1
|
Malik AA, Ahmed N, Shafiq M, Elharake JA, James E, Nyhan K, Paintsil E, Melchinger HC, Team YBI, Malik FA, Omer SB. Behavioral interventions for vaccination uptake: A systematic review and meta-analysis. Health Policy 2023; 137:104894. [PMID: 37714082 PMCID: PMC10885629 DOI: 10.1016/j.healthpol.2023.104894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/22/2023] [Accepted: 08/15/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries. METHODS We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately. FINDINGS Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes. INTERPRETATION Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.
Collapse
Affiliation(s)
- Amyn A Malik
- Yale Institute for Global Health, New Haven, CT 06510, USA; Analysis Group, Inc, Boston, MA 02199, USA
| | - Noureen Ahmed
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Mehr Shafiq
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University School of Public Health, New York, NY 10032, USA
| | - Jad A Elharake
- Yale Institute for Global Health, New Haven, CT 06510, USA; UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA; The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Erin James
- Yale Institute for Global Health, New Haven, CT 06510, USA
| | - Kate Nyhan
- Yale University, New Haven, CT 06510, USA
| | - Elliott Paintsil
- Yale Institute for Global Health, New Haven, CT 06510, USA; Columbia University Institute of Human Nutrition, New York, NY 10032, USA
| | | | | | - Fauzia A Malik
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA
| | - Saad B Omer
- UT Southwestern Peter O'Donnell Jr. School of Public Health, Dallas, TX 75390, USA.
| |
Collapse
|
2
|
Vaz A, Mata A, Critcher CR. Analogies Offer Value Through the Struggle to Make Them Work: Making Sense of the Psychological Immune System. PSYCHOLOGICAL INQUIRY 2022. [DOI: 10.1080/1047840x.2021.2004815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- André Vaz
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - André Mata
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Clayton R. Critcher
- Haas School of Business, University of California, Berkeley, California, USA
| |
Collapse
|
3
|
Clayton K, Finley C, Flynn DJ, Graves M, Nyhan B. Evaluating the effects of vaccine messaging on immunization intentions and behavior: Evidence from two randomized controlled trials in Vermont. Vaccine 2021; 39:5909-5917. [PMID: 34481697 DOI: 10.1016/j.vaccine.2021.08.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 03/17/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
The effectiveness of vaccines in reducing child morbidity and mortality worldwide relies on public acceptance. However, relatively little is known about the effects of vaccine communication on vaccine attitudes and immunization behavior. Previous research suggests that common communication approaches may be ineffective or even counterproductive, especially among vaccine-hesitant parents. However, these studies typically rely on observational data or self-reported measures of vaccination intention. Using novel research designs, we tested the attitudinal and behavioral effects of messages encouraging vaccination in both a survey experiment conducted among a large sample of parents in Vermont who expressed hesitancy about childhood immunizations and a field experiment among parents whose children were overdue for vaccines. We find that neither a message promoting immunization as a social norm nor a message correcting common misperceptions about vaccines was measurably more effective than a standard public health message at improving parents' attitudes toward vaccines, intention to vaccinate their children, or compliance with the recommended vaccine schedule. Our results highlight the need for more research on approaches to successfully reducing vaccine hesitancy among parents.
Collapse
Affiliation(s)
- Katherine Clayton
- Department of Political Science, Stanford University, United States.
| | - Christine Finley
- Immunization Program, Vermont Department of Health, United States
| | - D J Flynn
- School of Global and Public Affairs, IE University, Spain
| | - Meredith Graves
- Immunization Program, Vermont Department of Health, United States
| | - Brendan Nyhan
- Department of Government, Dartmouth College, United States
| |
Collapse
|
4
|
Foley E, Breit S, Marsh C, Ault K, Lydic M. Attitudes toward Rubella and Varicella Vaccination during Preconception Care. Kans J Med 2021; 14:215-219. [PMID: 34540135 PMCID: PMC8415390 DOI: 10.17161/kjm.vol1415205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/05/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Studies of anti-vaccine attitudes in the perinatal time period previously have not paid special attention to the MMR and varicella vaccines. Because both contain live attenuated virus, a contraindication during pregnancy, it is important to assess barriers to vaccination clinically during preconception to avoid the known fetal morbidity associated with congenital rubella or varicella infection. Methods The primary outcome of this study was to determine prevalence of patients with nonimmune status for rubella and varicella in the setting of advanced reproductive care. Secondary outcomes of interest included further understanding nonimmune reproductive-aged women's attitudes toward MMR and varicella vaccination during preconception. Patient records with laboratory orders for rubella or varicella immunoglobulin titers, placed at the KU Advanced Reproductive Care clinic between January 2017 and June 2020, were reviewed (n = 2,217). A cross-sectional survey was administered to patients with a laboratory reported negative titer result. Results Prevalence of nonimmunity to either rubella or varicella represented 6.0% (n = 134) and 3.8% (n = 85) of records, respectively; nineteen records (0.6%) demonstrated nonimmunity to both. The women who did not receive recommended vaccines following a non-immune titer result (n = 19) most commonly cited their rationale was to not delay fertility treatment further (n = 8), a requirement when receiving live attenuated virus vaccines. Conclusions The prevalence of nonimmune persons in the study population fell within the range recognized to be sufficient for herd immunity. The majority of survey respondents indicated that CDC recommended vaccinations were of high personal importance, with strong congruence of thought among those who answered in favor of vaccines when posed with several true or false statements about personal beliefs and vaccine efficacy. The risk/benefit analysis of postponing fertility treatment to achieve adequate levels of immunity should be a focused discussion when establishing fertility treatment goals with patients in the setting of advanced reproductive care.
