The associations between so-called alternative medicine (SCAM) and negative attitudes to vaccinations are, as discussed repeatedly on this blog, strong and undeniable. A new paper sheds more light on these issues.
By far the most common strategy used in the attempt to modify negative attitudes toward vaccination is to appeal to evidence-based reasoning. However, focusing on science comprehension is inconsistent with one of the key facts of cognitive psychology: Humans are biased information processors and often engage in motivated reasoning. On this basis, it is hypothesized that negative attitudes can be explained primarily by factors unrelated to the empirical evidence for vaccination; including some shared attitudes that also attract people to SCAM.
This study tested psychosocial factors associated with SCAM endorsement in past research; including aspects of spirituality, intuitive (vs analytic) thinking styles, and the personality trait of openness to experience. These relationships were tested in a cross-sectional, stratified CATI survey (N = 1256, 624 Females).
Questions regarding SCAM were derived from a previously validated instrument, designed to standardize the measurement of SCAM utilization, and distinguish between those that use a particular SCAM from those that do not. Each SCAM item provided an indication of whether the respondent had utilized each of the following therapeutic or self-treatment activities within the last 12 months:
- herbal and homeopathic remedies,
- energy-based and body therapies (including therapeutic massage),
- vitamins, yoga, meditation, prayer, body therapies, hypnosis, spiritual healing,
- and chiropractic or osteopathic treatments.
The results show that educational level and thinking style did not predict vaccination rejection. Psychosocial factors such as
- preferring SCAM to conventional medicine (OR .49, 95% CI .36-.66),
- endorsement of spirituality as a source of knowledge (OR .83, 95% CI .71-.96),
- openness (OR .86, 95% CI .74-.99),
all predicted negative attitudes to vaccination. Furthermore, for 9 of the 12 SCAMs surveyed, utilisation in the last 12 months was associated with lower levels of vaccination endorsement. Additionally, the rank-order correlation between the number of different alternative therapies used in the last 12 months and vaccination attitude score was significant. Finally, analytical thinking style was negatively related to all forms of CAM, with this relationship significant in three cases:
- herbal remedies ρ = −.08, p = .0014,
- homeopathy, ρ = −.06, p = .0236,
- prayer for the purpose of healing, ρ = −.15, p < .0001.
The authors concluded that vaccination scepticism appears to be the outcome of a particular cultural and psychological orientation leading to unwillingness to engage with the scientific evidence. Vaccination compliance might be increased either by building general confidence and understanding of evidence-based medicine, or by appealing to features usually associated with SCAM, e.g. ‘strengthening your natural resistance to disease’.
In the discussion section of their paper, the authors argue that these results describe a vaccine sceptic as viewing themselves as anti-authoritarian and unconventional, with a preference for unorthodox treatments with spiritual or ‘life-affirming’ features. The significant effect for personality, but not for cognitive style, is congruent with the notion that it is a reluctance to engage with the evidence, rather than a lack of capacity to appropriately process the evidence, that predicts vaccination scepticism…
SCAM endorsement and vaccination scepticism are components of a common attitudinal stance, with some shared psychosocial determinants. The results of the present study indicate that vaccination rejection is related to psychosocial factors: a general preference for complementary over conventional medicines, valuing diverse and unconventional alternatives, and a spiritual orientation to attitude formation. The null findings with regard to cognitive style and educational level suggest that factors unrelated to the actual empirical evidence for vaccination – i.e. a particular personality and attitudinal mindset are most instrumental in determining vaccination attitudes. Efforts to counter vaccination concerns should be mindful that negative vaccination views appear to form part of a broader attitudinal system that does not necessarily trust empirical or positivist evidence from authoritative sources. Vaccination promotion efforts may benefit from targeting groups associated with SCAM and building general confidence in scientific medicine, rather than targeting specific misunderstandings regarding vaccination.