Risk and trust in vaccine decision making

Vaccines are widely hailed as vital, safe, and cost-effective public health interventions that save lives and protect health. However, from the development of the first smallpox vaccine at the end of the eighteenth century until the present day, the legitimacy and safety of vaccination has frequently been challenged. Individuals making choices about vaccination have to evaluate reports, often contradictory, about risk. The ways that parents evaluate these reports and make decisions are crucially informed by trust. This paper examines and compares public evaluations of risk and the role of trust in three historic vaccine controversies: the implementation of the global smallpox eradication campaign, the debate over the whooping cough vaccine in the 1970s and 1980s in Great Britain, and the current debate over the MMR vaccine in Britain. The discussion of the MMR controversy will draw upon my recent fieldwork interviewing parents about the vaccination decisions they have made for their children. Parents balance a number of potential risks against one another and choose which risks they are most concerned about. In addition, the importance of herd immunity to successful immunisation programmes allows for an investigation of how individual and collective risks and benefits relate to one another. These issues are only recently beginning to be incorporated into the literature on risk, trust and sociocultural theory

Risk conceptualisations, trust and decision-making in the face of contradictory information: the case of MMR

This thesis investigates the process by which parents evaluate contradictory information about risk in order to make the decision whether to have their children immunised with the measles, mumps and rubella (MMR) vaccine. Contested reports associating the MMR vaccine with autism have resulted in diminished confidence and uptake of the vaccine in the UK. Interviews and focus groups were used to develop an in-depth picture of parental notions of risk, trust and decision-making processes. Cultural consensus analysis was used to probe the areas of consensus and divergence of opinion, and a large-scale postal survey (N=996) assessed the level of agreement with the qualitative findings. Parental ambivalence to the safety of the vaccine reflected wider social concerns, and was crucially related to trust in governmental medical authority and medical practitioners. Trust was particularly damaged when practitioners and policy makers failed to recognise parents' concern for their children’s health and their unique knowledge of their own children. A key tool for fostering trust is narrative: this played a central role in galvanising resistance to the vaccine, but was not well used to engender trust and cooperation between parents and medical practitioners. Three practical strategies to protect children from diseases and harmful vaccine side effects, to rebuild trust, and to cope successfully with similar controversies in the future emerged from this research: fully involving the public in framing scientific research agendas, streamlining the reporting procedures for suspected adverse reactions, and fostering trusting personal relationships between patients and health care practitioners

Improving health and well-being through community health champions: a thematic evaluation of a programme in Yorkshire and Humber.

AIMS: The contribution that lay people can make to the public health agenda is being increasingly recognised in research and policy literature. This paper examines the role of lay workers (referred to as 'community health champions') involved in community projects delivered by Altogether Better across Yorkshire and Humber. The aim of the paper is to describe key features of the community health champion approach and to examine the evidence that this type of intervention can have an impact on health. METHODS: A qualitative approach was taken to the evaluation, with two strands to gathering evidence: interviews conducted with different stakeholder groups including project leads, key partners from community and statutory sectors and community workers, plus two participatory workshops to gather the views of community health champions. Seven projects (from a possible 12) were identified to be involved in the evaluation. Those projects that allowed the evaluation team to explore fully the champion role (training, infrastructure, etc.) and how that works in practice as a mechanism for empowerment were selected. In total, 29 semi-structured interviews were conducted with project staff and partners, and 30 champions, varying in terms of age, gender, ethnicity and disability, took part in the workshops. RESULTS: Becoming a community health champion has health benefits such as increased self-esteem and confidence and improved well-being. For some champions, this was the start of a journey to other opportunities such as education or paid employment. There were many examples of the influence of champions extending to the wider community of family, friends and neighbours, including helping to support people to take part in community life. Champions recognised the value of connecting people through social networks, group activities, and linking people into services and the impact that that had on health and well-being. Project staff and partners also recognised that champions were promoting social cohesiveness and helping to integrate people into their community. CONCLUSIONS: The recent public health White Paper suggested that the Altogether Better programme is improving individual and community health as well as increasing social capital, voluntary activity and wider civic participation. This evaluation supports this statement and suggests that the community health champion role can be a catalyst for change for both individuals and communities

Volunteer peer support and befriending for carers of people living with dementia: An exploration of volunteers' experiences.

