Internal and external factors affecting vaccination coverage: Modeling the interactions between vaccine hesitancy, accessibility, and mandates.

Society, culture, and individual motivations affect human decisions regarding their health behaviors and preventative care, and health-related perceptions and behaviors can change at the population level as cultures evolve. An increase in vaccine hesitancy, an individual mindset informed within a cultural context, has resulted in a decrease in vaccination coverage and an increase in vaccine-preventable disease (VPD) outbreaks, particularly in developed countries where vaccination rates are generally high. Understanding local vaccination cultures, which evolve through an interaction between beliefs and behaviors and are influenced by the broader cultural landscape, is critical to fostering public health. Vaccine mandates and vaccine inaccessibility are two external factors that interact with individual beliefs to affect vaccine-related behaviors. To better understand the population dynamics of vaccine hesitancy, it is important to study how these external factors could shape a population's vaccination decisions and affect the broader health culture. Using a mathematical model of cultural evolution, we explore the effects of vaccine mandates, vaccine inaccessibility, and varying cultural selection trajectories on a population's level of vaccine hesitancy and vaccination behavior. We show that vaccine mandates can lead to a phenomenon in which high vaccine hesitancy co-occurs with high vaccination coverage, and that high vaccine confidence can be maintained even in areas where access to vaccines is limited.

A cultural evolutionary model of the interaction between parental beliefs and behaviors, with applications to vaccine hesitancy.

Health perceptions and health-related behaviors can change at the population level as cultures evolve. In the last decade, despite the proven efficacy of vaccines, the developed world has seen a resurgence of vaccine-preventable diseases (VPDs) such as measles, pertussis, and polio. Vaccine hesitancy, which is influenced by historical, political, and socio-cultural forces, is believed to be a primary factor responsible for decreasing vaccine coverage, thereby increasing the risk and occurrence of VPD outbreaks. Behavior change models have been increasingly employed to understand disease dynamics and intervention effectiveness. However, since health behaviors are culturally influenced, it is valuable to examine them within a cultural evolution context. Here, using a mathematical modeling framework, we explore the effects of cultural evolution on vaccine hesitancy and vaccination behavior. With this model, we shed light on facets of cultural evolution (vertical transmission, community influences, homophily, etc.) that promote the spread of vaccine hesitancy, ultimately affecting levels of vaccination coverage and VPD outbreak risk in a population. In addition, we present our model as a generalizable framework for exploring cultural evolution when humans' beliefs influence, but do not strictly dictate, their behaviors. This model offers a means of exploring how parents' potentially conflicting beliefs and cultural traits could affect their children's health and fitness. We show that vaccine confidence and vaccine-conferred benefits can both be driving forces of vaccine coverage. We also demonstrate that an assortative preference among vaccine-hesitant individuals can lead to increased vaccine hesitancy and lower vaccine coverage.

Outcomes assessment of role-play scenarios for teaching responsible conduct of research.

We describe the summative assessment of role-play scenarios that we previously developed to teach central topics in the responsible conduct of research (RCR) to graduate students in science and engineering. Interviews with role-play participants, with participants in a case discussion training session, and with untrained students suggested that role-playing might promote a deeper appreciation of RCR by shifting the focus away from wanting to simply "know the rules." We also present the results of a think-aloud case analysis study and describe the development of a behaviorally-anchored rating scale (BARS) to assess participants' case analysis performance.

Development of role-play scenarios for teaching responsible conduct of research.

We describe the development, testing, and formative evaluation of nine role-play scenarios for teaching central topics in the responsible conduct of research to graduate students in science and engineering. In response to formative evaluation surveys, students reported that the role-plays were more engaging and promoted deeper understanding than a lecture or case study covering the same topic. In the future, summative evaluations will test whether students display this deeper understanding and retain the lessons of the role-play experience.

Social support in cyberspace: lessons learned.

The lessons learned from the implementation of phase one of Women to Women (WTW1), a research-based computer outreach program for rural women with chronic illness, and their influence on the development of phase two of Women to Women (WTW2) are discussed in this article. The changes implemented in WTW2 included moving from the FirstClass delivery platform to WebCT; increasing the intra- and interdisciplinary nature of the team by adding nurse experts in Web skills and women's health and non-nurse colleagues in family finance and nutrition; expanding the geographical area to be served from Montana to adjoining states; developing health teaching units that harness the internet as the major source of ever-current health information; including a control group in the study design; and selecting more pertinent, repeated measurement instruments to assess psychosocial variables.