title: Opening the 'Vaccine Hesitancy' black box: how trust in institutions affects French GPs' vaccination practices.
abstract: In recent years, vaccine hesitancy among health professionals has emerged as an important issue on public health agendas. However, we do not yet know very much about whether, and if so how, trust in institutions affects their practices.
  
  
  
  A path analysis model explaining the influence of trust on GPs' vaccine hesitancy was applied to a cross-sectional survey of 1,582 French GPs performed in 2014. We hypothesized that distrust in public health institutions influences GPs' concerns about the safety of various vaccines, their perceptions about the importance of vaccination, their self-efficacy in the doctor-patient relationship, and ultimately their vaccination recommendations to patients.
  
  
  
  GPs' trust in institutions was found to be significantly associated with lower vaccine hesitancy, an association mediated to a large extent by the vaccine's perceived safety (β = 0.09, P < 0.01) and the importance of vaccination (β = 0.46, P < 0.001).
  
  
  
  These results suggest that restoration of high vaccination coverage may require the re-establishment of a significant degree of trust in the public health system among health professionals.
authors.affiliation: a IRD French Institute of Research for Development, EHESP French School of Public Health, UMR_D 190 'Emergence des Pathologies Virales' , Aix Marseille University , Marseille , France.|b UMR PIMIT, INSERM 1187, CNRS 9192, IRD 249. Plateforme Technologique CYROI , Université de La Réunion , Réunion , France.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Raude
authors.affiliation: c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.|d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.|e ORS PACA, Southeastern Health Regional Observatory , Marseille , France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Fressard
authors.affiliation: f French Public Health Agency, Direction de la prévention - promotion de la santé , Saint-Maurice , France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Gautier
authors.affiliation: g Université de Lorraine, Université Paris Descartes, EA 4360 APEMAC , Nancy , France.|h CHU de Nancy, Service de Maladies Infectieuses , Nancy cedex , France.
authors.forename: Céline
authors.initials: C
authors.lastname: Pulcini
authors.affiliation: c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.|d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.|e ORS PACA, Southeastern Health Regional Observatory , Marseille , France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peretti-Watel
authors.affiliation: c UMR912 'Economics and Social Sciences Applied to Health & Analysis of Medical Information' (SESSTIM) , INSERM , Marseille , France.|d UMR_S912, IRD, 13006, Aix Marseille University , Marseille , France.|e ORS PACA, Southeastern Health Regional Observatory , Marseille , France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
mesh_terms: D003430:Cross-Sectional Studies; D005602:France; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D035502:Trust; D014611:Vaccination / Q000523:psychology* / Q000706:statistics & numerical data*; D014612:Vaccines / Q000008:administration & dosage* / Q000276:immunology*
chemical_list: D014612:Vaccines
keywords: GPs; Vaccine hesitancy; controversy; recommendations; trust