Economic preferences are crucial in decision making. While some preferences remain stable, changes in economic preferences have been linked to institutional and policy changes. We conduct three studies to explore the ways in which decision making might be impacted by economic preferences and underlying or changing policies. Our studies span the domains of preventative healthcare, strategic interactions, and education. Chapter 2 examines the relationship between cooperative decision making and changes in societal level institutions through a meta-meta analysis, incorporating experimental data from various previously conducted meta-analyses. We study the relationship between country or region level policy changes, as measured by economic freedom indices to experimental measures of prosocial and selfish behavior. Our results indicate a relationship between macro-level institutional changes and measures of co-operative behavior that varies based on the starting levels of economic freedom variables. This establishes a relationship between macro policies and individual behavior that suggests that governments should consider the consequences of policies on individual decision making. Chapter 3, using vignette experiments, explores how emotion reappraisal messaging interventions affect betrayal aversion and vaccine hesitancy. The measure of betrayal aversion in our study involves hesitancy in risking being betrayed in situations involving trust related to vaccines. We find that betrayal aversion is prevalent in about a third of our study participants and that two of our messaging interventions substantially reduce betrayal aversion involving vaccination decisions. Our results suggests a targeted messaging strategy for addressing a recently discovered new component of vaccine hesitancy, an important current topic in preventative healthcare. Chapter 4, introduces an active learning intervention in the form of a field experiment involving a health intervention nudge and explores its impact on class engagement and education outcomes of students. In addition, we look at the impact of the nudge on vaccination uptake among students. We find improved class engagement as well as improvement in test scores for students who had the opportunity and chose to participate in the nudge experiment. In addition, we find greater uptake of influenza vaccination, as targeted by the nudge treatment. Our results show that this effect is driven by men, with women having higher vaccination rates irrespective of the nudge treatment. JEL codes: C91, H1, 01, P5, I12, D91, A22, C93 / Doctor of Philosophy / This dissertation explores how policy changes in our environment, interact with our preferences and affect decision making in social decision making, healthcare and education domains. We explore macro policies designed to create country-level institutional changes, involving the legal system, monetary policy, trade and labor policy, as well as examining two individual-level interventions including targeted messaging to improve vaccination uptake, and course performance in introductory economics. These wide variety of policy interventions give us a wide spectrum of decisions to study across different domains. Chapter 2 examines the relationship between policy changes at the macro-institutional level and aggregate cooperative decision making. In this study, we establish a relationship between baseline institutional structure and changes in cooperative behavior corresponding to changes in societal level institutions. Our results suggests that current and historic societal level institutional structures should be kept in mind when designing policies. Chapter 3 explores the effect of messaging treatments targeting emotions on uptake of vaccination using a vignette experiment. Here, we study the effects on a particular emotion, betrayal aversion, which in our study, involves hesitancy related to the risk of getting betrayed in the context of vaccination. Our results suggest that a targeted messaging strategy, might prove to be effective in designing policies to improve vaccination uptake. Chapter 4 explores the impact of an active learning approach on class engagement and education outcomes of students in introductory economics. Providing students the chance to participate in a field experiment designed as a vaccination nudge, we incorporate the active learning component of the course and study the impact of participation in this active learning module. Our results suggest improved engagement and education outcomes among students who had the opportunity to participate in the experiment. Our results also suggest that proximity nudges might prove to be effective in improving vaccination uptake. We demonstrate the importance of designing context-specific policies for them to be instrumental in bringing about targeted change. At the aggregate country level, we find that similar type of policy interventions when introduced in countries with differing baseline institutional structures might lead to different results. At the individual level, we find evidence that targeted interventions does shape decisions. We find that targeted health communications messaging can lead to improvement in health behavior. We also find that introducing active learning modules improves learning outcomes among students. Taken together, the findings in this dissertation demonstrates how both economic preferences and underlying policies are important factors in decision making.

No description available.

