Impfverhalten psychologisch erklären, messen und verändern

Psychological antecedents of vaccination: definitions, measurement, and interventions

Zusammenfassung

Impfungen zählen zu den sichersten und effektivsten Methoden, Infektionen und daraus resultierende schwerwiegende Folgeerkrankungen und Todesfälle auf individueller wie gesellschaftlicher Ebene zu kontrollieren und zu verhindern. Dennoch entscheiden sich einige Menschen gegen Impfungen und es kommt immer wieder zu Ausbrüchen impfpräventabler Erkrankungen. Um gemeinsame Eliminationsziele sowie optimalen individuellen Schutz zu erreichen, ist es notwendig, die Gründe des (Nicht‑)Impfens zu identifizieren.

Das 5C-Modell beschreibt fünf wesentliche psychologische Gründe (Antezedenzien) der Impfentscheidung: Confidence (Vertrauen), Complacency (Risikowahrnehmung), Constraints (Barrieren in der Ausführung), Calculation (Ausmaß der Informationssuche) und Collective Responsibility (Verantwortungsgefühl für die Gemeinschaft). Dieser Beitrag zeigt auf, wie diese Gründe, die zu einer Impfung oder Nichtimpfung führen können, auf individueller Ebene gemessen werden und darauf basierend Interventionen entwickelt und evaluiert werden können.

Für Deutschland zeigt sich, dass insbesondere strukturelle Veränderungen, die Impfen einfach(er) machen, in Betracht gezogen werden müssen und nicht nur auf impfkritische Eltern fokussiert werden sollte.

Abstract

Vaccinations are among the safest and most effective ways to prevent morbidity and mortality from severe infectious diseases – both on an individual and societal level. Despite the availability of safe and effective vaccines some people decide against vaccination, which leads to recurrent outbreaks of vaccine-preventable diseases. In order to achieve the common goals of eliminating certain infectious diseases and to protect individual health, it is necessary to understand the antecedents of (non-)vaccination.

The 5C model describes five relevant psychological antecedents of vaccination: confidence, complacency (risk perceptions), constraints (barriers), calculation (extent of information search), and collective responsibility (willingness to protect the community). This contribution provides an overview of how these antecedents can be measured on an individual level and how interventions should be designed and evaluated to address the respective antecedents.

Data from Germany show that structural changes to reduce practical barriers are important to improve vaccine uptake. Thus, it is also important to address aspects beyond confidence.

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Literatur

  1. 1.

    World Health Organization (2019) Substantial decline in global measles deaths, but disease still kills 90 000 per year. http://www.who.int/news-room/26-10-2017-substantial-decline-in-global-measles-deaths-but-disease-still-kills-90-000-per-year. Zugegriffen: 20.02.2019

    Google Scholar 

  2. 2.

    World Health Organization (2018) Measles cases hit record high in the European Region. http://www.euro.who.int/en/media-centre/sections/press-releases/2018/measles-cases-hit-record-high-in-the-european-region. Zugegriffen: 02.09.2018

    Google Scholar 

  3. 3.

    Robert Koch-Institut (2018) Impfquoten bei der Schuleingangsuntersuchung in Deutschland 2016. https://doi.org/10.17886/epibull-2018-020. Zugegriffen: 20.02.2019

    Google Scholar 

  4. 4.

    Betsch C, Schmid P, Heinemeier DK et al (2018) Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PsyArXiv. https://doi.org/10.31234/osf.io/ytb7w

    Article  Google Scholar 

  5. 5.

    Betsch C, Böhm R, Chapman GB (2015) Using behavioral insights to increase vaccination policy effectiveness. Policy Insights Behav Brain Sci 2:61–73

    Article  Google Scholar 

  6. 6.

    MacDonald NE (2015) Vaccine hesitancy: definition, scope and determinants. Vaccine 33:4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036

    Article  PubMed  Google Scholar 

  7. 7.

