Navigating vaccine hesitancy: Strategies and dynamics in healthcare professional-parent communication.

Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST. More specifically, 60 hours of observations were carried out in three different pediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed. We focused on the specific context of the Czech Republic, which represents a country with a mandatory vaccination system and in which children's immunization is the responsibility of pediatric general practitioners. We demonstrate that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorize and label parents. Furthermore, we outline some of the different strategies HCPs employ while addressing concerns regarding vaccination. We identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents. The first strategy focused on the communication of risks associated with vaccination (and lack thereof). HCPs used a variety of discursive practices to familiarize the unfamiliar risks of vaccine-preventable diseases (by mobilizing representations that are part of collective memory, incorporating personal experiences to materialize the presence of risk and the confidence in the safety of vaccines and by situating risk as embedded in everyday processes and integral to the uncertainty of the global world). The second strategy involved the conscious employment of medical procedures that may contribute to reducing vaccination fears.

Making Sense of Dementia: Older Adults' Subjective Representations of Dementia and Alzheimer's Disease.

OBJECTIVES: This research explores how the representations and meanings of living with dementia are constructed by older adults. METHODS: Focus groups (N = 19) and in-depth interviews (N = 29) were conducted with older adults aged 65+ living in the Czech Republic, representing different levels of personal familiarity with care for an individual experiencing dementia. RESULTS: We identified 2 different discourses: (1) Tragedy discourse with two distinctive repertoires "dementia as a thief of personality" and "dementia as a thief of humanity." Within such discourse, dementia transcends mere medical terminology, serving as a symbolic representation of existential anxieties linked to aging and the perceived loss of control. (2) The discourse of Dementia as a specific way in which people approach the world was articulated mainly by caregivers, providing them with a coping mechanism and a means to reconstruct the agency of the person experiencing dementia. In older adults' representations, references to suffering among family members emerged as a primary association with dementia. Dementia was portrayed as "contagious" in its effect on the family members who were, in a sense, depicted as the primary sufferers of the disease. DISCUSSION: Dementia often serves as a symbolic tool for older adults to articulate concerns about advanced old age, extending beyond its clinical definition to convey deep-seated fears associated with aging. The experience of people surrounding those diagnosed with dementia and the permeability of the impacts of this disease between bodies represented crucial frameworks for conceptualizing dementia in the narratives of older adults.

Agency in urgency and uncertainty. Vaccines and vaccination in European media discourses.

Although Covid-19 was not the first pandemic, it was unique in the scale and intensity with which societies responded. Countries reacted differently to the threat posed by the new virus. The public health crisis affected European societies in many ways. It also influenced the way the media portrayed vaccines and discussed factors related to vaccine hesitancy. Europeans differed in their risk perceptions, attitudes towards vaccines and vaccine uptake. In European countries, Covid-19-related discourses were at the centre of media attention for many months. This paper reports on a media analysis which revealed significant differences as well as some similarities in the media debates in different countries. The study focused on seven European countries and considered two dimensions of comparison: between the pre-Covid period and the beginning of the Covid pandemic period, and between countries. The rich methodological approach, including linguistics, semantic field analysis and discourse analysis of mainstream news media, allowed the authors to explore the set of meanings related to vaccination that might influence actors' agency. This approach led the authors to redefine vaccine hesitancy in terms of characteristics of the "society in the situation" rather than the psychological profile of individuals. We argue that vaccine hesitancy can be understood in terms of agency and temporality. This dilemma of choice that transforms the present into an irreversible past and must be taken in relation to an uncertain future, is particularly acute under the pressure of urgency and when someone's health is at stake. As such, it is linked to how vaccine meaning is co-produced within public discourses.

Trust matters: The Addressing Vaccine Hesitancy in Europe Study.

This article presents the design of a seven-country study focusing on childhood vaccines, Addressing Vaccine Hesitancy in Europe (VAX-TRUST), developed during the COVID-19 pandemic. The study consists of (a) situation analysis of vaccine hesitancy (examination of individual, socio-demographic and macro-level factors of vaccine hesitancy and analysis of media coverage on vaccines and vaccination and (b) participant observation and in-depth interviews of healthcare professionals and vaccine-hesitant parents. These analyses were used to design interventions aimed at increasing awareness on the complexity of vaccine hesitancy among healthcare professionals involved in discussing childhood vaccines with parents. We present the selection of countries and regions, the conceptual basis of the study, details of the data collection and the process of designing and evaluating the interventions, as well as the potential impact of the study. Laying out our research design serves as an example of how to translate complex public health issues into social scientific study and methods.

