Frames of the vaccination hesitant and impact on the propensity to vaccinate girls against the Human Papilloma Virus (HPV): A survey experiment study

Journal title MECOSAN
Author/s Amelia Compagni, Giovanni Fattore, Diana Paraggio
Publishing Year 2026 Issue 2025/133
Language English Pages 21 P. 101-121 File size 0 KB
DOI 10.3280/mesa2025-133oa21522
DOI is like a bar code for intellectual property: to have more infomation click here

View article Download Open Access article

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

<p>Vaccination hesitancy, i.e. the refusal or delay in being vaccinated, is a complex phenomenon influenced by numerous factors including the communicative messages to which individuals are exposed. Little is known about the impact that framing vaccination hesitancy as a problem and the vaccination hesitant as the responsible for such problem has on the propensity to vaccinate.<br />In the study we report the results of a survey experiment in which respondents were randomly exposed to three different frames of the vaccination hesitant (as misinformed, anti-scientific and socially dangerous) and the<br />impact of these frames on the intention to vaccinate girls against the human papilloma virus (HPV). The frames were derived from the press statements of the Italian Minister of<br />Health between 2015 and 2017, and contained, besides different characterizations of the vaccination hesitant, the correspondent policy solutions to counteract such vaccination hesitancy.<br />Findings show how framing the vaccination hesitant as anti-scientific or socially dangerous that, in turn, supports policies mandating vaccination and sanctioning the vaccination hesitant, tends to discourage vaccination.<br />These findings alert us to the importance of designing with great care the communication about vaccinations and vaccination hesitancy and avoid counterproductive effects.</p>

