Author Identifier

Shantha Premila Karthigesu

Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Medical and Health Sciences

First Supervisor

Dr David A Coall

Second Supervisor

Emeritus Professor James S. Chisholm


Human infants are highly dependent on their parents for a prolonged period of time. The resources required to raise a child cannot be provided by biological parents alone and requires the assistance of others, usually relatives. Grandparents among them, have played the most significant role. With increased life expectancy in Western, educated, industrialised, rich and democratic (WEIRD) societies, grandparents have come to the forefront as informal childcare providers. Although the influence of a child’s social environment on health has been well-studied, the influence of grandparents, specifically in regard to breastfeeding remains inconclusive, while grandparental influence on paediatric vaccinations has not been investigated. Using an exploratory mixed-method research design this study investigated the perceived influence of grandparents on parents’ breastfeeding behaviour and paediatric vaccination uptake in Perth, Western Australia.

Focus group discussions were conducted to collect exploratory data on the beliefs, attitudes and perceived sources of influence on parents and grandparents towards breastfeeding and paediatric vaccines. Qualitative data was collected from Australian Aboriginal (N=15) and non-Aboriginal participants (N=73). Interpretative phenomenological data analysis revealed different themes for Aboriginal and non- Aboriginal participants. Although both groups reported positive beliefs and attitudes towards breastfeeding, Aboriginal grandmothers reported having a direct and positive influence on breastfeeding behaviour in young Aboriginal mothers. The influence of grandparents on non-Aboriginal parents’ breastfeeding behaviour was not always positive. The participants also shared positive beliefs and attitudes towards paediatric vaccines. Grandparents expressed full confidence in paediatric vaccines based on their memories of the diseases. Parents who had been vaccinated as children accepted immunisation as a normal part of child rearing. This data then informed the development of a questionnaire to quantitatively assess perceived grandparental influence.

Data from mothers, fathers, grandmothers and grandfathers (N=278) were analysed to test the effects of beliefs, attitudes and perceived sources of influence on breastfeeding behaviour and paediatric vaccine uptake. The study sample was typical of WEIRD societies and reported high levels of educational qualifications and income. Positive attitude scores did not have a significant effect on breastfeeding behaviour in parents or grandparents. This suggested the influence of external factors such as physiological challenges to breastfeeding, physical ecology of the mother and the attitudes towards formula feeding. Maternal grandmothers did report offering the most advice regarding breastfeeding. However, the type of advice imparted and the effect of the advice on breastfeeding behaviour could not be discerned from this data.

This cohort reported good knowledge on the benefits of paediatric vaccines and positive group influences and had low scores on vaccine anxiety. This was reflected by high confidence levels on the information available to them and the protection conferred to their children by vaccines. Grandparents who had high scores on knowledge and positive group influence reported they would advise their children on vaccinations for grandchildren. Less than 2% of the study sample scored high on vaccine anxiety and reported vaccine refusal and lack of confidence, which limited the study of whether grandparents could positively influence vaccine hesitant parents.

The quantitative study sample is not representative of the average population which restricts generalisation of the findings. The precise nature of grandparents’ influence on parents’ infant feeding and paediatric vaccines need further exploration among the different cultural groups. Education, income levels and cultural and traditional child care practices are likely to have the most influence on the relationship between parents and grandparents, and consequently the extent to which grandparents’ opinions are valued and accepted in relation to breastfeeding and paediatric vaccinations decisions

Access Note

Access to Chapter 3 and Appendices P, Q, R, & S of this thesis is not available.


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