Making sense of perceptions of risk of diseases and vaccinations: a qualitative study combining models of health beliefs, decision-making and risk perception

Abstract

BackgroundMaintaining high levels of childhood vaccinations is important for public health. Success requires better understanding of parents' perceptions of diseases and consequent decisions about vaccinations, however few studies have considered this from the theoretical perspectives of risk perception and decision-making under uncertainty. The aim of this study was to examine the utility of subjective risk perception and decision-making theories to provide a better understanding of the differences between immunisers' and non-immunisers' health beliefs and behaviours.MethodsIn a qualitative study we conducted semi-structured in-depth interviews with 45 Australian parents exploring their experiences and perceptions of disease severity and susceptibility. Using scenarios about 'a new strain of flu' we explored how risk information was interpreted.ResultsWe found that concepts of dread, unfamiliarity, and uncontrollability from the subjective perception of risk and ambiguity, optimistic control and omission bias from explanatory theories of decision-making under uncertainty were useful in understanding why immunisers, incomplete immunisers and non-immunisers interpreted severity and susceptibility to diseases and vaccine risk differently. Immunisers dreaded unfamiliar diseases whilst non-immunisers dreaded unknown, long term side effects of vaccines. Participants believed that the risks of diseases and complications from diseases are not equally spread throughout the community, therefore, when listening to reports of epidemics, it is not the number of people who are affected but the familiarity or unfamiliarity of the disease and the characteristics of those who have had the disease that prompts them to take preventive action. Almost all believed they themselves would not be at serious risk of the 'new strain of flu' but were less willing to take risks with their children's health.ConclusionThis study has found that health messages about the risks of disease which are communicated as though there is equality of risk in the population may be unproductive as these messages are perceived as unbelievable or irrelevant. The findings from this study have implications beyond the issue of childhood vaccinations as we grapple with communicating risks of new epidemics, and indeed may usefully contribute to the current debate especially in the UK of how these theories of risk and decision-making can be used to 'nudge' other health behaviours.

The Swedish A(H1N1) vaccination campaign—Why did not all Swedes take the vaccination?

“…When the influenza was perceived as similar to the ordinary seasonal influenza this was correlated to lower uptake of vaccine [27,34]. Parents who primarily expressed dread of complications from influenza, more often immunized their children whereas parents who primarily expressed dread of unknown or uncertain outcomes of vaccines, more often refused immunization of their children [35]. A rational appraisal of the situation seems to be the basis for both the acceptance and non-acceptance of vaccination [14,15].…”

Do changes in socio-demographic characteristics impact up-to-date immunization status between 3 and 24 months of age? A prospective study among an inner-city birth cohort in the United States

“…In particular, the perception of immunizations as a "social norm," religious beliefs, language, and vaccine hesitancy are likely additional factors influencing immunization patterns. 11,14,15,22,23 Though our analysis accounted for a range of candidate predictors, additional research in this area is warranted to advance our understanding of the mechanism connecting early immunization status with later immunization status.…”

“…13 Given that contemporary debates about the risks and benefits of vaccinations are often highlighted in the media, the impact of parental health literacy and its potential interaction with social norms and health beliefs on vaccine receipt in early childhood merits investigation. 11,14,15 Understanding changes in the relative influence of these predictors of vaccination status through 24 months of age may advance our understanding of the potential impact and ideal focus of outreach and intervention campaigns, yielding a potential decreased need for catch-up vaccination regimens as well as improved herd immunity.…”

Análisis de la toma de decisiones al final de la vida desde una perspectiva teórica contemporánea

“…un método preciso para maximizar los resultados de una intervención y brindar criterios para decidir en situaciones de riesgo y de incertidumbre. Algunos investigadores que defienden este modelo formal han experimentado buenos resultados en el análisis de decisiones de la vida cotidiana y aseguran que no exige un manejo especializado de matemáticas o de estadística 5 . A pesar de que esta teoría ha tenido críticas por su dificultad para ser demostrada empíricamente y hacer predicciones acertadas, sigue siendo utilizada todavía por muchos investigadores y profesionales 6 .…”