Recruiting a Hard-to-Reach, Hidden and Vulnerable Population: The Methodological and Practical Pitfalls of Researching Vaccine-Hesitant Parents.

While recruitment is an essential aspect of any research project, its challenges are rarely acknowledged. We intend to address this gap by discussing the challenges to the participation of vaccine-hesitant parents defined here as a hard-to-reach, hidden and vulnerable population drawing on extensive empirical qualitative evidence from seven European countries. The difficulties in reaching vaccine-hesitant parents were very much related to issues concerning trust, as there appears to be a growing distrust in experts, which is extended to the work developed by researchers and their funding bodies. These difficulties have been accentuated by the public debate around COVID-19 vaccination, as it seems to have increased parents' hesitancy to participate. Findings from recruiting 167 vaccine-hesitant parents in seven European countries suggest that reflexive and sensible recruitment approaches should be developed.

The role of dementia and Alzheimer's disease in older adults' representations of aging and anxieties regarding one's own future.

Dementia and Alzheimer's disease crucially influence the images of advanced age and represent a significant framework for the construction of anxieties regarding aging. By drawing on twenty-five in-depth interviews with older adults (age 65+ years) living in the Czech Republic, in this study, the influences of dementia and Alzheimer's disease on older adults' narratives of expectations and worries pertaining to their aging and future are analyzed. Three distinct ways in which participants narrate personal concerns related to Alzheimer's disease and integrate the risk of developing such a condition into their representations of fears associated with old age were identified: 1) Dementia as a perceived immediate risk, 2) dementia as the metonym of the fourth age, and 3) dementia as a distant tragedy but not a personal worry. These approaches differ in terms of the perception of the risk of developing dementia, anxiety-related responses related to future expectations, and the role of dementia in their representation of 'bad' old age. The different positions of dementia (specific health condition vs. signifier of dependency in old age) affected the participants' strategies related to medical screening and information seeking.

Voices from Silence? Reflections on 'Coming out' in Socialist Czechoslovakia.

The region of Central and Eastern Europe and oppressive social conditions in former socialist society often became symbols of the impossibility to articulate non-heterosexual identities under the conditions of a totalitarian regime. This study analyzes data from 19 in-depth interviews with people older than 50 living in the Czech Republic who identify themselves as lesbian, gay, or bisexual. It focuses on the ways in which their forced silence and inability to speak about their sexual desires resonated throughout their biographical narratives. The first part of this paper focuses on themes surrounding the absence of representations of non-heterosexual identities in socialist Czechoslovakia's public sphere and the impact of this absence on participants' perceptions of their own life experiences. The second part of the paper analyzes the ways in which participants relate to their own coming out and their reflections on their previous lives in relation to newfound opportunities to live outside of heterosexual norms. The paper strives to problematize the concept of "silence" as one of the defining features of this generation, in contrast with the concept of coming out as a sign of emancipation in younger generations.

Places of (in)visibility. LGB aging and the (im)possibilities of coming out to others.

Middle and older age are usually ignored in the studies of the processes of coming out. This paper analyses the opportunities, and also the barriers which aging brings to the possibility of articulating one's own sexual identity in relation to others. It presents the life-course perspective as a suitable analytical tool for the study of the impact of historical context and the changing social locations within the life-biography. Analysis presented in this paper is based on 19 in-depth interviews with LGB people aged fifty and older living in the Czech Republic. The paper focuses on the way they relate to the idea of coming out and how they reflect on their previous biography with respect to the possibilities to articulate their sexuality in various phases of their life. It analyses how aging creates possibilities as well as barriers to articulate sexual identity with respect to family and closed ones and points out the need to critically reflect the narratives of coming out as a linear process of leaving "the closet". Older age was by the participants depicted as an important context that disrupted some of the barriers preventing coming out to others. However, the vision of late old age linked with specific age-related contexts (such as life in residential care facilities) was associated with impossibility to express sexual identity.

Women's attitudes toward forming new partnerships in widowhood: The search for "your own someone" and for freedom.

This text is based on an analysis of 20 biographical interviews with women who are both retired and have been widowed. The text discusses women's attitudes toward beginning new intimate relationships and the kinds of partnerships some of them have formed in old age. The author discusses the role of gender and gendered behavior in the institution of marriage as an important factor influencing women's attitudes toward remarrying. The experience of being widowed is an important transition that, besides trauma and difficulties, also presents an opportunity to escape from the previous gender norms and expectations. The significance of these changes, which often open up opportunities for alternative forms of self-fulfillment, become part of the strategies that women select when entering future partnership arrangements.