Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, México.
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Mexico City, México.
Clin Rheumatol. 2023 Aug;42(8):2199-2207. doi: 10.1007/s10067-023-06609-5. Epub 2023 May 2.
INTRODUCTION/OBJECTIVES: Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals.
Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values.
We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy.
The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.
简介/目的：接种疫苗不仅涉及疫苗的公共治理或作为公共卫生关注的接种问题，还涉及个人、社会和伦理方面。本研究旨在描述影响一般接种决策和具体接种 COVID-19 疫苗决策的社会文化和道德叙事，这些决策是在两家医院的风湿病科患者中做出的。
这是一项定性研究，包括根据访谈指南进行的个人半结构化访谈。我们使用 ATLAS.ti 软件进行主题分析，并进行三角验证，以验证一致性并从医学人类学框架和叙事伦理方法的角度深入了解参与者的潜在道德价值观，从而帮助解释数据。
我们总共采访了 37 名患者和 3 名风湿病医生。从分析中得出了理解接种决策的五个核心主题：（1）疫苗和疾病的信息，（2）接种疫苗的感知风险-效益，（3）医患关系，（4）疫苗接种计划的治理，（5）对疫苗的态度。取决于疫苗类型，个人和家庭的接种经验各不相同。COVID-19 疫苗作为一种新的医疗技术，引起了更多的争议，导致人们犹豫不决。
墨西哥风湿病患者的接种决策有时可能会存在疑虑和不信任，特别是对于狼疮诊断的患者，但在大多数情况下，最终还是会接受接种。尽管患者做出并重视自主决策，但在集体层面上，涉及社会文化和伦理方面的过程也会影响决策。关键点 • 通过叙事、定性方法（如本研究中使用的方法）而不是仅使用定量方法，更好地确定疫苗决策的复杂性 • 接种疫苗的社会文化和道德观点塑造了决策，因此强调了将患者纳入制定有效临床实践指南以及制定合乎道德的公共政策的重要性 • 免疫接种的社会历史背景和个人经验比获得有关疫苗的生物医学信息更能影响疫苗决策，这表明基于信息缺陷模型的方法不足以克服疫苗犹豫。
