Vaccination in Aotearoa : the role of anticipated regret, temporal discounting and maternal mental health : a thesis presented in partial fulfilment of the requirements for the qualification of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand

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Background. Uptake of childhood vaccines in Aotearoa remains consistently lower than necessary for population immunity. Understanding drivers for vaccine hesitancy is a complex but essential exercise. New and expectant mothers are generally primary decision-makers about vaccination for their babies, yet the crucial timeframe for those decisions coincides with the highest risk period for perinatal anxiety and depression. Study aims. This study was designed to test the hypothesis that anxiety and depression in pregnancy and postnatally have an effect on vaccination rates, given research support for a link between psychological distress and decision-making challenges. Decision theory guided the study, specifically temporal discounting, and anticipated regret. Participants’ own perspectives about key influences on their decisions were also explored. Methods. The study was a cross-sectional survey of new and expectant New Zealand mothers, recruited via social media – N = 387 (quantitative); N = 411 (content analysis). Survey items included existing measures (EPDS, GAD-7, MCQ) alongside purpose-built items and open-ended questions. Possible confounds, ethnicity and socio-economic status, were identified from a literature search and statistically controlled. Results. Anticipated action regret (action and inaction) was strongly and significantly correlated with vaccination intention. However, the hypothesised relationships between temporal discounting and either perinatal depression or anxiety were not observed. Further, neither anticipated regret nor temporal discounting had the expected effects on vaccination intentions. The observed depression/intention relationship was negligible, and anxiety was moderately, statistically significantly, and (contrary to prediction) positively correlated with intention. The sixth hypothesis (partial mediation of the distress-intention relationship by temporal discounting and anticipated regret) was also unsupported. Content analysis of open-ended questions suggested six main categories of influence on vaccination intentions - beliefs (safety/risk, effectiveness); knowledge/experience; health protection; formal sources (health officials/professionals); social (whānau/family, others); and pragmatic. Latent themes - fear and confidence, underpinned each category. Most participants reported no change, unless a strengthening of their position, due to the COVID-19 pandemic. Conclusions. Overall, there was evidence of a strong relationship between anticipated regret and vaccination intentions. However, perinatal depression did not have an observable effect on intentions, and – contrary to predictions - perinatal anxiety increased, rather than decreased, intention to vaccinate. Although the hypotheses were not supported here, the findings nevertheless suggest that intention is impacted by predicted regret about the consequences of that decision. Furthermore, a role for anxiety or regret in vaccination decision-making was supported by analysis of participants’ self-reported key influences on their decision-making. In this sample, limited variance in levels of elevated levels of either depression or anxiety (most experiencing no to low symptoms) or vaccination intentions (most being pro-vaccination), potentially affected the results obtained. Further investigation of the role of emotion and perinatal distress relationship is justified.
Vaccination of infants, Psychological aspects, New mothers, Pregnant women, Mental health, Regret, New Zealand