Keywords: framing;vaccination hesitancy;communication;public health

  1. Guenther L., Gaertner M., & Zeitz J. (2021). Framing as a concept for health communication: A systematic review. Health Communication, 36: 891-899.
  2. Allport G.W. (1954). The nature of prejudice. Reading, MA: Addison-Wesley.
  3. Barry C.L., Brescoll V.L., Brownell K.D. & Schlesinger M. (2009). Obesity metaphors: how beliefs about the causes of obesity affect support for public policy. Milbank Quarterly, 87: 7-47.
  4. Benin A.L., Wisler-Scher D., Colson E., Shapiro E.D. & Holmboe E.S. (2006). Qualitative analysis of mothers’ decision-making about vaccines for infants: The importance of trust. Pediatrics, 117: 1532-1541.
  5. Betsch C. & Böhm R. (2016) Detrimental effects of introducing partial compulsory vaccination: experimental evidence. European Journal of Public Health 26: 378-381.
  6. Bonanni P., Ferro A., Guerra R., Iannazzo S., Odone A., Pompa M.G., Rizzuto E. & Signorelli C. (2015). Vaccine coverage in Italy and assessment of the 2012-2014 National Immunization Prevention Plan. Epidemiologia & Prevenzione, 39, Suppl.1, 14615.
  7. Chong D. & Druckman J. (2007a). A theory of framing and opinion formation in competitive elite environments. Journal of Communication, 57: 99-118.
  8. Chong D. & Druckman J.N. (2007b). Framing theory. Annual Review of Political Science, 10: 103-126.
  9. Colgrove J., Abiola S. & Mello M.M. (2010). HPV vaccination mandates – lawmaking amid political and scientific controversy. New England Journal of Medicine, 363: 785-791.
  10. Druckman J.N. (2001). On the limits of framing effects: who can frame?. Journal of Politics, 63: 1041-1066.
  11. Dror A.A., Eisenbach N., Taiber S., Morozov N.G., Mizrachi M., Zigron A., Samer Srouji S. & Sela E. (2020). Vaccine hesitancy: the next challenge in the fight against COVID-19. European Journal of Epidemiology, 35: 775-779.
  12. Ejelöv E. & Nilsson A. (2020). Individual factors influencing acceptability for environmental policies: A review and research agenda. Sustainability, 12, 2404.
  13. Entman R.M. (1993). Framing: Toward clarification of a fractured paradigm. Journal of Communication, 43: 51-58.
  14. Gabutti G., d’Anchera E., De Motoli F., Savio M., & Stefanati A. (2021). Human papilloma virus vaccination: focus on the Italian situation. Vaccines, 9, 1374.
  15. Gargiulo F., Cafiero F., Guille-Escuret P., Seror V. & Ward J.K. (2020). Asymmetric participation of defenders and critics of vaccines to debates on French-speaking Twitter. Scientific Reports, 10, 6599.
  16. Goldstein S., MacDonald N.E. & Guirguis S. (2015). Health communication and vaccine hesitancy. Vaccine, 33, 4212-4214.
  17. Haverkate M., D’Ancona F., Giambi C., Johansen K., Lopalco P.L., Cozza V., Appelgren E., on behalf of the VENICE project gatekeepers and contact points (2012). Mandatory and recommended vaccination in the EU, Iceland and Norway: results of the VENICE 2010 survey on the ways of implementing national vaccination programmes. Eurosurveillance, 17, pii-20183.
  18. Hendrix K.S., Finnell S.M., Zimet G.D., Sturm L.A., Lane K.A. & Downs S.M. (2014). Vaccine message framing and parents’ intent to immunize their infants for MMR. Pediatrics, 134, e675-e683.
  19. Henkel L., Sprengholz P., Korn L., Betsch C., Bohm R. (2023). The association between vaccination status identification and societal polarization. Nature Human Behavior, 7: 231-239.
  20. Hornsey M.J., Finlayson M., Chatwood G. & Begeny C.T. (2020). Donald Trump and vaccination: The effect of political identity, conspiracist ideation and presidential tweets on vaccine hesitancy. Journal of Experimental Social Psychology, 88, 103947.
  21. Isler O., Isler B., Kopsakeilis O., & Ferguson E. (2020). Limits of the social-benefit motive among high-risk patients: A field experiment on influenza vaccination behavior. BMC Public Health, 20: 240.
  22. Ingram H., Schneider A.L., & DeLeon P. (2007). Social construction and policy design. In: P. Sabatier (Ed.). Theories of the policy process (pp. 93-126). Boulder: Westview Press.
  23. Jacobson Vann J.C., Jacobson R.M., Coyne-Beasley T., Asafu-Adjei J.K. & Szilagyi P.G. (2018). Patient reminder and recall interventions to improve immunization rates. Cochrane Database Systematic Reviews, 1, CD003941.
  24. Jarrett C., Wilson R., O’Leary M., Eckersberger E., Larson H.J., SAGE Working Group on Vaccine Hesitancy (2015). Strategies for addressing vaccine hesitancy ‒ A systematic review. Vaccine, 33: 4180-4190.
  25. Kaufman J., Ryan R., Walsh L., Horey D., Leask J., Robinson P. & Hill S. (2018). Face‐to‐face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Systematic Reviews, 5, CD010038.
