Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability of vaccines – is one of the top ten threats to global health, according to the World Health Organization (WHO). The persuasive power of physicians and other healthcare providers, WHO advises, is critical to overcoming resistance.
But one size doesn’t fit all when it comes to countering vaccine hesitancy, cautions Stacey Finkelstein, associate professor of marketing in Stony Brook’s College of Business. She says physicians need to recognize and respond to psychological reactance, the tendency to react in opposition to messages that could be perceived as threatening autonomy or the freedom to choose.
People prone to reactance don’t respond well to authority, Finkelstein says, sometimes displaying behaviors that border on juvenile.
“If you tell a child they can’t have candy, they’ll want it even more. To get it, they’ll probably sneak candy or eat it at a friend’s house because you’ve taken away their ability to choose when to eat it,” she says.
That phenomenon means that new communication strategies may be necessary to ensure compliance with vaccine schedules. Recent research led by Finkelstein, along with fellow College of Business faculty Paul Connell, associate professor of marketing, and Gary Sherman, assistant professor of management, explores how psychological reactance impacts perceived physician-patient communication quality, vaccination safety, and vaccination priority.
According to the paper, those who are high in trait psychological reactance will evaluate pediatrician communication quality less favorably, will subsequently perceive vaccines as less safe, and reduce the priority placed on vaccinating their children.
Thus, Finkelstein says, “pediatricians need to consider tailoring messaging and interactions with patients based on psychological factors, including reactance.”
Vaccine hesitancy is something that Sharon Nachman, MD, chief of the division of pediatric infectious diseases at Stony Brook Children’s Hospital, has experienced first-hand.
“I can tell you from experience that vaccination acceptance has changed,” says Nachman. “When I started at Stony Brook more than 20 years ago, we saw at least one case of meningitis each month. Ten to 15% of those children died. It was not an uncommon occurrence. Then the Prevnar vaccine was licensed and we saw fewer and fewer cases of meningitis. After a while those events of meningitis became nonexistent.”
However, that very success is a double-edged sword. “We’ve done such a great job preventing illness that most young parents don’t see those illnesses and often don’t find a reason for vaccination,” Nachman says. “That has allowed people a space in popular dialogue to say, ‘we’re not vaccinating our children and you shouldn’t either.’”
Illustrating Nachman’s point, Finkelstein cites anecdotal evidence suggesting that immigrants living in the United States who arrived from Third World countries tend to prioritize vaccinations because they have seen the dire consequences of not vaccinating.
“People vary in how much they experience psychological reactance,” Finkelstein says. “Parents who are high in trait reactance might, for example, feel threatened when they learn that their pediatrician believes in vaccinating on a strict schedule and timeline endorsed by the American Academy of Pediatrics (AAP). We found that parents who are high in reactance indicate lower perceived communication quality with their physician, which results in lower perceived vaccination safety and priority.”
According to Nachman, establishing trust between physician and patient is paramount.
“Oftentimes, if a child is sick, parents don’t go to their primary care doctor but to a walk-in center, where someone they’ve never seen before will look at their child and say, ‘here’s what’s going on, here’s what you need to buy, you’re done’,” she says.
“It’s a brief visit, and the rest of the child’s health is not discussed. If a parent comes in with a preconceived notion about vaccines, the doctors have too little time in that one visit to talk about that. The default is that the parents then go back to the Internet, look it up and make a decision that’s often not based on fact.”
Ironically, Finkelstein says, exposure to reliable facts may increase vaccine hesitancy in some parents. “The persuasion literature in psychology suggests that counter-arguing is likely to lead them to ‘dig in’ and hold more firmly to their beliefs,” she says. “Instead, building a trusting relationship based on listening and mutual respect can make these conversations more fruitful and lead to lasting behavioral change.”
“One of the most important things is to not lead the discussion, but to be receptive,” she says. “What is it that’s worrying them? Once you get that information on the table and know their concerns, it might be easier.”
— Robert Emproto