JOURNEY TO VACCINATION: A QUALITATIVE EXPLORATION OF HOW BELIEFS, PERCEPTIONS AND PREVIOUS EXPERIENCES INFLUENCE VACCINATION BEHAVIOR

Purpose: Adult routine vaccination rates remain suboptimal. Social influences, beliefs and perceptions can significantly affect vaccination uptake. This study aimed to elicit the wider constellation of social and psychological factors likely to influence adult vaccination behavior over time and to explore whether vaccination decisions are driven by facts or intuition.

Method: Forty in-depth, face-to-face interviews (20 in the US and 20 in the UK) were conducted with members of the public who represented a range of socio-demographic characteristics associated with vaccination uptake. To elicit previous experiences, underlying beliefs and perceptions influencing vaccination decisions, specifically seasonal flu and tetanus, we developed the journey to vaccination, a new qualitative approach anchored on the heuristics and biases tradition and the customer journey mapping approach. Journeys to vaccination for flu and tetanus were produced for each participant, and typical journeys were proposed. Thematic analysis was used to analyze the data.

Result: Regular flu vaccinators were more likely to trust their doctor, family and friends than intermittent and non-vaccinators. Non-vaccinators were more likely to have had a vaccine or health-related adverse psychological experience during childhood, whereas tetanus vaccinators recalled their mother’s warnings during childhood about tetanus’ severity. Perceived susceptibility to both flu and tetanus, and perceived severity of tetanus were key triggers to vaccination. These two factors formed an “emotional prism” through which the vaccines’ costs and benefits were assessed. Those who felt vulnerable to flu, for example, although still able to recognize the vaccine’s side-effects and partial efficacy, were more likely to receive the flu vaccine than those who did not feel vulnerable. Tetanus-containing boosters were more trusted than flu vaccines, mainly due to the changing composition of the latter.

Conclusion: Vaccination behavior should be viewed as a continuum, from childhood to adulthood, and not in isolation from each other or from other important health, or lifestyle-related events. Integrated interventions should be considered. Our findings suggest that fear is an important trigger of both vaccination acceptance and refusal and that vaccination decision-making often circumvents facts.