Health Games: Overcoming the social dilemma in vaccination decisions and the consumption of antibiotics

• Applicants: Professorin Dr. Cornelia Betsch; Professor Dr. Robert Böhm
• Subject Area: Social Psychology, Industrial and Organisational Psychology ; Personality Psychology, Clinical and Medical Psychology, Methodology ; Public Health, Healthcare Research, Social and Occupational Medicine
• Term: from 2015 to 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 281591351

Scientific approaches often describe preventive and curative health decisions as individual decision-making tasks, where individuals weigh their own costs and benefits. However, some health decisions do not only affect the individual decision-maker, but also have direct or indirect effects on others. The classical perspective ignores potential positive or negative effects on others (externalities) as mechanisms and potential incentives in health decisions. Vaccinations, for instance, often have positive externalities because every vaccination reduces the transmission of a disease and thus indirectly protects unvaccinated individuals. Antibiotic use, in contrast, is an example for negative externalities, because excessive and inappropriate use leads to drug resistance and can harm uninvolved others if antibiotics are no longer effective. As a result, health decisions become social interactions when the decisions of several individuals and their health consequences influence each other, and individual interests have to be weighed up against collective interests. In a preceding project we systematically analyzed vaccination decisions as social interactions at the behavioral level. The three work packages of this follow-up project directly build upon the established research method of analyzing social-interactive health decisions through interactive decision tasks (Health Games). It has been repeatedly shown that interventions stressing prosocial aspects of vaccinations are helpful in increasing the willingness to vaccinate. Work package WP1 therefore critically examines this finding with regard to mediators as well as facilitating and attenuating moderators. Furthermore, previous studies showed that integrating vaccine effectiveness into the vaccination decision leads to a cognitive bias ("Vaccine Effectiveness Fallacy"). When vaccines are less effective, individuals are less willing to vaccinate. Theoretical models, however, suggest that this is incorrect from a normative perspective since with decreasing effectiveness the indirect protection also decreases. Therefore, WP2 identifies and evaluates different debiasing strategies. WP3 applies our research approach to antibiotic use in order to examine its determinants. These insights will facilitate the future development of strategies to reduce excessive and inappropriate antibiotic use. For this purpose, we developed a novel interactive decision task that models the social-interactive mechanisms in the development of antibiotic resistance. Based on these interdisciplinary research methods, this project extends theoretical models of health decision dilemmas, taking into account that behavioral predictions can vary depending on whether externalities of the individual decision are considered or not. The results of this project will increase our understanding and the development of evidence-based interventions to overcome vaccine hesitancy and antibiotic overuse.

• DFG Programme: Research Grants
• International Connection: Denmark
• Cooperation Partner: Privatdozent Dr. Ole Wichmann