Bakgrund: År 2019 utlystes vaccintveksamhet som ett av de tio största hoten mot global hälsa och antalet ovaccinerade barn har ökat kraftigt de senaste tre åren. Detta riskerar barnens hälsa och får konsekvenser för samhällets tillväxt och utveckling. Vaccinering är ett effektivt sätt att förebygga sjukdom och anses vara en av de största framgångarna för hälsa i historien. Trots omfattande evidens gällande vacciners nytta och säkerhet växer vaccintveksamheten världen över. Syfte: Att beskriva vilka faktorer som ligger bakom vårdnadshavares val att inte vaccinera sina barn med rekommenderade grundvaccinationer. Metod: Litteraturöversikt med deskriptiv design. Resultatet baserades på tio kvalitativa originalartiklar publicerade mellan år 2017 och 2023. Datainsamling gjordes via databaserna PubMed och CINAHL. Som teoretisk utgångspunkt användes begreppet hälsolitteracitet. Resultat: Ur de tio granskade studierna framkom fyra teman. De faktorer som påverkade beslutet var att vårdnadshavare ansåg att vacciner är skadliga och onödiga samt att vacciner är onaturliga och ges för tidigt. Vidare önskade vårdnadshavare fatta självständiga beslut gällande sina barns vaccinationer men upplevde inskränkt autonomi. Det fanns även en uttalad misstro till hälso- och sjukvården, myndigheter och läkemedelsföretag. Slutsats: Då vaccintveksamhet är ett växande fenomen är det viktigt att hälso- och sjukvården utvecklar kommunikationsstrategier för bästa möjliga bemötande och individanpassad information, vilket kan bidra till ett ökat förtroende. Sjuksköterskan kan bidra med evidensbaserad kunskap och information till vårdnadshavare samt säkerställa att varje familj blir bemött med respekt oavsett eventuella meningsskiljaktigheter.

The field of Early Childhood Education and Care (ECEC) traditionally encompasses care and education for children aged from birth to eight years. In this study, the focus is specifically on the field that provides services for children in prior to school settings, that being the birth to five sector. This sector is highly feminised and has emerged over the last century from philanthropic roots. Despite considerable work into leadership in other areas, until recent times, attention to aspects of leadership has been limited within the ECEC field and much of the research undertaken has focused heavily on centre-based leadership. This study investigated how personnel, from a range of services, understand and enact leadership. In terms of data analysis it draws heavily on symbolic interactionism as a methodological tool and engages standpoint feminist theory to inform the analytical process. Data were gathered from semi-structured interviews with twenty-six participants who also identified artefacts, which they considered influenced and supported their understandings of leadership. In addition, two focus groups were conducted to explore themes emerging from early analysis of the data. Findings indicate two categories, which emerge as relevant to how leadership is understood and enacted by participants. The first of these is the concept of interpreted professional identity, which reflects participants' interpretations of who they are as early childhood professionals informed by their own views and the views of others. How individuals interpret their sense of self (manifest in their professional identity) is influential in the secondary category, which is interpreted leadership capacity. This category reflects participants' leadership activity or inactivity. The analysis reflects a complex interplay between how participants interpret their professional sense of self (interpreted professional identity) and their capacity and willingness to enact leadership (interpreted leadership capacity). Individuals in the formation of their professional identity interpret factors, both internal to the ECEC field and external (through social expectations). The culture of the ECEC field (internal factors) includes competing elements such as a discourse of niceness juxtaposed against examples of horizontal violence. Factors external to the field suggest there are lingering social associations between heroic male images and leadership, which make women as leaders problematic. Within a highly feminised field such as ECEC, this study brings new perspectives to understandings of leadership and its enactment.

Background: Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the world and there are over 100 different varieties. Several of the varieties can lead to cancer. Although there are vaccines available, the vaccine coverage varies in the providing countries. Aim: The aim of this study was to describe aspects that make guardians choose to refrain from giving their children HPV-vaccines. Method: This Literature study is based on nine qualitative articles published between 2010 and 2020 and the articles were found in Cinahl and PubMed. Results: Guardians who refrained from the HPV-vaccine to their adolescents mentioned varied aspects. Some guardians were concerned about side effects of the vaccine and others mention a lack of knowledge and information about HPV and the vaccine. Guardians expressed concerns about vaccinating against sexually transmitted infections with their adolescents. A varied confidence in health care staff was mentioned by the guardians and they sought information from more unreliable sources such as stories from friends and family or the internet. The fact that HPV-vaccine only was provided to girls, in many of the countries, was a reason for the guardian’s skepticism. Conclusion: The result showed that there are various aspects that make guardians refrain from HPV-vaccine. Some reasons are more common in certain countries. Today's society is multicultural, which leads to a need for more studies to be done from an international perspective. Being able to meet the guardian’s various needs for information about HPV-vaccine is essential to get a higher HPV-vaccine coverage in the world.

No description available.

