COGNITIVE-PROCESSES AND THE DECISIONS OF SOME PARENTS TO FORGO PERTUSSIS VACCINATION FOR THEIR CHILDREN

Public health analyses suggest that, in spite of the possibility that pertussis vaccine may cause rare cases of neurological injury, catastr ophic risks to individual children are lower if they are vaccinated. A number of parents, however, choose not to vaccinate their children. T he purpose of this study was to investigate the decision processes of some parents who choose to vaccinate and some parents who choose not t o do so. Surveys were mailed to 500 randomly selected subscribers of M othering magazine. Two hundred and ninety-four completed questionnaire s were returned (59%). In addition to well-recognized factors in vacci nation decisions, perceived dangers of the vaccine, and of the disease and susceptibility to the disease, several cognitive processes not pr eviously considered in vaccination decision studies were found to be i mportant predictors in this population of parents: perceived ability t o control children's susceptibility to the disease and the outcome of the disease; ambiguity or doubts about the reliability of vaccine info rmation; a preference for errors of omission over errors of commission ; and recognition that if many other children are vaccinated, the risk to unvaccinated children may be lowered. Although perhaps most cases of undervaccination for pertussis reflect more general problems of hea lth care access, some parents choose to forego vaccination for their c hildren for other reasons. Traditional risk-benefit arguments alone wi ll be unlikely to persuade these parents to reassess their decisions. Efforts to increase childhood vaccination must incorporate an understa nding of the cognitive processes that help drive these decisions.