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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Date
2023
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Massey University
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Abstract
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.
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Keywords
Vaccination of infants, Psychological aspects, New mothers, Pregnant women, Mental health, Regret, New Zealand