Introduction: Previous research suggests that decision-making processes related to System 1 and 2 and deviations from rationality can significantly impact individuals’ behavior and important life outcomes, including health-related ones. These may be particularly significant in the emotionally burdened context of child vaccination, which may trigger further deviations from rational thinking. Still, it is not fully understood how different cognitive and emotional factors related to these cognitive systems interact, and only a small portion of studies has focused on researching these constructs in the context of health.
Objectives: The aim of this thesis was to address the role of cognitive (cognitive reflection, heuristic thinking, need for cognition, faith in intuition, maximization) and emotional factors (dispositional optimism vs. pessimism, emotions toward vaccination) in the context of other well-known factors (trust in and satisfaction with health provider, trust toward authorities) which contribute to health-decision-making and behavior. The latter included general health decision-making (leading a healthy everyday lifestyle, engagement in healthy behaviors, and medical adherence), as well as the parental decision on child vaccination (vaccine conspiracy beliefs, uptake, and vaccine attitudes in the affective, cognitive and behavioral component). Special focus was also put on vaccine-hesitant parents’ reasoning and hypothetical situations in which they would reconsider vaccinating and describing different strategies by which they avoid mandatory vaccination.
Methods: This thesis consisted of three studies. The first was a cross-sectional correlational study with a non-probabilistic sample of 186 volunteer student participants. The second was a cross-sectional correlational study with a non-probabilistic sample of 823 volunteer parents surveyed online. The third, qualitative study included semi-structured interviews conducted with 25 vaccine-hesitant parents recruited through a mixed purposeful sampling strategy.
Results: The results of the first study showed that leading a healthy everyday lifestyle was predicted by maximizing, which also predicted engagement in health-promoting activities. Such engagement was also predicted by optimism and the ability to override heuristic and biased thinking, while a higher need for cognition and trust in healthcare predicted adherence to medical advice. The results of the second study showed vaccine conspiracy beliefs were associated with stronger unpleasant emotions toward vaccination, intuitive-experiential thinking, and lower education, while unpleasant emotions toward vaccination and intuitive thinking were associated with a lesser vaccine uptake. Next, disillusionment with authorities predicted all vaccine attitude components, performance on heuristic and biases tasks predicted the affective and cognitive but not the behavioral component, whereas cognitive reflection had no impact on vaccine attitudes. Finally, a moderation effect of disillusionment on the association between heuristic and biases tasks and the cognitive and behavioral attitude components was identified. Parents with low disillusionment demonstrated positive vaccine attitudes regardless of their rationality, whereas for parents with high disillusionment a significant positive correlation between performance on heuristics tasks and attitudes was identified, indicating rationality can decrease the negative effects of disillusionment. The results of the third study indicated that decision-making on child vaccination is complex and associated with different interrelated factors, especially the intuitive-experiential cognitive style, as well as supported the social intuitionist model of moral reasoning. Also, it indicated that parents adopt different strategies of avoiding mandatory vaccination and differ in their determination and potential to reconsider their decision, as well as hypothetical situations in which they might do so.
Conclusion: These results provide novel insights on the importance of cognitive and emotional factors in health decision-making. It is demonstrated that vaccine hesitancy is linked to the functioning of the intuitive-experiential cognitive style and that rationality can contribute to health-supporting behaviors in a beneficial manner.