Page 112 - Preventing pertussis in early infancy - Visser

Chapter 7
Chapter 7
Attitude in intervention development
Attitude, including its associated beliefs described above, played a large role in the development of the intervention, because of this clear association with intention. In chapter 6 we described how we selected several theoretical methods and practical applications, intending to influence attitude. This resulted in the application of scenario based risk information, values clarification, modelling, persuasive communication and framing in the invitation letter, information folder, website and in the online deliberation tool. For example, the stimulation of reflection on personal and professional values in the online deliberation tool is a practical application of the method of values clarification, which we chose based on the importance of, among others, attitude and moral norm as its associated belief. The focus on responsibility in the invitation letter was also derived from the importance of responsibility as a determinant of attitude.
The role of decisional uncertainty
We described decisional uncertainty in the qualitative study (chapter 2) as a feeling of doubt towards the respondents’ decision on pertussis cocooning vaccination. In both quantitative studies (chapters 4 and 5) the negative influence of uncertainty on the intention to accept a pertussis cocooning vaccination was confirmed. As such, decisional uncertainty seems to be a valuable addition to the theoretical model for pertussis cocooning acceptance. The degree of decisional uncertainty we measured was higher among HCWs (24% in maternity assistants, 28% in midwives and 35% in paediatric nurses) than among parents (10%). The reason for this is unclear.
Decisional uncertainty has not been previously investigated as a determinant of vaccination acceptance. However, in the literature on decision aids, uncertainty is often used as one of the constructs of decisional conflict. For example, Shourie et al. (2013) have shown that their decision aid was able to reduce decisional conflict and increase vaccine uptake. This also indicates a possible relation between uncertainty and uptake.
Decisional uncertainty in intervention development
We described in chapter 3 how the respondents compared the values they ascribed to the vaccination programme to their own core values, and used this to base their decision on. Arguing from these findings, we could assume that reflection on values might diminish decisional uncertainty and thereby might improve vaccination uptake. These assumptions are in line with the confirmation of the importance of decisional uncertainty and responsibility in the quantitative studies, with literature on value congruent choices, with the use of value clarification in other vaccination programmes, and with the use of values in forming opinions on other “wicked problems” such as nanotechnology (O'Connor 1995, Lipschitz et al. 2013, Felt et al. 2014, Lehmann et al. 2017). The indication that reflection on values is important to deliberately decide to accept a vaccination ultimately led to the development of the online deliberation tool. However, the specific role of reflection on values in the decision making process needs further exploration and confirmation in future research, and fell out of the scope of this thesis. Upon evaluation it will become clear
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