Beyond seeking information: Lessons learned from a qualitative investigation of the information practices of parents about COVID-19 vaccination in Canada

ABSTRACT

Recent reports indicate a concerning decline in routine childhood vaccination rates globally. Parental engagement with health information is critical in shaping vaccine acceptance amid rising skepticism and shifting sociopolitical dynamics. In this study, we investigated how Canadian parents engaged with information to decide on COVID-19 vaccination for their children. Using an exploratory qualitative design, we conducted semi-structured interviews with 48 parents between April and August 2022. Data were analyzed thematically and organized around McKenzie’s model of information practices. Our findings revealed that parental engagement is a dynamic process shaped by emotional, social, and informational factors. While parents sought evidence-based information, they also employed sophisticated strategies to navigate uncertainty. Novel insights include the use of source triangulation to build epistemic authority, the strategic use of information avoidance to mitigate social stigma, and a transition toward cognitive closure once decisions were finalized. Notably, most parents reached a “case closed” state before pediatric vaccines were authorized, relying on trusted sources (i.e. schools and pediatricians) as proxies and their experiential lived evidence for decision-making. To improve communication about childhood vaccination, including in future health crises, we recommend a proactive approach that recognizes the finite life cycle of information engagement. Public health strategies can prioritize early messaging before cognitive closure occurs and leverage distributed trust by using health-care providers and schools as primary information proxies. These findings offer a blueprint for navigating the psycho-social complexities of health communication.

Introduction

As we emerge from the COVID-19 pandemic,^1,2 a key public health challenge is sustaining adequate vaccination coverage among children, including routine and seasonal vaccines. At the same time, routine childhood immunization rates have declined significantly in Canada and globally.^3,4 For instance, between December 2019 and December 2023, coverage for one dose of the measles, mumps, and rubella (MMR) and four doses of the diphtheria, tetanus, and acellular pertussis (DTaP) vaccine decreased from 89.5% to 82.5% and 79.9% to 72.1%, respectively, among 2-y-olds in provinces and territories participating in the STARVAX surveillance system.⁴ Similar declines in childhood immunization coverage have been observed globally,⁵ raising questions about parents’ information engagement and whether vaccination communications strategies meet their needs.

The COVID-19 pandemic has highlighted both the strengths and shortcomings of public health communication, revealing how trust, transparency, and accessibility shape families’ vaccine decisions.^6–10 Lessons learned from the COVID-19 pandemic include the importance of clear messaging, confidence in health-care providers, and equitable access to credible information, which may be leveraged to support the uptake of other key childhood vaccines, such as those for measles, human papillomavirus (HPV), and influenza. While COVID-19 vaccination became exceptionally polarized in connection with other societal partisan turns in Canada and elsewhere, pandemic vaccination efforts also surfaced broader challenges around vaccine communication and access. This is particularly important in contexts like the Canadian province of Alberta, where recent political shifts that reduce accessibility of COVID-19 vaccines have introduced new barriers and sources of hesitancy, including out-of-pocket payment for COVID-19 vaccines for individuals without preexisting medical conditions.^11,12 This change has not been limited to Canada; in the neighboring USA, Florida officials have proposed repeals of school vaccine mandates, which may introduce hesitancy by shifting the responsibility for childhood vaccination entirely to parents and guardians and damaging public perception of vaccine safety or effectiveness.¹³ However, parental vaccination decisions are often influenced by inequitable access to credible information and barriers to health care (e.g., long work commutes, gaps in childcare, caregiving responsibilities),^14–16 which are factors that may further widen immunization gaps and increase vulnerability to vaccine-preventable diseases. As the sociopolitical landscape surrounding vaccination continues to evolve, so too must public health approaches to fostering vaccine confidence.