Collapse
Affiliation(s)
- Elise Foley
- University of Kansas School of Medicine-Salina, Salina, KS
| | - Shelby Breit
- University of Kansas School of Medicine-Salina, Salina, KS
| | - Courtney Marsh
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Kevin Ault
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Michael Lydic
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
5
|
Bierbaum M, Nillesen EEM. Sustaining the integrity of the threatened self: A cluster-randomised trial among social assistance applicants in the Netherlands. PLoS One 2021; 16:e0252268. [PMID: 34081712 PMCID: PMC8174741 DOI: 10.1371/journal.pone.0252268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Stereotypes and stigma associated with living on welfare or a low income can be a psychological threat that hampers performance and undermines aspirations. Our paper explores the potential of a novel self-affirmation intervention to mitigate such adverse impacts. The intervention comprises a verbal self-affirmation exercise for applicants during their first meeting with a caseworker. We conduct a cluster-randomised trial among a sample of 174 applicants for social assistance benefits in a Social Services office in Maastricht, the Netherlands. We measure outcomes on feelings of self-worth, stress, societal belonging, job search behaviour self-efficacy and cognitive performance immediately after the meeting. In our full sample, the intervention has a negative impact on feelings of societal belonging, but no effect on other outcomes. Effects, however, vary by subgroups. Our treatment increases negative feelings of self-worth and negatively affects societal belonging, but also improves cognitive performance among the group that had paid work in the previous two years. By contrast, self-affirmation positively impacts job search behaviour self-efficacy and cognitive performance for individuals who face increased challenges to (re)integrate into the labour market, proxied by lower levels of education or social assistance receipt in the previous two years. Since our intervention gives rise to testing more than one null hypothesis, we control the false discovery rate using the Benjamini-Hochberg approach. Our findings are sobering. Effects only remain significant for negative feelings of self-worth and improved cognitive performance for one particular subgroup: individuals with paid work in the past two years. This suggests self-affirmation may have reminded them of the time they still had a job, hence creating a backlash effect on feelings of self-worth. At the same time, they may have felt a need to distinguish themselves from others on social assistance benefits resulting in better cognitive performance. These interpretations are consistent with theory and empirical evidence on social identity and self-categorisation. We discuss the implications of our results and outline avenues for future work.
Collapse
Affiliation(s)
- Mira Bierbaum
- UNU-MERIT, Maastricht, the Netherlands
- Maastricht Graduate School of Governance, Maastricht University, Maastricht, the Netherlands
- International Labour Organization, Geneva, Switzerland
- * E-mail:
| | - Eleonora E. M. Nillesen
- UNU-MERIT, Maastricht, the Netherlands
- Maastricht Graduate School of Governance, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
6
|
Trevors GJ. The Roles of Identity Conflict, Emotion, and Threat in Learning from Refutation Texts on Vaccination and Immigration. DISCOURSE PROCESSES 2021. [DOI: 10.1080/0163853x.2021.1917950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
7
|
de Munter AC, Ruijs WLM, Ruiter RAC, van Nimwegen DJJ, Oerlemans AJM, van Ginkel R, Hulscher MEJL, Hautvast JLA. Decision-making on maternal pertussis vaccination among women in a vaccine-hesitant religious group: Stages and needs. PLoS One 2020; 15:e0242261. [PMID: 33180859 PMCID: PMC7660565 DOI: 10.1371/journal.pone.0242261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction As of December 2019, pregnant women in the Netherlands are offered pertussis vaccination to protect their newborn infant against pertussis infection. However, the manner in which pregnant women decide about this maternal pertussis vaccination is largely unknown. The aim of this study is to gain insight into the decision-making process regarding maternal pertussis vaccination, and to explore the related needs among the vaccine-hesitant subgroup of orthodox Protestant women. Methods Charmaz’s grounded theory approach was used to develop a decision-making framework. To construct this framework we used an explorative multimethod approach in which in-depth interviews and online focus groups were supplemented by a literature search and research group meetings. This study was carried out in a hypothetical situation since the maternal pertussis vaccination had yet to be implemented in the Dutch immunisation programme at the time of the study. Results Twenty-five orthodox Protestant women participated in an interview, an online focus group, or in both. The findings of this study resulted in a decision-making framework that included three stages of decision-making; an Orientation stage, a value-based Deliberation stage, and Final decision stage. The Orientation stage included the needs for decision-making categorised into Information needs and Conversation needs. Women indicated that -if they were to receive sufficient time for Orientation and Deliberation- they would be able to reach the stage of Final decision. Conclusion The decision-making framework resulting from our findings can be used by health care professionals to provide women with information and consultation in the decision-making process. Future studies should investigate whether the stages of and needs for decision-making can be found across other vaccine-hesitant subgroups and vaccinations.
