title: Risk Communication, Values Clarification, and Vaccination Decisions.
abstract: Many health-related decisions require choosing between two options, each with risks and benefits. When presented with such tradeoffs, people often make choices that fail to align with scientific evidence or with their own values. This study tested whether risk communication and values clarification methods could help parents and guardians make evidence-based, values-congruent decisions about children's influenza vaccinations. In 2013-2014 we conducted an online 2×2 factorial experiment in which a diverse sample of U.S. parents and guardians (n = 407) were randomly assigned to view either standard information about influenza vaccines or risk communication using absolute and incremental risk formats. Participants were then either presented or not presented with an interactive values clarification interface with constrained sliders and dynamic visual feedback. Participants randomized to the risk communication condition combined with the values clarification interface were more likely to indicate intentions to vaccinate (β = 2.10, t(399) = 2.63, p < 0.01). The effect was particularly notable among participants who had previously demonstrated less interest in having their children vaccinated against influenza (β = -2.14, t(399) = -2.06, p < 0.05). When assessing vaccination status reported by participants who agreed to participate in a follow-up study six months later (n = 116), vaccination intentions significantly predicted vaccination status (OR = 1.66, 95%CI (1.13, 2.44), p < 0.05) and rates of informed choice (OR = 1.51, 95%CI (1.07, 2.13), p < 0.012), although there were no direct effects of experimental factors on vaccination rates. Qualitative analysis suggested that logistical barriers impeded immunization rates. Risk communication and values clarification methods may contribute to increased vaccination intentions, which may, in turn, predict vaccination status if logistical barriers are also addressed.
authors.affiliation: Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.|Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.|Research Centre of the CHU de Québec, Quebec City, Quebec, Canada.
authors.forename: Holly O
authors.initials: HO
authors.lastname: Witteman
authors.affiliation: Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
authors.forename: Selma
authors.initials: S
authors.lastname: Chipenda Dansokho
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Exe
authors.affiliation: Department of Information and Communication, Laval University, Quebec City, Quebec, Canada.
authors.forename: Audrey
authors.initials: A
authors.lastname: Dupuis
authors.affiliation: Department of Psychology, Laval University, Quebec City, Quebec, Canada.
authors.forename: Thierry
authors.initials: T
authors.lastname: Provencher
authors.affiliation: Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.|Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.|Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.|Risk Science Center, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
mesh_terms: D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D006801:Humans; D018570:Risk Assessment; D014611:Vaccination
keywords: Children; immunization; influenza; interface design; risk communication methods; vaccination; values clarification exercise; values clarification methods; values congruence