This dissertation is an examination of trust in vaccine science, with a focus on ideas about vaccination outside the scientific consensus. It is grounded in empirical research, including 35 interviews and a review of publicly available documents, books, and academic articles. Theoretically, it is informed by theories in the sociology of science, social movements, and the sociology of expertise. In substantive chapters, it investigates the origins of the modern ‘anti-vaccine’ movement, the spread of the movement's ideas in different sociocultural and political contexts, and the perspectives and personal experiences of those who are part of the movement. Overall, it contributes to a growing body of literature that aims to change the conversation around vaccine hesitancy from an information-deficit problem to an issue about trust in institutions. The dissertation is organized into three main papers. The first is an analysis of a specific historic episode, namely the 1998 MMR (measles, mumps, rubella) vaccine-autism controversy. I find that institutional incentive structures unintentionally circulated misinformation about the MMR vaccine by former medical doctor Andrew Wakefield and posit the role that academic reward structures have in fostering public trust. The second paper examines vaccine hesitancy with a social movement lens, specifically focusing on the strategies used by the anti-vaccine movement to organize and frame their message. I introduce the concept of an ‘anti-scientific intellectual movement’ to understand the increasing trend of social groups opposing science as a set of institutions. The third paper is a study of the lived experiences of participants who were interviewed in 2019 about their views on vaccination and how their individual experiences and meaning-making activities impacted their trust in vaccine science. I find strong distrust in scientific institutions, a desire for open dialogue and debate, and dissatisfaction with the ‘anti-vaccine’ label which participants felt erased the nuance in their perspectives. Altogether, this dissertation makes significant contributions to ongoing discussions about the public face of science and how to effectively engage with public audiences to build trust. / Dissertation / Candidate in Philosophy

At the beginning of 2020, the SARS-CoV-2 virus, known more commonly as COVID-19, created a pandemic. To slow its spread, healthcare workers were heavily encouraged to vaccinate themselves. However, nurses have been less likely to be vaccinated against COVID-19 than physicians. Four common themes have been associated with vaccine hesitancy among nurses, namely certain demographic variables (e.g., younger age and female sex), fears of the vaccine, conspiracy theories and news sources, and medical and psychological histories that pertain to receiving the COVID-19 vaccine. Thus, this study aimed to identify whether these factors apply to Florida nurses' decisions to get vaccinated after the height of the pandemic. To approach this problem, sixty-five participants were surveyed through a Qualtrics cross-sectional questionnaire. The results revealed that approximately 18.5% of participants were not vaccinated. Trends in the data revealed that older age and a postgraduate education level were associated with receiving the vaccine. Non-vaccinated participants had less confidence in the vaccine's ability to reduce the risk of hospitalization, death, and infection, and they had a stronger fear of side effects and the vaccine's rapid development. Several vaccinated and non-vaccinated participants also believed vaccine conspiracy theories, such as that vaccine safety data is falsified. Many non-vaccinated nurses also received SARS-CoV-2 information from social media or their patients, whereas many vaccinated nurses received information from government news sources or physicians. Non-vaccinated nurses also tended to have more discomfort towards hypodermic injections than vaccinated nurses. These conclusions are generalizable to the nurses of this study and may not be generalizable to all nurses. However, because nurses are on the frontlines of the healthcare field and have an essential role in informing the public about health, the results of this study can help inform vaccine education interventions should a future pandemic occur.

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.

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.

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.

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.