Disgust as an emotional driver of vaccine attitudes and uptake? A mediation analysis.

P M Luz,C J Struchiner,H E Brown

doi:10.1017/s0950268819000517

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.

Highlights

Despite vaccines being the most important public health intervention to date [1], some individuals and/or communities choose not to vaccinate, mostly for personal reasons
We explored whether the association between the exposures (Disgust Sensitivity, Germ Aversion and Perceived Susceptibility) and the outcome results from a direct effect or an indirect effect through a mediator (Vaccine Attitudes)
We show two opposing roles for disgust on vaccine uptake, a direct positive effect combined with an indirect negative effect through Vaccine Attitudes, which in-turn influences the manifest behaviour in the absence of other predictors

Summary

Introduction

Despite vaccines being the most important public health intervention to date [1], some individuals and/or communities choose not to vaccinate, mostly for personal (religious and philosophical) reasons. For strictly pro- or antivaccine groups, the decision to get vaccinated is likely straight-forward leading them to vaccinate or not, respectively. The group that hesitates with regard to vaccines likely includes those who are unsure of their assessment of vaccines (which may well be vaccinespecific), as well as those who have no knowledge, no interest or no time. The relatively small effect of most interventions (with the exception of mandatory vaccination [8]) aimed at decreasing anti-vaccine attitudes, increasing vaccine knowledge and/or promoting vaccine uptake [9] suggests that the link between attitudes, beliefs, knowledge and behaviour is multifaceted. Approaches aimed at correcting vaccination misinformation among vaccine sceptics have been shown to have no effect or even backfire [10,11,12] while employers that mandate vaccination may face litigation [13]

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