without supervision would be safe for my child’ | 4.06 | 1.96 | 3.67–4.44 |
| 7. a) ‘I would prefer my healthcare provider to administer a vaccine patch to me’ | 4.94 | 1.54 | 4.63–5.25 | 7. b) ‘I would prefer my healthcare provider to administer a vaccine patch to my child’ | 5.43 | 1.50 | 5.13–5.72 |
| 8. ‘I believe the vaccine patch could be as effective as an injection’ | 5.34 | 1.29 | 5.09–5.60 | ||||
| Domain 2: Usability | |||||||
| 9. ‘I think the vaccine patch would be easy to use’ | 5.82 | 1.13 | 5.60–6.05 | ||||
| 10. ‘I believe the vaccine patch will deliver the correct dose’ | 5.30 | 1.24 | 5.05–5.54 | ||||
| 11. a) ‘I think it would be easy to give myself a vaccine patch’ | 5.47 | 1.44 | 5.18–5.75 | 11. b) ‘I think it would be easy to give my child a vaccine patch’ | 5.29 | 1.56 | 4.98–5.60 |
| 12. ‘I believe the vaccine patch’s instructions for use are easy to understand’ | 5.69 | 1.12 | 5.47–5.91 | ||||
| Domain 3: Acceptability | |||||||
| 13. a) ‘I would prefer to have a vaccine patch for myself rather than an injection’ | 5.18 | 1.47 | 4.89–5.46 | 13. b) ‘I would prefer my child to have a vaccine patch rather than an injection’ | 5.39 | 1.34 | 5.13–5.65 |
| 14. ‘I feel that the red mark after a vaccine patch is acceptable’ | 5.68 | 1.13 | 5.46–5.91 | ||||
| 15. a) ‘A 10 second application time (required amount of time to wear the vaccine patch) is acceptable for myself’ | 5.99 | 1.06 | 5.78–6.20 | 15. b) ‘A 10 second application time (required amount of time to wear the vaccine patch) is acceptable for my child’ | 5.59 | 1.20 | 5.36–5.83 |
| 16. ‘Non-medical people can use vaccine patches with instructions’ | 5.24 | 1.28 | 4.99–5.49 | ||||
| 17. ‘Vaccine patches will be more convenient than injections’ | 5.89 | 1.00 | 5.69–6.09 | ||||
| 18. ‘I believe vaccine patches would be better for children’ | 5.77 | 1.22 | 5.54–6.01 | ||||
| 19. ‘I think vaccine patches would be useful for people frightened of needles’ | 6.14 | 1.06 | 5.93–6.35 | ||||
| 20. a) ‘I would pay more for a vaccine patch rather than an injection for myself’ | 3.96 | 1.75 | 3.61–4.31 | 20. b) ‘I would pay more for a vaccine patch rather than an injection for my child’ | 4.86 | 1.55 | 4.56–5.17 |
Note: (R), item score is reversed. Scores range from 1 (strongly disagree) to 7 (strongly agree).
Safety and efficacy
Parents perceived the MAP to be somewhat safer than needle and syringe (N&S), less painful, and have fewer side effects. MAPs were also perceived to reduce needle-stick injuries. Parents perceived MAP administration by an HCP to their child in a clinic safer than self-administering to themselves in a clinic with a mean difference of 0.57 (95% CI: 0.31–0.83, t[101] = 4.39, p = <.001). Parents perceived self-administering a MAP vaccine was safer for themselves compared to their child (mean difference = 0.70, 95% CI: 0.41–0.98, t[101] = 4.88, p = <.001). There was a preference for HCP-administered MAP for their child compared to themselves (mean difference = 0.52, 95% CI: 0.29–0.74, t[98] = 4.58, p = <.001). Parents believed that MAPs could be as effective as N&S.
Usability
Parents agreed that MAPs would be easy to use and could deliver a correct dose. They perceived MAPs to be easy to administer to themself and their child, with no significant difference between responses (mean difference = 0.21, 95% CI: −0.05–0.47, t[100] = 1.59, p = .1). They also agreed that the instructions for use were easy to read.
