Risk conceptualisations, trust and decision-making in the face of contradictory information: the case of MMR

Abstract

This thesis investigates the process by which parents evaluate contradictory information about risk in order to make the decision whether to have their children immunised with the measles, mumps and rubella (MMR) vaccine. Contested reports associating the MMR vaccine with autism have resulted in diminished confidence and uptake of the vaccine in the UK. Interviews and focus groups were used to develop an in-depth picture of parental notions of risk, trust and decision-making processes. Cultural consensus analysis was used to probe the areas of consensus and divergence of opinion, and a large-scale postal survey (N=996) assessed the level of agreement with the qualitative findings. Parental ambivalence to the safety of the vaccine reflected wider social concerns, and was crucially related to trust in governmental medical authority and medical practitioners. Trust was particularly damaged when practitioners and policy makers failed to recognise parents' concern for their children’s health and their unique knowledge of their own children. A key tool for fostering trust is narrative: this played a central role in galvanising resistance to the vaccine, but was not well used to engender trust and cooperation between parents and medical practitioners. Three practical strategies to protect children from diseases and harmful vaccine side effects, to rebuild trust, and to cope successfully with similar controversies in the future emerged from this research: fully involving the public in framing scientific research agendas, streamlining the reporting procedures for suspected adverse reactions, and fostering trusting personal relationships between patients and health care practitioners.