Table 1 Summary of cross-case themes

Vaccine attitudes

Opposed to all vaccines (except did vaccinate once to attend a trip)

Accepting of all that have been tested

Accepting of traditional childhood vaccines

Trauma with past vaccines

Son’s negative reaction to MMR; had son vaccinated with slower schedule of vaccines before age 3; self and son had negative flu experience; extended family members experienced negative responses to vaccines

No past trauma; did choose to have a slower schedule for child vaccines for youngest child who was at higher risk due to preexisting health conditions

Experienced negative health outcomes from COVID-19 vaccine; past negative reaction to chicken pox resulting in favorable attitudes for that vaccine; receives flu vial nasal administration (not shot)

Care for family members’ health

Not want son to experience negative response to a vaccine (prevent what happened in the past); home schooled son to reduce his exposure

Made cautious decisions to keep youngest child safe; homeschooling long after others returned to school

Espoused childhood vaccines to keep children safe; concern that COVID-19 vaccine was unsafe for people

Social support significance

Recommitted to and sought out social support networks such as church and love tribe and going on scout hiking trip

Avoided going out as a family; has a neighbor family to interact with (harder for wife to not have social connection)

Turned to co-workers during the day when children slept to decompress from the stress of the pandemic

Decision-making motivations

Decisions about vaccination heavily influenced by past traumas and need to keep son safe. High premium on respecting that people know what is right and comfortable for them. Believes in science to a certain degree

When making decisions, was highly motivated to keep family safe and keep others safe (for community good). He shared information with others in digestible ways (to promote vaccine) during the pandemic. Believes in science strongly

Decisions influenced by past side effects experienced by illness (for example, sick with chicken pox, so motivated to take vaccine), employment pressure, length of vaccine development/ research, and vaccine side effects compared with long-term benefits

Value information

High: get information from non-governmental sources, old textbooks

High: get information from government and scientific literature

High: sought out information from pharmaceutical vaccine developers

Trust in social media, news, politicians, and medical community

Major distrust of social media, news, politicians, and medical professionals. Believes that big pharmaceutical companies influence the content of news, media and politicians via funding them

Trusted CDC and other reputable governmental sources of information. Recognized the disconnect of what was put forth in the media and what he was privy to when he was making decisions

Believed she was tricked by pandemic messaging; went to big pharmaceutical websites for information; did not trust government sources; believes big pharmaceutical companies values making money when natural remedies work

Disappointment in humanity

Disappointed that people do not recognize that others need to make choices for themselves and context

Observed that people struggle to make logical decisions using scientific information

Appalled by racism against Asians and paranoia of contracting COVID-19 making people fearful of each other

Future recommendations

Make sure information is provided so that people can provide truly informed consent

Presenting objective information to others so they are free to use it to make (hopefully) informed decisions. People hate being told what to do or feeling their choices are being taken away

Make sure information is provided so that people can provide truly informed consent

Future vaccines

Will not say “never” but will not agree to vaccines based on mRNA

Willing to uptake future vaccines after reviewing data

With enough research and few side effects, would consider future vaccines