  26. Kim S., Pjesivac I., & Jin Y. (2019). Effects of message framing on influenza vaccination: understanding the role of risk disclosure, perceived vaccine efficacy, and felt ambivalence. Health Communication, 34: 21-30.
  27. Kim S.H., & Willis A.L. (2007). Talking about obesity: News framing of who is responsible for causing and fixing the problem. Journal of Health Communication, 12: 359-376.
  28. Kübler D. (2001). Understanding policy change with the advocacy coalition framework: an application to Swiss drug policy. Journal of European Public Policy, 8: 623-64.
  29. Lane S., MacDonald N.E., Marti M. & Dumolard L. (2018). Vaccine hesitancy around the globe: Analysis of three years of WHO/UNICEF Joint Reporting Form data – 2015-2017. Vaccine, 36: 3861-3867.
  30. Larson H.J. (2022). Defining and measuring vaccine hesitancy. Nature Human Behavior, 6: 1609-1610.
  31. Larson H.J., Jarrett C., Eckersberger E., Smith D.M.D. & Paterson P. (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007-2012. Vaccine, 32: 2150-2159.
  32. Larson H.J., de Figueiredo A., Xiahong Z., Schulz W.S., Verger P., Johnston I.G., Cook A.R. & Jones N.S. (2016). The state of vaccine confidence 2016: Global insights through a 67-country survey. EBio-Medicine, 12: 295-301.
  33. MacDonald N.E., SAGE Working Group on Vaccine Hesitancy (2015). Vaccine hesitancy: Definition, scope and determinants. Vaccine 33: 4161-4164.
  34. Merolla J., Ramakrishnan S. & Haynes C. (2013). “Illegal,” “undocumented,” or “unauthorized”: Equivalency frames, issue frames, and public opinion on immigration. Perspectives on Politics, 11: 789-807.
  35. Ministero della Salute-Italian Ministry of Health (2018). Coperture vaccinali al 31.12.2022 per HPV. -- Available at: <a href="http://www.salute.gov.it/imgs/C_17_tavole_27_1_0_file.pdf">http://www.salute.gov.it/imgs/C_17_tavole_27_1_0_file.pdf</a>.
  36. Nan X., Xie B., & Madden K. (2012). Acceptability of the H1N1 vaccine among older adults: The interplay of message framing and perceived vaccine safety and efficacy. Health Communication, 27: 559-568.
  37. Nyhan B. & Reifler J. (2010). When corrections fail: The persistence of political misperceptions. Political Behavior, 32: 303-330.
  38. Nyhan B., Reifler J., Richey S. & Freed G.L. (2014). Effective messages in vaccine promotion: A randomized trial. Pediatrics, 133: e835-e842.
  39. Olson O., Berry C., & Kumar N. (2020). Addressing parental vaccine hesitancy towards childhood vaccines in the United States: A systematic literature review of communication interventions and strategies. Vaccines, 8, 590.
  40. Omer S.B., Salmon D.A., Orenstein W.A., deHart M.P. & Halsey N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360: 1981-1988.
  41. Penţa M. A., and Băban A. (2018). Message framing in vaccine communication: a systematic review of published literature. Health Communication, 33(3): 299-314.
  42. Power J.G., Murphy S.T. & Coover G. (1996). Priming prejudice: How stereotypes and counter-stereotypes influence attribution of responsibility and credibility among ingroups and outgroups. Human Communication Research, 23: 36-58.
  43. Saeterdal I., Lewin S., Austvoll‐Dahlgren A., Glenton C. & Munabi‐Babigumira S. (2014). Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database Systematic Reviews, 11, CD010232.
  44. Schmidt A.L., Zollo F., Scala A., Betsch C. & Quattrociocchi W. (2018). Polarization of the vaccination debate on Facebook. Vaccine, 36: 3606-3612.
  45. Schneider A. & Ingram H. (1993). Social construction of target populations: Implications for politics and policy. American Political Science Review, 87: 334-347.
  46. Signorelli C. (2019). Quarant’anni (1978-2018) di politiche vaccinali in Italia. Acta Biomedica, 90: 127-133.
  47. Signorelli C., Guerra R., Siliquini R. & Ricciardi W. (2017). Italy’s response to vaccine hesitancy: an innovative and cost effective National Immunization Plan based on scientific evidence. Vaccine, 35: 4057-4059.
  48. Smith T.C. (2017). Vaccine rejection and hesitancy: A review and call to action. Open Forum Infectious Diseases, 4, ofx146.
  49. Streefland P.H. (2001). Public doubts about vaccination safety and resistance against vaccination. Health Policy, 55: 159-172.
  50. Yaqub O., Sophie Castle-Clarke S., Sevdalis N. and Chataway J. (2014). Attitudes to vaccination: A critical review. Social Science & Medicine, 112: 1-11.
  51. Zhang E.J., Chughtai A.A., Heywood A. & Mac-Intyre C.R. (2019). Influence of political and medical leaders on parental perception of vaccination: A cross-sectional survey in Australia. BMJ Open, 9, e025866.

Amelia Compagni, Giovanni Fattore, Diana Paraggio, Frames of the vaccination hesitant and impact on the propensity to vaccinate girls against the Human Papilloma Virus (HPV): A survey experiment study in "MECOSAN" 133/2025, pp 101-121, DOI: 10.3280/mesa2025-133oa21522