Information, Perceptions and Health Behavior (2021-2022)

Health decisions and behavior are often intertwined with perceptions influenced by information access, culture and social norms, and policies that may elicit acceptance or resistance. For example, vaccines have been a savior invention for individual health and the greater society, but doubts about vaccines’ necessity, efficacy and safety have endured since the 1800s. Vaccine hesitancy has led to suboptimal immunizations globally. In the U.S., only 70% of children complete the recommended childhood vaccine series and 34% of adults regularly receive vaccinations for seasonal influenza.

Misinformation and antivaccine sentiments in recent years have caused resurgences of diseases that were eliminated or nearly eradicated. While COVID-19 persists, the public’s intent to vaccinate is unclear and changing. Of note, racial and ethnic minorities with higher infection susceptibility and mortality often have lower confidence and acceptance for vaccines, perpetuating chronic disparity. 

This project team examined how vaccine acceptance for COVID-19 and other diseases change over time; compared individual, societal and vaccine-specific barriers and motivators to vaccination; and analyzed how language framing and data presentation influence vaccination decisions. The team used surveys, focus groups and in-depth individual interviews to determine the factors that may be affecting levels of hesitancy, including risk perception, social norms and sources of information. Their work offered policymakers comprehensive, up-to-date insights and recommendations for planning, executing and monitoring immunization programs.


Summer 2021 – Summer 2022

Team Outputs

Understanding the Factors That Influence Vaccine Hesitancy (2022 Fortin Foundation Bass Connections Virtual Showcase)

Vaccine Hesitancy: Social Norms, Risk Perception, and Information Source (poster by Brooke Bier, Michaela Kotarba, Alejandra Mella-Velazquez, Don Nguyen, Taylor Parker, Kartik Pejavara and Danielle Smith, presented at Fortin Foundation Bass Connections Showcase, Duke University, April 13, 2022)

Parent–Child Vaccination Concordance and Its Relationship to Child Age, Parent Age and Education, and Perceived Social Norms. Pikuei Tu, Danielle Smith, Taylor Parker, Kartik Pejavara, J. Lloyd Michener and Cheryl Lin. 2023. Vaccines 11(7):1210.

Changes in Confidence, Feelings, and Perceived Necessity Concerning COVID-19 Booster. Cheryl Lin, Brooke Bier, Ann M. Reed, John J. Paat and Pikuei Tu. 2023. Vaccines 11(7):1244.

Vaccinated Yet Booster-Hesitant: Perspectives from Boosted, Non-Boosted, and Unvaccinated Individuals. Cheryl Lin, Brooke Bier, Rungting Tu, John J. Paat, Pikuei Tu. 2023. Vaccines 11(3):550.

Parent-Child Vaccination Concordance: Influence of Emotions, Social Norms and Political Attitudes. Taylor Parker, Kartik Pejavara, Danielle Smith, Pikuei Tu, Cheryl Lin. Presented at American Public Health Association Annual Meeting, Boston, MA, November 6, 2022.

Adolescent Risk Perception and Motivations Toward COVID-19 Vaccination. Brooke Bier, Michaela Kotarba, Cheryl Lin, Pikuei Tu. Presented at American Public Health Association Annual Meeting, Boston, MA, November 6, 2022.

Internal and External Motivations and Risk Perception toward COVID-19 Vaccination in Adolescents in the U.S. Pikuei Tu, Michaela Kotarba, Brooke Bier, Rachel Clark, Cheryl Lin. 2022. Vaccines 10(5):697.

“I Would Never Push a Vaccine on You”: A Qualitative Study of Social Norms and Pressure in Vaccine Behavior in the U.S. Cheryl Lin,Taylor Parker, Kartik Pejavara, Danielle Smith, Rungting Tu, Pikuei Tu. 2022. Vaccines 10(9).


Don Nguyen

This Team in the News

Meet the Members of the 2021-2022 Bass Connections Student Advisory Council


Image: MTA’s Heroic Frontline Workers Begin COVID-19 Vaccinations, by Metropolitan Transportation Authority of the State of New York, licensed under CC BY 2.0

MTA’s Heroic Frontline Workers Begin COVID-19 Vaccinations.

Team Leaders

  • Cheryl Lin, John Hope Franklin Center, Duke Policy and Organizational Management Program, Markets and Management Studies, International Studies
  • James Michener, School of Medicine-Family Medicine and Community Health
  • Pikuei Tu, John Hope Franklin Center, Duke Policy and Organizational Management Program, Markets and Management Studies, International Studies

/graduate Team Members

  • Don Nguyen, Global Health - MSc

/undergraduate Team Members

  • Brooke Bier, Psychology (AB)
  • Michaela Kotarba, Interdepartmental
  • Alejandra Mella, Program II (AB)
  • Taylor Parker, Chemistry (AB)
  • Kartik Pejavara, Computer Science (BS)
  • Danielle Smith, Neuroscience (BS)

/yfaculty/staff Team Members

  • Susan Kline, School of Medicine-Pediatrics
  • John Paat, School of Medicine-Medicine: General Internal Medicine
  • Ann Reed, School of Medicine-Pediatrics

/zcommunity Team Members

  • Laura Bayzle, The Link Group
  • Leslie Beitsch, Department of Behavioral Sciences and Social Medicine - FSU
  • Mike McTaggart, Global Digital
  • Jewel Mullen, Dell Medical School-UT-Austin