Uncertainty and Negative Emotions in Parental Decision-making on Childhood Vaccinations: Extending the Theory of Planned Behavior to the Context of Conflicting Health Information

Communicating scientific uncertainty in the early stages of the COVID-19 pandemic: A message experiment

The World Health Organization (WHO) officially declared COVID-19 a pandemic on March 11, 2020. It was a time of significant uncertainty as experts were not yet certain whether social distancing behaviors were necessary to slow the spread of the virus. Some public communicators opted to acknowledge uncertainty based on the limited evidence, whereas others downplayed uncertainty. This situation provided researchers with an opportunity to advance theory by explicating and testing cognitive responses to message uncertainty. Immediately following the WHO declaration (March 13-19, 2020), U.S. adults (N = 1186) were randomly assigned to one of six conditions in a 2 (message uncertainty: low, high) × 3 (argument support: expert, threat, precedent) between-participants experiment. Overall, perceived uncertainty negatively mediated the impact of message uncertainty on intentions. However, participant education was a key moderator. For those with more than a high school education, uncertain messages were related to higher intentions to social distance through increased critical reflection. For those with a high school education or less, uncertain messages were related to lower intentions through decreased message credibility.

Conflicted and Relevant: Systematic Processing of Information on PFAS Contamination

Per- and polyfluoroalkyl substances (PFAS) contamination is an emerging environmental and public health crisis. Thus, it is crucial to understand public risk perception and communication behaviors surrounding this issue. Guided by the heuristic-systematic model of information processing, this study explores the impact of conflicting information and personal relevance on information insufficiency and information processing. Through an online experiment, 1,062 U.S. adults were randomly assigned to one of four conditions as part of a 2 (information type: conflicting vs. consistent) × 2 (personal relevance: high vs. low) between-subjects factorial design. Both main effect and interaction effect were detected. Specifically, information insufficiency was highest among participants in the high personal relevance and consistent information condition. Personal relevance also had a main effect on information processing. Conflicting information indirectly elevated information processing through increased information insufficiency, but only when personal relevance was low. These findings suggest the importance of providing consistent and personally relevant information related to the risk of PFAS contamination.

Decision-Making Regarding Elective Child and Adolescent Vaccinations Among Native Hawaiian and Pacific Islander Parents in Orange County

Native Hawaiians and Pacific Islanders (NHPIs) in aggregate experience greater health burdens than non-Hispanic Whites, such as a higher incidence of cervical cancer and COVID-19. Given the importance of vaccinations in preventing and reducing the severity of diseases, such as the flu, cervical cancer, and COVID-19, the receipt of vaccines during childhood and adolescence is crucial. Therefore, this qualitative study aimed to explore the factors associated with NHPI parents' decisions regarding vaccinating their children with these elective vaccinations-that is, vaccinations not required for child care, preschool, or K-12 admissions in California but highly recommended. A total of 15 NHPI parents were recruited through a community-based organization. Semi-structured interviews explored parents' reasons for accepting or denying each vaccine for their child(ren). Results demonstrated variable acceptance of each vaccine, though consistent themes included protection and concerns over side effects. This study also found two general types of parents-those who treat vaccines the same and those with varying opinions about each vaccine. Results from this study demonstrate the family- and community-oriented nature of NHPI communities, suggesting that future interventions target not only parents but also their families and communities to cultivate vaccine acceptance through social networks. Furthermore, addressing all three vaccines during well-child visits may benefit parents who view each vaccine as separate entities with individual pros and cons. Such interventions could contribute toward reducing the burdens of particularly chronic health disparities.

Willingness to be vaccinated against COVID-19: the role of risk perception, trust in institutions, and affects

Introduction

Vaccination is one of the most effective ways to stop the COVID-19 pandemic and prevent severe disease. This study aims to ascertain the determinants of COVID-19 vaccination acceptance in the French population before the vaccine was introduced (France's second lockdown) and during the roll-out of the vaccination campaign (France's third lockdown). We focus on the following as determinants of willingness to be vaccinated: risk perception, affects related to the risk, and trust in political and health institutions.

Method

The study was conducted among two convenient samples including 591 and 474 participants. The results show that the timing of the crisis was important. While the intention to be vaccinated was relatively low before the vaccines were introduced, it became significantly higher when the vaccination campaign was deployed.