    Bedford H, Attwell K, Danchin M et al (2017) Vaccine hesitancy, refusal and access barriers: the need for clarity in terminology. Vaccine. https://doi.org/10.1016/j.vaccine.2017.08.004

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Horstkötter N, Müller U, Ommen O et al (2017) Einstellungen, Wissen und Verhalten von Erwachsenen und Eltern gegenüber Impfungen – Ergebnisse der Repräsentativbefragung 2016 zum Infektionsschutz. BZgA-Forschungsbericht Köln Bundeszentrale für Gesundheitliche Aufklärung

    Google Scholar 

  9. 9.

    Gagneur A, Lemaître T, Gosselin V et al (2018) A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health. https://doi.org/10.1186/s12889-018-5724-y

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Larson HJ, Jarrett C, Schulz WS et al (2015) Measuring vaccine hesitancy: the development of a survey tool. Vaccine 33:4165–4175

    Article  PubMed  Google Scholar 

  11. 11.

    Thomson A, Robinson K, Vallée-Tourangeau G (2016) The 5 As: a practical taxonomy for the determinants of vaccine uptake. Vaccine 34:1018–1024. https://doi.org/10.1016/j.vaccine.2015.11.065

    Article  PubMed  Google Scholar 

  12. 12.

    Betsch C, Rossmann C, Pletz MW et al (2018) Increasing influenza and pneumococcal vaccine uptake in the elderly: study protocol for the multi-methods prospective intervention study Vaccination60. BMC Public Health. https://doi.org/10.1186/s12889-018-5787-9

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Bruder M, Haffke P, Neave N et al (2013) Measuring individual differences in generic beliefs in conspiracy theories across cultures: conspiracy Mentality Questionnaire. Front Psychol 4:225

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Betsch C, Steinmeyer L, Horstkötter N, Ommen O (in preparation) Psychological Antecendents of Vaccination in Germany: A national representative survey

  15. 15.

    Rossmann C (2013) Strategic health communication. Theory- and evidence-based campaign development. In: Holtzhausen D, Zerfass A (Hrsg) The Routledge handbook of strategic communication. Routledge, Taylor & Francis Group, New York, London, S 409–423

    Google Scholar 

  16. 16.

    Webb TL, Joseph J, Yardley L, Michie S (2010) Using the Internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 12:97–114. https://doi.org/10.2196/jmir.1376

    Article  Google Scholar 

  17. 17.

    Schmid P, Rauber D, Betsch C et al (2017) Barriers of influenza vaccination intention and behavior—a systematic review of influenza vaccine hesitancy, 2005–2016. PLoS ONE 12:e170550. https://doi.org/10.1371/journal.pone.0170550

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Betsch C, Bödeker B, Schmid P, Wichmann O (2018) How baby’s first shot determines the development of maternal attitudes towards vaccination. Vaccine 36:3018–3026. https://doi.org/10.1016/j.vaccine.2018.04.023

    Article  PubMed  Google Scholar 

  19. 19.

    Kata A (2012) Anti-vaccine activists, Web 2.0, and the postmodern paradigm—An overview of tactics and tropes used online by the anti-vaccination movement. Vaccine 30:3778–3789. https://doi.org/10.1016/j.vaccine.2011.11.112

    Article  PubMed  Google Scholar 

  20. 20.

    Diethelm P, McKee M (2009) Denialism: what is it and how should scientists respond? Eur J Public Health 19:2–4

    Article  PubMed  Google Scholar 

  21. 21.

    Smith IM, MacDonald NE (2017) Countering evidence denial and the promotion of pseudoscience in autism spectrum disorder. Autism Res 10:1334–1337

    Article  PubMed  Google Scholar 

  22. 22.

    Schmid P, MacDonald NE, Habersaat K, Butler R (2018) Commentary to: how to respond to vocal vaccine deniers in public. Vaccine 36:196–198

    Article  PubMed  Google Scholar 

  23. 23.

