Page 110 - Preventing pertussis in early infancy - Visser

Chapter 7
Chapter 7
Developing a strategy to implement pertussis vaccination of new
parents and healthcare workers
Our theoretical framework was the basis for the questionnaire studies and the subsequent Intervention Mapping process for developing an intervention. In the next paragraphs we will first elaborate on three determinants of our theoretical framework to show how they appeared in our studies, how they relate to international literature and how they were accounted for during the IM process and in the proposed vaccination programme. For elaboration in this chapter we chose those determinants that – in our studies – were consistently significantly associated with the intention to accept a pertussis vaccination when offered: attitude, decisional uncertainty and anticipated negative affect. This is followed by a discussion on the three predominant themes that seemed to be rooted within the determinants: experience, information and trust. The themes came forward in the qualitative study (chapter 2), and seemed to overarch the determinants and provided a broader context regarding multiple beliefs and constructs. Again, we will show how these themes relate to international literature and how they were accounted for during the IM process and in the proposed vaccination programme. During the IM process, the choice of the specific theoretical methods and practical applications to effectuate change was made within planning group discussions. In these discussions feasibility and potential fit with the intervention context and the target group were continuously considered. Upon implementation and evaluation the actual feasibility and effectiveness of each component will become clear, and specific information for future adaptation will become available.
Determinants of intention: attitude, decisional uncertainty and anticipated negative affect
The role of attitude
We found attitude to have the largest positive association with the intention to accept a pertussis cocooning vaccination in all investigated target groups (chapters 4 and 5). To find attitude as an important predictor of the intention to vaccinate was not a surprising outcome. Multiple previous vaccination acceptance studies have shown similar results (Myers et al. 2011, Cornally et al. 2013, Fisher et al. 2013). In order to be able to successfully take this attitude into account when developing a vaccination programme, it is important to consider how this attitude seems to be formed. In both target groups, the respondents’ attitudes were clearly explained by their general vaccination beliefs, efficacy outcome expectations (in HCWs: more specifically the perceived cost-benefit ratio) and moral norm (in HCWs: more specifically their perceived personal responsibility to prevent pertussis in patients).
General vaccination beliefs as determinant of attitude arose from our qualitative study, and comprised of critical vaccination beliefs such as the perceived necessity of (new) vaccines, naturalistic beliefs and disease beliefs, which in turn seemed to be influenced by trust in government, science and industry. The general vaccination beliefs of both parents
112
108