Results

The results show that risk perception and trust in health institutions are the most relevant predictors of intention to be vaccinated.

Discussion

Results are discussed in terms of the effectiveness of communication campaigns.

The impact of the COVID-19 pandemic on parental vaccine hesitancy: A cross-sectional survey

BACKGROUND

It is unclear how hesitancy towards pediatric vaccines has changed quantitatively since the onset of the COVID-19 pandemic, and if changes are more readily apparent in clusters of low COVID-19 vaccination. In this study, we assess how clusters of low COVID-19 vaccination correlate with changing parental beliefs about childhood vaccines.

METHODS

A cross-sectional, opt-in, internet-based survey of parents resident in the U.S. was conducted during August-September 2022. Our survey measured changes in beliefs about childhood vaccine safety, importance, and effectiveness since the start of COVID-19. We also measured parents' perceived vaccination rates in the community, assessing its relationship with changing vaccination perceptions using Rao-Scott chi-square tests, and multinomial logistic regression models.

RESULTS

Among 310 parents of children 0-17 years old, 11 % (95 % CI: 7 %, 15 %) believed that childhood vaccines are less safe, 12 % (95 % CI: 8 %, 17 %) less important, and 13 % (95 % CI: 9 %, 18 %) less effective since the start of the COVID-19 pandemic. About 9 % (95 % CI: 5 %, 12 %) stated COVID-19 vaccination coverage was low in their community. Among those who stated COVID-19 vaccination coverage was low, 38 % reported believing childhood vaccines were less effective (vs 12 % of those who stated vaccination coverage was high). This corresponds to 4.34 times greater odds of believing childhood vaccines were less effective since the start of the pandemic (95 % CI: 1.38, 13.73) in those who believe COVID-19 vaccination coverage to be low in their community vs high.

CONCLUSION

Our study demonstrates that parental perceptions about childhood vaccines have been affected by the COVID-19 pandemic through geographic and social clustering of non-vaccination. Beliefs about the COVID-19 vaccine have spillover with beliefs about childhood vaccines, and more negative beliefs may be clustering in areas with low vaccination coverage, which could predispose the area to outbreaks of vaccine-preventable disease.

The Role of Uncertainty and Negative Emotion in Chinese Parents' Self-Medication of Children with Antibiotics

Parents self-medicating their children with antibiotics (SMA) without consulting healthcare professionals is a common practice in China. Previous research has focused primarily on examining the socioeconomic factors that contribute to the prevalence of SMA. This study adopts and extends the theory of planned behavior to understand the cognitive and emotional factors that are associated with parental SMA in China. The responses to an online survey were collected from 961 parents of children aged 6-12 years old, primarily from Gansu, Shandong, and Shaanxi provinces. More than half of the participants (66.5%) engaged in parental SMA. Amoxicillin, Cephradine, and Azithromycin were the most frequently selected antibiotics used for children. Structural equation modeling showed that uncertainty was positively associated with negative emotions, which were in turn positively associated with attitude toward SMA. Uncertainty was also negatively associated with perceived behavioral control (PBC), but the association between PBC and SMA behavior was not significant. Attitude and subjective norm were both positively associated with SMA behavior. The relationship between subjective norm and attitude was also positive. Understanding the psychological factors driving parental SMA may inform tailored interventions to promote responsible antibiotic use among parents.

Factors associated with parental COVID-19 vaccine attitudes and intentions among a national sample of United States adults ages 18-45

PURPOSE

This study explored factors associated with parents' attitudes and intentions to seek information about the COVID-19 vaccine for their children (ages 0-18) and intentions to vaccinate their age-eligible children.

DESIGN AND METHODS

As part of an anonymous online cross-sectional survey, parents' vaccine attitudes, COVID-19 vaccine intentions for their children, health literacy, health numeracy, and sociodemographic variables were assessed. Multivariable ordered logistic regression models identified factors associated with parents' COVID-19 vaccine intentions for their children.