    Schmid P, Betsch C (unter Begutachtung) Advocating for Science: How to Rebut Science Denialism in Public Discussions

  24. 24.

    Ständige Impfkommission (2017) Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018

    Google Scholar 

  25. 25.

    Dixon GN, Clarke CE (2013) Heightening uncertainty around certain science: media coverage, false balance, and the autism-vaccine controversy. Sci Commun 35:358–382. https://doi.org/10.1177/1075547012458290

    Article  Google Scholar 

  26. 26.

    Chen RT (1999) Vaccine risks: real, perceived and unknown. Vaccine 17(Suppl 3):S41–S46

    Article  PubMed  Google Scholar 

  27. 27.

    Bödeker B, Betsch C, Wichmann O (2015) Skewed risk perceptions in pregnant women: the case of influenza vaccination. BMC Public Health 15:1

    Article  Google Scholar 

  28. 28.

    Nyhan B, Reifler J, Richey S, Freed GL (2014) Effective messages in vaccine promotion: a randomized trial. Pediatr Electron Pages 133:e835–e842. https://doi.org/10.1542/peds.2013-2365

    Article  Google Scholar 

  29. 29.

    O’Keefe DJ, Nan X (2012) The relative persuasiveness of gain- and loss-framed messages for promoting vaccination: a meta-analytic review. Health Commun 27:776–783. https://doi.org/10.1080/10410236.2011.640974

    Article  PubMed  Google Scholar 

  30. 30.

    Eitze S, Betsch C (in Vorbereitung) Sequelae as influenza vaccination booster

  31. 31.

    Thaler RH, Sunstein CR (2008) Nudge: improving decisions about health, wealth, and happiness. Yale University Press, New Haven

    Google Scholar 

  32. 32.

    Chapman GB, Li M, Colby H, Yoon H (2010) Opting in vs opting out of influenza vaccination. JAMA 304:43–44. https://doi.org/10.1001/jama.2010.892

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Gollwitzer PM (1999) Implementation intentions: strong effects of simple plans. Am Psychol 54:493–503. https://doi.org/10.1037/0003-066X.54.7.493

    Article  Google Scholar 

  34. 34.

    Jacobson Vann JC, Jacobson RM, Coyne-Beasley T et al (2018) Patient reminder and recall interventions to improve immunization rates. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003941.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Milkman KL, Beshears J, Choi JJ et al (2011) Using implementation intentions prompts to enhance influenza vaccination rates. Proc Natl Acad Sci USA 108:10415–10420. https://doi.org/10.1073/pnas.1103170108

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    van Lier A, Oomen P, de Hoogh P et al (2012) Præventis, the immunisation register of the Netherlands: a tool to evaluate the National Immunisation Programme. Euro Surveill 17(17):20153

    PubMed  Google Scholar 

  37. 37.

    Nic Lochlainn LM, Woudenberg T, van Lier A et al (2017) A novel measles outbreak control strategy in the Netherlands in 2013–2014 using a national electronic immunization register: a study of early MMR uptake and its determinants. Vaccine 35:5828–5834. https://doi.org/10.1016/j.vaccine.2017.09.018

    Article  PubMed  Google Scholar 

  38. 38.

    Betsch C, Böhm R (2016) Detrimental effects of introducing partial compulsory vaccination: experimental evidence. Eur J Public Health 26:378–381. https://doi.org/10.1093/eurpub/ckv154

    Article  PubMed  Google Scholar 

  39. 39.

    Meier NW, Böhm R, Korn L, Betsch C (unter Begutachtung) Evolving Individual Preferences for Vaccination Policies

  40. 40.