Acceptability
Parents viewed MAPs as more acceptable that N&S for themself and their child, favoring it for themselves more so than their child (mean difference = 0.22, 95% CI: 0.01–0.42, t[101] = 2.08, p = .04). Parents felt that erythema after MAP administration would be acceptable. Participants were somewhat agreeable that laypeople could administer MAPs. They agreed that MAPs could be more convenient than N&S. Parents perceived a 10-second application time more acceptable for themselves than their child (mean difference = 0.39, 95% CI: 0.19–0.59, t[97] = 3.83, p = <.001). Participants perceived MAPs as particularly useful for children with needle-related anxiety. There was strong evidence that parents would pay more for a MAP to be administered to their child than themselves over N&S (mean difference = 0.91, 95% CI: 0.58–1.24, t[98] = 5.51, p = <.001).
Discussion
Our findings suggest that parents perceived MAPs as a suitable alternative to N&S vaccinations for themselves and their children. These findings align with previous research that has highlighted MAPs as an acceptable method of vaccination among children.8,9 Parents considered MAPs as safe and effective, with a preference for administration by a HCP in a clinic, particularly for their children. Self-administration is a potential but would need to be performed under the supervision of a health provider due to possible adverse events.1,3 Participants indicated that MAPs would be easy to use on themselves and their children, and that the instructions for use were easy to understand. Parents generally found MAPs acceptable, including predictable side-effect of erythema, layperson use, application times, and particularly for use in those with needle-related anxiety. Parents appeared to be more willing to pay for their child to receive a MAP over an N&S vaccine. These findings align with other populations, including healthy adults, older adults, and HCPs.1,3,5,9,10
To date, Phase I and II trials have primarily been conducted in healthy adult populations, demonstrating protective immunogenicity for MAP vaccines such as influenza, measles – rubella, and Japanese encephalitis.2,11–14 However, larger Phase III trials are required to support regulatory approval and public confidence. Few clinical trials have evaluated MAPs in pediatric populations, with existing studies limited to measles – rubella vaccine2 or placebo.15 This study’s findings support the potential role of MAPs in improving vaccine acceptance and uptake, particularly among children and those with needle-related anxiety. Self-administration and pediatric use may require HCP support or trained users, but further investigation is needed. While parents in our study expressed willingness to pay more for MAPs for their child, further research is needed to explore how cost considerations may influence long-term adoption in real-world settings. This sample was relatively small across three countries, which may affect this report’s generalizability.
Conclusion
Parents indicated that MAPs may be a safe, effective, user-friendly, and acceptable alternative to N&S vaccination. Future research should focus on real-world studies of parent and pediatric MAP vaccination. Opportunities to enhance vaccine acceptability and access are crucial to protecting children from preventable diseases.
Acknowledgments
We thank the participants for their time and contribution to this study. Findings from this study were presented at the Public Health 2026 Santé publique, Montréal, QC Canada.
Biography
Matthew N. Berger is a Research Officer in the Specialty of Child and Adolescent Health and an affiliate of the Sydney Infectious Diseases Institute at the University of Sydney. He also works clinically as a Communicable Disease Nurse with Vancouver Coastal Health. Matthew holds a Bachelor of Science (Nursing) and postgraduate qualifications including a Master of Science in Medicine (Infection and Immunity), a Master of Philosophy (Medicine) from the University of Sydney, and a Master of Public Health (Epidemiology) from the University of New South Wales. He completed his PhD in 2025, focusing on the safety, usability, and acceptability of microarray patches for vaccination. His research expertise spans novel vaccine delivery technologies, communicable diseases, infection prevention and control, public health surveillance, sexual and reproductive health, adolescent health, and digital health. Matthew is board certified in infection prevention and control (CIC), a Credentialled Infection Control Professional (Primary), and a Fellow of the Royal Society for Public Health. He is a member of the Canadian Public Health Association and the Public Health Association of Australia.
Funding Statement
The lead author (MNB) received a New South Wales Health Partnership Scholarship that enabled the study to be undertaken.
Disclosure statement
MNB was awarded an NSW Health PhD Partnership Scholarship to examine the usability and acceptability of high-density microarray patches (HD-MAPs) under development by Vaxxas Pty Ltd. CD and SRS are investigators involved in research on the usability and acceptability of the Vaxxas HD-MAP. EM, RZS, and SB report no conflicts of interest.
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