Healthcare Professionals’ Discursive Constructions of Parental Vaccine Hesitancy: A Tale of Multiple Moralities

Abstract

Healthcare professionals play a crucial role in addressing the concerns of vaccine-hesitant parents since they form a trusted source for vaccine-related information. An increasing body of evidence suggests that healthcare professionals are faced with complexities when navigating the sensitive topic of parental vaccine hesitancy, as they balance their own vaccine- and context-specific concerns with institutional and societal pressures to vaccinate. Furthermore, health choices, such as parental choices for childhood vaccination, are often linked to moralisation. Given the emphasis on effective communication with vaccine-hesitant parents in the patient-centred care literature, it is important to consider healthcare professionals’ interpretations of parental vaccine hesitancy. Hence, a deeper understanding of how healthcare professionals make sense of, and moralise, childhood vaccination can help us understand how moralisation might appear in their communication with hesitant parents (in)directly. Drawing on a critical social–psychological framework for discourse analysis, this study analyses 39 semi-structured interviews with healthcare professionals in Flanders, Belgium, and presents the discursive patterns articulated by healthcare professionals on parental vaccine hesitancy. The findings elucidate how healthcare professionals perpetuate, or resist, moral discourse in their accounts of vaccine hesitancy by constructing five different interpretative repertoires, that is, a “good” or “bad” parenting repertoire, a freedom of choice repertoire, an individual risk–benefit repertoire, a public health repertoire, and an accessibility repertoire. Our study highlights the complexities healthcare professionals experience in negotiating vaccine hesitancy, as their understandings of vaccine hesitancy are affected by, and contribute to, existing moral dilemmas and dominant discourses surrounding health and parenting.

Keywords

healthcare professional moral perspectives immunisation social constructionism

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References

Amin

A. B.

Bednarczyk

R. A.

Ray

C. E.

Melchiori

K. J.

Graham

Huntsinger

J. R.

Omer

S. B.

(2017). Association of moral values with vaccine hesitancy. Nature Human Behaviour, 1(12), 873–880. https://doi.org/10.1038/s41562-017-0256-5

Austvoll‐Dahlgren

Helseth

(2010). What informs parents’ decision‐making about childhood vaccinations? Journal of Advanced Nursing, 66(11), 2421–2430. https://doi.org/10.1111/j.1365-2648.2010.05403.x

Batt

Lippman

(2002). Preventing disease: Are pills the answer? Women and Health Protection in collaboration with DES Action Canada. https://www.researchgate.net/profile/Sharon-Batt/publication/347945715_Preventing_Disease_Are_Pills_the_Answer/links/5fe95f30299bf14088504cd6/Preventing-Disease-Are-Pills-the-Answer.pdf

Bensing

(2000). Bridging the gap.: The separate worlds of evidence-based medicine and patient-centered medicine. Patient Education and Counseling, 39(1), 17–25. https://doi.org/10.1016/S0738-3991(99)00087-7

Betsch

Böhm

(2016). Detrimental effects of introducing partial compulsory vaccination: Experimental evidence. The European Journal of Public Health, 26(3), 378–381. https://doi.org/10.1093/eurpub/ckv154

Billig

Condor

Edwards

Gane

Middleton

Radley

(1988). Ideological dilemmas: A social psychology of everyday thinking. Sage Publications, Inc.

Biswas

Mustapha

Khubchandani

Price

J. H.

(2021). The nature and extent of COVID-19 vaccination hesitancy in healthcare workers. Journal of Community Health, 46(6), 1244–1251. https://doi.org/10.1007/s10900-021-00984-3

Blackburn

Stathi

(2019). Moral discourse in general practitioners’ accounts of obesity communication. Social Science & Medicine (1982), 230, 166–173. https://doi.org/10.1016/j.socscimed.2019.03.032

Bozzola

Spina

Russo

Bozzola

Corsello

Villani

(2018). Mandatory vaccinations in European countries, undocumented information, false news and the impact on vaccination uptake: The position of the Italian pediatric society. The Italian Journal of Pediatrics, 44(1), 67. https://doi.org/10.1186/s13052-018-0504-y

10.

Bradley

Elder

(2020). Addressing vaccine hesitancy. The Permanente Journal, 24(4), 20.216. https://doi.org/10.7812/TPP/20.216

11.

