Page 34 - Preventing pertussis in early infancy - Visser
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Chapter 2
Qualitative study
What this study adds
Although other studies describe outcome expectations as an influential factor (Goins et al. 2007, Wicker et al. 2008, Cheng et al. 2010, Top et al. 2010, Miller et al. 2011, Baron- Epel et al. 2012, Wiley et al. 2013, Vasilevska et al. 2014, Dempsey et al. 2015, Hayles et al. 2015, O'Leary et al. 2015, Hayles et al. 2016), our participants, interestingly, also said that their perceived cost-benefit ratio (of a government vaccine strategy) influenced their decision. This suggests that people may weigh societal benefits and drawbacks for their personal decisions. To our knowledge, this has not previously been described in the vaccination acceptance literature.
In the literature about pertussis cocooning vaccination acceptance and vaccination acceptance in general, the concept of moral norm has been emphasised with regard to responsibility. Sometimes explicitly (Godin et al. 2010, Juraskova et al. 2011, Dube et al. 2012, Harmsen 2014, Hayles et al. 2016), sometimes implicitly; ‘to protect others’ and ‘to protect my patient’ are the phrases used as important reasons for accepting a vaccine (Goins et al. 2007, Wicker et al. 2008, Hollmeyer et al. 2009, Top et al. 2010, Baron-Epel et al. 2012, Yaqub et al. 2014, Hayles et al. 2015). This partially concurs with our findings. Our data suggest the possible addition of justice to the concept of the moral norm. Since ‘justice’ was more frequently a topic for professionals, it may function differently in different vaccination settings.
Anticipated regret has not yet appeared in other research about accepting vaccination for pertussis cocooning. However, recent research in other settings seems to show that anticipated regret does indeed influence vaccination decisions (Chapman et al. 2006, Liao et al. 2013, Lagoe et al. 2015, Leder et al. 2015).
Miller’s study states that ‘a lack of information to base a decision on’ was a reason for people to refuse pertussis vaccination in the USA (2011). This may be similar to the decisional uncertainty found in our data. However, some participants declared that this decisional uncertainty originated in the large amount of available information about vaccination that propagates strong opinions either for or against. This resembles Poltorak’s description (2005) of parental uncertainty in deciding whether to accept an MMR vaccination for their child.
Experience, information, and trust
In reflecting on our data, we noticed three predominant themes rooted in the different determinants of intention to accept pertussis vaccination: experience, information, and trust. These themes might be important in understanding the decision-making for pertussis cocooning vaccination, and they might provide entry points for the design of an effective vaccination programme.
Participant experiences are important in their assessment of the various risks for their decision-making, and these experiences are also important in formulating the roles of autonomy and decisional uncertainty. In previous studies, associations have been described between earlier vaccine acceptance (for instance for influenza) and present acceptance of a
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