The novelty of the COVID-19 vaccine heightened parental perceptions of responsibilities to protect their children by ensuring they were safely vaccinated because of the urgency of the pandemic and the context of rapidly changing public health information.^17,18 Furthermore, public health officials and researchers were pressured to deliver accurate, understandable, and timely information for both the public and health-care professionals. The pace at which vaccination information evolved during the COVID-19 pandemic, including the vaccine rollout and the enormous quantity of pandemic misinformation, contributed to increased concerns, altered information engagement, and transformed decision-making behaviors among many individuals.^19,20 Parents who were uninterested or ambivalent about vaccines may have been unwilling to make additional efforts to identify and engage with credible information about COVID-19 vaccination.^21,22 Furthermore, pandemic-related stress may have dissuaded some parents from engaging with vaccine-related information as they already felt overwhelmed with changing discourses and evolving public health messaging.^23–26

Information engagement encompasses both behavioral participation, such as sharing, commenting, and reading, along with attitudinal perception, which refers to users’ subjective evaluations of the usability and relevance of content.²⁷ It also involves perseverance, or the lasting cognitive impact, and practical application of information.²⁷ To understand these complex behaviors, we must move beyond a narrow view of information seeking. As Erdelez²⁸ points out, the term information seeking behavior may be misleading, as it fails to capture passive or incidental ways people acquire information. Consistent with the social constructionist paradigm, which emphasizes concrete and situated activities within social contexts, McKenzie’s²⁹ two-dimensional model of information practices offers a valuable framework for understanding how individuals engage with information in everyday life. The first dimension outlines four modes of information practice: active seeking, where individuals intentionally search for specific information; active scanning, which involves purposeful attention to information sources without a defined goal; non-directed monitoring, referring to incidental or passive awareness of information encountered in the environment; and by proxy, where information is acquired indirectly through others, such as family, friends, or community members.²⁹ The second dimension considers the nature of interaction with information sources, whether through direct engagement, intermediaries, or passive receipt.²⁹ This model highlights that information engagement is not always deliberate or structured but instead often occurs through a mix of intentional and serendipitous encounters. It is particularly relevant in health contexts, where individuals may navigate complex and evolving information environments shaped by social, cultural, and political factors.

Understanding how parents’ COVID-19 information engagement and decision-making strategies evolved during the pandemic may contribute to developing more effective vaccination communication, which will be valuable during future public health crises.^30,31 This is particularly relevant for parents who were neither firmly pro- nor anti-vaccine but were initially undecided and therefore in an active state of information-seeking and assessment due to the urgency and uncertainty surrounding a novel pandemic pathogen and a selection of new vaccines. These high-information-engagement individuals represent a critical group for targeted communication strategies,³² as they are often the most receptive to credible, timely, and context-sensitive public health messaging.

In this study, we explored how Canadian parents engaged with information to guide their decisions about vaccinating their children against COVID-19. We sought to answer two key questions: (1) What sources did parents engage with for COVID-19 vaccine information and decision-making? and (2) How did parents’ engagement with COVID-19 vaccine information evolve as the pandemic progressed?

Materials and methods

The statement should read as follows: This exploratory qualitative study is one part of a four-stage multifaceted project that examined engagement with online COVID-19 information and misinformation in Canada using: (1) “a machine learning algorithm” to investigate reinformation in the media³³, (2) a survey, (3) qualitative interviews, and (4) an environmental scan and scoping review.³⁴ The study being reported here is part of stage 3 and is based on semi-structured interviews with parents of one or more child(ren) aged 11–18 years in 2022. We published elsewhere about how intersectionality-shaped vaccine decision-making³⁵ and about how familial relationships and parenting norms shaped vaccination among interview participants.³⁶ In this article, we focus on self-reported changes to parents’ information engagement during the pandemic.

