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Look! A Morsel of Good Vaccination News

2014 April 6
by Eric Horowitz

It’s been a bad few weeks for vaccination. Whooping cough continues to make a comeback; it was revealed that some New York City schools have third-world vaccination rates; and a study led by Brendan Nyhan found that four different interventions were unable to shift vaccination intentions.

So it may come as a surprise that a new study actually produced some good news. An intervention based on anticipated regret questions (ARQ) and graphical communication managed to successfully shift parental intentions on vaccination.

Our goal in conducting this research was to determine possible interventions that might help parents appreciate the risks of not vaccinating their daughters against HPV infection…We hypothesized that an intervention designed to help mothers visualize the risks of nonvaccination (a graphical depiction of how cervical cancer risk is affected by HPV vaccination) would moderate the effects of ARQ on behavioral intentions…We found that among mothers who saw the graphic message, asking ARQ had a significant positive effect on both message involvement and behavioral intention…the ARQ intervention had no significant effect on vaccination intentions in the text-only condition.

The “graphical” intervention showed filled stadium bleachers to illustrate the number of people who could be saved from cancer, whereas the text-only condition showed only the number. The ARQ procedure involved two questions: 1) If your daughter was not immunized against HPV and developed cervical cancer, how responsible would you feel, and 2) If your daughter was not immunized against HPV and developed cervical cancer, how much regret would you feel?

Additional analyses suggested that rather than changing parental beliefs about the benefits of vaccination, combining ARQ with a graphical message was effective because the ARQ increased emotional involvement with the information contained in the graphics. That is, instead of increasing the perceived downside of nonvaccination, the intervention appeared to have increased the salience of the existing perceived downside.

And now for the caveats. The study involved only 320 mothers, and unlike the Nyhan study, it used random assignment to parse out an effect rather than analyzing how the opinions of individual mothers shifted. Prior research on ARQ also suggests it’s most effective among parents who already have high vaccination-intention levels, so the intervention in the study may ultimately fail to convert stubborn opponents. Finally, the study focused on an HPV vaccine for girls aged 11-16, and not the MMR or whooping cough vaccines for young children that seem to be the basis for the most outlandish fictional side effects.

Clearly, it would be a mistake to rush into building ARQ into the vaccination decision process, but the strategy of targeting potential regret may be promising in ways that purely informational strategies are not (though it should be noted that some of the ineffective interventions in Nyhan’s study — such as presenting a mother’s account of her child’s measles hospitalization — may have featured inducing regret in a more indirect manner.) People on the fence about vaccination are probably already considering the regret they’ll feel if their child develops autism, so inducing them to think about the regret of disease may help level the playing field. Eliminating the small pockets of vaccination opposition is still an uphill climb, but it’s good to see that it’s at least possible for an intervention to have the desired positive effect.
Cox, D., Sturm, L., & Cox, A. (2014). Effectiveness of Asking Anticipated Regret in Increasing HPV Vaccination Intention in Mothers. Health Psychology DOI: 10.1037/hea0000071

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