Page 61 - Preventing pertussis in early infancy - Visser

Chapter 4
Quantitative study parents
high as the reported intention (Sheeran P. Strobe W 2002). For this it seems crucial, however, to use an effective vaccination programme adapted to the target group, and targeting the determinants of the intention.
Determinants of intention
Various vaccination acceptance studies in diverse populations for a range of vaccines show attitude to be the most important determinant of the intention to accept a vaccine (Myers et al. 2011, Cornally et al. 2013, Fisher et al. 2013). In line with these findings, this study also showed attitude to have the greatest impact on the parental intention to accept a pertussis cocooning vaccination.
Anticipated affect or anticipated regret has been identified as predictor of preventive health behaviour (Sandberg et al. 2008, Conner et al. 2015), including vaccination acceptance (Lagoe et al. 2015, Leder et al. 2015). The operationalisation of anticipated regret is comparable to our determinant anticipated negative affect of non- acceptance, which showed in our data to be a unique correlate of intention.
To our knowledge, decisional uncertainty has not been a regular extension for either the RAA or one of its predecessors, i.e. Theory of Planned Behaviour (TPB) and Theory of Reasoned Action (TRA). The decisional uncertainty construct has been added to our framework because of its prominent place in our qualitative study (Visser et al. 2016). It reflects the amount of doubt a person experiences on the decision to accept or decline a pertussis cocooning vaccination. Poltorak (Poltorak et al. 2005) described a similar influential factor for the acceptance of MMR (measles, mumps, rubella) vaccination in 2005: lack of confidence in the decision on vaccination. Our study confirms the association between decisional uncertainty and parental intention to accept a pertussis cocooning vaccination.
Determinants of attitude
Our results on the beliefs underlying the attitude of parents towards pertussis cocooning vaccination confirm findings of others explaining the acceptance of such a vaccination: 1. perceived risks (of an adult contracting pertussis, of spreading pertussis, of pertussis in infants), 2. negative associations with vaccines (side effects, distrust in vaccines, fear of needles), 3. expectations about the effectiveness of vaccination (Cheng et al. 2010, Miller et al. 2011, Beel et al. 2013, Wiley et al. 2013, Rossmann Beel et al. 2014, Dempsey et al. 2015, Hayles et al. 2015, MacDougall et al. 2015, O'Leary et al. 2015, Hayles et al. 2016).
Additionally, our study confirms the association of general vaccination beliefs and moral norm with parental attitude towards pertussis cocooning vaccination. The general vaccination beliefs reflect critical vaccination attitudes and comprise of consideration aspects, naturalistic beliefs, and general distrust in government and industry (Figure 1). We described these items in one determinant because both in our qualitative study and in the data presented here these views showed great coherence (Visser et al. 2016). Several studies in other vaccination settings described parts of this determinant. In line with what we found, Harmsen (Harmsen 2014) also showed the correlation between consideration
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