Intellectual humility’s association with vaccine attitudes and intentions

Abstract

Vaccinations are critical to public health but uptake levels remain suboptimal. Intellectual humility, a virtue characterized by nonjudgmental recognition of one’s own intellectual fallibility, may support the promotion of favorable vaccine attitudes. The current study investigated whether intellectual humility is related to anti-vaccination attitudes and intentions to vaccinate against the flu. Through an online survey management system, participants (N = 246, Mage = 39.06 years, SDage = 10.57, 50.80% female, 79.20% White, 6.50% Black/African American, 7.80% Asian, 1.20% Hispanic/Latino, and 5.30% Other) completed a measure for intellectual humility, the anti-vaccination attitudes (VAX) scale, and a three-item flu vaccine intention scale. We found that intellectual humility negatively correlated with anti-vaccination attitudes. This correlation was largely driven by openness to revising one’s viewpoint and lack of intellectual overconfidence. Additionally, we found that intellectual humility did not relate to flu vaccination intentions. Finally, we discuss the implications of these findings and their potential to support the eventual development of strategies to leverage intellectual humility into a health promotion strategy.

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Intellectual humility’s association with vaccine
attitudes and intentions
Amy R. Senger & Ho P. Huynh
To cite this article: Amy R. Senger & Ho P. Huynh (2020): Intellectual humility’s association with
vaccine attitudes and intentions, Psychology, Health & Medicine
To link to this article: https://doi.org/10.1080/13548506.2020.1778753
Published online: 16 Jun 2020.
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Intellectual humility’s association with vaccine attitudes
and intentions
Amy R. Senger
a
and Ho P. Huynh
b
a
Department of Psychology and Philosophy, Sam Houston State University, Huntsville, TX, USA;
b
Department of Science and Mathematics, Texas A&M University-San Antonio, San Antonio, TX, USA
ABSTRACT
Vaccinations are critical to public health but uptake levels remain
suboptimal. Intellectual humility, a virtue characterized by nonjudg-
mental recognition of one’s own intellectual fallibility, may support the
promotion of favorable vaccine attitudes. The current study investi-
gated whether intellectual humility is related to anti-vaccination atti-
tudes and intentions to vaccinate against the u. Through an online
survey management system, participants (N = 246, M
age
= 39.06 years,
SD
age
= 10.57, 50.80% female, 79.20% White, 6.50% Black/African
American, 7.80% Asian, 1.20% Hispanic/Latino, and 5.30% Other) com-
pleted a measure for intellectual humility, the anti-vaccination atti-
tudes (VAX) scale, and a three-item u vaccine intention scale. We
found that intellectual humility negatively correlated with anti-
vaccination attitudes. This correlation was largely driven by openness
to revising one’s viewpoint and lack of intellectual overcondence.
Additionally, we found that intellectual humility did not relate to u
vaccination intentions. Finally, we discuss the implications of these
ndings and their potential to support the eventual development of
strategies to leverage intellectual humility into a health promotion
strategy.
ARTICLE HISTORY
Received 1 November 2019
Accepted 2 June 2020
KEYWORDS
Intellectual humility;
vaccination; vaccine
attitudes; vaccination
intentions; flu
In 2017, only 33.4% of young and middle age adults received the flu vaccine (Centers for
Disease Control and Prevention; CDCP, 2017). Vaccinating against the influenza virus
can lower the chance of contracting the virus and is crucial for public health (CDCP,
2018); however, vaccination uptake remains suboptimal. Intellectual humility, a virtue
characterized by having a ‘nonthreatening awareness of one’s intellectual fallibility’
(Krumrei-Mancusco & Rouse, 2016, p. 210), may help counter this trend. In this study,
we investigated whether intellectual humility is related to vaccine attitudes and intention
to vaccinate against the flu virus.
Intellectual humility
Although various definitions of intellectual humility exist (e.g. Davis et al., 2016; Hoyle
et al., 2016; Samuelson et al., 2015), in this paper, we subscribed to a multidimensional
conceptualization of intellectual humility, which has four facets (Krumrei-Mancusco &
CONTACT Ho P. Huynh hhuynh@tamusa.edu Department of Science and Mathematics, Texas A&M University-
San Antonio, San Antonio, TX 78224, USA
PSYCHOLOGY, HEALTH & MEDICINE
https://doi.org/10.1080/13548506.2020.1778753
© 2020 Informa UK Limited, trading as Taylor & Francis Group

