Vaccination of High-Risk Children from The Perspective of Pediatric Subspecialists: A Qualitative Study

INTRODUCTION: This study aimed to examine pediatric subspecialists' experiences, perceptions, and clinical decision-making processes regarding the vaccination of high-risk children using a qualitative approach, thereby identifying the individual and systemic factors influencing this process.
METHODS: In this qualitative study, semi-structured in-depth interviews were conducted with physicians from different pediatric subspecialties working at a tertiary education and research hospital in Ankara, Türkiye. The interviews were audio-recorded, transcribed, and the data were analyzed using thematic analysis methods.
RESULTS: Seventeen pediatric subspecialists were included in this study. The analysis identified seven main themes: (1) risk group vaccination perception and clinical framework, (2) vaccine prioritization and clinical priorities, (3) clinical decision-making process and uncertainties, (4) institutional structures and systemic functioning, (5) communication with families and vaccine hesitancy, (6) access, reimbursement, and logistical issues, and (7) training needs and development recommendations. Participants defined the risk group as a dynamic and specialty-specific concept and emphasized influenza, pneumococcal, and meningococcal vaccines as vital priorities. Differences between guidelines and patient-based clinical variability create significant uncertainties in decision-making.
DISCUSSION AND CONCLUSION: The results reveal that the vaccination of at-risk children should not be left to individual physician initiative; rather, a structured healthcare system approach is necessary, coordinated by units specializing in preventive healthcare services, such as social pediatrics, and supported by standard algorithms, free access policies, and integrated electronic record systems.

Keywords: High-risk children, vaccination, pediatric subspecialists, clinical decision-making, health system barriers.