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Promoting vaccination? Focus on behaviour more than persuasion

4 April 2018
How do we promote vaccine-preventable infections?
Behavioural strategies are better than persuasion for promoting vaccination, a new review of the evidence reveals.

Focus on behaviour, not persuasion, to increase vaccinations, says evidence.

Faced with outbreaks of influenza and other vaccine-preventable diseases, parents, educators, healthcare providers, and policymakers around the world often want to know how to persuade people to get their vaccinations.

Published today in Psychological Science in the Public Interest, the study concludes that vaccination campaigns aiming to change perceptions and attitudes about vaccines are less effective than facilitating vaccination in more direct ways.

Public health campaigners should instead focus on changing people’s behavior, the authors of the review say.

A common myth is that it’s easy to persuade people to get vaccinated
Associate Professor Julie Leask, University of Sydney

Public health campaigners should instead focus on changing people’s behaviour, the authors of the review say.

To understand the factors that underlie vaccination-related behaviour, the report by scholars from Carnegie Mellon University, University of Minnesota, University of Sydney, and University of Colorado Anschutz Medical Campus assessed evidence from psychological science, public health, medicine, nursing, sociology, and behavioural economics.

One of the challenges of vaccination is that uptake varies across vaccines. Childhood vaccination generally has strong public support, with the majority of infants in most countries receiving recommended vaccines.  In contrast, many adults forego vaccines such as the seasonal flu vaccine.

Australian author Julie Leask, Associate Professor at the University of Sydney, says, “The report is a reminder for all health services, workplaces and governments to make it as easy as possible for people to be vaccinated – reminders, nudges and removing as many barriers as possible is what is most effective.”

“A common myth is that it’s easy to persuade people to get vaccinated,” says researcher Professor Noel Brewer of the University of North Carolina, first author on the report.

“But when was the last time hearing a fact one time led you to exercise regularly, lose weight, or quit smoking? It’s the same for vaccination.”

A common myth is that it’s easy to persuade people to get vaccinated
Professor Noel Brewer, University of North Carolina

The best available data indicate that the percentage of people who actively refuse all vaccines is incredibly small and that neither vaccine refusal nor delay is on the rise. These findings contradict the media-fueled narrative that an increasing number of people is rejecting immunisations.

In reality, most people receive most vaccines in line with their health care providers’ recommendations. Many others have favorable attitudes toward vaccination but do not always follow through to receive vaccines in full or on time.

The researchers find that the most effective vaccination interventions build on these favorable intentions, employing behavioral strategies to:

  • Facilitate action by providing patients with reminders and prompts
  • Reduce barriers by setting default orders and appointments
  • Shape behavior by developing incentives, sanctions, and requirements

“Vaccination is one of the greatest public health achievements in the past century. Yet, vaccine uptake is well below optimal for some vaccines, and healthcare providers routinely face parents and patients who are hesitant about receiving vaccines,” explains Professor Gretchen Chapman of Carnegie Mellon University.

“Accessing the full benefits of vaccination entails facilitating behavior, and the insight for doing that comes from psychological science.

“Our main message to policy makers and providers is that, surprisingly, the strongest evidence supports impacting vaccination directly by leveraging, but not trying to change, what people think and feel,” Chapman says.

In some cases, people encounter false or misleading information about vaccines. Research shows that the best way to correct this misinformation is to reiterate the facts clearly and in a way that fits with people’s intuitive beliefs.

These conclusions are supported by multiple sources of evidence, but the researchers note that much of the available research on vaccination behavior is limited in quality or quantity. Studies investigating vaccination attitudes and behavior over time are rare and few studies examine the specific mechanisms or components that make for effective interventions.

“Should we stop communicating about vaccination? No. It’s not going to cause big jumps in vaccination rates. We need to help people practically too,” Dr Leask says.

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