Page 113 - Preventing pertussis in early infancy - Visser

whether the online deliberation tool is an effective practical application targeting these determinants, or whether the programme should be adapted on this point. Also, to facilitate future adaptation we recommend to further determine, specify and confirm which values are most important to reflect on, while aiming to reduce decisional uncertainty.
The role of anticipated negative affect
In the qualitative study (chapter 2) we found that negative affects (such as regret) upon anticipation of either accepting or declining vaccination were associated with a respondent’s intention to accept a pertussis cocooning vaccination. Our quantitative studies (chapters 4 and 5) confirm the importance of anticipated negative affects regarding non- acceptance. These anticipated negative affects have been described as addition to the Reasoned Action Approach (RAA) before and were also found in previous studies on vaccination acceptance (Lagoe et al. 2015, Leder et al. 2015).
Anticipated negative affects regarding acceptance of vaccination turned out to univariately show a negative association with acceptance. Only in midwives, this association also remained significant in the multivariate analysis. The reason for this remains unclear, but it might indicate a slightly critical vaccination attitude among the midwives in our study. This matches the observation that relatively many midwives in our study reported to have a specific philosophical background, and did not vaccinate their own children according to the National Immunisation Programme (NIP). This finding is potentially subject to response bias, because the HCWs who returned the questionnaires were possibly the HCWs with the most distinct opinions about vaccination. Furthermore, as far as we know this is the first study that suggests a critical vaccination attitude among midwives in the Netherlands, and we recommend that this suggestion is checked in future further study. If confirmed however, this finding potentially has an impact on the role of midwives in promoting vaccination among their clients, which is a reason for concern.
Anticipated negative affect in intervention development
Although the influence of anticipated negative affect regarding non-acceptance seemed clear, the planning group discussions led us to be careful in the applications concerning this determinant. It was suggested that too much emphasis on this determinant might have counterproductive effects, similar to the effects we saw in the reaction to a previous vaccination policy where vaccination was demanded quite forcefully, described in chapter 3. We therefore chose to influence anticipated negative affect in the invitation letter, information folder and website only with regard to stimulating deliberate decision making. Only in the online deliberation tool we introduced a peer model who indicated to feel guilty if she was not vaccinated herself and a patient would contract pertussis.
General discussion
General discussion
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