Brunson

E. K.

Sobo

E. J.

(2017). Framing childhood vaccination in the United States: Getting past polarization in the public discourse. Human Organization, 76(1), 38–47. https://doi.org/10.17730/0018-7259.76.1.38

12.

Busfield

(2017). The concept of medicalisation reassessed. Sociology of Health & Illness, 39(5), 759–774. https://doi.org/10.1111/1467-9566.12538

13.

Capurro

Greenberg

Dubé

Driedger

(2018). Measles, moral regulation and the social construction of risk: Media narratives of “anti-vaxxers” and the 2015 Disneyland outbreak. Canadian Journal of Sociology, 43(1), 25–48. https://doi.org/10.29173/cjs29301

14.

Capurro

Jardine

C. G.

Tustin

Driedger

(2022). Moral panic about “covidiots” in Canadian newspaper coverage of COVID-19. PLoS One, 17(1), Article e0261942. https://doi.org/10.1371/journal.pone.0261942

15.

Clarkson

Jasper

J. D.

(2022). Individual differences in moral judgment predict attitudes towards mandatory vaccinations. Personality and Individual Differences, 186(part B), Article 111391. https://doi.org/10.1016/j.paid.2021.111391

16.

Davies

Harré

(1990). Positioning: The discursive production of selves. Journal for the Theory of Social Behaviour, 20(1), 43–63. https://doi.org/10.1111/j.1468-5914.1990.tb00174.x

17.

Deml

M. J.

Buhl

Notter

Kliem

Huber

B. M.

Pfeiffer

Burton-Jeangros

Tarr

P. E.

(2020). 'Problem patients and physicians’ failures': What it means for doctors to counsel vaccine hesitant patients in Switzerland. Social Science & Medicine (1982), 255, Article 112946. https://doi.org/10.1016/j.socscimed.2020.112946

18.

Di Pietro

M. L.

Poscia

Teleman

A. A.

Maged

Ricciardi

(2017). Vaccine hesitancy: Parental, professional and public responsibility. Annali dell'Istituto Superiore di Sanità, 53(2), 157–162. https://doi.org/10.4415/ANN_17_02_13

19.

Dubé

È.

(2017). Addressing vaccine hesitancy: The crucial role of healthcare providers. Clinical Microbiology and Infection: 23(5), 279–280. https://doi.org/10.1016/j.cmi.2016.11.007

20.

Dubé

È.

Laberge

Guay

Bramadat

Roy

Bettinger

J. A.

(2013). Vaccine hesitancy: An overview. Human Vaccines & Immunotherapeutics, 9(8), 1763–1773. https://doi.org/10.4161/hv.24657

21.

Dubé

È.

Ward

J. K.

Verger

MacDonald

N. E.

(2021). Vaccine hesitancy, acceptance, and anti-vaccination: Trends and future prospects for public health. Annual Review of Public Health, 42(1), 175–191. https://doi.org/10.1146/annurev-publhealth-090419-102240

22.

Ecker

Kutalek

(2021). ‘I’m not an anti-vaxer!’—Vaccine hesitancy among physicians: A qualitative study. The European Journal of Public Health, 31(6), 1157–1163. https://doi.org/10.1093/eurpub/ckab174

23.

Edley

(2001). Analysing masculinity: Interpretative repertoires, ideological dilemmas and subject positions. In Wetherell

Taylor

Yates

(Eds.), Discourse as data: A guide for analysis (pp. 189–228). Sage and The Open University, London and Milton Keynes.

24.

Fernbach

(2011). Parental rights and decision making regarding vaccinations: Ethical dilemmas for the primary care provider. Journal of the American Academy of Nurse Practitioners, 23(7), 336–345. https://doi.org/10.1111/j.1745-7599.2011.00627.x

25.

Frohlich

K. L.

Potvin

(2008). Transcending the known in public health practice: The inequality paradox: The population approach and vulnerable populations. American Journal of Public Health, 98(2), 216–221. https://doi.org/10.2105/AJPH.2007.114777

26.

Fukuda

Kokubo

Tanimoto

Wang

Hagishima

Ikegaya

(2014). Risk assessment for infectious disease and its impact on voluntary vaccination behavior in social networks. Chaos, Solitons & Fractals, 68, 1–9. https://doi.org/10.1016/j.chaos.2014.07.004

27.

