שנת סיום: 2023
כותרת עבודת הדוקטורט: Vaccine Hesitancy and Development of Theoretical-Applied Communication Strategies to Correct Information and Communicate Uncertainty during Emerging Infectious Diseases Adapted to Groups with Different Attitudes toward Vaccines
מנחים: פרופ' ענת גסר-אדלסבורג ופרופ' גוסטבו מש
Abstract
Research framework: The benefits of vaccination in preventing and eradicating infectious diseases are well established. However, vaccine hesitancy is still expanding, especially after the COVID-19 outbreak. Most literature to date has referred to hesitant groups in order to characterize them and examine effective strategies to promote vaccination. Still, at the same time, it appears that up until now, the formal health system has failed to understand this group and engage in effective dialogue with them. During periods of emerging infectious diseases, the general public - not just the hesitant group - often turns to the new media sources for information, including the risk of getting infected, disease severity, possible treatments, and vaccination. The issue of vaccination on social media is considered one of the main concerns for health organizations. And although vaccine content is widely presented across the new media, this content may contain mis(information) and be veiled in uncertainty – all of which leads to increased vaccine hesitancy. Therefore, issues such as communicating information and communicating uncertainty are currently top priorities for health organizations in the field of risk communication – especially during periods of emerging infectious diseases.
Objectives: The general objectives of this doctoral dissertation include: (1) providing a better understanding of the phenomenon of vaccine hesitancy during an outbreak of infectious diseases; (2) examining the responses of different groups regarding vaccination to the correction of misinformation by health organizations; and (3) developing recommendations for communication strategies adapted to different groups (pro-vaccination, hesitating, and anti-vaccination groups) to correct information and communicate uncertainty in social media.
The specific doctoral dissertation objectives include: (1) identifying hesitant attitudes among pro-vaccination parents; (2) testing the difference between the rate of hesitant attitudes and the rate of hesitancy in practice among pro-vaccination parents; (3) examining the association of background characteristics (gender, age, marital status, education, and religious affiliation) with the difference between hesitant attitudes and hesitancy in practice among pro-vaccination parents (Section 4.1); (4) identifying the perceptions and attitudes of hesitant and anti-vaccination parents regarding vaccinating their children; (5) describing the responses of potential participants to the request to participate in academic research regarding their perceptions and attitudes on the subject of vaccines (Section 4.2); (6( examining the responses of groups with different attitudes/behaviors regarding vaccination; (7) examining the effect of the common methods of correcting information regarding the response of subgroups, while examining issues of reliability, satisfaction, information seeking, and how health organization tools aid the decision-making process regarding vaccines (Section 4.3); (8) identifying the communication strategies used by the Israeli Ministry of Health regarding vaccines during epidemic crises (before and after the COVID-19 pandemic) (Section 4.4) and; (9) identifying the communication strategies used by healthcare workers regarding vaccines before and after the COVID-19 crisis (Section 4.4).
Research methodology: This doctoral dissertation is based on a sequential explanatory design of mixed methods. The first part used a controlled experiment. An online survey was distributed to a panel of samples that represented the adult population in Israel in January 2020 during a measles outbreak in Israel. A total of 570 parents whose children were in kindergarten (3-5 years of age) were filtered out of the representative samples of the population in Israel. The first part of the questionnaire, which was identical for all of the participants, included a validated vaccine hesitancy scale. The second part of the questionnaire consisted of two controlled experiments designed by manipulating two variables: correcting information and communicating uncertainty about the measles disease and the vaccine against measles. Each experiment included two versions of two conditions: Condition 1- a common information correction/common communicating uncertainty approach, formulated as a short response without addressing the emotional element (empathy and addressing the public’s fears and concerns), and in terms that dismiss criticism and oppositional voices; and Condition 2 – recommended (theory-based) information correction/communicating uncertainty approach, mainly communicating information transparently and addressing the public’s concerns. In addition, the variables of reliability, satisfaction, information seeking, and how health organization tools aid the decision-making process regarding vaccines were also measured. However, both experiments showed insignificant differences regarding the measured variables between Condition 1 and Condition 2. As a result, the doctoral dissertation focused only on Condition 1 - the common communication or correcting information methods, and aimed to examine the responses of groups with different vaccination attitudes and behaviors to this form of communicating information (Section 4.3). In addition, this doctoral dissertation examines hesitant attitudes among different groups regarding vaccination using a validated vaccine hesitancy scale (Section 4.1).
The quantitative part was followed by the qualitative part, which aimed to provide a better understanding and interpretation of the quantitative findings. The qualitative part consisted of two sub-studies. The first sub-study employed the hermeneutic phenomenological method using two research tools: (1) in-depth interviews with 7 hesitant and 11 anti-vaccination Jewish parents in Israel and; (2) the researchers' field notes from this study process, which describe the responses of 32 potential participants to the request to participate in this academic research (Section 4.2). The second sub-study was based on in-depth interviews with 18 healthcare workers (physicians and nurses), and used a semi-structured protocol as a research tool (Section 4.4).
