It Just Doesn't Feel Right - The Relevance of Emotions and Intuition for Parental Vaccine Conspiracy Beliefs and Vaccination Uptake

"[V]accine interventions which are based on analytical and logical approaches may have the potential to fail."

It can be said that vaccine-hesitant beliefs and conspiracy theories in general share several elements, such as negative attitudes towards science, dependency on the media and social networks in perpetuating beliefs, and connection to different aspects of intuitive and experiential decision-making. In that context, this study investigates parental vaccine conspiracy beliefs and actual vaccination uptake in their children in Croatia, a country with mandatory, free-of-charge vaccination for diphtheria, tetanus, pertussis, hepatitis B, HiB, poliovirus, and measles, mumps, and rubella (MMR).

Data for the cross-sectional design and correlational study were collected through a Croatian survey that was posted and shared on social media (Facebook) and Croatian parents' info portal Roda, from April to May 2018. Questions gathering demographic information and addressing child vaccination uptake to date were followed by several standardised instruments: Rational-Experiential Inventory, Life-Orientation Test - Revised, Vaccine Conspiracy Beliefs Scale (VCBS), and the Emotions towards Vaccination Scale (EVT). Designed for the purpose of this study, the EVT included various pleasant and unpleasant emotional states and asked respondents to rate how strong they feel each of these emotions while thinking about vaccinating their children on a 5-point scale. A higher score indicates more unpleasant emotional states towards vaccination.

Analyses were performed on 823 participants who had one or more children. In the sample, 65.6% participants stated their children have received all mandatory vaccines so far, 22.6% stated their children received some but not all mandatory vaccines, and 4% stated their children have not received any of the mandatory vaccines.

A correlation analysis was conducted as the first step in exploring the relationship between various predictors (education, age, marital status, political ideology, need for cognition, faith in intuition, emotions towards vaccination and optimism) and criterion variables (vaccine conspiracy beliefs and vaccine uptake). The correlations are presented in Table 2 in the paper. The results indicate the expected strong positive correlations between the two criterion variables. Both criteria also had a positive correlation with higher unpleasant emotions towards vaccinations. Vaccine conspiracy beliefs were negatively correlated with level of education and a more conservative political ideology, and positively correlated with faith in intuition. Parents who hold lower unpleasant emotions towards vaccination and place more trust in their intuition vaccinate their children more often. This interaction was not found for parents who hold moderate or high unpleasant emotions towards vaccination. Contrary to expectations, individuals' propensity towards analytical thinking did not impact the explored criteria.

Reflecting on the findings, the researchers note:

• Both vaccine conspiracy beliefs and vaccine uptake were predicted by specific unpleasant emotions towards vaccination and not by a more generalised tendency towards more positive or negative emotional outlook on life. This finding, which is contrary to the researchers' hypothesis, remains to be explored in future research.
• In contrast, the findings indicate that parental vaccine-related cognitions and behaviours are susceptible to more direct effect of specific emotions towards vaccination related to a range of different emotions, including anger, fear, disgust, anxiety, repulsiveness, worry, and lack of relaxation and calmness. Other researchers have proposed the affect-heuristic as a mental shortcut to explain how people, during the act of making a decision, refer to their affective pool that contains positive and negative tags that are more or less consciously associated with a representation of an event. Such tags are readily available, enabling one to be faster in handling the uncertain and complex world. In line with this, the results suggest that strong unpleasant emotions that some parents hold towards vaccinations directly motivate the action of avoiding vaccinating their children. Strong unpleasant emotions might also affect the perception of risk associated with vaccines.
• "Although the contribution of intuitive thinking was fairly small, it was not surprising as emotions represent a substantial part of the experiential-intuitive thinking style....Relying on intuition in making vaccination decisions was not directly associated with a lesser uptake, because...for parents who hold no strong unpleasant emotions towards vaccination, greater relying on intuition contributed to more vaccination uptake. This was not found for those who have moderate or high unpleasant emotions towards vaccination."
• The strong contribution of unpleasant emotions to conspiracy beliefs is also not surprising, say the researchers, as studies show that unpleasant emotions such as anxiety, as well as uncertainty or feelings of lack of control, contribute to general conspiracy beliefs. The findings also suggest a strong association between conspiracy beliefs and vaccination uptake, in a way that higher conspiracy beliefs are related to lower uptake.
• The results indicate that need for cognition, as a measure of the individuals' motivation to engage in analytical and rational thinking, had no role in vaccine conspiracy beliefs or vaccine uptake. Based on this result, the researchers suggest that vaccine hesitancy emerges as a result of strong unpleasant emotions towards vaccination, which suppress the role of rational reasoning. Alternatively, vaccine-hesitant parents might employ their analytic reasoning, investing time and effort in investigating vaccination and reflecting on it, but finally make the choice of avoidance based on emotional reasoning.

Thus, a key takeaway from this study is that attempts to persuade vaccine-hesitant parents to vaccinate children using numbers or statistical data, e.g., information concerning the frequency and risks of catching an infectious disease or scarcity of vaccine side effects, will probably not be effective in increasing vaccine uptake, since the underlying reasoning does not seem to be grounded in analytical or rational thinking but, rather, experientially intuitive processing. Experientially grounded behaviour is much harder to change, and it changes mostly with repetitive or intense experience. This means it could be particularly challenging to create interventions to reduce hesitancy and increase vaccination uptake, especially with regard to time and resource limitations. Furthermore, some interventions based on inducing fear of infectious diseases in parents can backfire and be counterproductive, contributing to even lesser intentions to vaccinate.

In conclusion, child vaccination is a highly personal topic that is often approached in an emotional and vivid fashion; in this context, parents form beliefs and act from an affect-heuristic. Thus, it is not that vaccine-hesitant parents lack the skills necessary to rationally understand vaccine-related information, but they seem to base their decision on faulty criteria primarily related to emotions, which helps explain the impact negative experiences and vividness of other people's experience play in vaccine hesitancy. "These results have direct implications for addressing vaccine hesitancy within public campaigns and policies."