Mapping the Morality of Vaccine Hesitance: Associations of Moral Foundation Values with Vaccine Hesitance Open Access

Abstract

Each year, there is an increase in vaccine hesitance and refusal throughout the world, indicating a need for effective interventions. Existing messaging interventions demonstrate modest short-term success, but some may backfire and worsen hesitance. Values-based messages appeal to core morality, which influences the attitudes individuals then have on topics like vaccination. To better tailor interventions, we must understand how underlying moral values, not just attitudes, differ by hesitance type. Here we show that values of harm and fairness are not significantly associated with vaccine hesitance, but values of purity and liberty are. We found that medium-hesitance parents were twice as likely as low-hesitance parents to highly emphasize purity (aOR: 2.08, 95% CI: 1.27-3.40). High-hesitance respondents were twice as likely to strongly emphasize purity (aOR: 2.15, 95% CI: 1.39-3.31) and liberty (aOR: 2.19, 95% CI: 1.50-3.21). Our results demonstrate that the importance of harm and fairness, two values often emphasized in traditional vaccine-focused messages, are not predictive factors for vaccine hesitance. This, in conjunction with significant associations of purity and liberty, indicates a need for inclusion of broader themes in vaccine discussions. These findings have the potential for application to other health decisions and communications as well.

Table of Contents

BACKGROUND AND LITERATURE REVIEW 1
INTRODUCTION 1
BACKGROUND 1
VACCINE HESITANCE 2
EXISTING INTERVENTIONS 6
Opt-in and Opt-out Messages and Reminders 6
Gain-Framed and Loss-Framed Messages 9
Culturally Targeted Messaging 11
General Limitations 13
INFORMATION PROCESSING 14
MORAL FOUNDATIONS THEORY 15
STUDY PREMISE 17
MANUSCRIPT 19
ABSTRACT 19
INTRODUCTION 20
METHODS 21
Study Population Recruitment 21
Survey Instrument 22
Scoring and Cleaning Data 23
Statistical Analysis 24
RESULTS 25
DISCUSSION 26
Limitations 27
Strengths 28
Conclusions 29
PUBLIC HEALTH IMPLICATIONS AND POSSIBLE FUTURE DIRECTIONS 30
PUBLIC HEALTH IMPLICATIONS 30
FUTURE DIRECTIONS 30
REFERENCES 31
FIGURES 41
TABLES 44

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Vaccine hesitancy Health communication Vaccines
Committee Chair / Thesis Advisor	Omer, Saad B, Emory University Bednarczyk, Robert A, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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