Enhancing characterization of the decision-making architecture of parents responsible for the vaccination status of their school-aged children : exploring the epidemiological utility of assessing healthism, trust, and social identity in northern lower Michigan / by Daniel Gene Dutkiewicz II.

Decision-making characteristics of heterogeneous subgroups of parents have been defined by parental levels of trust in medical authorities and healthism (or heath agency) expressed in medical encounters. Integrating social identity constructs into this framework can clarify how vaccination-related inconvenience can nudge parents with low healthism/low trust decision-making orientations (for simplicity's sake, these parents are labeled here as "agnostics") toward vaccination; how conventional (vaccine) waiver education can provoke social identity threat in parents with high healthism/low trust decision-making orientations (more simply labeled here as "activists"); and how new interventions can be developed to reduce bias and increase trust between activist parents who file waivers for their school-aged children and public health professionals. This study investigated 3 primary hypotheses: 1) A mini assessment based on healthism/trust measures could accurately classify activist and agnostic parents; 2) Activist parents, compared to agnostic parents, excel at promoting healthier non-vaccination related behaviors in their school-aged children; and 3) Activist parents, compared to agnostic parents, exhibit greater sensitivity to the role of social encouragement and support, but less sensitivity to vaccination-related inconvenience. This study employed a cross-sectional design. Parents were recruited from two health departments in northern lower Michigan with elevated waiver rates, and the final study sample was comprised of 26 parents who fully vaccinated their child entering 7th grade and 25 parents who filed waivers for their child entering 7th grade. Parents completed survey questions about healthy behaviors and the role of trust, healthism, inconvenience, and social encouragement/support in their vaccination-related decision making. In unadjusted analyses, activist parents, compared to the fully vaccinating parents, exhibited significantly higher mean healthy behavior scores (65.17 v. 62.54; p-value = 0.101) and higher mean scores on a sub-scale that indicated higher physical activity (16.68 v. 15.42; p-value = 0.07). However, in adjusted analyses, these associations disappeared; male parents remained significantly associated with lower healthy behavior scores (p-value = 0.0084) and lower physical activity sub-scores (p-value = 0.0510). In adjusted and unadjusted analyses, the fully vaccinating parents, compared to the activist parents, exhibited significantly higher mean scores on several inconvenience sensitivity measures and on the social encouragement sensitivity measure (which is a surprise finding). To reduce bias and increase trust between activist parents and waiver educators in Michigan, consideration should be given to better aligning mandatory waiver education with social identity theory, which can be accomplished by more systematically inducing a common ingroup identity based on "playing on the same team." In addition, to avoid inadvertently provoking stereotype threat for female activist parents and to improve intergroup relations, waiver educators could adopt a new messaging strategy that affirms the unique subgroup identity of female activist parents, which can be accomplished by emphasizing that female activist and female fully-vaccinating parents, compared to their male counterparts, appear to excel at promoting non vaccination-related health behaviors in their school-aged children.

Description based on online resource; title from PDF title page (ProQuest, viewed December 1, 2020)