This article explores how continuity of care - understood as long-term relationships between parents and paediatric general practitioners (PGPs) shaped by healthcare system characteristics – affects parental vaccine hesitancy (VH). Qualitative data from the Czech Republic were collected through interviews with PGPs (N = 15), nurses (N = 4) and parents (N = 30) who had intentionally delayed or refused at least one mandatory childhood vaccination. Moreover, 60 h of ethnographic observation were carried out in three paediatric practices in Prague. Thematic analysis identified patterns in how continuity of care influences vaccination decisions. The study revealed four ways in which continuity of care can both mitigate and reinforce VH. First, continuity enables mutual selection strategies of PGPs and parents, creating homogenous practices that limit exposure to diverse perspectives. Second, it provides opportunities for communication, allowing open dialogue to develop or distrust to deepen over time. Third, continuity shapes how disagreement is negotiated within parent-PGP relationships, where trust can be strengthened and challenged by the vaccination agenda. Finally, system-level constraints, such as time pressure and limited capacity, reduce the potential of continuity to support informed decision-making. While continuity of care is often assumed to foster trust and promote vaccine adherence, our findings highlight the paradoxical nature of continuity of care: the same continuity that supports cooperation can also entrench doubt, reduce flexibility, and limit PGPs’ ability to engage with hesitant families. The study underscores the need to address not only interpersonal communication but also the structural conditions within which continuity of care operates when tackling VH. • Continuity of care operates bidirectionally, building either trust or doubt • Four identified dynamics illustrate how continuity can mitigate or reinforce VH • Continuity's impact depends on organisational and structural features of healthcare • Addressing VH calls for provider communication skills, trust, adequate system setup • The study advances understanding of how healthcare organisation shapes VH
Kotherová et al. (Wed,) studied this question.