Do cognitive styles affect vaccine hesitancy? A dual-process cognitive framework for vaccine hesitancy and the role of risk perceptions.

Abstract Rationale In this study, we consider cognitive differences in vaccine hesitancy and how perceived risks intervene in this relationship. Recent research agrees on the existence of two cognitive processes, intuitive and analytic cognition. Different individuals lean toward one of these processes with varying degrees of strength, influencing day-to-day behavior, perceptions, and decisions. Thinking dispositions might influence, at the same time, vaccine acceptance and perceived risks of vaccine-preventable disease, but the implications of individuals’ cognitive differences for vaccination uptake have seldom been addressed from a sociological standpoint. Objective We bridge this gap by adopting a dual-process framework of cognition and investigate how thinking styles have a direct association with vaccine hesitancy and an indirect one through perceptions of risk. Methods We use data from original surveys carried out between September and November 2019 on a sample of the Italian population, participating in an online panel run by a major Italian survey company. We use Karlson, Holm, and Breen (KHB) decomposition to compare coefficients of nested-nonlinear models, separate the direct and indirect association of cognitive processes with vaccine hesitancy, and disentangle the contribution of each measure of risk perception. Results Net of individual socio-demographic characteristics, intuitive thinking is positively associated with the likelihood of being vaccine hesitant, and this direct association is as important as the indirect one through risk perceptions. Affective risk perceptions account for over half of the indirect association, underlining the centrality of affective versus probabilistic approaches to risk perception. Conclusion This study contributes to the existing literature by highlighting the importance of including cognitive characteristics in vaccine hesitancy research, and empirically showing individuals' qualitatively complex perceptions of risks. Taking into account individuals’ preferred cognitive style and affective concerns might be important in developing better tailored communication strategies to contain vaccine hesitancy.