Discussion
Although evidence-based communication interventions to promote HeVD
vaccination by horse owners were not identified, the BeSD framework
enabled orientation and synthesis of the research on horse owner vaccine
decision-making, suggesting that the BeSD framework could be adopted to
understand HeVD vaccination uptake by horse owners.
The BeSD framework was originally developed to characterise the drivers
of parental decisions to vaccinate children (and later COVID vaccine
decisions among adults) (World Health Organization, 2022a), and this
review demonstrates that there are similarities between the underlying
drivers of vaccination decisions among horse owners and parents. Most
lie within the BeSD Thinking and Feeling Domain in which
non-vaccinating parents also perceive low disease risk, are concerned
about vaccine side-effects, believe that vaccines are unsafe and
ineffective, and share mistrust of health professionals (Brown et al.,
2010; Chow, Danchin, Willaby, Pemberton, & Leask, 2017; Smith, Amlôt,
Weinman, Yiend, & Rubin, 2017). Fitting under the BeSD Social
Processes Domain, the social “othering” and dismissal by medical
professionals that is experienced by some non-vaccinating parents (Wiley
et al., 2021) is like the ostracism from veterinarians experienced by
HeVD-vaccine skeptical horse owners (Manyweathers et al., 2020). Within
the same domain, healthcare provider recommendations to parents are akin
to those from veterinarian to horse owners (Crawford & Leask, 2022;
Helps, Leask, Barclay, & Carter, 2019; Smith et al., 2017). Within the
BeSD Practical Issues Domain, the cost of vaccination as
an influence on horse owner vaccination decisions also influences
parents vaccination decisions; for example, cost is a known barrier to
Meningococcal B vaccination, which is not included in the National
Immunisation Program schedule for all non-Indigenous Australian children
(Taha et al., 2022; Wang, Clarke, Afzali, & Marshall, 2014).
The BeSD Motivation Domain is a point at which the populations
might differ. It is not possible to quantify the probability of
intention to vaccinate (motivation) in the current review; however, it
is clear that there are groups of horse owners with little motivation to
vaccinate their horses against HeVD, and overall, motivation must be
lower than that of parents for childhood vaccines because there is
currently >95% versus ~12% uptake
for childhood vaccines and HeVD vaccine, respectively (M. Taylor et al.,
2016; Wiley et al., 2021). Horse owners behave similarly to parents in
that increased risk perception will result in increased vaccination
motivation (Helps et al., 2019), but the complexity of HeV transmission
necessitates that HeVD prevention extends beyond vaccine acceptance to
include non-pharmaceutical approaches which do not necessarily align
well with the current vaccine-focused BeSD framework. This complexity
was acknowledged in the community juries study, in which participants
identified the need for better communication and public education about
the behaviours, ecological benefits, and zoonotic risk that bats pose
(Degeling et al., 2018). Where the biggest barriers to HeVD vaccination
lie – whether associated with the domains of ‘Thinking and Feeling’ and
‘Social Processes’ or the domain of ‘Practical Issues’ – needs further
investigation beyond this preliminary appraisal.
This review highlighted both similarities and differences in the
perceptions, feelings, motivations, social processes, and practical
issues that horse owners and parents face in the context of HeVD and
childhood vaccine decision-making, respectively. It provides insights
about how horse owners engage with HeVD information and how the
information influences their behaviour, and the circumstances in which
horse owners might consider HeVD vaccination. This information, which is
part of the why behind the low uptake of HeVD risk mitigation
behaviour by horse owners, now needs to be measured to know their
relative importance (Manyweathers, Field, Longnecker, et al., 2017;
Wiethoelter et al., 2017; WHO, 2022a) as well as assessment and
integration of other influencing factors such as the use of alternative
mitigation strategies and zoonotic transmission risk. Once adapted for
the HeVD context, the BeSD framework could be used to systematically
measure the drivers of HeVD vaccination to inform the development of
communication or educational interventions (WHO, 2022a). Following
implementation of such HeVD communication interventions, BeSD data
collection tools could then be used to monitor and evaluate the
interventions, and to guide interventions to reduce HeVD vaccine
coverage gaps (WHO, 2022a), thus reducing the risk of HeVD to horses and
people.