Flu infections have shown an increase across the United States, leading to at least 81,000 hospitalizations and 3,100 deaths during the current season, according to the U.S. Centers for Disease Control and Prevention.
Research on Vaccine Decision-Making
New research from a Cornell psychology professor investigates the factors influencing lower flu vaccination rates. The study proposes that individuals make decisions less on raw facts and more on their intuitive understanding, or "gist," of those facts, and how this understanding aligns with their core values.
In two studies comparing different theories, general questions assessing participants' overall sense of risks and benefits predicted vaccine hesitancy more effectively than precise, quantitative measures. The categorization of risks and benefits as none, low, medium, or high significantly correlated with individuals' intentions to receive a vaccine. For example, participants who perceived benefits as none or low, or risks as medium or high, were less inclined to vaccinate.
Valerie Reyna, a professor of Human Development in the Department of Psychology and College of Human Ecology at Cornell, stated, "We make decisions based on the bottom-line gist of information: What does all this information boil down to? What’s the decision really about?" Reyna is the lead author of "A New Look at Vaccination Behaviors and Intentions: The Case of Influenza," published on November 29 in Behavioral Sciences. Co-authors included David Garavito, Sarah Edelson, Aadya Singh, Dr. Michelle Galindez, Julia Fan, and Jiwoo Suh.
Theoretical Framework
Traditional decision theories, such as "reasoned action" and "planned behavior," often emphasize tradeoffs between outcomes and their probabilities, assuming rational mechanisms drive behavior. Dual process theories distinguish between impulsive and deliberative systems, suggesting improved decisions when the latter is engaged. Reyna noted that these models may not fully describe the current context of vaccination decisions for many individuals.
Reyna, a developer of "fuzzy trace" theory, suggests that decision-making involves two processes: the encoding of literal facts and the creation of meaning about those facts based on individual background and experiences.
Study Methodology and Findings
The research involved over 700 college students and nearly 200 community members. Participants were asked about their past flu vaccination status or intentions and responded to questions aligned with classic, dual process, and fuzzy trace theories. These questions included their knowledge of and access to flu vaccines, their precise perception of risk on a scale from 0 to 100, and their overall sense of the vaccine’s risks and benefits.
Among the younger adult cohort, vaccine knowledge and accessibility accounted for 14% of the variation in intentions to vaccinate. This figure increased to 58% when responses to the "gist" questions were included. In the community sample, the ability to predict vaccination intentions improved from 57% to 80% with the addition of gist questions.
Reyna explained, "Part of our mind looks at details and precise facts, but the other part of our mind looks at the bottom-line, qualitative gist – and that’s the more determinative part." She added that individuals form a global impression, such as "Overall, I think the benefits from vaccination are high and the risks are nil," which represents the gist for those who vaccinate.
Implications for Public Health Communication
The research suggests that incorporating gist principles into sustained communication efforts could reduce vaccine hesitancy. This approach contrasts with current methods that often rely on lists of facts and trust in experts. While sharing basic background knowledge, such as the distinction between viruses and bacteria or how vaccines interact with immune systems, is considered essential, it is deemed insufficient on its own.
According to the research, facts need contextualization to foster a conceptual, gist understanding. Practitioners should then explain how vaccine risks and benefits align with core values, such as the desire to protect family and neighbors or to make informed choices. The research received support from the National Institute of Standards and Technology, the U.S. Department of Agriculture, and the Institute for Trustworthy AI and Society.