Understanding the Role of Peace of Mind in Childhood Vaccination: A Qualitative Study with Members of the General Public

It has been suggested that some members of the public might value the "Peace of Mind" (PoM) gained from knowing they and their family are protected from a vaccine-preventable disease (VPD), and that this PoM might be achieved not just from those who are vaccinated, but also others in the population. The aim of this study is to ascertain the importance of PoM in individuals' decision making about vaccines.

The Health Belief Model (HBM) was used in this study to understand vaccination-seeking behaviours and the role of PoM. The HBM includes 6 key domains that influence health behaviours: perceived severity, perceived susceptibility, modifying factors, perceived benefits, perceived barriers, and cues to action.

From August - September 2017, 4 focus groups were conducted in the United Kingdom (UK) involving 22 females and 2 males, aged 18-74 years, with a selection of non-parents, parents, guardians, and foster carers. Throughout the focus groups, the interviewer was mindful that both pro and anti-vaccination beliefs were likely to be discussed, and participants were encouraged to discuss varying views. Data were analysed using an inductive thematic framework approach and conceptualised using the HBM.

In general, participants noted that making vaccination decisions was a difficult process that required striking a delicate balance between the perceived benefits versus potential risks of each vaccination. Vaccine-associated PoM was associated with individuals' perceptions of disease severity, with individuals feeling more reassurance after obtaining vaccinations against diseases they considered to be severe compared to relatively mild diseases. Conversely, concerns about vaccination side effects reduced participants' PoM, but the duration of this effect varied between individuals. For some participants, who stated they regarded childhood vaccinations as a routine procedure, there was no indication that vaccinating their child was associated with feelings of reassurance or PoM; rather, they simply attended vaccination clinics as directed by their healthcare providers.

Other factors, such as social pressure and the emotional anxiety related to children's feelings, or physical reactions to vaccinations, also negatively impacted on participants' vaccine-associated PoM. All focus groups discussed the impact of structural variables on their PoM and resulting vaccination decisions, such as their knowledge (or, more specifically lack of knowledge) about certain VPDs.

Participants across all focus groups talked about either receiving postal or verbal reminders offering vaccination (cues to action). Most noted that these reminders were a key motivation for attending vaccination clinics, yet this factor was not found to impact on participants' overall PoM. All participants agreed that there was more information available now than ever before (e.g., via social media and/or news media), and, for some, this impacted negatively on their PoM, as it complicated their vaccination decisions. A few participants talked about collecting information from a range of sources to make vaccination decisions and the reassurance they received by having access to research that was corroborated by healthcare professionals.

In short, the study found differences in individuals' vaccination-associated PoM depending on their perceptions, concerns, and motivations associated with vaccination-seeking behaviours. Overall, vaccine-related PoM varied between participants in magnitude and fluctuated over time, even in the same individuals.

In conclusion, while recognising that the focus group participants' reflections are not generalisable, "these findings provide evidence that PoM is a key attribute of" the decision-making process of some individuals and has some value to the recipients. Therefore, "there may be a case for creating a framework for quantifying such benefits in the cost-effectiveness evaluation of vaccines, which in turn could have significant policy implications."