Problem och syfte: Vaccinationstveksamhet är ett uppseglande globalt problem och ett av tio prioriterade hot mot världshälsan. Elevhälsovårdens vaccinationer utgör en viktig del av elevers skydd mot sjukdomar. Ingen generell beskrivning av skolsköterskors strategier och arbetssätt med elever och vårdnadshavare som uttrycker vaccinationstveksamhet har identifierats och därför syftar aktuell studie till att belysa dessa. Metod: Kvalitativ intervjustudie med tio skolsköterskor yrkesverksamma inom grundskolor i delar av södra Sverige. Data analyserades med kvalitativ innehållsanalys. Resultat: Huvudkategorin Att så ett frö för vaccinationsacceptans framkom i dataanalysen. Arbetssättet och strategierna riktar sig mot både vaccinationstveksamma vårdnadshavare och elever. Två kategorier Att respektfullt stimulera vårdnadshavaren till att överväga sitt beslut och Att möjliggöra elevens delaktighet beskriver detta arbete. Underkategorierna som relateras till arbetet med vårdnadshavare beskriver bland annat regelbundet säkerställande av vaccinationsbeslutet och individualisering av information. Underkategorierna som relateras till arbetet med eleverna beskriver bland annat insatser för motvilligt ovaccinerade elever och anpassningar till tveksamma elever. En tredje kategori Skolsköterskans kompetens används långsiktigt beskriver övergripande hur skolsköterskornas arbetssätt och strategier utförs. Slutsats: Skolsköterskors arbete är långsiktigt och präglas av respekt för vårdnadshavarnas beslut samt elevernas självbestämmanderätt ur ett barnperspektiv. Skolsköterskor behöver bygga en god relation med familjen och informera dem utifrån en bred kunskapsgrund. / Objective: Vaccine hesitancy is a growing global problem and one of ten prioritised threats to world health. The vaccinations in school health services make up an essential part of pupils’ disease resistance. No generalised description of school nurses’ strategies and methods with pupils and guardians who express vaccine hesitancy has been identified and therefore the aim of this study is to elucidate these strategies and methods. Methods: Qualitative interviews with ten school nurses working in primary schools in parts of southern Sweden were performed. The data were analysed with content analysis. Results: The findings revealed the main category To plant a seed of vaccine acceptance. The strategies and methods target both vaccine-hesitant guardians and pupils. Two categories To respectfully stimulate guardians to consider their decision and To enable pupils’ participation describe these strategies and methods. The sub-categories related to work targeting guardians describes regular checking of the guardian’s decision and individualised information among other things. The sub-categories related to work targeting pupils describes actions for unwillingly unvaccinated pupils and individual arrangements for vaccine-hesitant pupils. A third category A long-term initiative using the school nurse’s competence describes the overarching strategies and methods of the school nurse. Conclusions: The school nurses have a long-term strategy marked by respect for the guardians’ decisions as well as the pupils’ rights of self-determination from a child rights’ perspective. The school nurses need to build a good relationship with the family and inform them using a broad base of knowledge.

Bakgrund: Vaccin är en av de främsta framgångarna i medicinhistorien. Vaccinmotstånd klassas som ett av de tio största hoten mot global hälsa. Motstånd förekommer i hela världen i alla sociala grupper av olika anledningar. Syfte: Beskriva BHV-sjuksköterskors erfarenheter av att möta föräldrar som avstår från att vaccinera sina barn enligt det allmänna vaccinationsprogrammet. Metod: En kvalitativ intervjustudie. Semistrukturerade intervjuer hölls med åtta BHV-sjuksköterskor i mellansvenska kommuner. Innehållsanalys med induktiv ansats användes för att analysera resultatet. Resultat: Resultatet mynnade ut i tre huvudkategorier: orsaker till att avstå från vaccination, orsaker till att genomföra vaccination samt erfarenheter från mötet. Respektive huvudkategori baserades på följande subkategorier: tveksamhet, personliga skäl, felaktig information, information baserad på vetenskap och beprövad erfarenhet; individuell anpassning, bygga relation och tillit, svårt möte samt starkt ställningstagande. Slutsats: BHV-sjuksköterskornas erfarenheter är att mötet med vaccinkritiska föräldrar är svårt. Föräldrarna har ofta tagit del av felaktig information. BHV-sjuksköterskorna försöker med hjälp av personlig anpassning och respekt för föräldrarna förse dem med korrekt information, allt för att bibehålla en god relation. / Background: Vaccines are one of the key successes in the history of medicine. Vaccine hesitancy is ranked as one of the ten biggest threats to global health. Hesitancy occurs throughout the world in all social groups for various reasons. Aim: Describe child health services nurses experiences of meeting parents who refrain from having their children vaccinated. Method: A qualitative interview study. Semi-structured interviews were held with eight child health services nurses in communities in mid Sweden. Content analysis with an inductive approach was used to analyze the results. Results: Three main categories were found, reasons for refraining from vaccination, reasons to go through with vaccination and experiences from the meeting. The main categories were based on the following subcategories, doubt, personal reasons, incorrect information, information based on science and proven experience, individual adaptation, building relationship, and trust, difficult meeting, and strong position. Conclusions: The experience of the child health services nurses is that the meeting with vaccine-critical parents is difficult. The parents have often received incorrect information. The child health services nurses, by using individual adaptation, and meeting the parents with respect, try to provide them with correct information, all in order to maintain a good relationship.

