Academic journal article Journal of Health Population and Nutrition

Sociobehavioural Research Methods for the Introduction of Vaccines in the Diseases of the Most Impoverished Programme

Academic journal article Journal of Health Population and Nutrition

Sociobehavioural Research Methods for the Introduction of Vaccines in the Diseases of the Most Impoverished Programme

Article excerpt

INTRODUCTION

Health-seeking can be conceptualized as an ongoing life-long process that includes both behaviours to cure or seek relief from specific symptoms or illnesses and behaviours to avoid symptoms and illnesses. The latter may include a range of activities, such as engaging in exercise, consumption or avoidance of certain foods, and/or use of traditional or biomedical preventive practices, e.g. vaccinations. These behaviours, however, occur within dynamic sociocultural and political-economic contexts, which (re)construct social roles and responsibilities, ideologies, and practices through day-to-day activities and interpersonal relationships.

A range of models have been developed over the past several decades to further understand the interactions of variables as they affect individual health-seeking processes. These include a range of 'behaviourist' models, such as the Health Belief Model (1), the Protection Motivation Theory (2), and the Stages of Change Theory (3). These behaviourist models of health-seeking, however, often neglect the context of actions of an individual and the complex relationships among individual, sociocultural and political-economic conditions. These models are primarily based on a western industrialized concept of medicine and individual action, including cost-benefit analysis. Alternatively, political economic theories, including feminist and critical theory, incorporate the limitations on choices and actions of individuals through the social construction of groups (e.g. race, gender) and within specific institutional infrastructure (4,5). While the political economic theories provide a framework for expansion of understanding the health-seeking processes beyond behaviours of individuals, they have also been criticized as too deterministic, with insufficient attention to individual and group initiatives and resistance (6).

In recent years, sociobehavioural health studies have used a number of behaviourist and cultural and political-economic theories to account for decision-making of individuals regarding vaccination. These studies have included perceptions about and acceptability of existing vaccines (7) and hypothetical vaccines, e.g. HIV, human papillomavirus (8-10). Among the behaviourist studies, a number of variables, which can be categorized as 'disease'- or 'vaccine'-related, emerge as potentially salient to the decision-making process for vaccination. In terms of perceptions about and attitudes towards the preventable disease, such variables as perceived severity of the disease or characteristics of the disease (11) and vulnerability to the disease (12) have been recognized as contributing to acceptance and use of vaccination. Vaccine-related variables have included 'comfort and confidence' in vaccine (9), general positive attitudes towards immunization (13), perceived benefits and risks of vaccination (14), cost of vaccine (15), and characteristics and delivery of vaccine, e.g. number of injections (16,17).

Other vaccine-acceptance studies have relied more on a sociocultural and/or political-economic framework. In some of these studies, such variables as client-healthcare provider communication and healthcare infrastructure are delineated as important to acceptance and participation of individuals in vaccination programmes or campaigns. In a study of British parents who refused MMR and/or meningococcal C vaccines for their children, poor communication and inadequate information from healthcare providers was one reason for these decisions (18). In a qualitative study in Britain, both 'confidence and trust' in healthcare providers and exposure to media information about the safety of MMR vaccine influenced the vaccine decision-making process of parents (19). Similarly, among Italian mothers, their satisfaction with information about immunization affected their acceptance of MMR and pertussis vaccines (13). A survey of healthcare providers regarding influenza immunization for adults and the elderly found that inadequate or ineffective outreach methods were an obstacle to recruiting patients for vaccination. …

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