Vaccines | Free Full-Text | Mapping the Cognitive Biases Related to Vaccination: A Scoping Review of the Literature
A thematic analysis of the data in the context of current immunization strategies and a scoping review of the possible cognitive biases impacting vaccination are necessary for the evaluation of the knowledge gap. In this article, we review existing literature with the intent of understanding the theoretical investigations carried out on the effects of cognitive bias on overall vaccination. As part of the review, we provide a practical categorization scheme to assist with organizing the diverse range of cognitive bias concepts. The second goal is to evaluate the impact of cognitive bias on knowledge of vaccine dynamics and vaccination coverage, as well as suggestions for responding to cognitive bias and mitigating it.
2.1. Study Process
2.2. Search Strategy
MeSH terms including (“Vaccination” OR “Immunization”) AND (“Cognitive Bias” OR “Biases” OR “Cognitive Distortion”) were used in different combinations using Boolean operators to search articles for this study. The search strategy was designed in consultation with experts. The next step was “snowballing,” which included iteratively searching all full-text article reference lists and current reviews for any new publications that can have been appropriate for inclusion. A rigorous iterative process was used to create this review. The cited references were searched using Google Scholar and Medline, and the “similar articles” section was checked as part of the citation-tracking process.
2.4. Study Selection
2.5. Data Extraction
The qualitative data were extracted by A.R. and reviewed by A.K.S. After the initial evaluation, any disputes were addressed and settled by mutual discussion or consultation with A.L.W. and M.L.B. This review addresses the factors and biases that were most extensively prevalent.
2.6. Analysis and Data Items
Given that this was a scoping review whose primary goal was to outline the existing literature on cognitive biases impacting vaccination, a qualitative narrative synthesis was conducted.
These cognitive biases were categorized into the following three broad categories:
Group #1: Cognitive biases seen during processing vaccine-related information;
Group #2: Cognitive biases seen during vaccination-related decision-making;
Group #3: Cognitive biases due to prior beliefs regarding vaccination.
2.7. Identification of Knowledge Gaps
Different cognitive biases in vaccination were identified, and potential biases were line-listed. An evaluation of knowledge gaps was then performed. Further development focused on a methodology for prioritizing knowledge areas that need investigation.
Overall, 24 cognitive biases were found to be have the potential to affect the vaccination process.
3.1. Group #1: Cognitive Biases Seen during Processing of Vaccine-Related Information
3.2. Group #2: Cognitive Biases Seen during Vaccination Decision-Making
3.3. Group #3: Cognitive Biases Due to Prior Beliefs Regarding Vaccination
Public health professionals may use the categorized information and the observed cognitive biases to promote vaccine acceptance and confidence. Public health authorities may tailor their strategies, interventions, and other kinds of communication based on the categories presented in this review to downgrade the effects of cognitive biases associated with poor vaccination decisions. In group #2, cognitive biases may be considered first to be targeted. An attempt may be made to improve vaccine decision-makers’ perceptions of uncertainty, ambiguity, and loss in relation to the outcomes of immunization. Program managers may utilize the specific tools to address the cognitive biases in group #2 as well as mechanisms to inform caregivers about vaccine safety and adverse events (AEs) based on the existing evidence in a manner that enhances confidence in immunization programs.
Despite our efforts to detect cognitive biases related to vaccination and decision-making about vaccination in accordance with the guidelines of a scoping review, the outcome cannot be regarded as a systematic review. The proposed remedies for cognitive biases, the underlying causes of each cognitive bias and how they affect behavior, and the specific mechanisms by which the cognitive biases create transitions between phases have not been discussed. This may also apply to elements not included in our research, such as proposed therapies, the root causes of cognitive biases, transitional processes between phases, and the use of other grounded health-behavior models. Furthermore, the articles that were subsequently cited and included in this review may have been influenced by publication bias. Also, this study did not include any quality assessment of biases in the included articles.
Vaccine reluctance has become an increasingly pressing public health challenge that has been observed during the course of the COVID-19 pandemic and continues to pose a challenge. In order to promote innovative approaches to increasing vaccine acceptability and building confidence in the community, an understanding of the impact of relevant cognitive biases is important. This review has attempted to highlight possible cognitive biases that influence vaccination decision-making and communication. These findings might be beneficial for immunization program managers, policymakers, and immunization communication officials to devise multipronged communication strategies to address cognitive biases associated with an intent to boost vaccine acceptance and improve confidence in vaccine uptake decision-making by parents, the elderly, and adolescents. The cognitive biases identified to be part of three broad categories (seen during the processing of vaccine-related information, seen during vaccination-related decision-making, and due to prior beliefs regarding vaccination) can be helpful in exploring their relative influence on immunization acceptance or aversion in future studies.
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