Gabe

Coveney

C. M.

Williams

S. J.

(2016). Prescriptions and proscriptions: Moralising sleep medicines. Sociology of Health & Illness, 38(4), 627–644. https://doi.org/10.1111/1467-9566.12383

28.

Galanakis

Jansen

Lopalco

Giesecke

(2013). Ethics of mandatory vaccination for healthcare workers. Euro Surveillance, 18(45), Article 20627. https://doi.org/10.2807/1560-7917.ES2013.18.45.20627

29.

Geertz

(2008). Thick description: Toward an interpretive theory of culture. In Oakes

Price

P. L.

(Eds.), The cultural geography reader (pp. 41–51). Routledge.

30.

Giubilini

Douglas

Savulescu

(2018). The moral obligation to be vaccinated: Utilitarianism, contractualism, and collective easy rescue. Medicine, Health Care and Philosophy, 21(4), 547–560. https://doi.org/10.1007/s11019-018-9829-y

31.

Goodman

(2017). How to conduct a psychological discourse analysis. Critical Approaches to Discourse Analysis Across Disciplines, 9(2), 142–153. https://www.lancaster.ac.uk/fass/journals/cadaad/wp-content/uploads/2017/12/09-Goodman.pdf

32.

Greenhalgh

Wessely

(2004). Health for me’: A sociocultural analysis of healthism in the middle classes. British Medical Bulletin, 69(1), 197–213. https://doi.org/10.1093/bmb/ldh013

33.

Hall

C. M.

Northam

Webster

Strickland

(2022). Determinants of seasonal influenza vaccination hesitancy among healthcare personnel: An integrative review. Journal of Clinical Nursing, 31(15–16), 2112–2124. https://doi.org/10.1111/jocn.16103

34.

Hancock

(2020). Policy, power and interests. In Hancock

(Eds.), Health policy in the market state (pp. 19–47). Routledge.

35.

Healy

C. M.

Pickering

L. K.

(2011). How to communicate with vaccine-hesitant parents. Pediatrics, 127(Suppl 1), S127–S133. https://doi.org/10.1542/peds.2010-1722S

36.

Hervik

S. E. K.

Thurston

(2016). ‘It’s not the government’s responsibility to get me out running 10 km four times a week’-Norwegian men’s understandings of responsibility for health. Critical Public Health, 26(3), 333–342. https://doi.org/10.1080/09581596.2015.1096914

37.

Heyerdahl

L. W.

Dielen

Nguyen

Van Riet

Kattumana

Simas

Vandaele

Vandamme

A.-M.

Vandermeulen

Giles-Vernick

Larson

Grietens

K. P.

Gryseels

(2022). Doubt at the core: Unspoken vaccine hesitancy among healthcare workers. The Lancet regional health. Europe, 12, Article 100289. https://doi.org/10.1016/j.lanepe.2021.100289

38.

Horrill

McMillan

D. E.

Schultz

A. S.

Thompson

(2018). Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives. Nursing Inquiry, 25(3), Article e12237. https://doi.org/10.1111/nin.12237

39.

Horwood

Augoustinos

(2022). ‘It’s more than sadness’: The discursive construction of depression on Australian depression websites. Qualitative Health Research, 32(7), 1185–1196. https://doi.org/10.1177/10497323221102240

40.

Karafillakis

Dinca

Apfel

Cecconi

Wűrz

Takacs

Suk

Celentano

L. P.

Kramarz

Larson

H. J.

(2016). Vaccine hesitancy among healthcare workers in Europe: A qualitative study. Vaccine, 34(41), 5013–5020. https://doi.org/10.1016/j.vaccine.2016.08.029

41.

Kraaijeveld

S. R.

(2020). Vaccinating for whom? Distinguishing between self-protective, paternalistic, altruistic and indirect vaccination. Public Health Ethics, 13(2), 190–200. https://doi.org/10.1093/phe/phaa005

42.

Larsen

L. T.

Cecchini

(2023). Connective and tactfully tactical: Connective tactics and professional authority in doctor-patient relationships. Social Science & Medicine, 326, Article 115924. https://doi.org/10.1016/j.socscimed.2023.115924

43.