With ageing populations and greater reliance on the voluntary sector, the number of volunteer-led peer support and befriending services for carers of people with dementia in England is set to increase. However, little is known about the experiences of the volunteers who deliver these interventions, many of whom are former carers. Using in-depth semi-structured interviews with 10 volunteer peer supporters and befrienders, this exploratory study investigated volunteers' experiences of delivering the support, the types of relationships they form with carers and their perceptions of its impact upon them and on carers. Data were analysed using framework analysis. Findings showed that volunteers benefitted from their role due to the 'two-way' flow of support. Experiential similarity and having common interests with carers were considered important to the development of mutually beneficial relationships. Volunteers perceived that carers gained emotional and social support, which in turn improved the carers' coping ability. Being able to see positive changes to carers' lives was important for volunteers to gain enjoyment and satisfaction from their role. However, volunteers also identified challenges with their role, such as dealing with carers' emotions. Future research should investigate ways of reducing potential burden on volunteers and explore the impact of volunteering specifically on former carers of people with dementia

The role of volunteer support in the community for adults with hearing loss and hearing aids

Objectives: To explore interactions between audiology patients and volunteers, to describe encounters and define the role of volunteers. Methods: Qualitative ethnographic and interview study of volunteer-patient interactions. Ten volunteer participants from two volunteer schemes in South West England were observed and interviewed. Three patient participants were interviewed. Results: Analysis of observational data showed that volunteers provided support relating to local services and hearing aids, but did not engage in discussions about hearing loss. Interviews with volunteers identified gaps in audiology provision, including accessible services and clear information and highlighted a need for more support from audiology services to enable them to fulfil their role. Volunteer interactions with patients mimicked a clinician-patient encounter and volunteers employed strategies and behaviours used by professional audiologists. Conclusions: Audiology volunteers could provide an accessible bridge between health services and the community but their care is limited to focus on hearing aids. Practice implications: Volunteers enable patients to use hearing aids appropriately and are a core element of current care arrangements. However, volunteers express a need for adequate support from audiology services. Volunteers have the potential to increase service capacity and to bridge the gaps between community and audiology healthcare services

How can 'we' help? Exploring the role of shared social identity in the experiences and benefits of volunteering

Previous research on volunteering has largely focussed on the individual characteristics and experiences of volunteers, or on their relationship with the volunteering organisation; neglecting the group dynamics of volunteering. To address this gap, we apply a social identity and 'Social Cure' perspective in a thematic analysis of interviews with 40 volunteers from across the South of England. This analysis highlights that group identities are fundamental to volunteers’ motivations and experiences of volunteering. Sharing an identity with other volunteers promoted feelings of belonging, which in turn impacted upon participants' wellbeing. Identity processes also underpinned interactions with the beneficiaries of help, and how volunteers managed the challenges of helping. Finally, shared identity facilitated collective support between volunteers, which was necessary to deal with the challenges of the volunteering role, and this could be facilitated or hindered by the volunteering organisation. We discuss the implications for how volunteering organisations can enhance identity-mediated helping, as well as for understanding the impact of volunteering on health and wellbeing

What are the beliefs and perceptions of practice nurses' influence about the uptake of the Measles, Mumps and Rubella vaccine? An integrative literature review

Aim. To ascertain the beliefs and perceptions of practice nurses’ influence about the uptake of the Measles, Mumps and Rubella vaccine. Background. Immunisation decision making for parents is a complex process. Principle health professionals involved in immunisation programmes are health visitors, general practitioners and practice nurses. There is evidence that health visitors and general practitioners influence parental immunisation decision making. However, there is a lack of evidence about the influence of the practice nurse despite their well-documented role in immunisation. Design. Integrative Literature Review Data sources. A systematic search of electronic databases, including: CINAHL; Medline; PubMed; Google Scholar; Science Direct and Scopus from February 1998 - April 2017. Hand searching and reviewing of secondary references were also undertaken. Review methods. Two reviewers independently screened records on title and abstract. Studies where the beliefs and perceptions of practice nurses regarding the Measles, Mumps and Rubella vaccine were explored and were published in English were included. The data were analysed using the integrative review processes. Results. Twelve studies were included; these studies were principally descriptive and were of variable methodological quality. Four themes were identified: parental immunisation influencing factors; practice nurse characteristics; information & communication and personal views and concerns. While this review provides an excellent baseline for this information, more recent research conducted in the current policy environment is urgently needed to determine if these views persist. Conclusion. Immunisation training and annual updates are essential for practice nurses to keep abreast with the evidence base underpinning national immunisation programmes