Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 372

13.3.2.2 Determinants of Consumers' Vaccination Behavior

Differences in consumers' vaccination behavior have been related to socio-
demographic and social psychological variables.
Socio-demographic variables associated with vaccination include age, health
status, gender, education, income, profession, race/ethnicity, and religion. For
example, being aged 65 years and over or suffering from chronic illness or working
in the medical fi eld was the strongest predictor for having received the infl uenza
vaccination across 11 European countries (Endrich et al. 2009 ). Increasing parental
educational attainment was signifi cantly associated with higher infl uenza vaccina-
tion uptake among US college dormitory students (Uddin et al. 2010 ). Combined
seasonal or H1N1 infl uenza vaccination coverage among the US population aged
≥

6 months was higher among non-Hispanic whites compared with non-Hispanic
blacks and Hispanics (Setse et al. 2011 ). Religion was negatively associated with
vaccination in the United States (Doyle et al. 2010a ) and the Netherlands (Ruijs
et al. 2011 ).
Many studies have investigated relationships between social psychological vari-
ables and vaccination intentions and behavior. The main conceptual frameworks under-
lying these studies are the health belief model (Becker 1974 ; Becker et al. 1974 ;
Rosenstock 1974 ), Rogers' protection motivation theory (Rogers 1975 , 1983 ), the
theory of reasoned action (Fishbein and Ajzen 1975 ), and the theory of planned behav-
ior (Ajzen 1988 , 1991 ). The key constructs of these frameworks tend to overlap and
include the following: (1) the perceived threat from a disease, (2) the attitude toward
vaccination, (3) norms, and (4) behavioral control/self-effi cacy beliefs. Additional fac-
tors investigated include anticipated regret and past vaccination behavior.

Perceived Threat/Risk from a Disease

The perceived threat or risk from a disease (e.g., Brewer et al. 2004 ; Chapman and
Coups 2006 ; Weinstein et al. 2007 ) is a key construct in the health belief and protection
motivation models. The perceived risk from infl uenza was signifi cantly positively asso-
ciated with medical students' vaccination intentions (Betsch and Wicker 2012 ). A low
perceived risk of contracting pertussis was the main reason for not receiving tetanus
diphtheria acellular pertussis (Tdap) vaccination (Miller et al. 2011 ). Perceived risk is
based on the perceived likelihood of getting a disease (personal vulnerability/suscepti-
bility) and the perceived seriousness or severity of the disease. Both can vary greatly
across different ethnic groups (Timmermans et al. 2005 ).
The perceived likelihood of getting a disease is infl uenced by its prevalence,
which economists see as an important driver of the demand for prevention: the
higher (lower) the prevalence, the higher (lower) the demand for prevention
(Philipson 2000 ). The prevalence-elasticity hypothesis predicts that the growth of
infectious diseases is self-limiting because rising prevalence motivates preventive
action such as vaccination, which reduces prevalence. It also predicts that vaccina-
tion success lays the ground for the return of an infectious disease because it reduces