Larson

H. J.

De Figueiredo

Xiahong

Schulz

W. S.

Verger

Johnston

I. G.

Jones

N. S.

(2016). The state of vaccine confidence 2016: Global insights through a 67-country survey. EBioMedicine, 12, 295–301. https://doi.org/10.1016/j.ebiom.2016.08.042

44.

Larson

H. J.

Jarrett

Eckersberger

Smith

D. M.

Paterson

(2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012. Vaccine, 32(19), 2150–2159. https://doi.org/10.1016/j.vaccine.2014.01.081

45.

Leask

Kinnersley

Jackson

Cheater

Bedford

Rowles

(2012). Communicating with parents about vaccination: A framework for health professionals. BMC Pediatrics, 12(1), 154. https://doi.org/10.1186/1471-2431-12-154

46.

Locke

Budds

(2020). Applying critical discursive psychology to health psychology research: A practical guide. Health Psychology and Behavioral Medicine, 8(1), 234–247. https://doi.org/10.1080/21642850.2020.1792307

47.

Lofgren

Hewitt

das Nair

(2015). Doing fence sitting: A discursive analysis of clinical psychologists’ constructions of mental health. Qualitative Health Research, 25(4), 470–485. https://doi.org/10.1177/1049732314549479

48.

Lupton

(1993). Risk as moral danger: The social and political functions of risk discourse in public health. International Journal of Health Services: Planning, Administration, Evaluation, 23(3), 425–435. https://doi.org/10.2190/16AY-E2GC-DFLD-51X2

49.

Lyons

A. C.

(2014). Morality, responsibility and risk: The importance of alternative perspectives in vaccination research. International Journal of Behavioral Medicine, 21(1), 37–41. https://doi.org/10.1007/s12529-013-9346-6

50.

MacDonald

N. E.

(2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036

51.

Maertens

Willen

Van Damme

Roelants

Guérin

de Kroon

Vandermeulen

(2022). Studie van de vaccinatiegraad in Vlaanderen 2020. https://www.laatjevaccineren.be/sites/default/files/2022-04/Rapport_070322_Final.pdf

52.

Manca

Humble

R. M.

Aylsworth

Cha

Wilson

S. E.

Meyer

S. B.

Greyson

Sadarangani

Parsons Leigh

MacDonald

S. E.

Canadian Immunization Research Network CIRN investigators . (2022). “We need to protect each other”: COVID-19 vaccination intentions and concerns among racialized minority and indigenous peoples in Canada. Social Science & Medicine, 313, Article 115400. https://doi.org/10.1016/j.socscimed.2022.115400

53.

McCoy

(2008). Autonomy, consent, and medical paternalism: Legal issues in medical intervention. Journal of Alternative and Complementary Medicine (New York, N.Y.), 14(6), 785–792. https://doi.org/10.1089/acm.2007.0803

54.

Numerato

Cardano

Gariglio

Scavarda

Hasmanová Marhánková

(2021). Sampling guidelines and interview guide for the healthcare professionals. Vax-Trust Deliverable, 4(3), 1–12. https://cordis.europa.eu/project/id/965280/results

55.

Olusanya

O. A.

Bednarczyk

R. A.

Davis

R. L.

Shaban-Nejad

(2021). Addressing parental vaccine hesitancy and other barriers to childhood/adolescent vaccination uptake during the coronavirus (COVID-19) pandemic. Frontiers in Immunology, 12, Article 663074. https://doi.org/10.3389/fimmu.2021.663074

56.

Opel

D. J.

Heritage

Taylor

J. A.

Mangione-Smith

Salas

H. S.

DeVere

Zhou

Robinson

J. D.

(2013). The architecture of provider-parent vaccine discussions at health supervision visits. Pediatrics, 132(6), 1037–1046. https://doi.org/10.1542/peds.2013-2037

57.

Paterson

Meurice

Stanberry

L. R.

Glismann

Rosenthal

S. L.

Larson

H. J.

(2016). Vaccine hesitancy and healthcare providers. Vaccine, 34(52), 6700–6706. https://doi.org/10.1016/j.vaccine.2016.10.042

58.

Ponterotto

J. G.

(2006). Brief note on the origins, evolution, and meaning of the qualitative research concept thick description. Qualitative Report, 11(3), 538–549. https://doi.org/10.46743/2160-3715/2006.1666

59.

Potter

Wetherell

(1987). Parker

(Eds.), Discourse and social psychology: Beyond attitudes and behaviour. Sage.

