Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 375

Beliefs about nonfi nancial costs also represent a barrier to vaccination. In a US
study, 17% of non-vaccinated nurses said they were too busy to get a fl u vaccination
(Clark et al. 2009 ).
Norms
Subjective norms refer to a person's perception of the degree to which important
others (referents) think he or she should or should not perform the behavior (e.g.,
“people who are important to me would approve/disapprove of my having a swine
fl u vaccination”), and the person's motivation to comply with these referents (e.g.,
“people who are important to me infl uence my decision to have a swine fl u vaccina-
tion,” Myers and Goodwin 2011 ). Potential referents include governments, medical
societies, physicians, family members, friends, and celebrities (e.g., “I heard a TV/
movie personality suggest not getting the fl u vaccine,” Flood et al. 2010 ). Subjective
norms, also called “injunctive norms,” have been complemented by “descriptive
norms,” which refer to perceptions of what others are doing (Smith-McLallen and
Fishbein 2008 ) (e.g., “most people I know vaccinate their children for the seasonal
fl u,” Flood et al. 2010 ).
Making vaccination mandatory can raise vaccination rates substantially (Averhoff
et al. 2004 ; Kharbanda et al. 2010 ; Salmon et al. 2006 ; Abrevaya and Mulligan
2011 ). However, Doyle et al. ( 2010b ) found no correlation between meningitis vac-
cination rates and vaccination requirements across US states. Because most vacci-
nation mandates and recommendations concern young children and selected groups
of at-risk adults (diabetes, asthma, etc.), they may contribute to the higher vaccina-
tion rates observed among these groups compared to adolescents and adults not at
risk. However, because mandatory vaccinations usually are subsidized, the impact
of the mandate is confounded with the price impact. Mandatory vaccination may
trigger reactance behavior (Brehm and Brehm 1981 ), by which people take mea-
sures to restore their perception of personal choice.
Whether or not a health care professional recommends vaccination, and the strength
of the recommendation has a strong impact on a consumer's vaccination decision. Lack
of provider recommendation was the most important factor explaining failure to receive
the hepatitis vaccine A (Bardenheier et al. 2003 ). Among insured women aged 19-26
years, those who discussed the HPV vaccine with their physician and received a
recommendation were overwhelmingly more likely to be vaccinated, and the likeli-
hood of vaccination was 4 times as high when the recommendation was strong
compared with when the recommendation was not strong (Rosenthal et al. 2011 ).
More generally, the belief that people's importance to self and support vaccina-
tion is positively associated with vaccination intention and behavior (e.g., Allen
et al. 2010 ; Flood et al. 2010 ; Myers and Goodwin 2011 ). For example, young
women who felt their mothers might not want them to be vaccinated were much less
likely to complete the three-dose HPV vaccine series than those who felt their moth-
ers would “defi nitely” want them to be vaccinated (Moore et al. 2010 ). One study
found no direct infl uence of subjective norms on parents' vaccination intentions