Page 116 - Preventing pertussis in early infancy - Visser

Chapter 7
Chapter 7
be affected by previous experiences, and can in turn influence the way in which information is perceived. Some aspects of trust, namely the trust in government and industry, were included in the measure for the general vaccination beliefs in the quantitative study among parents (chapter 4). It showed a significant positive association with the attitude towards pertussis cocooning acceptance.
The importance of trust described in this thesis has also been shown in other vaccination acceptance studies (Leask et al. 2006, Larson et al. 2011, Baron-Epel et al. 2012, Baron-Epel et al. 2013) and is in line with observed changes in society towards more distrust in government, industry and science. This is attributed to originate from a shift towards a risk culture, in which manufactured risks seem exceedingly important, and outweigh the naturally occurring risks (Beck 1992). Furthermore, developments towards patient empowerment and shared decision making, with an emphasis on personal responsibility, feed the moral imperative to be knowledgeable in order to protect your best interest (Hobson-West 2007). For those parents, in the words of Hobson-West, “trusting blindly can be the biggest risk of all”. Psychologically, this change in trust influences the other side of the medal of the omission bias we described before in the paragraph on experiences (Asch et al. 1994, Wroe et al. 2005, Bish et al. 2011). Declined trust in vaccines is accompanied by an increased perceived risk of vaccination, which more easily outweighs the risk from the omission of the vaccination. Also, trust is often mentioned in the developments around vaccine hesitancy in recent years. In the discourse around vaccine hesitancy, the terminology and definitions still need to settle, but it is clear that trust is a very important factor and is, with the term confidence, also part of the definition of vaccine hesitancy (Larson et al. 2015, Larson et al. 2015, MacDonald et al. 2015, Peretti-Watel et al. 2015, Shapiro et al. 2018).
Trust in intervention development
Although the relevance of trust is very clear, its changeability is not so evident. Within the development of the vaccination programme we therefore chose to aim for the more feasible goal to support people in their decision making by reducing their decisional uncertainty. This is further described in the paragraph on decisional uncertainty in this chapter. Furthermore, a method or practical application to influence a societal issue such as trust seems to better fit a national context. We therefore recommend that within policy development on a national level the issue of maintaining the public’s trust is always on the agenda. To solve the issue of trust on a smaller scale, previous research suggests to focus on the building of a trusted doctor-patient relationship (Dube et al. 2015). For the parents in our study it is not clear who the vaccine provider should be, and the relationship between company doctors and healthcare workers in the Netherlands is often not really tight. Therefore, for the parents and healthcare workers in our studies, it is not directly evident how investing in a more trustful doctor-patient relationship should be executed and if this is a feasible strategy to follow.
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