The interview guide was developed by a national, interdisciplinary team of experts with academic and professional backgrounds in nursing, sociology, health communication, medical anthropology, pediatrics, public health, and information science. This collaborative design ensured that the guide included a range of perspectives relevant to understanding vaccine decision-making in diverse populations.³⁷ The interview guide was pilot tested among research assistants to ensure clarity, natural flow, and train research assistants prior to data collection. Two team members (TM and an RA) with extensive training in qualitative interviewing led this process and guided minor amendments during testing and after the first round of interviews to help participants address all important questions and to maintain a narrative flow through topics. Five team members (EAM, EC, TM, DG, and an RA) conducted the interviews in English and French. Each interviewer co-constructed data by loosely following the interview guide to ensure participants could focus on the factors that were most relevant to each participant. The ethics board approved this approach to making light revisions to the interview guide and semi-structuring interviews during data collection.

Participant recruitment and selection

We recruited participants from respondents to an online survey carried out by Leger, a Canadian polling firm, that explored COVID-19 vaccine attitudes, decisions, and access among respondents in 2021 (N = 6026). Survey respondents were 18 y or older, could communicate in French or English, and had internet access. Among the 3402 survey respondents who consented to be contacted for follow-up interviews, 360 met the inclusion criteria outlined below.

The inclusion criteria included self-identification as a parent or a guardian of at least one child between ages 11 and 18 y. We used survey data to purposively select respondents with diverse social characteristics (e.g., self-identified ethnic identity, province of residence, gender, migration/citizenship status, first language, income, education, and employment). We specifically included respondents whose survey responses reflected some level of uncertainty (e.g., undecided, preferring to wait for more evidence).³⁸ Respondents at the extreme ends of the vaccine hesitancy spectrum (completely pro-vaccine or anti-vaccine) were excluded because we aimed to understand how those who were uncertain about vaccination and may have taken time to make decisions engaged with available information.

Based upon these criteria, 142 respondents were invited to complete an online consent form and to schedule an interview. Forty-eight parents completed an interview between April and August of 2022 (2–2.5 y after the pandemic was declared). At the start of this study (April 2022), COVID-19 vaccines were widely available in Canada, and individuals aged 5 and older were eligible for vaccination according to Health Canada approval, the National Advisory Committee on Immunization (NACI) recommendations, and provincial immunization schedules. Specifically, NACI strongly recommended children aged 5–11 y receive a primary series of the Pfizer-BioNTech (10 mcg) COVID-19 vaccine. NACI specified that this series should be offered with a preferred interval of at least 8 weeks between the first and second dose to optimize the immune response.³⁹

Data collection and analysis

The 48 participant interviews were completed by one of five researchers in English or French via Zoom video conferencing (n = 47) or telephone (n = 1). Interviews were semi-structured and lasted 22–60 minutes (see supplemental material for interview guide). We assigned each participant a pseudonym.

Data collection and analysis processes were concurrent. We used an applied thematic analysis approach⁴⁰ to inductively identify overt and implicit responses about COVID-19 and vaccine information-seeking and engagement behaviors, preferred sources of information, and reasons for information disengagement. Five researchers were involved in the data coding, including EAM, TM, EC, and JL. Each transcript was independently coded by at least two researchers in NVivo 12 software (QSR International) for evidence of information-seeking behavior and information engagement. Discrepancies between coders were discussed during regular team meetings and resolved through consensus among the coding team. The coding framework was iteratively developed and refined throughout the analysis.

Additionally, we drew on McKenzie’s model²⁹ to interpret the findings from the thematic analysis. This model was a valuable framework because it allows for the description of “idiosyncrasies” present in real-life information engagement, which are not always the systematic processes associated with more directed information seeking. Rather than using McKenzie’s model as a rigid coding framework, we applied it after the initial thematic analysis to understand how parents navigated and engaged with rapidly evolving and sometimes conflicting public health messaging during the pandemic. Throughout analysis, we ensured rigor through iterative discussions, memoing, and consensus-building within the research team.

Ethics approval

We received ethics approval from the University of Alberta Research Ethics Board (ID: Pro00102401).