RESULTS

Parents/guardians (n = 963) were mostly White (82.3%), insured (88.0%), and college graduates (57.3%). Men reported higher intentions than women to seek information about the COVID-19 vaccine for their children (p = 0.003) and higher intentions to vaccinate their children (p = 0.049). Parental characteristics associated with increased intentions to have their children vaccinated included higher educational attainment (p < 0.001), more positive general vaccine attitudes (p < 0.001), preference for health information in a language other than English (p = 0.006), higher income (p = 0.048), having health insurance (p = 0.05), health literacy (p = 0.024), and health numeracy (p = 0.049).

CONCLUSIONS

Multiple sociodemographic characteristics including male gender, higher health literacy and numeracy, and language preference are noteworthy factors associated with parental COVID-19 vaccine intentions that could inform the planning and implementation of educational interventions.

PRACTICE IMPLICATIONS

Nurses are important sources of trusted information and play an important role in parent/family health education and in understanding myriad factors that may improve attitudes and enhance readiness toward vaccine uptake. Our findings emphasize the potential value of examining tailored/targeted COVID-19 vaccine education according to key influencing factors.

Parents' and Health Professionals' Attitudes to Advancing Primary MMR Vaccine Administration from Fifteen to Six Months of Age-A Qualitative Thematic Analysis Embedded in a Randomized Trial

Declining levels and duration of passively acquired maternal antibodies prompted a Danish trial to test the feasibility of advancing administration of the first measles, mumps, and rubella vaccine (MMR1) from 15 to 6 months of age. A trial-embedded qualitative study aimed to understand parents' (N = 24) and health professionals' (N = 11) attitudes about the measles, mumps, and rubella vaccine (MMR) in general and about advancing MMR1 administration. Overly positive parent attitudes were contrasted by members of a vaccine-skeptical organization including parents considering that their child was seriously vaccine-injured long ago. Parents' attitudes to advancing MMR1 mirrored their attitudes about the MMR vaccine in general, with four positions along a continuum of trust in the healthcare system: unquestioning trust, acceptance after careful consideration, challenging indecisiveness, and defensive rejection. Low tolerance was identified between vaccine supporters and vaccine opponents. Parents of children with perceived serious vaccine-related injuries described lifelong unresolved feelings of guilt. Supporters of advanced MMR1 saw it as a timely and convenient administration of a well-known vaccine, whereas opponents feared it would disturb the children's immature immune systems and emphasized difficulties in recognizing side effects so early in life. Health professionals were supportive of advancing the MMR1 vaccine and they carefully challenged the parents. Current MMR vaccine supporters show readiness to advance MMR1 administration.

Exploring Critical Factors Associated with Completion of Childhood Immunisation in the Eastern Province of Saudi Arabia

(1) Background: surveillance data from the Saudi Ministry of Health shows that the Kingdom’s large-scale immunisation programme has significantly reduced the mortality and morbidity of the target diseases among children. In this study, we review relevant literature and test a number of hypotheses related to the association between demographic, socio-economic, clinic-related, and parents-related variables and completion of childhood immunisation. In doing so, this study identifies critical factors associated with completion of childhood immunisation and presents important implications to healthcare practitioners, particularly in Saudi Arabia; (2) Literature review: a systematic literature review was conducted to understand what is currently published concerning parents’ immunisation compliance in Saudi Arabia and the factors associated with immunisation compliance. (3) Methods: from March to May 2022, an online survey was administered to parents attending one of the 27 primary health care (PHC) centres in Qatif. Data from parents (n = 353) were analysed using exploratory factor analysis, correlation, and a series of OLS and logistic regression models; (4) Results: parental (child) age was negatively (positively) associated with the completion status of childhood immunisation (both p < 0.05). Parents with positive attitudes, social norms, perceptions towards immunisation, and those working in private companies were more likely to immunise their children (all p < 0.05). Conversely, living in an apartment building, walking to PHCs, waiting longer at PHCs, and having higher knowledge of immunisation were negatively associated with the completion of childhood immunisation (all p < 0.05); (5) Conclusions: several factors that positively or negatively influence the completion of childhood immunisation have been identified. Future studies may investigate the causal link between these factors and parental decision-making regarding childhood immunisation.

