Abstract:

This study investigates the “Availability Paradox” within the Romanian healthcare system, whereby the expansion of medical infrastructure (from 51.6 to 57.05 medical practices per 100,000 inhabitants) has been accompanied by a decline in immunization coverage rates, from 95% to 76%. The central issue is defined by the erosion of parental trust and a mechanism of expert substitution, whereby medical expertise is increasingly replaced by informal social influences. The main objective is to assess the psychosocial determinants of vaccination decision-making through the lens of the 3C model (Confidence, Calculation, and Constraints). The study seeks to explain the dissonance between adults’ status as vaccinated healthcare consumers and their hesitancy regarding pediatric vaccination. A quantitative research design was employed, based on a sociological survey administered to a sample of 120 urban respondents, with a strategic concentration on individuals of reproductive age (83% under 40 years old). Data analysis included: (1) descriptive statistics to profile the sample and identify central tendencies; (2) correlational analysis using Yule’s coefficient of association to test the proposed hypotheses; and (3) Principal Component Analysis (PCA), theoretically applied to reduce the dimensionality of 13 operational variables into broader decision-making factors. The sample exhibited a mean age of 33.62 years (SD = 7.08), with a substantial concentration of respondents under the age of 30 (45%). The findings revealed a critical gap between respondents’ own vaccination status (86.67%) and their firm intention to vaccinate their children (51.67%). A strong positive association was identified between a medical background and vaccine acceptance (Yule’s Q = 0.96). In contrast, the results demonstrated an expert-substitution mechanism through an extremely strong negative correlation (Yule’s Q = −0.97) between the influence of social circles and consultation with medical specialists. PCA enabled the extraction of two principal macro-factors: “Trust and Expertise”, associated with accredited information sources, and “Social Influence and Hesitancy”, associated with informal networks and uncertainty. The findings confirm that the mere availability of healthcare services does not guarantee their utilization in the absence of trust. Consequently, a paradigm shift in healthcare marketing is recommended, moving from a distribution-oriented approach toward the management of trust-based physician–parent relationships. Practical recommendations include diversifying vaccination access points (e.g., pharmacies and schools) and implementing transparent communication strategies to counteract the influence of informal networks in the perception and assessment of epidemiological risks.