Results

A total of 48 participants identifying as ethnically diverse non-Indigenous (n = 40) or Indigenous (n = 8) people from seven provinces participated in this study (see Table 1). The largest proportion of participants identified as White (n = 14), women (n = 31), or residing in an Eastern Canadian province (n = 29). The majority completed their interview in English (n = 38).

Table 1.

Summary of participants’ characteristics (N = 48).

Characteristica	n
Age (y)
≤39	11
40–49	22
50–59	14
≥60	1
Gender
Woman	31
Man	16
Two-spirit	1
Region
Atlantic (PEI)	1
Eastern (ON, QC)	29
Western (AB, BC, SK, MB)	18
Ethnicity
Arab	2
Black	4
East Asian	8
Latin American	3
South Asian	8
Jewish	1
White	14
Indigenous
First Nations	4
Métis	2
Indigenous – no details	2
Interview language
English	38
French	10

^aBased on survey responses except for ethnicity. Participants self-reported ethnicity from interviews.

Guided by McKenzie’s model and our analysis of the interview transcripts, we organized participants engagement with COVID-19 vaccine information into four categories reflecting distinct patterns of information practices: (1) active information-seeking behaviours, (2) information avoidance and emotional landscape, (3) evolution of information engagement, and (4) reliance on trusted sources and prior COVID-19 vaccination experiential evidence.

Active information seeking behavior

Participants actively sought information to address their needs and questions. They strategically sought out information, driven to verify facts and avoid perceived bias. This involved consulting multiple sources, with participants identifying credibility, accuracy, and trustworthiness as key factors in their selection. For Marianne, this meant purposefully seeking information from “many different sources … Whether it’s [the] government, whether it’s private, whether it’s extremist groups too. I want to know what they are saying, and what they are thinking” [Translated from French]. Marianne’s quote shows a strategy of purposely seeking to engage with diverse perspectives.

Participants described employing techniques such as cross-referencing and source triangulation to verify credibility as well as to identify inconsistencies and perceived misinformation. They guided their own and their children’s information engagement with these techniques. For instance:

I said [to my child?] you just have to open your eyes and know what the traps [are] and whats not. And at the end of the day, its still your decision. I know theres a lot of being brainwashed right now … so by having those tools you just have to extrapolate, summarize, and see whats the inconsistencies because […] if its not consistent with one another, I mean you can see the red flags […]. If one news is telling this, you just cross reference it. (Rexford)

When you want to verify information, the best way is to go to the source. Because even sometimes, [in] newspaper articles, you have to check … Well, in fact, its by cross-referencing certain information that you can get a more objective idea [Translated from French].

(Theo)

When actively seeking information about COVID-19 vaccines for children’s vaccination, many participants preferred sources that were accessible and evidence-based, such as government websites, which were praised for being “plain and simple” by Calina. Likewise, Kasey thought “something from the public health officials and government websites would be more straightforward and [have] information and [that I could] choose what to do with it.” This active, focused search and information triangulation extended to social networks, with participants like Shakira consulting friends to determine the accuracy of information they had found:

I noticed there were a lot of comments below and then mentioned it to a couple of friends I know who kind of do the same research with me, and we both, [a] couple of us came to the conclusion that it wasnt accurate, because we researched it.

(Shakira)

While some participants desired simple information, others who actively engaged in information-seeking behaviors characterized their searches as resembling formal “research,” emphasizing the use of structured tactics and credible sources to justify their decisions. By emulating the process of information search (through social networks), participants constructed a sense of epistemic authority that allowed them to navigate conflicting narratives with greater confidence.

The above quotes illustrate that participants sought information strategically, consulting multiple sources, evaluating credibility, and cross-referencing to detect inconsistencies or misinformation, which aligns with the concept of information triangulation⁴¹ in the event of uncertainties.^42,43 Overall, these practices reflected how participants managed information to make informed decisions about their children’s health.