Collapse
Affiliation(s)
- Anne C. de Munter
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
- * E-mail:
| | - Wilhelmina L. M. Ruijs
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Robert A. C. Ruiter
- Department of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Dagmar J. J. van Nimwegen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Infectious Disease Control, GGD Gelderland-Zuid, Nijmegen, The Netherlands
| | - Anke J. M. Oerlemans
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rijk van Ginkel
- “Fruits of Passion; Together Fighting Human Suffering”, Bodegraven, The Netherlands
| | - Marlies E. J. L. Hulscher
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeannine L. A. Hautvast
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
8
|
O' Leary F, O' Donovan J. Attitudes of elite athletes and their support staff to the influenza vaccine. Ir J Med Sci 2020; 190:1231-1236. [PMID: 33111253 DOI: 10.1007/s11845-020-02408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza is an important public health issue, even amongst healthy adults. Uptake rates of the influenza vaccine amongst elite athletes vary and can depend on the attitudes of their coaches, fellow athletes and support staff. International studies have documented a fear amongst elite athletes to the potential side effects of the vaccine. AIMS Determine the influenza vaccine uptake rates in elite Irish athletes and their support staff along with attitudes, fears and barriers to receiving it. METHODS A cross-sectional survey was performed in the Sport Ireland Institute. Elite athletes and support staff from the 2019 database were invited to participate via an anonymous online survey. The database included a variety of sports, e.g. athletics, boxing, cycling, rowing, swimming and para-athletics. RESULTS From 218 athletes and staff invited, 39% (n = 87 [43 male, 44 female]) responded to the online survey. Fifty-nine percent (n = 51) of participants received the influenza vaccine during the 2018/2019 season. Forty-six percent (n = 40) completely agree that the influenza vaccine is safe. Fourteen percent (n = 12) of participants believe the vaccine causes influenza. "Getting sick" from the vaccine was the biggest fear for participants. Athletes were least likely to recommend the influenza vaccine to others and most likely to fear missing time from training or work as a result of it. CONCLUSIONS Elite Irish athletes are vulnerable to contracting influenza annually, despite free access to immunisation. Barriers to receiving the vaccine include location access, education and fear of side effects.
Collapse
Affiliation(s)
- Frank O' Leary
- Sport Ireland Institute, National Sports Campus, Abbotstown, Dublin 15, Ireland.
| | - James O' Donovan
- Sport Ireland Institute, National Sports Campus, Abbotstown, Dublin 15, Ireland
| |
Collapse
|
9
|
Abstract
Research on the drivers of vaccine acceptance has expanded but most interventions fall short of coverage targets. We explored whether vaccine uptake is driven directly or indirectly by disgust with attitudes towards vaccines acting as a possible mediator. An online cross-sectional study of 1007 adults of the USA via Amazon's Mechanical Turk was conducted in January 2017. The questionnaire consisted of four sections: (1) items assessing attitudes towards vaccines and vaccine uptake, (2) revised Disgust Scale (DS-R) to measure Disgust Sensitivity, (3) Perceived Vulnerability to Disease scale (PVD) to measure Germ Aversion and Perceived Susceptibility, and (4) socio-demographic information. Using mediation analysis, we assess the direct, the indirect (through Vaccine Attitudes) and the total effect of Disgust Sensitivity, Germ Aversion and Perceived Susceptibility on 2016 self-reported flu vaccine uptake. Mediation analysis showed the effect of Disgust Sensitivity and Germ Aversion on vaccine uptake to be twofold: a direct positive effect on vaccine uptake and an indirect negative effect through Vaccine Attitudes. In contrast, Perceived Susceptibility was found to have only a direct positive effect on vaccine uptake. Nonetheless, these effects were attenuated and small compared to economic, logistic and psychological determinants of vaccine uptake.
Collapse
|