Rouse, 2016). First, independence of intellect and ego allows a person to be secure in their
own opinions. Second, openness to revising one’s viewpoint facilitates change in one’s
opinion when faced with convincing alternative evidence. Third, respect for other’s
viewpoints allows civil discourse to take place when discussing concepts or ideas despite
holding a conflicting view. Finally, lack of intellectual overconfidence helps one avoid
intellectual hubris.
Intellectual humility is often studied within contentious topics such as religion and
politics (Hoyle et al., 2016; Leary et al., 2017; Porter & Schumann, 2018). For example,
prior research demonstrates that people high in intellectual humility are less willing to
perceive their religious views as superior and are more likely to label essays arguing the
opposing religious view as accurate (Leary et al., 2017). Relatedly, researchers have found
that intellectually humble pastors were more tolerant of diverse religious views (Hook
et al., 2017). Regarding politics, research indicated that intellectually humble people were
more likely to seek dissenting opinion articles about a contentious topic than articles
confirming their own views (Porter & Schumann, 2018). These findings especially
illustrate intellectual humility’s facet of openness to revising one’s viewpoint.
Furthermore, intellectual humility is also studied within areas of cognition (Krumrei-
Mancuso et al., 2019). Intellectual humility’s facet of lack of intellectual overconfidence
appears to take the center stage in the topic of cognition. For instance, people with low
intellectual humility are known to overestimate their performance on cognitive tests
(Krumrei-Mancuso et al., 2019). When people overestimate their performance, it indi-
cates an inflated view of self, which is inconsistent with the facet of lack of intellectual
overconfidence. Furthermore, intellectual humility has a positive association with scores
of general knowledge (Krumrei-Mancuso et al., 2019), which indicates that people who
are intellectually humble are more knowledgeable in general. This relationship may exist
because intellectually humble people are open to new information or because of their
curiosity and mastery orientation (Krumrei-Mancuso et al., 2019).
These findings across different topics suggest that intellectual humility may help
transcend a range of controversial beliefs (Hoyle et al., 2016) because it allows for civil
discourse to occur and it may increase people’s openness to opposing views. Increasing
people’s openness to opposing views is particularly important within vaccination
research because people who know less about vaccinations inaccurately perceive them-
selves as knowing as much or more than healthcare professionals (Motta et al., 2018).
Intellectual humility shows promise for applications in vaccination research because of
its potential to open people to alternative views and its association with higher levels of
knowledge. In particular, people who are high in intellectual humility may be more
willing to reject inflexible anti-vaccination attitudes and may be more willing to consider
vaccinating.
Attitudes toward vaccination
Vaccination attitudes are positive, negative, or neutral evaluations of vaccines (see Eagly
& Chaiken, 1993). Recent research on anti-vaccination attitudes has conceptualized anti-
vaccination attitudes as a multidimensional construct with four facets (Martin & Petrie,
2017). The first facet, mistrust of vaccine benefit, illustrates people’s disbelief in vaccines’
ability to protect against infectious diseases. For example, someone who does not trust in
2A. R. SENGER AND H. P. HUYNH

