What is the evidence for...

…the 11 attitude roots

The roots are the result of an extensive study by the JITSUVAX team, who created a ‘taxonomy’ of arguments against vaccination. Through a systematic literature review of 152 scientific articles and thematic analysis of 2,414 anti-vaccination arguments, we developed a hierarchical taxonomy of anti-vaccination arguments that not only identifies 62 common and recurring themes, but, crucially, relates the arguments to 11 attitude roots that explain why an individual might express opposition to vaccination.

This taxonomy has been validated in both linguistic and psychological terms. First, we used a dataset of COVID-19 anti-vaccine misinformation to develop a computational model through a combination of human coding and machine learning algorithms. The human coders identified attitude roots for a sample of 582 debunked claims about COVID-19 vaccinations, and the natural language processing model predicted these assigned roots with considerable skill.

Second, we recruited 1,250 participants from the British general population to measure how much they endorsed anti-vaccination arguments expressing the themes in the taxonomy. We found using a factor analysis that endorsement of arguments from all the 11 attitude roots was best modelled as a single variable reflecting the strength of participants’ belief in anti-vaccination arguments, and this belief strength was significantly predicted by 11 well-established psychological measures expected to be associated with the attitude roots.

In addition, using all the attitude roots, we found that the attitude roots tended to cluster in distinct personality profiles and we identified 4 anti-vaccination and 4 pro-vaccination profiles amongst our participants’ responses to the psychological measures, which help to understand how the attitude roots are related. In short, this taxonomy serves as a validated theoretical framework to link expressed opposition of vaccines to their underlying psychological processes.

…the effectiveness of the responses on this site?

The responses on this site are based on the Empathetic Refutational Interviewing methodology developed by the JITSUVAX team. The four steps of the ERI build on a large body of scientific research from psychology and public health on changing misinformed beliefs, vaccine acceptance, and patient communication.

The ERI protocol itself has been specifically tested by simulating it with nearly 3,000 members of the public from the UK and US, particularly those with non-positive vaccination opinions. JITSUVAX researchers conducted a series of online randomised controlled experiments to test the components of the ERI independently and also as a combined package. These experiments found that:

  • Eliciting vaccination concerns through asking participants to explain their reasoning is an important and viable first step: talking about their negative position on vaccines did not make participants any more endorsing of anti-vaccination arguments. Thus, we can open the conversation by eliciting concerns without worrying that patients would be more entrenched in their position.
  • Participants were consistently more supportive towards a doctor using the ERI-based technique than a doctor who directly refuted anti-vaccination arguments (without affirming their patient first) or simply asserted the safety and efficacy of vaccines without affirmation or tailoring their response. Affirmation is thus a critical step to maintain a relationship during the conversation.
  • Tailored refutations were more compelling to participants, who were also more trustful and open to the doctor giving the refutation than if the doctor did not tailor the refutation. This step thus helps to maintain the relationship and build receptivity to the belief correction as well as further information one might wish to give.
  • Participants increased in vaccine acceptance after reading factual information about vaccinations, herd immunity, and the risks of a disease, accompanied by illustrations. Our own findings here echo decades of previous research that also found that when people understand these facts, their acceptance of vaccines tends to increase.
  • Overall, the ERI was the best compared to various control conditions at reducing the strength of people’s anti-vaccination argument beliefs, increasing vaccine acceptance, while also generating support, trust, and receptivity towards the doctor having the conversation.

The ERI has also been tested in a randomised controlled experiment with 201 Health Care Professionals (HCPs) from the UK and 120 from Finland to gauge their response to the technique. JITSUVAX researchers presented HCP participants with text scenarios featuring a HCP and patient (or caregiver) interacting either using the ERI or control scenarios where the HCP only gave the patient/caregiver vaccination facts.

Participants in the study felt the HCPs using the ERI handled the conversation with the patient better than the HCPs who only gave facts. When asked to describe how they would approach a discussion with patients who had similar vaccination concerns, participants who read about the ERI more often described being empathetic and affirmative to patients than participants who read about the facts-only approach.

The ERI is undergoing field tests in 2023/2024.

Further information about JITSUVAX can be found here.

Reports on our work are here.

Our scientific publications are listed here.