New international research shows vivid mental images experienced by pregnant women when they think about vaccination directly influence their decision whether or not to get vaccinated.
Led by researchers from The University of Western Australia and the University of Plymouth in the United Kingdom, the study is the first to investigate the prevalence of vaccination-related mental imagery during pregnancy and link it to both vaccine hesitancy and vaccination behaviour.
The research was conducted with more than 400 pregnant women in Perth, who were invited to complete a brief survey while waiting for appointments at King Edward Memorial Hospital.
The women were asked for their perceptions of risks relating to whooping cough, influenza and COVID-19 and whether they visualised any positive or negative impact on their babies – such as a sick baby in hospital – relating to the diseases or associated vaccinations.
Verified vaccine uptake data was obtained through official immunisation records at the end of participants' pregnancy to examine whether and when each vaccine was received, if at all.
The findings, published in the journal Social Science & Medicine, showed mental images were common and – depending on whether the image was positive or negative, and whether it was about the impacts of diseases or the vaccine itself – could be used in some cases to predict if and when the women ultimately received the vaccine during pregnancy.
Dr Julie Ji, Adjunct Research Fellow at the UWA School of Psychological Science and Lecturer in Psychology at the University of Plymouth, said pregnancy was a sensitive period when health decisions carried extra emotional and psychological weight.
"Our results suggest that vivid emotional mental scenes that pop to mind when someone is thinking about vaccination are not just incidental, they may be meaningfully linked to how people feel about vaccines, and in some cases, whether and when they get vaccinated," Dr Ji said.
Other key findings included that women who reported negative mental images about vaccines – such as worrying scenarios of harm or side effects – also tended to report greater hesitancy towards the whooping cough and influenza vaccines, particularly if they had not yet been vaccinated.
This pattern was observed even after taking into account women's general attitudes towards receiving government-recommended vaccines during pregnancy, suggesting mental images capture a unique aspect of how vaccine decisions are psychologically experienced, rather than simply reflecting general maternal vaccination attitudes.
When the researchers looked at women's actual vaccination behaviour, a different pattern emerged.
Those who reported positive mental images about vaccines, such as imagining antibodies being passed through the umbilical cord, were more likely to receive the whooping cough vaccine and to get it earlier in their pregnancies.
The researchers said this highlighted the potential importance of positive mental imagery in vaccine decision-making and behaviour, such as being able to imagine how vaccines offer protection for oneself and one's baby.
By the end of their pregnancy, participants were most likely to have received the whooping cough vaccine (82.1 per cent vaccinated), with lower uptake for influenza (60.1 per cent) and very low uptake for COVID 19 (7.2 per cent).
Co-author Professor Katie Attwell, who leads VaxPolLab in UWA's School of Social Sciences, said that at a time when hesitancy and lower vaccine uptake posed significant threats to public health, the study highlighted the importance of examining psychological factors involved in maternal vaccination decision-making.
"Now that we understand the importance of these mental images, we can support health professionals and government campaigns to be more conscious of what visual seeds they might be sowing," Professor Attwell said.
The study, funded by the Telethon Channel 7 Western Australia Child Research Fund, was conducted by an interdisciplinary team of researchers spanning psychology, midwifery, social sciences, paediatrics and infectious diseases across institutions in the UK and Australia. They include Professor Zoe Bradfield, from Curtin University and North Metropolitan Health Service, who led the KEMH recruitment.
The researchers are now exploring how mental imagery can be harnessed to support informed decision-making during pregnancy.