Decision-making on COVID-19 vaccination: A qualitative study among health care and social workers caring for vulnerable individuals

In January 2021, the Swiss government introduced the first COVID-19 vaccines and prioritized allocation to at-risk individuals and professionals working with them. Despite this opportunity, vaccine uptake among staff employed in retirement homes and institutes for people with disabilities was suboptimal. This study aimed to capture real-time decision-making about COVID-19 vaccine among staff employed in nursing homes and institutes for people with disabilities in Southern Switzerland. We conducted semi-structured phone-interviews with 25 staff employed in retirement homes and institutes for people with disabilities between February and May 2021, i.e., when participants had to decide whether they wanted to adhere to the priority vaccination programme. Among participants, 21 either signed up for the COVID-19 vaccination or were fully or partly vaccinated at the time of the interview. For most participants, the vaccination choice was a challenging process: information appeared to be lacking and conflicting; numerous moral principles were at stake and contradictory; the way vaccination was organized clashed with the health values to which respondents had been previously exposed; finally, the fear of discrimination for those who decided not to get vaccinated loomed over the vaccination choice. Participants decided for or against vaccination based on principles, traditions, emotions, and a reflexive assessment of the personal vs. collective benefit of the vaccination, the latter being the most common within the investigated sample. This study shows that deciding to get vaccinated against COVID-19 is a nuanced process and that individuals cannot simply be categorized as "novax" or "provax" based on their vaccination decision.

Psychological and situational factors associated with COVID-19 vaccine intention among postpartum women in Pakistan: a cross-sectional study

OBJECTIVES

Contributing factors to COVID-19 vaccination intention in low-income and middle-income countries have received little attention. This study examined COVID-19-related anxiety and obsessive thoughts and situational factors associated with Pakistani postpartum women's intention to get COVID-19 vaccination.

DESIGN

Cross-sectional study administering a survey by a telephone interview format between 15 July and 10 September 2020.

SETTING

Four centres of Aga Khan Hospital for Women and Children-Garden, Kharadar, Karimabad and Hyderabad-in Sindh Province, Pakistan.

PARTICIPANTS

Women who were enrolled in our longitudinal Pakistani cohort study were approached (n=1395), and 990 women (71%) participated in the survey, of which 941 women who were in their postpartum period were included in the final analysis.

PRIMARY OUTCOME MEASURE AND FACTORS

COVID-19 vaccine intention, sociodemographic and COVID-19-related factors, Coronavirus anxiety, obsession with COVID-19 and work and social adjustment were assessed. Multiple multinomial logistic regression analysis was used to identify factors associated with women's intentions.

RESULTS

Most women would accept a COVID-19 vaccine for themselves (66.7%). Only 24.4% of women were undecided about vaccination against COVID-19, and a small number of women rejected the COVID-19 vaccine (8.8%). Women with primary education were less likely to take a COVID-19 vaccine willingly than those with higher education. COVID-19 vaccine uncertainty and refusal were predicted by having no experience of COVID-19 infection, childbirth during the pandemic, having no symptoms of Coronavirus anxiety and obsession with COVID-19. Predictors for women's intention to vaccinate themselves and their children against COVID-19 were similar.

CONCLUSION

Understanding the factors shaping women's intention to vaccinate themselves or their children would enable evidence-based strategies by healthcare providers to enhance the uptake of the COVID-19 vaccine and achieve herd immunity against Coronavirus.

Willingness to Take the COVID-19 Vaccine as Reported Nine Months after the Pandemic Outbreak: A Cross-National Study

Although vaccination has been identified as an effective measure of reducing the spread of COVID-19, hesitancy to obtain a vaccine for COVID-19 has been shared. The aim of this cross-national study was to examine (i) the willingness in the general population to take the COVID-19 vaccine nine months after the pandemic outbreak and (ii) the willingness to take the vaccine in relation to sociodemographic variables, whether one has experienced COVID-19 infection, concerns about health and family, and trust in the authorities’ information about the pandemic. A cross-sectional survey design was used to collect data online in Norway, the UK, the USA, and Australia. Chi-Square tests or Fisher’s Exact test were used to analyze the data. Logistic regression analysis was used to assess direct associations between the independent variables and the outcome. Within the total sample (n = 3474), living in a city, having a college education, being concerned about your own health and the health of next of kin, and trusting information provided by authorities increased the likelihood of reporting willingness to take the COVID-19 vaccine. Across all countries, participants who reported trust in the authorities’ information about COVID-19 demonstrated a significantly higher plausibility of taking the COVID-19 vaccine.