Page 108 - Preventing pertussis in early infancy - Visser

Chapter 7
Chapter 7
Another issue is the importance of organisational factors. Because literature showed their explicit influence as potential barriers or enablers on the translation from intention into actual behaviour, we included them in the development of our framework. Given the hypothetical character of our study, we focused chapters 4 and 5 on the intention to accept the vaccination, and consequently organisational factors fell out of scope. While some conditions for the practical organisation of a pertussis vaccination programme for HCWs are included in chapter 6, the assessment of these factors would be fully appropriate in a (future) intervention study.
Knowledge usually also has a prominent role as influential factor in other frameworks. Measuring knowledge was unfortunately neither useful nor feasible in our study, because pertussis cocooning and pertussis vaccination for HCWs were not implemented in the Netherlands at that time. This denied the respondents an opportunity to be familiar with the vaccination strategy. We therefore provided brief information on pertussis, pertussis vaccination and the rationale for pertussis cocooning to explain the context to the participants in the focus group, interview and questionnaire studies. It is quite likely, however, that knowledge should have a place in our theoretical model. We therefore already took knowledge into account in the proposed vaccination programme in chapter 6.
Furthermore, it is important to realise that this theoretical model focuses on determinants, rather than on the decision making process itself. The model therefore shows what potentially influences one’s intention to vaccinate and not how people decide on pertussis vaccination. In other words: the arrows in the model are not further specified and discussed in this thesis. In other fields of research, many literature is available on how decisions are made. Our studies also suggest the importance of this subject, because they show decisional uncertainty to be a relevant determinant and suggest that reflection on values might support decision making. However, more research is needed to specifically apply the theories of decision making to the vaccination field and to assess the specific role of reflection on values and deliberate choices in the vaccination decision making process.
Finally, the development of our theoretical model coincided with an overall increase in reluctance to accept vaccines in recent years. Vaccine hesitancy has been used more and more frequently as a term to describe these developments. During the time our study took place, in 2012, the WHO Strategic Advisory Group of Experts (SAGE) on Immunisation established a Working Group on Vaccine Hesitancy, to define vaccine hesitancy and to identify its determinants (WHO , Larson et al. 2014, Larson et al. 2015, MacDonald et al. 2015) (Figure 7.2).
The SAGE working group presented determinants of vaccine hesitancy in a vaccine hesitancy determinants matrix (Figure 7.2). Comparing this matrix to our theoretical framework, we find that most of the concepts from our theoretical framework are also reflected in this matrix, with the exception of decisional uncertainty and anticipated regret. Our framework, in turn, encompasses all possible determinants identified by the SAGE Working Group matrix of determinants. The benefit of our theoretical framework over this
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