Flu cases are increasing across the United States, with at least 81,000 hospitalizations and 3,100 deaths reported so far this season, according to the U.S. Centers for Disease Control and Prevention. Despite these rising numbers, flu vaccination rates remain lower than expected.
New research led by Valerie Reyna, a professor of psychology at Cornell University, suggests that people's decisions about flu vaccination are influenced more by intuition and their overall sense of risk and benefit than by detailed factual information. Reyna explained that traditional models in decision-making have emphasized rational analysis of risks and benefits but may not fully capture how people actually make health choices.
"We make decisions based on the bottom-line gist of information: What does all this information boil down to? What's the decision really about?" said Valerie Reyna, Lois and Melvin Tukman Professor of Human Development in the Department of Psychology and College of Human Ecology. "If we know the essence of how someone feels about these ideas, we can explain and predict their intentions with respect to vaccination."
Reyna is director of the Lab for Rational Decision Making and first author of "A New Look at Vaccination Behaviors and Intentions: The Case of Influenza," published in Behavioral Sciences on November 29.
Her studies involved more than 700 college students and nearly 200 community members who were asked whether they had received or intended to receive a flu vaccine. The research found that participants' general impressions—categorized as none, low, medium or high risks or benefits—were stronger predictors of vaccine hesitancy than precise numerical assessments or knowledge-based questions.
"Part of our mind looks at details and precise facts, but the other part of our mind looks at the bottom-line, qualitative gist – and that's the more determinative part," Reyna said. "People form a global impression of what they are told and experience, for example, 'Overall, I think the benefits from vaccination are high and the risks are nil.' That would be a gist for people who get vaccinated, and that's what we showed."
In one sample group (younger adults), knowledge about vaccines accounted for only 14% in predicting intent to vaccinate; including questions focused on gist increased predictive power to 58%. In another community sample group, predictive accuracy rose from 57% to 80% when gist-based questions were included.
The findings indicate that communication strategies focusing solely on lists of facts may not be effective in reducing vaccine hesitancy. Instead, public health practitioners might achieve better results by putting facts into context that align with individuals’ core values—such as keeping loved ones safe or making informed choices—and fostering a conceptual understanding rather than just providing information.
"If you follow that recipe, you will be much more likely to make a difference with people, according to our research," Reyna said. "You have to take the right approach, and it's fundamentally different from what we're currently doing."
The study was supported by grants from several organizations including the National Institute of Standards and Technology; U.S. Department of Agriculture; and Institute for Trustworthy AI and Society.