Information avoidance and emotional landscape

Some participants reported avoiding information, including in social conversations, to stay away from negative emotions, social tension, or stigma. Kadie reported: “I just scroll past [information on public health guidelines] because it makes me upset.” Some participants experienced feelings of social discomfort or stigmatization. Brenda described purposefully disengaging in conversations if she felt singled out. She explained: “So when I feel that if the conversation does come up, and the tone […] has changed […]. I put a stop to it. I’m like no, we’re not having that conversation and I’m not talking about it.” This defensive stance suggests that the perceived stigma was not necessarily inherent in the vaccine information itself but was triggered by the exclusionary or judgmental way that information was presented during social interactions. Brenda’s reaction was a self-protective response to the intense social pressures she observed, like Leonard, who noted that “a lot of people feel pressured … fear of losing their jobs, or fear of you know, not looking good in the eyes of their peers.” By articulating these fears, these participants clarify that “stigma” in this context refers to the threat of social devaluation and professional repercussions. Thus, information engagement can become a trigger for these anxieties, leading participants to set hard boundaries to prevent being “othered” or marginalized. These accounts highlighted that polarization around COVID-19 vaccination may shape information engagement, and avoidance in these instances was not a failure of search, but a strategic boundary set against the social and emotional costs of the pandemic.

Despite engaging in avoidance practices, pandemic information nonetheless intruded or “broke through” to some participants at times. For instance, Zara, who actively avoided anything “coming up in the press” still saw news pop-ups on her feed. Zara explained further:

because I am done with restrictions. […] I’m not in denial, but I’m ignoring it. … I do see pop up in my newsfeed, sometimes, that numbers [of COVID-19 cases] have increased and stuff like that.

This explanation illustrates intentional disengagement rather than a lack of awareness. Zara recognized that COVID-19 information and public health messaging were ongoing and constantly evolving, yet she deliberately limited her attention to these updates. This reflects a coping strategy shaped by a sense of being “done” with pandemic restrictions, aligning with literature on information avoidance regarding affectively negative health topics.⁴⁴ In such contexts, individuals may disengage from potentially useful information, such as children’s vaccination updates or new guidelines, specifically to maintain a sense of being “done,” as that information would require additional emotional labor. For Zara, the desire to preserve her psychological well-being and maintain a sense of normalcy outweighed the perceived benefit of staying informed, suggesting that avoidance served as a protective mechanism against “news fatigue” associated with the novel and evolving pandemic.⁴⁵

Evolution of information practices and non-directed monitoring

As the pandemic and public health information evolved, many participants’ information behaviors and practices waned, shifting from active seeking to a state of perceived information sufficiency. Some participants felt no need to continue pursuing information once they had reached a level of confidence in their acquired information, citing information sufficiency as a reason to disengage. For example, Aurelie explained, “I already had enough information” [Translated from French], illustrating a sense of cognitive saturation, where she felt they had acquired the necessary information to feel secure and not seek new information. This suggests that information engagement is not a static state but an evolving practice that diminishes as confidence in one’s acquired information and existing knowledge base grows.

Conversely, other participants exhibited a “case closed” mentality, where disengagement was driven by a perceived sense of finality of a decision (i.e., completed vaccination) that had already been executed. Kasey, for example, stopped looking for vaccine information entirely explaining, “I personally have not looked at any information [about] the vaccine since receiving it [vaccine].” Kasey’s report of not having looked at any information “since receiving it” suggests that once the decision is made and the action taken, the relevance of ongoing information pursuit evaporates because the decision was completed for that vaccine, although decisions about additional COVID-19 vaccine doses or other vaccines recommended in childhood could still be ongoing. In these instances, the waning of information seeking was less about information sufficiency and more about the functional end of a decision-making life cycle. These shifts show that participants’ disengagement is a sophisticated response to their evolving context, moving from high-effort triangulation to a pragmatic cessation of search as they transitioned from seekers to deciders.

