Public Versus Private Beliefs

Immunization programs are sometimes challenged by the ‘negative health beliefs’ of the populations they are trying to reach. Further, it’s often assumed that programs must campaign to shift those beliefs as a prerequisite to the program’s success. However, beliefs are often intractable in the individual and reinforced by community norms; they’re not easy to change.

A program in Zambia in 1999 was faced with “hard to reach and hard to convince” populations.* Among these groups were members of the Apostolic Church in Zambia. The church’s doctrine explicitly rejected all ‘Western’ medicine. This was a belief that the community affirmed; publicly, all members adhered to it.

However, researchers discovered that, privately, many people did want to participate in the vaccination program — but they were worried about the reactions of their fellow members.** Researchers devised an elegant solution: health workers stayed late in the area so members could come for immunization when fewer people would be there to see them.

This group, which publicly denied the value of vaccination, ended up vaccinating almost all of their children. Without this additional observation, the program may have assumed the need to change this publicly articulated ‘negative health belief’. By putting all assumptions on the table, however seemingly bullet-proof, programs open themselves up to interventions that are more responsive to the challenges facing users.

*Communication for Immunization and Polio Eradication in Zambia: A joint case study by CBOH, MOH, UNICEF, WHO/AFRO and USAID (1999)
**This phenomenon is known as ‘pluralistic ignorance’, where a majority of group members privately reject a social norm while incorrectly assuming that most others accept it. See: Miller et al (1991) When social comparison goes awry: The case of pluralistic ignorance.