• Angela Tufvesson - Hong Kong

1Q5A: How personality traits shape attitudes to vaccination

Emerging research shows personality and psychosocial factors impact influenza vaccination rates in surprising ways. Professor André Hajek and Professor Hans-Helmut König from the Hamburg Center for Health Economics in Germany explain how understanding individual differences can increase the willingness to vaccinate.

(PART 5 of 5) Re:solve Global Health’s latest Q&A series examines the positive association between influenza vaccination and cardiovascular health. We asked five experts in diverse locations, and from varied backgrounds, including cardiology, pharmaceuticals, and health economics, to answer this crucial question: How can we make best use of influenza vaccination to improve cardiovascular health?

How do psychological factors impact influenza vaccination uptake?

Our research has shown that lower levels of self-esteem and a higher level of perceived stress are associated with an increased likelihood of getting regular flu shots among people aged 60 and over in Germany.

The findings were quite unexpected for us, and in contrast to our initial hypotheses. They may be explained by the fact that people with high self-esteem have been shown to use cognitive methods more frequently to reduce the negative effects of their own risky behaviour compared to people with low self-esteem. This is plausible given the fact that a high self-esteem is not associated with one’s own accomplishments or favourable experiences.

Due to this tendency to dismiss unfavourable information and delude themselves that negative consequences of their actions are impossible, people with high self-esteem are more likely to engage in dangerous behaviours including drug use and alcohol consumption. This may explain our identified association.

Moreover, higher levels of perceived stress are associated with higher anxiety levels. Higher anxiety levels are commonly associated with increased concerns about consequences of getting a flu. This could drive the vaccination rates.

How do interpersonal relationships influence influenza vaccination rates?

In a longitudinal study, we found that higher loneliness is associated with decreased use of the flu vaccine within the same group—people aged 60 and over in Germany.

The research is still in its infancy, but it may be explained by the fact that taking the flu vaccine may not be perceived as the social norm among individuals scoring high in loneliness, because they may not have perceived social pressure to use such services by relatives or friends.

People scoring high in loneliness may also have a general lack of motivation to use such preventive healthcare services.

How can we use these findings to influence vaccination rates at a population level?

We think clinicians and policymakers could be increasingly aware of personality-related factors like conscientiousness and psychosocial factors like loneliness, and use this knowledge to increase the willingness to vaccinate.

Personality traits can change throughout the lifespan, and efforts to increase conscientiousness—one of the Big Five personality traits that reflects a tendency to be responsible, goal-directed and adhere to norms—may be beneficial.

In a systematic review, we showed that conscientiousness is positively associated with the use of cancer screenings, a preventive action which is at least somewhat comparable to flu vaccination.

Specially designed apps can guide self-reflection as well as new behaviours, provide feedback on progress, and remind people to make self-formulated if-then plans, where they commit to doing a certain thing in a specific situation to encourage behaviour change.

Should there be greater focus on the psychological determinants of influenza vaccination?

Research on the effects of psychosocial and personality factors on the utilisation of preventive services is still in its infancy, especially in low- and middle-income countries (LMICs); so, statements must still be made with caution.

However, the findings to date already indicate that precisely such factors, in addition to classic factors such as socioeconomic status, age and gender, can contribute to explaining differences in the utilisation of preventive services like influenza vaccination.