Beliefs about Vaccinations: Comparing a Sample from a Medical School to That from the General Population

"[C]linicians should focus less on convincing parents of the benefits of childhood vaccinations and emphasize communication that counters anti-vaccination beliefs."

To gain insight as to how people perceive the positives and negatives of vaccinations, this study sought to determine whether people's beliefs pertaining to childhood vaccination and their beliefs about what other people think about the evidence vary as a function of population type (i.e., medical school students/faculty, or "medical affiliates", and the general public). Such an investigation can provide opportunities to explore how medical affiliates are delivering messages about domain-specific knowledge to a lay audience. Literature has highlighted that parental health-related decision making is influenced by the effectiveness of paediatricians' communication about childhood vaccinations. Yet the overestimation of the layperson's knowledge can be problematic in the delivery of crucial information. This mismatch may lead to increased resistance to the use of preventive health measures, such as childhood vaccinations, as overestimations may influence a discrepancy between physician-patient shared understanding about the benefits and risks of childhood vaccinations.

Conducted in the United States (US) via a survey of students and faculty within a medical school (n = 58) and a sample from the general population (n = 177), the study addresses 5 research questions: (i) To what extent do people agree with supporting (pro) and opposing (anti) statements regarding vaccinations? (ii) Do people categorise these statements as facts or beliefs? (It has been argued that categorising a statement as a fact, as opposed to a belief, is related to people's views of social norms; people tend to categorise statements as facts when they think that most people would agree with it.) (iii) Do people agree as to what is a fact and what is a belief? (iv) Are people accurate in predicting what the general adult population would believe? (v) Do the answers to these questions vary between medical affiliates (i.e., a population more versed in domain-specific knowledge) and the general population?

The online survey involved presenting a list of 20 statements about general world knowledge: 10 statements that were generally accepted as facts (e.g., "a hammer is a tool used to pound nails"), and 10 statements that were generally accepted as beliefs (e.g., "sleeping with the windows open is good for you"). For each, participants were asked to answer the following questions: (i) "How strongly do you agree with this statement?" (4-point Likert scale); (ii) "What percentage of the general adult population would agree with this statement?" (5-point scale); and (iii) "Is this statement a fact or belief?" (dichotomous response). Following these statements, the participants completed a similar task with respect to 20 statements pertaining to childhood vaccination, including 10 pro-vaccination and 10 anti-vaccination statements.

Selected findings:

• Both groups were more likely to agree with the pro-vaccination statements (as compared to the anti-vaccination statements).
• Both groups were more likely to categorise pro-vaccination statements as facts and anti-vaccination statements as beliefs, but the medical affiliates were significantly more likely to categorise more pro-vaccination statements as facts.
• There was no consensus between which statements were categorised as facts and which statements were categorised as beliefs within the medical affiliates or within the general population.
• Both groups underestimated the number of people that would agree with them; however, the medical affiliates showed the effect significantly more.

Implications for medical education and health communication are discussed. For instance, since the data suggest that both the general population and the medical affiliates agree with the pro-vaccination statements, medical affiliates do not necessarily have to emphasise the positives of childhood vaccinations. In contrast, the general public are more likely to agree with the anti-vaccination statements compared to medical affiliates. This discrepancy suggests that clinicians should spend time focusing on countering parents' anti-vaccination ideals during their clinical visits. The hope would be that the general population's perceptions of the negative effects of vaccinations may be lessened - and anti-vaccination parents would be encouraged to accept the benefits of vaccinations - when their clinicians focus their attention on the parents' concerns.

Furthermore, by highlighting the findings in this study, (i.e., medical affiliates have the tendency to underestimate laypersons' shared beliefs), physician communication training programmes may benefit from addressing physicians' delivery of information and assumptions of parents' level of vaccination understanding. In addition, physicians may benefit from acknowledging the discrepancy between their perception of the general population's beliefs compared to the general population's actual beliefs, as this may encourage physicians to re-evaluate and reframe conversations with parents regarding childhood vaccinations.

After suggesting various directions for future research, the article concludes with a final observation: "Despite various public health interventions, such as media coverage and vaccination advertisements, if physicians are not advocating for vaccination coverage, parents are less likely to choose to vaccinate their child."