    Gurerk O, Irlenbusch B, Rockenbach B (2006) The competitive advantage of sanctioning institutions. Science 312:108–111. https://doi.org/10.1126/science.1123633

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Johnson EJ, Goldstein D (2003) Do defaults save lives? Science 302:1338–1339

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen IQWIG (2017) Konzept für ein natl. Gesundheitsportal. https://www.iqwig.de/de/projekte-ergebnisse/projekte/gesundheitsinformation/p17-02-konzept-fuer-ein-nationales-gesundheitsportal.7849.html. Zugegriffen: 20.02.2019

    Google Scholar 

  43. 43.

    Betsch C, Böhm R, Korn L, Holtmann C (2017) On the benefits of explaining herd immunity in vaccine advocacy. Nat Hum Behav 1:56. https://doi.org/10.1038/s41562-017-0056

    Article  Google Scholar 

  44. 44.

    Betsch C, Böhm R, Korn L (2013) Inviting free-riders or appealing to prosocial behavior? Game-theoretical reflections on communicating herd immunity in vaccine advocacy. Health Psychol 32:978–985. https://doi.org/10.1037/a0031590

    Article  PubMed  Google Scholar 

  45. 45.

    Böhm R, Meier NW, Groß M et al (2018) The willingness to vaccinate increases when vaccination protects others who have low responsibility for not being vaccinated. J Behav Med. https://doi.org/10.1007/s10865-018-9985-9

    Article  PubMed  Google Scholar 

  46. 46.

    Korn L, Betsch C, Böhm R, Meier NW (2018) Social nudging: The effect of social feedback interventions on vaccine uptake. Health Psychol 37:1045-1054. https://doi.org/10.1037/hea0000668

    Article  PubMed  Google Scholar 

  47. 47.

    Hayes AF (2013) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. Guilford, New York

    Google Scholar 

  48. 48.

    Poethko-Müller C, Schmitz R (2013) Impfstatus von Erwachsenen in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 56:845–857. https://doi.org/10.1007/s00103-013-1693-6

    Article  PubMed  Google Scholar 

  49. 49.

    Darvishian M, Bijlsma MJ, Hak E, van den Heuvel ER (2014) Effectiveness of seasonal influenza vaccine in community-dwelling elderly people: a meta-analysis of test-negative design case-control studies. Lancet Infect Dis 14:1228–1239. https://doi.org/10.1016/S1473-3099(14)70960-0

    Article  PubMed  Google Scholar 

  50. 50.

    Noar SM, Benac CN, Harris MS (2007) Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull 133:673

    Article  PubMed  Google Scholar 

  51. 51.

    Butler R, MacDonald NE, SAGE Working Group on Vaccine Hesitancy (2015) Diagnosing the determinants of vaccine hesitancy in specific subgroups: The Guide to Tailoring Immunization Programmes (TIP). Vaccine 33:4176–4179. https://doi.org/10.1016/j.vaccine.2015.04.038

    Article  PubMed  Google Scholar 

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Förderung

Die hier berichtete Forschung der am Artikel beteiligten Arbeitsgruppen wurde von der DFG (BE3970/11-1, BE3970/8-1, BO4466/2-1), der Asia Pacific Alliance for the Control of Influenza (APACI) und dem BMBF (Förderkennzeichen 03ZZ0819A-D) gefördert.

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Correspondence to Prof. Dr. Dipl.-psych. Cornelia Betsch.

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Interessenkonflikt

C. Betsch, P. Schmid, L. Korn, L. Steinmeyer, D. Heinemeier, S. Eitze, N.K. Küpke und R. Böhm geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Betsch, C., Schmid, P., Korn, L. et al. Impfverhalten psychologisch erklären, messen und verändern. Bundesgesundheitsbl 62, 400–409 (2019). https://doi.org/10.1007/s00103-019-02900-6

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Schlüsselwörter

  • Impfmüdigkeit
  • Psychologie
  • Interventionen
  • Impfkritik
  • Gesundheitskommunikation

Keywords

  • Vaccine hesitancy
  • Psychology
  • Interventions
  • Anti-vaccination
  • Health communication