Speaking to the Unvaccinated: Part I — Autonomy

Group exercise activity with a friend
For people who still need to get vaccinated, telling them they should just get vaccinated doesn’t seem to work. So, what does?

Believe it or not, the challenge of shifting health behaviours is nothing new. Extensive research on the topic has illustrated a unique skill-set among our most persuasive health professionals. These professionals have a particular way of being with patients. This involves communicating with compassion, acceptance, partnership and respect. Let’s be honest. We don’t see a lot of that on social media, which may explain why a small portion of unvaccinated communities have become so emboldened.

“Just let me live my life.”

Ignorance is bliss, especially when it comes to our health. We don’t want to restrict the availability of cola or chips in cafeterias. Likewise, we don’t want to be excluded from restaurants, concerts and pubs if we aren’t vaccinated. People will always seek out a life where they have a sense of freedom, or ability to self-determine their life priorities. According to self-determination theory, people need to experience the following before they shift their perspectives psychologically:

  • Autonomy: the need to feel in control of our life. This sense of being able to take direct action can result in people making changes to their life.
  • Competence: the need achieve mastery of tasks and life skills. The feeling of competence makes people more likely to take action and set goals.
  • Connection or relatedness: the need for belonging and attachment to others. The sense of connection or relatedness motivates us to take actions that help us fit in social groups.

So, today’s unvaccinated aren’t wrong. They have an internal drive to be in control of their life. They make health decisions from a perspective of what they feel good (or competent) at. And, they seek to fit into their family and friend groups… perhaps even their occupation or trade. These human needs all drive the decision to get vaccinated more than regulations ever will. Motivation comes from within, and it ultimately reflects our collective desire to ‘just live our life’.

“Now, it’s personal.”

External rewards and punishments have long been known to be weak motivators of health behaviours. People just aren’t motivated by prizes, nominal cash amounts, tax credits or certificates. In fact, overreliance on extrinsic motivators has been associated with reduced motivation to change health behaviours across several studies and health challenges.

We instead see people are more motivated to act when the decision is “personal” to them. What makes the decision to get vaccinated personal?

Think of these scenarios:
  • “I don’t understand why some people can get sick after they have been vaccinated.” The feeling of ‘incompetence’ (or lack of understanding) urges most of us to play it safe. In this case, we default to not taking action until we feel more confident in our choices.
  • “I might harm my unborn child.” Pregnant mothers are often some of the most fearful of new vaccines with conflicting or unknown evidence. The stakes are high, and they just can’t imagine being the one to potentially harm their unborn child.
  • “My co-workers openly judge other people who got vaccinated.” People often fear that decisions they make around health will separate them from the group. Most will follow the crowd. And, without open communication about health behaviours, the most vocal viewpoints are assumed to be the ‘majority’ opinion.
  • “My boss won’t give me sick time for a vaccine side effect.” Most people seek to minimize losses in their life, even when the potentially large rewards (e.g. prevention of getting sick with COVID) outweigh the risks. Any upfront costs are weighted much more heavily in our decision-making processes.
Now, think of these opportunities:
  • “[Friend] was vaccinated, and is doing great!” People should be encouraged to publicly celebrate the moment they got vaccinated, showing social proof for the decision to get vaccinated. Health privacy laws that prevent people from ‘sharing’ their vaccine status in open and safe mediums should be immediately reconsidered.
  • “Workplaces which are 85%+ vaccinated will be offered a one-time bonus.” Workplace policies can also be used to show the vast majority are vaccinated, and encourage people to work towards a shared goal.
  • “Every employee is encouraged to take paid time off (sick days) if they feel tired or have a side-effect following vaccination.” People need to feel supported and safe in their decision to get vaccinated. Any up-front costs or uncertainty should be addressed immediately.
  • “Vaccinated people will be given priority entrance.” People want to feel special, and public health policies should make vaccinated people feel like they are part of a desirable ‘in-group’.
  • “We celebrate those who got the shot.” Likewise, people should be periodically recognized (in a collective way) for their decision to get vaccinated. This again shows social proof.

We can’t easily regulate our way out of this pandemic. However, we can motivate our way out of it. People-focused public health policy gives people choices in their life. In doing so, it incentivizes all of us to make health decisions that resonate with deeply human needs for autonomy, competence and connection.

Published by Adam Henley

Adam is a Registered Nurse with experience in chronic disease management, symptom measurement, hematology/oncology, primary care behavioural health and geriatrics. He combines counselling, nutrition & exercise with traditional home nursing care. Adam cares to live health together with clients in a manner consistent with Parse’s Theory of Human Becoming. At the heart of his care, Adam offers evidence-based strategies to transform health together.

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