Factors Influencing Complete Basic Immunization Coverage among Infants in Lubuk Siam Village: A PRECEDE-Based Approach

Abstract

Background: Immunization coverage in Indonesia declined, with most prov
inces, including Riau, missing the Ministry of Health's strategic plan targets. 
In Lubuk Siam Village, Riau, community awareness of the importance of im
munization was low. A 2023 survey showed that only 13% of toddlers were im
munized.
Methods: This mixed-method study utilized a sequential exploratory design. It 
began with the collection of qualitative data, which was then followed by quan
titative data to enhance the findings. The study was conducted from May to 
September 2025 in Riau, Indonesia. The target population consisted of all moth
ers with toddlers aged 0 to 60 months. A total of 113 mothers participated in 
the study. 
Results: Bivariate analysis showed that family support (p = 0.031), knowledge 
(p = 0.004), and attitude (p < 0.001) were significantly associated with immu
nization status. In the final multivariable model, attitude was the strongest pre
dictor of immunization status (AOR = 9.11; p < 0.001). Qualitative findings 
identified parental concerns about vaccine side effects, lack of paternal support, 
low maternal education, weak community leadership, limited health promotion 
activities, and family-centered decision-making as barriers to immunization. 
Conclusions: Maternal attitude was the most influential factor associated with 
immunization status. Family support, community influences, and health educa
tion were identified as key factors affecting immunization uptake. Strengthen
ing family engagement and health promotion programs may improve immuni
zation coverage