In this article, we elucidate a symbiotic relationship between complementary and alternative medicine (CAM) and rejection of, or hesitancy towards, vaccination. In Fremantle, Western Australia, and Adelaide, South Australia, we conducted in-depth interviews from September 2013-December 2015 with 29 parents who had refused or delayed some or all of their children's vaccines. Our qualitative analysis found that for many, their do-it-yourself ethic and personal agency was enhanced by self-directed CAM use, alongside (sometimes informal) CAM practitioner instruction. Reifying 'the natural,' these parents eschewed vaccines as toxic and adulterating, and embraced CAM as a protective strategy for immune systems before, during and after illness. Users saw CAM as harm-free, and when it came to experiences that non-users might interpret as demonstrating CAM's ineffectiveness, they rationalised to the contrary. They also generally glossed over its profit motive. CAM emerged as part of an expert system countering Western medicine. CAM's faces were trusted and familiar, and its cottage capitalism appeared largely free from the taint of "Big Pharma." A few parents employed a scientific critique of CAM modalities - and a minority were dubious of its profit motive - but others rejected the epistemology underpinning biomedicine, framing CAM as a knowledge not poisoned by avarice; a wisdom whose very evidence-base (anecdote and history) was demeaned by an arrogant scientific process only permitting belief in that which could be quantified. However, all parents engaged with Western medicine for broken bones and, sometimes, medical diagnoses. Our analysis suggests that pro-vaccination health professionals, policymakers and information-providers seeking to address the role of CAM in vaccine rejection face significant challenges due to the epistemic basis of some parents' decisions. However, we make some suggestions for professional practice and policy to enhance trust in vaccination.

In terms of public health, childhood vaccination programs have benefits that far outweigh risks. However, some parents decide not to vaccinate their children. This paper explores the ways in which such parents talked about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013–2016 we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Australia. Interviews were conducted in an open and non-judgmental manner, akin to empathic neutrality. Interviews focused on parents talking about the factors that shaped their decisions not to (or partially) vaccinate their children. All interviews were transcribed and analysed using both inductive and deductive processes. The main themes focus on parental perceptions of: 1. their capacity to reason; 2. their rejection of Western medical epistemology; and 3. their participation in labour intensive parenting practices (which we term salutogenic parenting). Parents engaged in an ongoing search for information about how best to parent their children (capacity to reason), which for many led to questioning/distrust of traditional scientific knowledge (rejection of Western medical epistemology). Salutogenic parenting spontaneously arose in interviews, whereby parents practised health promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations). Salutogenic parenting practices included breastfeeding, eating organic and/or home-grown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. We interpret our data as a ‘logic of care’, which is seen by parents as internally consistent, logically inter-related and inter-dependent. Whilst not necessarily sharing the parents’ reasoning, we argue that an understanding of their attitudes towards health and well-being is imperative for any efforts to engage with their vaccine refusal at a policy level.

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Aims -Childhood vaccination programs have benefits that far outweigh risks, in public health terms.However, some parents decide not to immunise their children. This paper explores the ways in which such parents talk about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children.Methods -Between 2013-2016 we undertook 29 in-depth interviews with non-vaccinating and/or 'vaccine hesitant' parents in Fremantle, Western Australia and Adelaide, South Australia. Our analysis of the interviews identified particular constructions of risk and responsibility. All interviews were transcribed and analysed using both inductive and deductive processes.Findings -Our analysis mirrors the chronological process through which parents navigate risk. We start with the concept of 'responsibilisation', which underpins parental engagement with decision making and praxis. We then explore how responsiblisation takes the form of detailed and time-consuming 'research'.Parents then attempt to navigate multiple and conflicting 'risks': the risk of vaccine preventable diseases, risks associated with vaccination, risks associated with their own perceived lack of understanding. After engaging with risk, parents justify the decision and accept the associated 'responsibility'. Parents use this sense of responsibility to navigate through the 'responses' of others, which we conceptualise as the risk of unwelcome consequences.Conclusion -Parents have a reflexive understanding of the physical, psychological and socio-economic risks they incur as a consequence of their choice to either partially vaccinate, delay vaccination or reject vaccination for their children. They construct these risks with reference to particular discourses, engagement with expert opinion and lifestyle choices emblematic of late modernity. The risks they are willing to accept, and the subsequent responsibility and blame they assume when choosing to abstain, or partially abstain, from vaccinating their children are, to the parents, coherent with their interpretation of best parenting practice.

BackgroundThis paper explores the nature and reasoning for (dis)trust in Australian public and private hospitals. Patient trust increases uptake of, engagement with and optimal outcomes from healthcare services and is therefore central to health practice, policy and planning.MethodsA qualitative study in South Australia, including 36 in-depth interviews (18 from public and 18 from private hospitals).Results‘Private patients’ made active choices about both their hospital and doctor, playing the role of the ‘consumer’, where trust and choice went hand in hand. The reputation of the doctor and hospital were key drivers of trust, under the assumption that a better reputation equates with higher quality care. However, making a choice to trust a doctor led to personal responsibility and the additional requirement for self-trust. ‘Public patients’ described having no choice in their hospital or doctor. They recognised ‘problems’ in the public healthcare system but accepted and even excused these as ‘part of the system’. In order to justify their trust, they argued that doctors in public hospitals tried to do their best in difficult circumstances, thereby deserving of trust. This ‘resigned trust’ may stem from a lack of alternatives for free health care and thus a dependence on the system.ConclusionThese two contrasting models of trust within the same locality point to the way different configurations of healthcare systems, hospital experiences, insurance coverage and related forms of ‘choice’ combine to shape different formats of trust, as patients act to manage their vulnerability within these contexts.