Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review
Affiliation
Department of Health Communication, School of Public Health, The University of Tokyo
Date
Summary
"Messages targeting the anticipated affect may be equally or more effective in encouraging HPV vaccination than those targeting cognitive beliefs."
In light of low uptake of human papillomavirus (HPV) vaccines in many countries, there is a need for government agencies and healthcare professionals to continue to communicate with individuals and communities to encourage HPV vaccination. Previous research on HPV vaccination promotion has adopted behavioural models, such as the health belief model and theory of planned behaviour, with a focus on cognitive beliefs. Recent studies have also examined the affective (self-conscious emotional) determinants of health behaviours as a complement to cognitive-behavioural models. For example, anticipated affect, which is the expectation of an affective response to the behaviour (e.g., "If I do not receive the HPV vaccine, I will feel regret"), has received attention. This paper reviews studies that examined anticipated affect associated with HPV vaccination to identify gaps in the literature and practice implications for encouraging HPV vaccination.
On July 18 2022, the researchers systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles published in or after 2000 that quantitatively and qualitatively examined anticipated affect in connection to HPV vaccination. Twenty-one studies were identified. Seventeen studies examined "anticipated inaction regret" (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behaviour, intention, willingness, and acceptability. Furthermore, 7 studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity.
In discussing gaps in the literature, the researchers observe that the current review found no study on HPV vaccination examined "anticipated inaction guilt". Regret arises when an individual's action or inaction results in a negative outcome for oneself. By contrast, guilt arises when an individual's action or inaction results in a negative outcome for another person. As a result, if daughters develop cervical cancer due to their inability to receive the HPV vaccination, their parents may feel guilty for not allowing them to receive the vaccine. Furthermore, if their daughters experience vaccine-related adverse events after receiving an HPV vaccination, their parents may feel guilty about vaccinating them. Therefore, future studies should examine the effects of anticipated inaction and action guilt on HPV vaccination.
Furthermore, as outlined here, future studies should examine anticipated guilt in terms of gain- and loss-framed appeals, which might differ in the likelihood of evoking parental anticipated guilt. A gain-framed message such as "if you have your daughter receive HPV vaccine, your daughter will be protected against disease" may be less likely to evoke anticipated guilt than a loss-framed message, such as "if you do not have your daughter receive HPV vaccine, your daughter will not be protected against disease", because the latter message specifically points to situations that may evoke guilt in a way that the former message does not. Thus, anticipated affect can be a potential moderator and mediator in gain- and loss-framed appeals.
The present review found that most of the quantitative studies (thirteen studies) adopted a cross-sectional design, so future studies should examine the anticipated affect toward HPV vaccination using experimental designs to accumulate stronger evidence. In addition, the gap between self-reported vaccination behaviour and actual vaccination should be determined because self-reported behavior can be influenced by social desirability and recall biases. Hence, future studies should examine actual HPV vaccination as an outcome.
In conclusion, this review found that anticipated affects were associated with HPV vaccination outcomes and may influence people's vaccination decisions. It is suggested here that government agencies and health professionals use messages that can target the anticipated inaction negative affect, such as regret (e.g., "if you do not receive HPV vaccination, you will feel regretful when you develop HPV-related diseases in the future"), as well as messages based on cognitive-behavioural models that, for instance, convey perceived susceptibility and severity, as well as vaccine effectiveness and safety.
In light of low uptake of human papillomavirus (HPV) vaccines in many countries, there is a need for government agencies and healthcare professionals to continue to communicate with individuals and communities to encourage HPV vaccination. Previous research on HPV vaccination promotion has adopted behavioural models, such as the health belief model and theory of planned behaviour, with a focus on cognitive beliefs. Recent studies have also examined the affective (self-conscious emotional) determinants of health behaviours as a complement to cognitive-behavioural models. For example, anticipated affect, which is the expectation of an affective response to the behaviour (e.g., "If I do not receive the HPV vaccine, I will feel regret"), has received attention. This paper reviews studies that examined anticipated affect associated with HPV vaccination to identify gaps in the literature and practice implications for encouraging HPV vaccination.
On July 18 2022, the researchers systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles published in or after 2000 that quantitatively and qualitatively examined anticipated affect in connection to HPV vaccination. Twenty-one studies were identified. Seventeen studies examined "anticipated inaction regret" (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behaviour, intention, willingness, and acceptability. Furthermore, 7 studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity.
In discussing gaps in the literature, the researchers observe that the current review found no study on HPV vaccination examined "anticipated inaction guilt". Regret arises when an individual's action or inaction results in a negative outcome for oneself. By contrast, guilt arises when an individual's action or inaction results in a negative outcome for another person. As a result, if daughters develop cervical cancer due to their inability to receive the HPV vaccination, their parents may feel guilty for not allowing them to receive the vaccine. Furthermore, if their daughters experience vaccine-related adverse events after receiving an HPV vaccination, their parents may feel guilty about vaccinating them. Therefore, future studies should examine the effects of anticipated inaction and action guilt on HPV vaccination.
Furthermore, as outlined here, future studies should examine anticipated guilt in terms of gain- and loss-framed appeals, which might differ in the likelihood of evoking parental anticipated guilt. A gain-framed message such as "if you have your daughter receive HPV vaccine, your daughter will be protected against disease" may be less likely to evoke anticipated guilt than a loss-framed message, such as "if you do not have your daughter receive HPV vaccine, your daughter will not be protected against disease", because the latter message specifically points to situations that may evoke guilt in a way that the former message does not. Thus, anticipated affect can be a potential moderator and mediator in gain- and loss-framed appeals.
The present review found that most of the quantitative studies (thirteen studies) adopted a cross-sectional design, so future studies should examine the anticipated affect toward HPV vaccination using experimental designs to accumulate stronger evidence. In addition, the gap between self-reported vaccination behaviour and actual vaccination should be determined because self-reported behavior can be influenced by social desirability and recall biases. Hence, future studies should examine actual HPV vaccination as an outcome.
In conclusion, this review found that anticipated affects were associated with HPV vaccination outcomes and may influence people's vaccination decisions. It is suggested here that government agencies and health professionals use messages that can target the anticipated inaction negative affect, such as regret (e.g., "if you do not receive HPV vaccination, you will feel regretful when you develop HPV-related diseases in the future"), as well as messages based on cognitive-behavioural models that, for instance, convey perceived susceptibility and severity, as well as vaccine effectiveness and safety.
Source
Vaccines 2023, 11(1), 124; https://doi.org/10.3390/vaccines11010124. Image credit: Any Lane via Pexels (free to use)
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