Page 106 - Preventing pertussis in early infancy - Visser

Chapter 7
Chapter 7
Introduction
In this thesis we gained insight into the intention to accept a possible future pertussis
cocooning vaccination among parents and healthcare workers (HCWs) who work with infants, and the factors (determinants) that would influence this acceptance. During this process we developed a theoretical framework, which describes the potential determinants of pertussis cocooning vaccination acceptance. Subsequently, we used Intervention Mapping (IM) to identify how we can respond to the most relevant and changeable determinants in the design of a comprehensive pertussis cocooning vaccination programme. The choice to specifically focus the IM process on HCWs as a target group was the result of the progression of new advice by the Health Council of the Netherlands in recent years, which we explained in chapter 1.
In this final chapter we will discuss the main outcomes and implications of this thesis and examine its relation to the currently available literature. We will include those methodological considerations that were not previously discussed in the separate chapters. Finally, we will outline our recommendations for public health practice, policy and further research.
Theoretical framework
We designed the theoretical framework in the preparatory phase of the
questionnaire studies and IM process, to be able to better identify and understand the most relevant and changeable determinants of a positive pertussis vaccination intention. This theoretical framework was based on the results of the qualitative study (chapter 2), together with the determinants that were already known from previous research. Because these determinants best fitted in with the behavioural change theory known as the ‘Reasoned Action Approach’ (RAA), this theory was ultimately used as a reference point (Fishbein et al. 2010), which we adapted to our specific research findings.
Our theoretical framework (Figure 7.1) argues that vaccination behaviour is determined by the intention to perform this behaviour. Intention, in turn, is determined by knowledge, personal previous experiences and psychosocial determinants. Here, we included the psychosocial determinants attitude, social norm and perceived control, which are also the traditional RAA determinants of intention. Additionally, we also included anticipated negative affect and decisional uncertainty as psychosocial determinants. Subsequently, the RAA describes that personal beliefs form a basis for the psychosocial determinants. Attitudinal beliefs seemed the most important in our theoretical framework. Therefore, we included the attitudinal beliefs that we found in the literature. Based on the qualitative study of chapter 2 we also added perceived cost-effectiveness (as a concept of outcome expectations) and justice (as a concept of moral norm). Finally, organisational factors can influence vaccination behaviour, despite people’s intentions. The framework showed good fit, with (pseudo) R2 rates of around 80% (chapters 4 and 5) in the quantitative studies among both parents and healthcare workers (HCWs) who work with infants.
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