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.

The overall aim of this thesis was to examine beliefs about human papillomavirus (HPV) prevention, especially vaccination, among parents, immigrant women, adolescents and school nurses, and to promote primary prevention among adolescents. The methods used in the thesis were focus group interviews, individual interviews, a web-based questionnaire, and finally, a randomised controlled intervention study. The immigrant women were largely in favour of HPV prevention, although barriers, such as logistic difficulties, and cultural or gender norms were found. Parents’ decision concerning vaccination of their daughters depended on several factors. Regardless of their final choice, they made the decision they believed was in the best interest of their daughter. The benefits outweighed the risks for parents choosing to vaccinate while parents declining made the opposite judgement. The majority of the school nurses reported that the governmental financial support given because of the vaccination programme had not been used for the intended purpose. Three out of four nurses had been contacted by parents who raised questions regarding the vaccine; most were related to side effects. The educational intervention had favourable effects on the adolescents’ beliefs regarding HPV prevention, especially among those with an immigrant background. Furthermore, the intention to use condom as well as actual vaccination rates among girls was slightly increased by the intervention. Trust in the governmental recommendations and the amounts of information given are important factors in the complex decision about HPV vaccination. Attention given to specific needs and cultural norms, as well as the possibility to discuss HPV vaccination with the school nurse and provision of extra vaccination opportunities at a later time are all strategies that might facilitate participation in the school-based HPV vaccination programme. School nurses need sufficient resources, knowledge and time to meet parents’ questions and concerns. The vaccinations are time-consuming and the governmental financial support needs to be used as intended, for managing the vaccination programme. A school-based intervention can have favourable effects on the beliefs and actual actions of young people and may possibly thus, in the long term, decrease the risk for HPV-related cancer.

In response to a desired degree of participation within vaccination against the Covid-19 pandemic, the Swedish government chose to implement mandatory marketing measures. This has been exemplified by vaccine mandates which caused to provoke varying reactions from affected consumers. This study was, thus, based on investigating established marketing strategies for sensitive products from a consumer perspective and measuring the perceived level of trust between the state and its citizens. The study adhered to a qualitative research method to facilitate the assessment of a phenomenon with respect to medicalization. Semi-structured interviews were designed based on three main categories of respondents: critical-, neutral-, and positive-minded individuals, in relation to opinions concerning the marketing of vaccines and government mandates. Respondents were further distributed on the basis of four age groups to investigate the relevance of the individual's age and their corresponding level of trust. Based on the following results, however, there appeared to be no established link between these two variables, i.e. age and confidence. Furthermore, it has been shown that respondents' previous attitudes were related to their degree of social capital which determined the individuals' level of trust with regard to the state and its implementation of the vaccine mandate. The respondents' previous attitudes on the subject of vaccination mainly affected the level of trust they had for their state and how well they could identify with the message behind the marketing of vaccines. Further conclusions also showed a link between the degree of consumers' relatability with regard to the marketing message and their respective consumer behavior, for example within the vaccination frequency of each individual respondent. / Som svar till ett önskat vaccinationsdeltagande mot Covid-19 pandemin valde den svenska regeringen att implementera tvingande markandsföringsåtgärder i form av exempelvis vaccin mandat som väckte varierande reaktioner från påverkade konsumenter. Denna studie utgick därmed från att utreda etablerade marknadsföringsstrategier kring känsliga produkter utifrån ett konsumentperspektiv och mäta den uppfattade förtroendenivån mellan respektive stat och medborgare. Studien förhöll sig till en kvalitativ forskningsmetod för att underlätta undersökningen av ett fenomen med avseende för medikalisering. Semistrukturerade intervjuer utformades utifrån tre huvudsakliga respondentkategorier: kritiskt, neutralt samt positivt inställda individer, i förhållande till deras antaganden för marknadsföring av vaccin och statliga mandat. Ytterligare fördelades respondenter utifrån fyra åldersgrupper för att utreda relevansen kring individens ålder och dess korresponderande förtroendenivå. Utifrån följande resultat uppkom det däremot inte någon förekommande koppling mellan dessa två variabler, det vill säga ålder och förtroende. Vidare har det påvisats att respondenternas tidigare inställningar relaterade till deras grad av socialt kapital avgjorde för individernas tillitsnivå med avseende på staten och dess implementering av vaccin mandat. Huvudsakligen påverkade respondenternas tidigare inställningar kring ämnet om vaccinering den nivå av förtroende de utgjorde för staten samt hur väl de kunde identifiera sig med den etablerade marknadsföringens budskap. Vidare slutsatser visade även på en koppling mellan graden av konsumenters relaterbarhet med avseende på marknadsföringens budskap samt deras respektive konsumentbeteende exempelvis inom de individuella respondenternas vaccinationsfrekvens.