Reliance on trusted sources and prior COVID-19 vaccination experiential evidence

Participants relied on information by proxy from trusted sources and institutions, as well as their own past experiences with adult COVID-19 vaccination to inform decisions for their children. They relied on a trusted source to vet and provide information on their behalf. For instance, some participants depended on information provided by institutions like their children’s schools to guide their information engagement about their child’s COVID-19 vaccination. Sabina mentioned, “They [kids] were getting information from their school board.” Rachel further explained:

The school sends out Flyers and or, you know, newsletters or say most of it done not on paper form anymore. Most of its done through emails to the parents. […] I think theyre pretty accurate. We’ve got a pretty good school district here.

For other participants, rather than conducting a new, active information search, they relied on their memory of older information that they had used to inform decisions for their own vaccination and their experiences for their children’s vaccination. For example, some participants explained:

We didn’t look […]. When we saw that it was Pfizer, we didnt look any further. Because at their age [12 and 14 years old], for us, it was logical that the side effects would be the same […] So we didn’t look any further. [Translated from French].

(Sylvie)

All the same [information as used for self vaccination], yes. Whatever was best for her age group [15 years old]. It was actually released for her age group and what was made available for them. That was the only news we were interested in. What can she get, and when can she get it, and where to get it?

(Gabriel)

Similarly, the decision for some participants to trust information from their child’s pediatrician without efforts to engage with other sources was a clear instance of reliance on a trusted professional for information seeking by proxy. For instance, Sylvie, who did not search for information on her older children’s vaccinations, indicated that “We talked to the pediatrician about my little one [10 years old]” [Translated from French].

Discussion

This study explored how parents’ information engagement and source selection evolved during a period of high information uncertainty. Our findings revealed that engagement was not a static behavior, but a dynamic process characterized by a transition from proactive seeking to more complex states of information sufficiency or emotional avoidance. While the context was the COVID-19 pandemic, these results uncover fundamental underlying information practices and processes that may be relevant to decision-making about other vaccinations and likely structure information practices across any large-scale public health emergency involving an unfolding evidence base. Critically, these psychological states of information sufficiency and emotional avoidance during information engagement identified in this study may contribute to understanding current shifts in routine vaccine uptake, such as the declining routine vaccine coverage rates, which has consequently resulted in the loss of measles elimination status in Canada ⁴⁶ and evolving vaccine recommendations in the United States.⁴⁷ Parents often sought information they perceived as credible and evidence-based, such as government and public health websites. This preference aligns with existing literature on trust in official sources.^48–50 Also, social networks and relationships with trusted authorities like health-care providers and schools influenced information engagement and decision-making, reflecting findings from earlier studies.^51,52 Furthermore, some parents avoided information engagement in response to stigma or emotionally charged topics about the pandemic and vaccination, corroborating findings from studies in Canada,⁵³ France,⁵⁴ and Australia.⁵⁵ While parental active-information seeking, information-seeking by proxy, and information avoidance strategies are already known in the literature,^56,57 parents in this study provided novel insights into parental decision-making, such as triangulating information from diverse sources and relying on proxy and lived experiential evidence for their children’s vaccination decisions.

Our findings align with and expand upon recent studies,^22,48,58 which also showed accessibility, perceived trust, and the evidence-base of COVID-19 information shaped parent engagement. While Cyrkot et al.⁵⁸ and Hartling et al.⁴⁸ provide valuable insights within Canadian contexts, our study offers a novel contribution by demonstrating that perceptions of information credibility were not fixed but were shaped by participants’ subjective interpretations and complex mechanisms for determining what information is trustworthy. Effective engagement with and use of vaccination information for decision-making requires access to and trust in information sources,^52,59 and our findings illustrate how parents navigated identifying credible information in a fragmented information environment. Consistent with previous research,^49,60,61 parents concerned about trust and bias triangulated multiple-information sources through cross-referencing to determine information credibility when making COVID-19 vaccination decisions. For example, although many parents trusted their government and/or public health agencies as authorities, whose influence shaped vaccination decisions, a few still required individual verification activities for decision-making due to perceived biases. This additional responsibility for parents to discern information credibility within social and politically polarized contexts may have implications for information engagement. However, without trust in credible and authoritative public health messaging, cross-referencing of different information sources may lead to susceptibility to confirmation bias or echo chambers, in which individuals search for information that aligns with their beliefs or opinions,^62,63 and not necessarily a public health recommendation. Furthermore, this tendency toward individual verification suggests that parents are not merely passive consumers but are actively constructing a sense of epistemic authority, adopting lay-scientific practices to navigate the complexities of science evolving in real-time during health crises.