the flu vaccine’s ability to protect against the flu would most likely have anti-vaccination
attitudes. The second facet of anti-vaccination attitudes is worries about vaccine’s unfore-
seen future effects. A person who has anti-vaccination attitudes may have concerns about
vaccines causing unforeseen complications. The third facet of anti-vaccination attitudes
are concerns about commercial profiteering. Due to vaccines’ affiliations with large
production companies, people may question whether companies market vaccines to
earn a profit or whether vaccines are a legitimate necessity for public health (Martin &
Petrie, 2017). Finally, the fourth facet is preference for natural immunity (Martin &
Petrie, 2017). Some people may hold the misconception that natural immunity is super-
ior to any immunity vaccines could provide, which results in anti-vaccination attitudes.
As introduced, knowledge is an important element of intellectual humility (Krumrei-
Mancuso et al., 2019) and may play a key role in determining how intellectual humility is
related to vaccination attitudes. However, knowledge has a complicated relationship with
vaccination attitudes and uptake. Some research shows that people who know less about
vaccinations are more likely to receive them, in part, because they tend to rely on their
health provider’s recommendations (Larson et al., 2014; Leask et al., 2012; Redelings
et al., 2012). Whereas, other research shows that people who know less about vaccina-
tions are more likely to have negative attitudes towards vaccinations and are less likely to
receive vaccinations (Larson et al., 2014; Martinello et al., 2003; Motta et al., 2018; Tong
et al., 2008). For example, individuals who knew less about the relationship between
autism and vaccines thought they knew as much or more than medical or scientific
professionals (Motta et al., 2018). In other words, prior research demonstrates that
increased knowledge may be related to increased negative attitudes toward vaccinations
and decreased negative attitudes toward vaccinations.
A nuanced understanding of knowledge as it relates intellectual humility may assuage
this apparent contradiction in the literature. Intellectual humility is related to one’s
general knowledge and is about understanding that one’s knowledge can be wrong
(Krumrei-Mancuso et al., 2019). Therefore, in one instance, people who know little
about vaccinations but hold strong negative feelings toward vaccinations (i.e. low knowl-
edge, strong anti-vaccinations attitudes; the Dunning-Kruger effect) may be low in
intellectual humility because of their apparent intellectual overconfidence. Whereas in
the other case, people who may have done extensive research and have a great deal of
knowledge about vaccinations but hold strong negative feelings about vaccinations (i.e.
high knowledge, strong anti-vaccination attitudes) may also be low in intellectual humi-
lity because their established knowledge leads them to be inflexible in their views and
closed-off to the possibility of revising them. As such, we expect intellectual humility to
be negatively related to anti-vaccination attitudes.
Vaccine intentions
Intention to vaccinate or vaccine intention is a popular outcome measure used to predict
vaccination rates, especially in studies related to HPV vaccine or HIV prophylaxis
(Barnack et al., 2010; Dhalla et al., 2012). Vaccine intentions are often measured in
conjunction with vaccination attitudes as both are important in determining actual
health behavior (i.e. theory of planned behavior; Ajzen, 1991; Kahn et al., 2003).
Attitudes are also a common predictor of vaccine intentions in addition to the benefits
PSYCHOLOGY, HEALTH & MEDICINE 3

of vaccination, such as reduction of disease-related complications and a reduced need for
medical attention (Myers & Goodwin, 2011). Additionally, knowledge of vaccines pre-
dicts vaccine uptake (Betsch & Wicker, 2012). Since knowledge of vaccinations is
a significant predictor of vaccine behavior, intellectual humility could potentially aid in
efforts to increase vaccination against the flu by opening people to scientific knowledge
about vaccines that they may not have considered otherwise.
Summary and hypotheses
The current literature shows that intellectual humility is beneficial across various situa-
tions such as politics, religion, cognition (Hoyle et al., 2016; Krumrei-Mancuso et al.,
2019; Porter & Schumann, 2018). However, it remains unknown whether intellectual
humility is associated with anti-vaccination attitudes and flu vaccine intentions. The
objective of the study was to investigate the relationships among intellectual humility,
vaccine attitudes, and flu vaccine intentions. We hypothesized that participants who have
higher levels of intellectual humility would have weaker anti-vaccination attitudes and
stronger flu vaccine intentions.
Method
Participants
Participants (N = 245) were recruited from Amazon Mechanical Turk (MTurk) and were
compensated 2.00 USD for their participation. Participants were eligible to participate if
they were 18 or older and lived in the United States. We limited participation to
U.S. residents because we wanted to investigate vaccine attitudes in the U.S. context.
The mean age was 39.06 years (SD = 10.57), 50.80% were female, and the majority
identified as White (79.20%; Black/African American 6.50%, Asian 7.80%, Hispanic/
Latino 1.20%, Other 5.30%). See Table 1 for a summary of participant demographics.
Table 1. Summary of participant demographics.
Variable Frequency Percent
Sex
Male 121 49.2
Female 125 50.8
Highest Level of Education
High school graduate (high school diploma or equivalent including GED) 39 15.9
Some college but no degree 51 20.7
Associate degree in college (2-year) 35 14.2
Bachelor’s degree in college (4-year) 101 41.1
Master’s degree 15 6.1
Doctoral degree 2 0.8
Professional degree (JD, MD) 3 1.2
Race/Ethnicity
White/Caucasian 194 79.2
Black/African American 16 6.5
Asian/Pacific Islander 19 7.8
Hispanic/Latino 3 1.2
Other 13 5.3
4A. R. SENGER AND H. P. HUYNH

