ObjectivesTo explain vaccination refusal in a sample of Australian parents.DesignQualitative design, purposive sampling in a defined population.SettingA geographically bounded community of approximately 30 000 people in regional Australia with high prevalence of vaccination refusal.ParticipantsSemi structured interviews with 32 non-vaccinating parents: 9 fathers, 22 mothers and 1 pregnant woman. Purposive sampling of parents who had decided to discontinue or decline all vaccinations for their children. Recruitment via local advertising then snowballing.ResultsThematic analysis focused on explaining decision-making pathways of parents who refuse vaccination. Common patterns in parents’ accounts included: perceived deterioration in health in Western societies; a personal experience introducing doubt about vaccine safety; concerns regarding consent; varied encounters with health professionals (dismissive, hindering and helpful); a quest for ‘the real truth’; reactance to system inflexibilities and ongoing risk assessment.ConclusionsWe suggest responses tailored to the perspectives of non-vaccinating parents to assist professionals in understanding and maintaining empathic clinical relationships with this important patient group.