As the pandemic evolved and new information emerged, some participants reported passively engaging or avoiding COVID-19 pandemic and vaccination information, corresponding with findings from previous studies.^60,64 This may be due to information fatigue,⁶⁵ information sufficiency, vaccination decisions already made based on prior information, or passive compliance with public health recommendations. While compliance with public health guidelines is widely considered a positive health attitude, inactive engagement with information during an evolving health crisis may result in health decisions based on outdated evidence or misinformation. This underscores the importance of promoting public health information engagement among parents and the public to facilitate informed decision-making. Although health authorities and public health agencies made efforts to institute community-tailored, inclusive, respectful, and culturally responsive communication mechanisms for COVID-19 messaging,^6,7 the challenges of regulating online platforms capable of reaching large masses of people with credible information may have also presented a window of opportunity for spreading inflammatory messages.⁶⁶ These dynamics contribute to avoidance of dissimilar opinions to prevent negative emotions. Such avoidance behaviors highlight that health information often carries an “emotional price tag,” where the social cost of potential stigma or peer judgment in polarized contexts outweighs the perceived utility of remaining informed. These findings advance understanding of the significance of considering the psycho-social aspects of health information communication and its impact on engagement in decision-making during pandemics or other health crises.⁶⁷

Finally, a crucial finding from this study was that most parents had already disengaged from COVID-19 information before Health Canada approved vaccines for use in children. This early withdrawal from information engagement suggests a transition toward cognitive closure; once a decision is mentally actioned, the functional life cycle of information seeking ends, regardless of new clinical developments. They relied on proxy-information strategies for their children, such as the same information used for their own vaccination decisions and their lived vaccination experiences. This is a novel finding within the Canadian context and partly aligns with a similar German study,⁶⁴ which showed that some parents ceased information seeking early in the pandemic. This finding contrasts with a previous qualitative Canadian study,¹⁷ which reported that parents often made different decisions for their children. This may be due to information fatigue and heightened familiarity with COVID-19 vaccine safety at the time of data collection. Furthermore, social and normative pressures shaped by neo-liberal values, including expectations of individual responsibility and parental vigilance,⁶⁸ likely encouraged parents to protect their children immediately once vaccination was recommended. In this high-stakes, polarizing environment, participants appeared to align their children’s vaccination decisions with their own, which may have helped minimize the cognitive and emotional effort of reassessing conflicting information. Lastly, participants’ consultations with health-care providers and engagement in school information also emphasize parental trust in health-care providers and schools for children’s health information, which was also found in other studies.^69,70