Measures
Intellectual humility was measured using the Comprehensive Intellectual Humility
Scale (Krumrei-Mancusco & Rouse, 2016). The scale consisted of the four subscales:
Independence of Intellect and Ego; Openness to Revising One’s Viewpoint; Respect
for Other’s Viewpoints, and Lack of Intellectual Overconfidence. Participants indi-
cated their agreement/disagreement to items across all subscales using a five-point
Likert scale: (1) = strongly disagree to (5) = strongly agree. A higher score indicated
higher intellectual humility.
Anti-vaccine attitudes were measured using the Vaccine Attitudes Examination
(VAX) Scale (Martin & Petrie, 2017). The VAX scale contained four subscales:
Mistrust of Vaccine Benefit, Worries about Unforeseen Future Effects, Concerns about
Commercial Profiteering, and Preference for Natural Immunity. Participants indicated
their agreement/disagreement with various statements using a six-point Likert scale
(1) = strongly disagree and (6) = strongly agree. A higher score indicated stronger anti-
vaccination attitudes.
Flu vaccine intentions were measured using a three-item flu vaccine scale (Sar &
Rodriguez, 2019). Participants indicated their agreement/disagreement with these
statements using a seven-point Likert scale (1) = not at all and (7) = extremely
likely. See Table 2 for means, standard deviations, and Cronbach’s alphas for all
measures.
Procedure
All study materials and procedures were approved by the authors’ Institutional
Review Board. Participants clicked on a link forthe online study hosted on
Qualtrics, a survey management system. Following consent procedures, participants
completed the study measures and provided demographic information. To control
for potential order effects, the main study measures were presented in random
order. Lastly, participants read a debriefing statement and were thanked for their
participation.
Table 2. Summary of possible ranges, cronbach’s alphas, means, standard deviations, and percentile
scores for each scale and subscale.
Percentiles
Scale/Subscale Possible Range α Mean SD 5 10 25 50 75 90 95
Intellectual Humility overall 1–5 .90 3.75 0.59 2.82 2.95 3.39 3.82 4.14 4.45 4.73
Independence of intellect and ego - .94 3.42 1.16 1.51 2.00 2.40 3.70 4.40 5.00 5.00
Openness to revising one’s viewpoint - .89 4.11 0.74 2.71 3.02 3.80 4.00 4.80 5.00 5.00
Respect for other’s viewpoints - .89 4.23 0.70 3.00 3.33 3.83 4.33 4.83 5.00 5.00
Lack of intellectual overconfidence - .85 3.25 0.81 1.83 2.17 2.67 3.17 3.83 4.33 4.83
VAX scale overall 1–6 .86 2.34 1.16 1.00 1.10 1.40 2.00 2.93 4.29 4.80
Mistrust of vaccine benefit - .96 2.17 1.16 1.00 1.00 1.33 2.00 2.67 3.67 5.00
Worries – unforeseen future effects - .90 2.76 1.42 1.00 1.00 1.67 2.67 3.67 5.00 5.33
Concerns – commercial profiteering - .93 2.07 1.34 1.00 1.00 1.00 1.67 2.67 4.33 5.00
Preference for natural immunity - .93 2.32 1.40 1.00 1.00 1.00 2.00 3.00 4.67 5.33
Flu Vaccine Intentions 1–7 .86 3.60 1.95 1.00 1.00 1.92 3.33 5.33 6.67 7.00
N = 245.
PSYCHOLOGY, HEALTH & MEDICINE 5