60.

Reich

J. A.

(2016). Of natural bodies and antibodies: Parents' vaccine refusal and the dichotomies of natural and artificial. Social Science & Medicine, 157, 103–110. https://doi.org/10.1016/j.socscimed.2016.04.001

61.

Ringel

M. M.

Ditto

P. H.

(2019). The moralization of obesity. Social Science & Medicine, 237, Article 112399. https://doi.org/10.1016/j.socscimed.2019.112399

62.

Rus

Groselj

(2021). Ethics of vaccination in childhood—a framework based on the four principles of biomedical ethics. Vaccines, 9(2), 113. https://doi.org/10.3390/vaccines9020113

63.

Rutjens

B. T.

Sutton

R. M.

van der Lee

(2018). Not all skepticism is equal: Exploring the ideological antecedents of science acceptance and rejection. Personality & Social Psychology Bulletin, 44(3), 384–405. https://doi.org/10.1177/0146167217741314

64.

Shenton

A. K.

(2004). Strategies for ensuring trustworthiness in qualitative research projects. Education for Information, 22(2), 63–75. https://doi.org/10.3233/EFI-2004-22201

65.

Sibley

A. L.

Schalkoff

C. A.

Richard

E. L.

Piscalko

H. M.

Brook

D. L.

Lancaster

K. E.

Miller

W. C.

V. F.

(2020). “I was raised in addiction”: Constructions of the self and the other in discourses of addiction and recovery. Qualitative Health Research, 30(14), 2278–2290. https://doi.org/10.1177/1049732320948829

66.

Stephens

Carryer

Budge

(2004). To have or to take: Discourse, positioning, and narrative identity in women’s accounts of HRT. Health, 8(3), 329–350. https://doi.org/10.1177/1363459304043473

67.

Stivers

Timmermans

(2020). Medical authority under siege: How clinicians transform patient resistance into acceptance. Journal of Health and Social Behavior, 61(1), 60–78. https://doi.org/10.1177/0022146520902740

68.

Thille

P. H.

Russell

G. M.

(2010). Giving patients responsibility or fostering mutual response-ability: Family physicians’ constructions of effective chronic illness management. Qualitative Health Research, 20(10), 1343–1352. https://doi.org/10.1177/1049732310372376

69.

Van Hooste

W. L. C.

Bekaert

(2019). To be or not to be vaccinated? The ethical aspects of influenza vaccination among healthcare workers. International Journal of Environmental Research and Public Health, 16(20), 3981. https://doi.org/10.3390/ijerph16203981

70.

Vuolanto

Almeida

Anderson

Auvinen

Beja

Bracke

Cardano

Ceuterick

Correia

De Vito

Delaruelle

Delicado

Esposito

Ferrara

Gariglio

Guerreiro

C. S.

Marhánková

J. H.

Hilário

A. P.

Hobson‐West

Wagner

(2024). Trust matters: The addressing vaccine hesitancy in Europe study. Scandinavian Journal of Public Health, 52(3), 14034948231223791. https://doi.org/10.1177/14034948231223791

71.

Wartenberg

T. E.

(1988). The situated conception of social power. Social Theory and Practice, 14(3), 317–343. https://doi.org/10.5840/soctheorpract198814314

72.

Wetherell

(2015). Discursive psychology: Key tenets, some splits, and two examples. In I. Parker (Ed.), Handbook of critical psychology (pp. 315–324).

73.

WHO . (2019). Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019

74.

WHO . (2021). Weekly epidemiological record (Meeting of Strategic Advisory Group of Experts on Immunizaiton, October 2021: Conclusions and recommendations, issue. https://www.who.int/publications/i/item/who-wer9650-613-632

75.

WHO . (2022). Behavioural and social drivers of vaccination: Tools and practical guidance for achieving high uptake. https://apps.who.int/iris/handle/10665/354459

76.

Wood

L. A.

Kroger

R. O.

(2000). Doing discourse analysis: Methods for studying action in talk and text. Sage.

77.

Younas

Fàbregues

Durante

Escalante

E. L.

Inayat

Ali

(2023). Proposing the “MIRACLE” narrative framework for providing thick description in qualitative research. International Journal of Qualitative Methods, 22, 160940692211471. https://doi.org/10.1177/16094069221147162