Policy implications

Vaccination information engagement may be shaped by social dynamics, including social or political polarization, evolving health crises (the changing context), and information fatigue. The prevalence of misinformation will remain a challenge to effective public health communication as modern information technologies emerge. Eventual disengagement from public health information in this study reaffirms the need for early and timely communication, and engagement with parents/guardians during health crises. Credible messaging about vaccination may be inadequate for parents already disengaged from vaccination information or experiencing information/vaccination fatigue. Therefore, by leveraging distributed trust through local institutions, such as schools and community health-care providers, public health authorities may support continued access to credible information for parents who have disengaged from official sources, particularly those who are uncertain or partially engaged in vaccination decisions. Although some parents may passively engage public health information and comply with protocols, research suggests vaccine acceptance is fragile (e.g., controversies about one specific product increasing risk of Vaccine-Induced Immune Thrombosis with Thrombocytopenia Syndrome),^71–73 highlighting the need to make credible information available and desirable when needed, by capitalizing on trusted sources. Messaging should be tailored to different subgroups, considering factors such as children’s ages, parental vaccination history, and community health literacy. To address information fatigue, communications can be concise, actionable, and include visual summaries or FAQs. By leveraging distributed trust through local institutions, such as schools and community health-care providers, public health authorities can reach parents who have already reached cognitive closure and are no longer actively monitoring central government updates. Given ongoing globalization, mass immigration, and climate change, more pandemics and health crises are likely to occur in the next decades. We suggest that public health authorities develop communication templates to enable rapid deployment of evidence-based information through multiple trusted sources, such as health-care providers, schools, and community organizations. This approach may support parents and the public in triangulating information and making vaccination decisions in rapidly evolving contexts.

Strengths and limitations

A key strength of this study lies in the diversity of the research team, whose multiple perspectives supported a robust and reflexive analysis process. However, the recruitment strategy, which relied primarily on an online survey, may have led to the underrepresentation of individuals with limited internet access or significant language barriers in English or French. While McKenzie’s model of information practices offered a valuable framework for interpreting the data, not all modes were equally represented in participants’ responses. Specifically, active scanning, which refers to purposeful attention to information sources without a specific goal,²⁹ did not emerge as a prominent pattern. This absence may reflect contextual factors such as the urgency of vaccine-related decisions, suggesting the model’s applicability may be contingent on the context of a public health crisis. Also, it is likely that some parents might have actively scanned for information during adult vaccine rollout and development. Therefore, future research is needed to validate or adapt such models for high-stakes information environments. The inclusion criteria for this study required participants to self-identify as a parent or guardian of at least one child between the ages of 11 and 18 y, as children younger than 11 y were the focus of separate studies examining different outcomes. Accordingly, our analysis focused on parents with at least one child in this age range, potentially excluding parents with only younger children, who may have different information-seeking behaviors and decision-making processes. Although this study offers some insight, further research is needed to understand information engagement regarding routine childhood vaccinations.

Conclusions

This study revealed how parents navigated and coped with the unprecedented uncertainty of the COVID-19 pandemic. It was a novel and high-stakes situation that presented unique informational challenges as they waited for pediatric vaccine authorization. We found that information engagement shifted over time from active seeking and triangulation of information to more passive approaches driven by emotional, social, and informational factors, such as information fatigue and perceived information sufficiency. Many parents had already disengaged from new public health information before the authorization of childhood vaccines. For these parents, they relied on their own vaccination experiences and decisions to inform those for their children. We recommend proactive strategies that prioritize early and timely messaging and uses reliable agents like health-care providers and schools to disseminate information. While these findings are most directly applicable to the next global pandemic or crisis, they also offer important insights for improving information engagement during any localized health crisis where children are at risk and the evidence is rapidly unfolding.

Biography

Emmanuel Akwasi Marfo is an SSHRC Postdoctoral Fellow at the University of Calgary and an Associate Lecturer at the Faculty of Nursing, University of Alberta. His work examines barriers and facilitators to vaccine access and uptake, with a particular emphasis on HPV and COVID-19 vaccination, using equity-oriented approaches. Employing qualitative, scoping review, and policy-relevant methods, Dr. Marfo investigates how social, structural, and systemic factors influence health outcomes for marginalized populations.

Funding Statement

This study was funded by the Canadian Institutes of Health Research (CIHR) [Grant number: GA3177725].

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21645515.2026.2670833

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the sensitive nature of this research and the richness of the qualitative interviews, which cannot be fully anonymized, supporting data are not publicly available. Participants did not provide written consent for their data to be shared beyond the research team.