Results
A correlation analysis was performed to test our hypotheses. We hypothesized that
intellectual humility would be negatively associated with anti-vaccination attitudes and
positively associated with flu vaccine intentions. The results supported the first hypoth-
esis but not the second. Overall intellectual humility and overall anti-vaccination atti-
tudes were negatively associated r(237) = −.14, p =.04. The subscales of Openness to
Revising One’s Viewpoint and Lack of Intellectual Overconfidence were largely respon-
sible for driving this significant correlation. Openness to Revising One’s Viewpoint was
negatively correlated with Mistrust of Vaccine Benefits, r(237) = −.22, p = .001, Concerns
about Commercial Profiteering, r(237) = −.18, p = .004, and Preference for Natural
Immunity, r(237) = −.20, p = .002. Additionally, Lack of Intellectual Overconfidence
was negatively correlated with Worries about Unforeseen Future Effects, r(237) = −.21,
p = .001, Concerns about Commercial Profiteering, r(237) = −.25, p < .001, and
Preference for Natural Immunity, r(237) = −.28, p < .001.
Overall intellectual humility and flu vaccine intentions were not significantly asso-
ciated r(234) = .08, p = .25. However, flu vaccine intentions negatively correlated with the
overall VAX scale and its subscales r(234) = −.44., p < .001. See Table 3 for a summary of
the correlations.
Discussion
We hypothesized that intellectual humility would be negatively associated with anti-
vaccination attitudes, and the results confirmed this hypothesis. We also hypothesized
that intellectual humility would positively correlate with flu vaccine intentions. However,
the results failed to support the second hypothesis. Overall, the findings align with the
current literature regarding intellectual humility’s psychological benefits.
One possible explanation for the inverse relationship between anti-vaccination atti-
tudes and intellectual humility might be intellectual humility’s relationship to knowledge.
Table 3. Summary of correlations.
Variable 1 2 3 4 5 6 7 8 9 10
1. Intellectual Humility overall –
2. Independence of intellect and
ego
.62** –
3. Openness to revising one’s
viewpoint
.73** .18** –
4. Respect for other’s viewpoints .74** .22** .56** –
5. Lack of intellectual
overconfidence
.72** .14* .50** .42** –
6. VAX scale overall −.14* 0 −.19** .03 −.24** –
7. Mistrust of vaccine benefit −.12 0 −.22** −.03 −.13* .83** –
8. Worries – unforeseen future
effects
−.12 −.05 −.12 .06 −.21** .91** .60** –
9. Concerns – commercial
profiteering
−.14* .02 −.18** .02 −.25** .92** .68** .78** –
10. Preference for natural
immunity
−.13* .05 −.20** .04 −.28** .86** .64** .75** .79** –
11. Flu Vaccine Intentions .08 0 .12 .03 .09 −.44** −.48** −.37** −.35** −.37**
N = 245. *Correlations are significant with p <.05 **Correlations are significant with p <.01.
6A. R. SENGER AND H. P. HUYNH

