Page 111 - Preventing pertussis in early infancy - Visser

and HCWs showed a significant association with the attitude towards pertussis cocooning vaccination in the quantitative studies. The final items operationalising the determinant, however, differed slightly between the target groups.1 There is – to our knowledge – no validated measure available from literature to indicate one’s general vaccination beliefs. Although in our qualitative study the sub factors in this determinant showed great coherence, previous studies showed parts of this determinant as separate influential factors (Black et al. 2010, Larson et al. 2011, Harmsen 2014, Yaqub et al. 2014, Lehmann et al. 2015, MacDougall et al. 2015). The items we measured within general vaccination beliefs also show great similarities with the items measured within recently proposed vaccine hesitancy scales (Shapiro et al. 2018).
Outcome expectations as determinant of attitude came forward in two categories: the expectations of the direct outcome for oneself (such as perceived efficacy of the vaccination) and the expectations of the outcome for society. The results of the qualitative study indicated that both parents and HCWs who work with infants considered not only the individual outcomes, but also societal outcomes in relation to pertussis cocooning (chapter 2). This consideration of the bigger picture is partly confirmed in the quantitative studies, where we – for example - found an association between the perceived cost-effectiveness of the pertussis cocooning vaccination and the attitude towards pertussis vaccination (chapters 4 and 5). In previous literature this relation is also suggested (Betsch 2014).
In the qualitative study (chapter 2) moral norm appeared to be an important determinant of one’s attitude towards pertussis cocooning vaccination. Although the ethically focused analysis on this subject identified more values, the first and clearest values identified were responsibility and justice. Responsibility has been described before as influential factor, albeit often implicitly by referring to important reasons for accepting a vaccine as “to protect others” or “to protect patients” (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. 2016). This influence is also found in our quantitative studi es (chapters 4 and 5): responsibility showed a positive association with the attitude towards pertussis cocooning vaccination in all investigated target groups. Justice (more specifically: fairness in the consideration of risks for patients and the risks for healthcare workers) however, has – to our knowledge – not been described before as influential on one’s vaccination attitude. Our quantitative study among healthcare workers (chapter 5) did not corroborate the assumed relation between justice and one’s attitude towards pertussis vaccination. This may partly have to do with the way in which we operationalised justice. It may also indicate that the role of justice might be limited.
1 This difference originated from the internal validation of the determinant in both studies. The items in the questionnaires were based on the qualitative study. In the study among parents these items all showed great coherence, while in the study among healthcare workers it appeared that “general beliefs on vaccination policy” and “beliefs on pertussis policy” were separate factors. We therefore analysed them separately for this target group. See also chapters 4 and 5.
General discussion
General discussion
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