Background The administration of the COVID-19 vaccines has met with resistance and hesitance from different population groups including people living with HIV/AIDS (PLWHA). It is concerning to know that PLWHAs are showing a higher rate of COVID-19 vaccine hesitancy than the general population. The objective of this study is to synthesize the literature and determine the correlates and predictors of COVID-19 vaccine hesitancy among PLWHA using primary and secondary data. Methods A scoping review was conducted to identify and summarize studies on COVID-19 vaccine hesitancy among PLWHA using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Extension for scoping reviews. For the secondary data, the Tennessee Department of Health HIV surveillance and COVID-19 immunization dataset was retrieved from the TDH partners and a questionnaire was developed and administered to PLWHA accessing care at the Ryan White HIV Center of Excellence in Johnson City for the primary data analysis. Results There was a significant association between age group (p < 0.001), gender (p < 0.001), and region (p < 0.001) and uptake of COVID-19 vaccination. PLWHA between the ages 35-44, 45-54, and 55+ in Tennessee were 1.4, 1.8, and 2.8 times more likely more to take doses of COVID-19 vaccines respectively than those between the ages of 15-24 in the State. At the Ryan White clinic, regularity with HAART (p=0.039), uptake of at least one of the other essential vaccines for PLWHA (p=0.011), belief about the safety of the COVID-19 vaccine (p< 0.001), and interference between the COVID-19 vaccine and HAART (p< 0.001) were significantly associated with the uptake of COVID-19 vaccination. Conclusion Efforts and strategies to improve the COVID-19 vaccine behavior of young PLWHA with social media-based vaccine education is imperative. Furthermore, the association between the regularity of HAART and the perception of the safety of the vaccine for PLWHA on COVID-19 vaccine uptake has implications for policy and intervention strategies.

Background:Vaccinating children is cost effective and important for public health. In Sweden, the high vaccine coverage is reflected by the public trust in vaccinations. However, vaccine hesitancy is a growing challenge worldwide. According to the WHO, vaccine hesitancy is one of the top ten threats to public health in the world today. Registered nurses have a key role for vaccinations, especially in providing information to parents. Aim:The aim was to examine why some children do not get vaccinated at the child care center and what strategies registered nurses use when responding to parents that are opposed or hesitant towards vaccines. Method: Semi structured interviews was undertaken with 12 registered nurses experienced in discussing vaccine safety with parents. Data was analyzed with inductive content analysis. Results:The analysis resulted in six categories and 11 subcategories. Reasons for doubt or hesitancy to vaccines were that consequences of the diseases were forgotten, parents felt worried about how the vaccine affected the child, and lack of trust. Basic strategies that were used to address parents were based on evidence-based information. It enabled trust in the registered nurse and the vaccine that was offered. Conclusion:InSweden,the normis tovaccinatechildren,somethingthatshouldnotbetakenforgranted. Theregistered nursecanatanearlystageprovideevidence-based informationtoparentsatthe child care centersandtherebyprovideknowledgeofthevaccine's health-promotingbenefits.This canpreventdoubtsabout vaccinations andgetmorechildrenvaccinated. / Bakgrund:Barnvaccinationer är kostnadseffektivt och har stor betydelse för folkhälsan. I Sverige är täckningsgraden hög och förtroendet för vaccin stort. Dock är tveksamhet till vaccin ett växande problem globalt. Enligt WHO är tveksamhet till vaccin ett av de tio största hoten för hälsa i världen idag. Sjuksköterskan har en nyckelroll i avseendet att vaccinera barn och ge information till föräldrar. Syfte:Syftet var att undersöka varför vissa barn inte blir vaccinerade på BVC, samt vad BHV-sjuksköterskor har för strategier att bemöta föräldrars motstånd eller tveksamhet till vaccin.  Metod:Semistrukturerade intervjuer utfördes med 12 barnhälsovårdssjuksköterskor som hade erfarenhet av att bemöta föräldrar kring frågor om vaccin. Analysmetod var induktiv innehållsanalys. Resultat:Ur analysen framkom sex kategorier och 11 underkategorier. Anledningar till tveksamhet eller motstånd till vaccin var att konsekvenserna av sjukdomarna glömts bort, att föräldrarna kände oro för hur vaccinet påverkade barnet samt brist på förtroende. Grundstrategier som BHV-sjuksköterskorna använde för att bemöta föräldrarna utgick från god evidensbaserad information. Det möjliggjorde högt förtroende för sjuksköterskan och det vaccin som erbjöds. Slutsats:I Sverige är det norm att vaccinera barn, något som inte bör tas för givet. Sjuksköterskan kan i ett tidigt skede ge evidensbaserad information till samtliga föräldrar på BVC och därigenom ge kunskap om vaccinets hälsofrämjande fördelar. Det kan förebygga tveksamhet till vaccinationer och få fler barn att vaccineras.