This relationship could be explained by the associations between anti-vaccination atti-
tudes and the intellectual humility facets of openness to revising one’s viewpoint and lack
of intellectual overconfidence. Specifically, it could be that people who are low in
intellectual humility hold anti-vaccination attitudes because they have high levels of
knowledge about vaccines, which may lead them become inflexible in their viewpoints.
It could also be that people who are low in intellectual humility hold anti-vaccination
attitudes because they have an unsubstantiated level of confidence for their level of
knowledge (i.e. a Dunning-Kruger effect; Motta et al., 2018).
Additionally, since intellectual humility is positively associated with general knowl-
edge (Krumrei-Mancuso et al., 2019), it may be that people who are more intellectually
humble are less likely to subscribe to anti-vaccination attitudes because they are aware of
scientific knowledge on the subject. Alternatively, it could be that people who show more
intellectual humility may simply not agree with anti-vaccination attitudes but possess
a neutral attitude towards vaccines because they are aware of alternatives, although not
necessarily scientific arguments. For instance, when people with high intellectual humi-
lity sought out an opposing view, it did not indicate their agreement with the opposing
view, but simply their openness to hearing alternative arguments (e.g. Porter &
Schumann, 2018).
The second finding that anti-vaccination attitudes were negatively associated with flu
vaccine intentions supports current literature on the relationship between attitudes and
intentions. Previous research indicates that people who hold positive vaccine attitudes
are more likely to have higher intentions to vaccinate (Kahn et al., 2003). Our current
findings add further support to past literature by demonstrating that anti-vaccination
attitudes inversely relate to flu vaccine intentions. Vaccine attitudes are a known pre-
dictor of vaccine intentions (Myers & Goodwin, 2011) so it follows that people, who were
more likely to agree with anti-vaccination attitudes, were subsequently less likely to
intend to vaccinate against the flu.
Lastly, the finding that flu vaccine intentions did not correlate with intellectual
humility warrants further research into the subject. The lack of association could be
due to limitations of the current study such as the time of year the study took place as
discussed in the limitations section. Alternatively, it could be that people who were
intellectually humble were open to knowledge about vaccines, which predicts intentions
(Betsch & Wicker, 2012), but have not come into contact with a convincing enough
argument. Intellectually humble people are open to alternative viewpoints (Hoyle et al.,
2016; Krumrei-Mancuso et al., 2019; Porter & Schumann, 2018); however, remaining
open to an argument does not guarantee agreement or the revising of one’s viewpoint.
Perhaps, intellectually humble people are open to information but have not come into
contact with an argument that has convinced them to vaccinate against the flu, especially
during the summer months.
Given the associations found, it is possible that intellectual humility may be useful as
a health-promotion strategy in the future. For example, other researchers have found that
people may temporarily change their levels of humility (e.g. Kruse et al., 2017). Thus, it
may be possible that manipulations to increase momentary (state) levels of humility, such
as expressing gratitude (Kruse et al., 2014) or engaging in experiences that increase the
feeling of awe (Stellar et al., 2018), may decrease anti-vaccination attitudes. Further study
is needed to investigate what specific strategies can increase intellectual humility, and
PSYCHOLOGY, HEALTH & MEDICINE 7

how such an increase may affect vaccination attitudes and intentions to vaccinate against
the flu. Special attention may need to be paid to the role of care providers (e.g. Huynh &
Dicke-Bohmann, 2020; Huynh et al., 2018). The current study lends evidence to support
the potential development of future interventions by establishing that a relationship
exists between intellectual humility and anti-vaccination attitudes.
Limitations and future directions
Some limitations of the study are the time of year the study took place, the study’s specific
focus on the influenza vaccination, and correlational design. Flu season takes place
during the months of January-October (CDCP, 2018). The current study took place
over the summer months, which could have resulted in overall lower vaccination inten-
tions due to the season. Future studies may consider investigating intentions during the
height of flu season, which may result in overall higher intentions to vaccinate as there is
a present and motivating need for the flu vaccine at that time. Additionally, the current
study only focused on the flu vaccine. It remains unknown whether the results of the
current study may generalize to other vaccinations as it is known that vaccine attitudes
(i.e. vaccine hesitancy) varies from vaccine to vaccine (MacDonald, 2015). Therefore,
caution should be exercised when generalizing the results of this study to other vaccines.
Finally, the current study is correlational in nature. Even if flu vaccination intentions
and/or behaviors directly correlated with intellectual humility, experimental manipula-
tion would still be needed to determine causality. Future studies should investigate if
intellectual humility can be induced and used to alter vaccine attitudes, intentions, and
uptake.
Conclusion
Flu vaccinations are an important part of public health, but still suffer from suboptimal
participation rates. Our study provides evidence for intellectual humility’s inverse rela-
tionship with anti-vaccination attitudes. With further research, intellectual humility may
be included in future public health efforts to increase flu vaccine uptake.
Disclosure statement
No potential conflict of interest was reported by the authors.
Funding
This research was supported by a Research Grant from the Psi Chi International Honors Society.
ORCID
Ho P. Huynh http://orcid.org/0000-0002-9931-7467
8A. R. SENGER AND H. P. HUYNH

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