Predicting intention to receive a seasonal influenza vaccination using Protection Motivation Theory.

RATIONALE Seasonal influenza vaccination rates are below the recommended targets, contributing to significant preventable harms. Protection Motivation Theory (PMT), a widely applied model of motivation to respond to threats, may provide some insights into strategies to increase the rate of vaccine uptake. Yet, previous research has omitted some of the proposed predictors of intention when applying this model to vaccination. OBJECTIVE The aim of the study is to assess the utility of the PMT in predicting intention to obtain the seasonal influenza vaccine. This study will be the first to examine the role of all six PMT constructs in predicting intention to receive the seasonal influenza vaccine. METHOD A cross-sectional study of 547 US residents was conducted using Amazon MTurk. RESULTS All constructs show significant bivariate correlations in the direction expected from the prior literature. Further examination of the theory within a linear regression model, however, found that perceived costs of vaccinating (i.e., response costs) did not uniquely account for variance in intention. All other components, perceived severity of and susceptibility to influenza, the perceived benefits of not vaccinating (i.e., maladaptive response rewards), the self-efficacy to vaccinate, and the perceived efficacy of vaccinating in preventing influenza (i.e., response efficacy) were unique predictors of intention. Overall, the PMT accounted for 62% of the variance in intention to vaccinate. CONCLUSIONS The study is the first to investigate influenza vaccination using all six theorised predictors of intention from the PMT. The findings highlight the importance of the simultaneous inclusion of all components of the model in assessing their potential utility as targets for intervention. Importantly, the results identify under-utilised constructs in the promotion of vaccine uptake, such as maladaptive response rewards, which should be considered targets for future intervention.

[1]  L. Sticchi,et al.  Influenza vaccination in healthcare workers: A comprehensive critical appraisal of the literature , 2017, Human vaccines & immunotherapeutics.

[2]  R. W. Rogers,et al.  Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change , 1983 .

[3]  Amelia M. Jamison,et al.  The Role of Risk Perception in Flu Vaccine Behavior among African‐American and White Adults in the United States , 2017, Risk analysis : an official publication of the Society for Risk Analysis.

[4]  Amelia M. Jamison,et al.  Determinants of influenza vaccination among high-risk Black and White adults. , 2017, Vaccine.

[5]  P. Sheeran,et al.  Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. , 2006, Psychological bulletin.

[6]  U. Parashar,et al.  Risk of Rotavirus Nosocomial Spread After Inpatient Pentavalent Rotavirus Vaccination , 2018, Pediatrics.

[7]  S. Michie,et al.  Factors associated with uptake of vaccination against pandemic influenza: a systematic review. , 2011, Vaccine.

[8]  N. MacDonald Vaccine hesitancy: Definition, scope and determinants. , 2015, Vaccine.

[9]  Peter R Harris,et al.  Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. , 2014, Psychological bulletin.

[10]  Kim F. Nimon,et al.  Tools to Support Interpreting Multiple Regression in the Face of Multicollinearity , 2012, Front. Psychology.

[11]  L. Grohskopf,et al.  Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season , 2015, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[12]  Songkai Yan,et al.  US healthcare costs attributable to type A and type B influenza , 2017, Human vaccines & immunotherapeutics.

[13]  R. Schwarzer,et al.  Who Participates in Seasonal Influenza Vaccination? Past Behavior Moderates the Prediction of Adherence , 2011, Advances in preventive medicine.

[14]  G. Franco,et al.  [Influenza risk perception and vaccination attitude in medical and nursing students during the vaccination campaigns of 2007/2008 (seasonal influenza) and 2009/2010 (H1N1 influenza)]. , 2011, La Medicina del lavoro.

[15]  Cornelia Betsch,et al.  Barriers of Influenza Vaccination Intention and Behavior – A Systematic Review of Influenza Vaccine Hesitancy, 2005 – 2016 , 2017, PloS one.

[16]  D. French,et al.  Do interventions containing risk messages increase risk appraisal and the subsequent vaccination intentions and uptake? – A systematic review and meta‐analysis , 2018, British journal of health psychology.

[17]  A. Tricco,et al.  Self-reported barriers and facilitators to preventive human papillomavirus vaccination among adolescent girls and young women: a systematic review. , 2014, Preventive medicine.

[18]  R. W. Rogers,et al.  A meta-analysis of research on protection motivation theory. , 2000 .

[19]  Alexander J. Rothman,et al.  International Journal of Behavioral Nutrition and Physical Activity , 2004 .

[20]  E. Jacobs,et al.  Implications of philosophical and personal belief exemptions on re-emergence of vaccine-preventable disease: The role of spatial clustering in under-vaccination , 2012, Human vaccines & immunotherapeutics.

[21]  Leily Ziglari Interpreting Multiple Regression Results: β Weights and Structure Coefficients , 2017 .

[22]  Torrin M. Liddell,et al.  Analyzing Ordinal Data with Metric Models: What Could Possibly Go Wrong? , 2017, Journal of Experimental Social Psychology.

[23]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[24]  N. Weinstein,et al.  Risk perceptions: assessment and relationship to influenza vaccination. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[25]  V. Mor,et al.  Estimating the Effect of Influenza Vaccination on Nursing Home Residents’ Morbidity and Mortality , 2015, Journal of the American Geriatrics Society.

[26]  A. Monto,et al.  Interim Estimates of 2016–17 Seasonal Influenza Vaccine Effectiveness — United States, February 2017 , 2017, MMWR. Morbidity and mortality weekly report.

[27]  V. Roth,et al.  Qualitative motivators and barriers to pandemic vs. seasonal influenza vaccination among healthcare workers: a content analysis. , 2014, Vaccine.

[28]  A. Patt Adaptive Capacity and Human Cognition , 2003 .

[29]  W. Thompson,et al.  Epidemiology of seasonal influenza: use of surveillance data and statistical models to estimate the burden of disease. , 2006, The Journal of infectious diseases.

[30]  R. Aungst,et al.  Healthy People 2020 , 2013, American Journal of Kidney Diseases.

[31]  Margaret Maglione,et al.  Interventions That Increase Use of Adult Immunization and Cancer Screening Services , 2002, Annals of Internal Medicine.

[32]  Yihui Xie,et al.  Dynamic Documents with R and knitr , 2015 .