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      Addressing issues of vaccination literacy and psychological empowerment in the measles-mumps-rubella (MMR) vaccination decision-making: a qualitative study

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      BMC Public Health
      BioMed Central

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          Abstract

          Background

          Whether or not to vaccinate one’s child is one of the first health-related decisions parents have to make after their child’s birth. For the past 20 years, the share of parents choosing not to immunize their children has increased in many countries, for various reasons. Among these, rumors affirming that vaccinations contain dangerous chemicals or might trigger severe chronic diseases have negatively affected parental attitudes towards pediatric immunizations, particularly the vaccination against measles, mumps and rubella (MMR), raising a number of public health concerns. The primary aim of this qualitative study is to understand what drives parents’ decision, giving special attention to vaccination literacy and psychological empowerment in such a context.

          Methods

          Twenty individual semi-structured interviews were conducted in the Canton of Ticino (Switzerland) between January and June 2014. Participants were either mothers or fathers of children less than 1 year old living in Switzerland. An inductive thematic analysis was performed to identify the main themes with regard to vaccination literacy and psychological empowerment in the MMR vaccination decision-making.

          Results

          Parents’ reports yielded four main themes: (a) the paradox of the free choice, referring to the misinterpretation of current vaccination policies; (b) giving up the power, pointing at the outcomes of a low perceived competence; (c) a far-reaching decision, reflecting the importance attributed to the MMR choice and the different levels of impact the decision can have; (d) the demand for shared-decision making, referring to the parental needs in relation to the child’s healthcare provider.

          Conclusion

          Understanding what drives parents’ management of their children’s immunization schedule in terms of vaccination literacy and psychological empowerment can help health professionals to communicate more effectively with parents in order to facilitate an informed decision, and stakeholders to design tailored health education programs and materials. This can ultimately help increase the coverage of the MMR vaccination.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12889-015-2200-9) contains supplementary material, which is available to authorized users.

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          Most cited references69

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          Proposed model of the relationship of risk information seeking and processing to the development of preventive behaviors.

          We articulate a model that focuses on characteristics of individuals that might predispose them to seek and process information about health in different ways. Specifically, the model proposes that seven factors-(1) individual characteristics, (2) perceived hazard characteristics, (3) affective response to the risk, (4) felt social pressures to possess relevant information, (5) information sufficiency, (6) one's personal capacity to learn, (7) beliefs about the usefulness of information in various channels-will influence the extent to which a person will seek out this risk information in both routine and nonroutine channels and the extent to which he or she will spend time and effort analyzing the risk information critically. By adapting and synthesizing aspects of Eagly and Chaiken's Heuristic-Systematic Model and Ajzen's Theory of Planned Behavior, we also expect that people who engage in more effortful information seeking and processing are more likely to develop risk-related cognitions, attitudes, and behaviors that are more stable (i.e., less changeable or volatile) over time. Since most forms of health information campaigns attempt to get people to adopt habitual or lifestyle changes, factors leading to the stability or volatility of those behavioral changes are essential concerns. Copyright 1999 Academic Press.
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            Anti-vaccination movements and their interpretations.

            Over the last two or three decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. In trying to explain why this is occurring, public health commentators refer to the activities of an anti-vaccination 'movement'. In the light of three decades of research on (new) social movements, what sense does it make to attribute decline in vaccination rates to the actions of an influential anti-vaccination movement? Two sorts of empirical data, drawn largely from UK and The Netherlands, are reviewed. These relate to the claims, actions and discourse of anti-vaccination groups on the one hand, and to the way parents of young children think about vaccines and vaccination on the other. How much theoretical sense it makes to view anti-vaccination groups as (new) social movement organizations (as distinct from pressure groups or self-help organizations) is as yet unclear. In any event there is no simple and unambiguous demarcation criterion. From a public health perspective, however, to focus attention on organized opponents of vaccination is appealing because it unites health professionals behind a banner of reason. At the same time it diverts attention from a potentially disruptive critique of vaccination practices; the critique in fact articulated by many parents. In the light of current theoretical discussion of 'scientific citizenship' this paper argues that identifying anti-vaccination groups with other social movements may ultimately have the opposite effect to that intended.
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              The influence of narrative v. statistical information on perceiving vaccination risks.

              Health-related information found on the Internet is increasing and impacts patient decision making, e.g. regarding vaccination decisions. In addition to statistical information (e.g. incidence rates of vaccine adverse events), narrative information is also widely available such as postings on online bulletin boards. Previous research has shown that narrative information can impact treatment decisions, even when statistical information is presented concurrently. As the determinants of this effect are largely unknown, we will vary features of the narratives to identify mechanisms through which narratives impact risk judgments. An online bulletin board setting provided participants with statistical information and authentic narratives about the occurrence and nonoccurrence of adverse events. Experiment 1 followed a single factorial design with 1, 2, or 4 narratives out of 10 reporting adverse events. Experiment 2 implemented a 2 (statistical risk 20% vs. 40%) × 2 (2/10 vs. 4/10 narratives reporting adverse events) × 2 (high vs. low richness) × 2 (high vs. low emotionality) between-subjects design. Dependent variables were perceived risk of side-effects and vaccination intentions. Experiment 1 shows an inverse relation between the number of narratives reporting adverse-events and vaccination intentions, which was mediated by the perceived risk of vaccinating. Experiment 2 showed a stronger influence of the number of narratives than of the statistical risk information. High (vs. low) emotional narratives had a greater impact on the perceived risk, while richness had no effect. The number of narratives influences risk judgments can potentially override statistical information about risk.
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                Author and article information

                Contributors
                marta.fadda@usi.ch
                miriam.katharina.depping@usi.ch
                peter.schulz@usi.ch
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                2 September 2015
                2 September 2015
                2015
                : 15
                : 836
                Affiliations
                Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano, Via G. Buffi 13, 6900 Lugano, Switzerland
                Article
                2200
                10.1186/s12889-015-2200-9
                4556054
                26328551
                453116bf-7538-40ec-bcf2-ede22d5332fc
                © Fadda et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 June 2015
                : 27 August 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Public health
                Public health

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