Main findings:
Quantitative findings
The main finding of the first part of the quantitative study indicated a difference between the rate of hesitant attitudes and the rate of hesitation in actual vaccination among the pro-vaccination group. According to socio-demographic characteristics, there was a significant difference between the rate of hesitant attitudes and the rate of hesitancy in practice among women and men, parents between 30-39 years of age, traditional parents, non-academic parents, and parents with BA degrees (Section 4.1).
The analysis of the responses of groups with different attitudes and behaviors regarding vaccination to health organizations’ common methods of communicating information during an epidemic outbreak indicated significant differences between the vaccination groups’ attitude/behaviors regarding the extent of their trust in the Ministry of Health, the reliability of the Ministry of Health’s response, satisfaction with the Ministry of Health's response, and the level of help they felt the Ministry of Health’s tools provided them regarding vaccine-related decision making (Section 4.3).
Qualitative findings
The findings of the qualitative study strengthen and interpret the results of the quantitative part. The qualitative findings of sub-study 1 indicated that while most interviewees admitted to the efficacy of vaccines in preventing diseases, they opposed the way vaccines are promoted - based on providing partial information and disregarding parents’ concerns and questions. Therefore, they demanded transparency about the efficacy and safety of vaccines. The findings also point to a paradoxical finding. On the one hand, these groups claim that health organizations do not understand their position, referring to them as “science deniers”, even though they are not. On the other hand, these parents choose to refrain from participating in scientific studies and voicing their opinions, thereby perpetuating the situation of being misunderstood (Section 4.2). The findings of sub-study 2 indicated that healthcare workers had a high level of trust in the Ministry of Health and claimed a decrease in the public’s trust in the health system following the COVID-19 outbreak. However, these healthcare workers still rely on the Ministry of Health as a primary source of information and adopt the same strategies of communication with the public (Section 4.4).
Scientific contribution: In light of the spread of vaccine hesitancy in Israel and worldwide, especially after the COVID-19 pandemic, this study may provide a deeper understanding of vaccine hesitancy. This is accomplished by suggesting a new division of groups regarding vaccination, based on a combination of attitudes and behaviors about vaccination, and by conceptualizing what is included under the umbrella of “vaccine hesitancy”. This research found that pro-vaccination parents, who vaccinate with all the vaccines according to the routine vaccination schedule, may still have hesitant attitudes. Therefore, this finding suggests that it is not accurate to identify the public regarding vaccination solely according to their attitudes or behaviors. Moreover, this study contributes to the scientific literature by revealing and emphasizing the importance of pro-vaccination groups who have hesitant attitudes, and the ways in which they respond to health organizations’ common communication strategies. In addition, this pioneering study does not examine the point of view of health organizations toward hesitant and anti-vaccination groups, as does most literature. Instead, this study focuses on hesitant and anti-vaccination parents and the ways in which they perceive the health system and its attempt to communicate with them.
Practical implications: This study shows that dividing the public into three main groups regarding vaccination does not actually reflect the currently existing spectrum or the public’s fluctuating attitudes and behaviors towards vaccination. Therefore, from a practical point of view, health organizations should refer to the public according to those who are pro-vaccination in behavior, but have hesitant attitudes. In addition, labeling hesitant groups with terms such as “science-deniers” and “conspiracy disseminators" prevents the possibility of managing an effective dialogue between these groups and the health organizations, as such terms only serve to exacerbate these groups’ lack of trust in the health system. To build trust, the health system does not need to convince hesitant and anti-vaccination groups to vaccinate, but rather to conduct a dialogue based on transparency and the principles of risk communication. These principles rely on an effective dialogue between the health organization and all vaccination groups, including those who are pro-vaccination, taking into consideration the difference between hesitant attitudes and hesitancy in practice among pro-vaccination parents.
Conclusion: Identifying the public regarding vaccination includes a broad spectrum of subgroups regarding the issue of vaccination based on a combination of attitudes and behaviors. Pro-vaccination individuals may have hesitant attitudes, but still vaccinate their children or get vaccinated themselves in accordance with all the recommended vaccines. Addressing this group's concerns and doubts is important because they may also eventually become hesitant in behavior. In addition, anti-vaccination individuals do not necessarily oppose all vaccines, in general, and although they may believe in the vaccine's importance and role in eradicating infectious diseases, they may strongly oppose the way in which vaccines are promoted. Despite this, they are inaccurately labeled as “science deniers” by health organizations and scientific researchers. Therefore, it is imperative that health organizations respect all vaccination groups, regardless of their attitudes or behavior, and address their concerns and fears in order to foster trust. In addition, health organizations must change their traditional communication methods and develop new communication strategies. These strategies should be based on the principles of health and risk communication such as transparency and managing a dialogue, while accepting different perceptions and admitting the errors and mistakes of the system.
ss of physical activity intervention.