Koopman, Nathan Richard

Vaccine hesitancy continues to influence public health practice in Ontario, particularly within a system that requires parents to complete non-medical exemptions under the Immunization of School Pupils Act, 1990. The purpose of this study was to explore how vaccine-hesitant parents understand their decisions and navigate institutional processes during the exemption pathway. Using Thorne's (2016) Interpretive Description, seven parents from Ontario participated in semi-structured interviews focused on experiences of trust, communication, and interactions with public health. Themes developed were:mutual othering, the role of epistemic conflict, vaccine refusal and exemption as symbolic resistance and restructuring trust through relationships. These findings show that vaccine decision-making is influenced not only by beliefs about safety or access, but also by the relational and moral context in which information is delivered. The study offers insights for public health nursing practice by highlighting the importance of relational approaches, ethical communication, and trust-building within mandatory immunization systems.

Author Keywords: immunization policy, institutional trust, interpretive description, parental decision-making, public health nursing, Vaccine hesitancy