The focus of this master’s thesis is on family-run small and medium enterprises and their adoption to information systems. The motivation for this research is to understand the family businesses’ challenges related to technology adoption, so that the level of hesitancy many family SMEs are having with the process can be understood and minimised. In addition, by understanding family businesses’ challenges related to information systems adoption, we can understand if they are different entities from non-family SMEs, and whether or not they require specialised guidance and support. To achieve the objectives of the master’s thesis, a qualitative multiple case study approach was undertaken involving three family SMEs who were interviewed using a semi-structured interview guide which was inspired by the four key contexts of the Decision-Maker-Technology-Organisation-Environment model. Upon the completion of a thematic analysis of the data, a total of seven themes emerged which can be used to help describe and answer how family SMEs perceive information systems adoption and the challenges. From the findings it was discovered that family SMEs usually hire relatives when they have a vacancy instead of hiring an individual who is more qualified and experienced in the job role, as it is easier and convenient to make use of the trusting relations between family members. In the majority of cases, this means that the family SMEs usually have a limited level of skills including IT knowledge and to overcome this issue they seek help from sources outside of their organisation. The results of this master’s thesis research show that Family SMEs usually have a positive outlook when it comes to carrying out the information systems adoption process,but despite this, hesitancy to initiate the information systems adoption process arose from the lack of awareness of the technology and its possibilities as well as the high cost of funding and setting up the information system.

Inledning: Vaccinationstveksamhet är ett fenomen som är viktigt att studera eftersom bekämpningen mot covid-19 och andra sjukdomar är beroende av att befolkningen vaccinerar sig. Området Rinkeby-Tensta har tidigare haft låg vaccinationstäckning på grund av oro över biverkningar. Syftet är att ta reda på inställningen för vaccination mot covid-19 i Rinkeby-Tensta. Metod: En tvärsnittsstudie utfördes med bekvämlighetsurval. Resultat: Resultatet visar att 72 respondenter besvarade enkäten varav 78 procent av respondenterna svarade att de antingen inte vill eller inte vet om de vill vaccinera sig. Diskussion: Utbildningsnivå är inte associerat med vaccinationsviljan. Att senarelägga vaccinacceptansen uppfattas som en fördel. Bekymmer över vaccinets biverkningar är en faktor i vaccinationsbeslutet. / Introduction: Vaccine hesitancy is a phenomenon that is important to study when the fight against covid-19 and other diseases is dependent on the population being vaccinated. Rinkeby-Tensta previously had low vaccination coverage due to concerns about side effects. The aim is to measure the attitude toward vaccination against covid -19 in Rinkeby-Tensta Method: A cross-sectional study was performed with convenience sample. Results: Results show that 72 respondents answered the survey, of which 78 percent of the respondents answered that they either do not want or do not know if they want to get vaccinated. Discussion: Level of education is not associated with willingness to get vaccinated. To postpone vaccinations is perceived as a benefit. Concerns about the side effects of vaccine is a factor in the vaccination decision.

Introduktion: Vaccin har blivit en global framgång för folkhälsan. Vaccinationer har bidragit till att flera barnsjukdomar blivit så sällsynta att de inte längre utgör hot mot samhället. Trots detta finns fortfarande en tveksamhet hos föräldrar kring barnvaccinationer. Vaccintveksamhet finns med som en punkt i WHO:s lista över tio hot mot den globala folkhälsan. Distriktssköterskor inom barnhälsovården och elevhälsovården har en viktig roll i vaccinationsarbetet. Syfte: Syftet var att belysa orsaker till föräldrars tveksamhet eller val att avstå barnvaccination. Metod: Systematisk litteraturstudie utifrån Polit &amp; Becks niostegsmodell. Databaserna som användes var Cinahl och Pubmed. Kvalitativ innehållsanalys enligt Graneheim och Lundman användes för att analysera de 16 artiklarna som användes i studien. Resultat: Består av fyra huvudkategorier; Rädsla att barnet tar skada av vaccinet, Uppfattningar om immunisering, Misstro till auktoriteter och Alternativa livstilsåskådningar. Konklusion: Det är av stor vikt att distriktssköterskan känner till varför föräldrar är osäkra eller väljer helt att avstå att vaccinera sina barn. Det finns en utmaning i att bemöta dessa föräldrar samtidigt som det kräver en bred kompetens grundat i evidens kring vaccination och folkhälsa. Målet är att bemöta barn och föräldrar på ett respektfullt och stödjande sätt när det gäller osäkerhet kring vaccinering.

