The Common Way in Which the Ministry of Health Conveys Information to the Public: A Simulation Among Israeli Parents with Different Attitudes and Behaviors Regarding Vaccination During a Measles Outbreak in Israel

"[H]ealth organizations need to foster trustworthiness among all the groups regarding vaccination, especially pro-vaccination individuals with hesitant attitudes who may eventually become hesitant also in behavior."

In the context of a vaccine-preventable disease outbreak, it is recommended that health authorities address the public's fears and concerns in order to gain their trust, while finding ways to challenge misinformation about vaccination that may be circulating online or in interpersonal communication circles. This study was conducted during the measles outbreak in Israel in January 2020. At that time, the authorities tried to impose sanctions to prevent unvaccinated children from entering kindergarten. The study examines how groups with different attitudes and behaviours regarding vaccination responded to health organisations' way of communicating information during an epidemic outbreak.

The study included 150 parents whose children were in kindergarten (aged 3-5 years). The first stage presented a dilemma for parents about whether or not to send their children to kindergarten during a measles outbreak, knowing that some kindergarten children were not vaccinated because of their parents' objection. In the next stage, they were shown a post written by the mother of one of the kindergarten children containing information about measles and about the measles vaccine. In the third stage, the participants were shown a response by the official health authority (such as the Ministry of Health), trying to correct the information in the mother's post. The correction was formulated based on previous statements of the Ministry of Health, which disregarded the public's fears and concerns in relation to the mother who had written the post and the other parents.

Using survey questions, the researchers classified the participants according to their actual vaccination behaviour (115 pro-vaccination participants, 35 vaccine-hesitant participants), according to their vaccination attitudes (114 participants with pro-vaccination attitudes and 36 participants with hesitant attitudes), and using a combination of their vaccination attitude and vaccination behaviour (102 pro-attitude/ pro-behaviour (PA/PB) participants, 12 pro-attitude/ hesitant-behaviour (PA/HB) participants, 13 hesitant-attitude/ pro-behaviour participants (HA/PB), and 23 hesitant-attitude/ hesitant-behaviour (HA/HB) participants.

A significant difference was found among the various groups regarding the extent of their trust in the Ministry of Health (χ2(3) = 46.33; P < 0.0001), where the lowest level of trust was found among the HA/HB group (M = 3.74). Similar findings apply to the reliability of the Ministry of Health's response (χ2(3) = 31.56; P < 0.0001), satisfaction with the Ministry of Health's response (χ2(3) = 25.25; P < 0.0001), and the level of help they felt the Ministry of Health's tools provided them regarding vaccine-related decision making (χ2(3) = 27.76; P < 0.0001). However, an insignificant difference was found between the vaccination attitude/behaviour groups according to information seeking (χ2(3) = 0.59; P = 0.8987). That is, this study indicates that most participants in all 4 vaccination groups reported they would continue seeking further information, even after reading the Ministry of Health's response to the post on social media. In other words, even the PA/PB finds the information they receive from the Ministry of Health insufficient.

In short, the findings indicate that groups with pro-vaccination attitudes have a higher level of trust in the Ministry of Health than groups with hesitant attitudes. This finding can be explained by the cognitive dissonance theory, which proposes that people seek psychological consistency about their attitudes, beliefs, and behaviours. Inconsistency between attitudes and behaviour is a primary type of cognitive dissonance, which may create psychological tension. This theory argues that some individuals resolve the dissonance by blindly trusting in whatever they want to believe, or by avoiding contradictory information that is likely to increase the magnitude of the cognitive dissonance. Consistently, this study indicates that individuals with a higher level of trust in the Ministry of Health tend to be PA/PB in order to attain psychological consistency between their attitudes and behaviour, and to avoid cognitive dissonance. Therefore, a higher level of trust among the groups with pro-vaccination attitudes leads to a higher level of trust in the safety and effectiveness of vaccines (which are promoted by the Ministry of Health), eventually resulting in behaviour that reflects vaccination acceptance, and vice versa.

In addition, these findings show that the pro-vaccination (in behaviour) group members with hesitant attitudes do not trust the information they receive from the Ministry of Health. However, their trust issues have not yet had an impact on their behaviour. This situation may change at some point, making these individuals hesitant in their behaviour in the future. Different interpretations may be offered to explain why a group expressing hesitant attitudes still chooses to vaccinate, despite their low level of trust in the health organization. For example, social norms were found to play a powerful role in vaccination-related decisions in several studies. Another interpretation of the gap between hesitant attitudes and pro-vaccination behavior may be attributed to risk perception. Parents may choose to vaccinate their children despite their concerns and fears because of a low-risk perception of adverse effects.

"In summary, the study findings emphasize the importance of trust as a central component in shaping the public’s attitudes and behaviors....In order to gain the public's trust, health organizations are required to change their traditional communication methods and adopt a new communication strategy based on communicating transparent and complete information, while addressing the public's fears and concerns."