"I didnt even know humans could get polio ... I swear thats for dogs". A co-produced, thematic analysis exploring adolescent attitudes to vaccines.

Immunisation forms a cornerstone of public health policy. However, uptake rates of routine vaccines offered in adolescence are sub-optimal, presenting both individual and public health risks. We worked with over 80 adolescents to co-design, pilot and analyse data for this qualitative analysis of adolescent attitudes. For the study itself we interviewed 30 adolescents aged 12-17 years and living in England. Five themes were identified: Understanding vaccines, Fear and comfort; Autonomy and control; Information sources and conspiracy theories; and Identity and Social norms. Among our participants, vaccine uptake was influenced by perceptions of vaccine preventable diseases and by fear of needles. Decision-making dynamics between parents and adolescents were complex, with autonomy disrupting as well as driving vaccine behaviour. Social media was not a major source of vaccine information for adolescents, with participants expressing disinterest in online vaccine content and implicating adults as the ones engaging with and sharing online vaccine disinformation. Finally, we found that adolescent development impacted vaccine attitudes. Younger participants were more likely to adopt a collective family attitude toward vaccines. Older participants were more able to consider long-term benefits and more likely to have established their own position on vaccines. Our findings highlight the need for adolescents to be: involved in vaccine decisions; given techniques to manage anxiety about vaccines; better educated about vaccine preventable diseases; and supported in developing the critical thinking skills needed to make informed health decisions.