People are increasingly turning to online communities for entertainment, information, and social support, among other uses and gratifications. Online communities include traditional online social networks (OSNs) such as Facebook but also specialized online health communities (OHCs) where people go specifically to seek social support for various health conditions. OHCs have obvious health ramifications but the use of OSNs can also influence people's mental health and health behaviors. The use of online communities has been widely studied but in the health context their exploration has been more limited. Not only are online communities being extensively used for health purposes, but there is also increasing concern that the use of online communities can itself affect health. Therefore, there is a need to better understand how such technologies influence people's health and health behaviors. The research in this dissertation centers on examining how online community use influences health and health behaviors. There are three studies in this dissertation. The first study develops a conceptual model to explain the process whereby the characteristics of a request from an OHC user for social support is answered by a wounded healer, who is a person leveraging their own experiences with health challenges to help others. The second study investigates how algorithmic fairness, accountability, and transparency of an OSN newsfeed algorithm influence the users' attitudes and beliefs about childhood vaccines and ultimately their vaccine hesitancy. The third study examines how OSN social overload, through OSN use, can lead to psychological distress and received social support. The research contributes theoretical and practical insights to the literature on the use of online communities in the health context. / Doctor of Philosophy / People use online communities to socialize and to seek out information and help. Online social networks (OSNs) such as Facebook are large communities on which people segregate into smaller groups to discuss joint interests. Some online communities cater to specific needs, such as online health communities (OHCs), which provide platforms for people to talk about the health challenges they or their loved ones are facing. Online communities do not intentionally seek controversy, but because they welcome all perspectives, they have contributed to phenomena such as vaccine hesitancy. Moreover, social overload from the use of OSNs can have both positive and negative psychological effects on users. This dissertation examines the intersection of online communities and health. The first study explains how the interaction of the characteristics of a request for social support made by an OHC user and the characteristics of the wounded healer drive the provision of social support. The model that is developed shows the paths through which the empathy of the wounded healer and the characteristics of the request lead to motivation to provide help to those in need on an OHC. In the second study, the role of characteristics of a newsfeed algorithm, specifically fairness, accountability, and transparency (FAT), in the development of childhood vaccine hesitancy is examined. The findings show that people's perceptions of the newsfeed algorithm's FAT increase their negative attitudes toward vaccination and their perceived behavioral control over vaccination. The third study examines how different uses of OSNs can influence the relationships between social overload and psychological distress and received social support. The findings show how OSN use can be tailored to decrease negative and increase positive psychological consequences without discontinuing use.

Vaccine Hesitancy is a critical public health issue that threatens global health security, increases rates of transmission of deadly diseases, and poses additional infectious risk to everyone. This dissertation uses records from the National Archives and Records Administration of the United States, National Archives of Mexico, World Health Organization, multiple Presidential Libraries, and an assortment of digital records to examine the historical roots of vaccine hesitancy. I argue that the choice to delay vaccination or outright refusal of vaccination often constitutes a form of political protest. This anti-vaccine sentiment has historically functioned as political protest that opposes American and Western presence in developing countries. Illustrative case studies of Pakistan and Mexico between 1947 and 1990 illustrate how the manner in which vaccines are distributed within the context of Cold War disease eradication campaigns can influence vaccine hesitancy. Horizontal vaccine programming in Mexico wherein vaccines were distributed using a robust, native public health infrastructure found more epidemiological success than Pakistani vaccination programs that relied on vertically-oriented, Western-led mass vaccination programming to mitigate the burden of infectious diseases including smallpox and polio. Rhetorical analysis of archival vaccine-related media in these countries also reflects the politicized nature of Cold War vaccine hesitancy. Additionally, this dissertation broadly considers the array of weaponry in the American diplomatic arsenal and compares the diplomatic utility of vertical mass vaccination campaigns with military assistance that was also provided to developing nations in the pursuit of American anti-communist goals in the midst of the Cold War. I argue that certain programmatic ambiguities in Cold War American Foreign Policy led to the production of a uniquely militarized form of American diplomacy. An examination of biosurveillance networks constructed to support the global eradication of smallpox and subsequently replicated to eradicate polio illustrate the long-standing historical intersection between public health programming and military force that underlie historical and modern vaccine hesitancy.