The Changing Working Class
I recently worked on a qualitative research project for a public health client that tested the following hypothesis: Parents of lower socioeconomic status will be more willing to vaccinate their pre-teens against HPV compared to parents of higher socioeconomic status. The hypothesis rested on prior research which found that families of lower income and education levels have higher vaccination rates. One study that specifically focused on the HPV vaccine found that white, affluent, and educated parents were least likely to choose the HPV vaccine for their kids. Explanations for these differences vary: for one, people living in poor neighborhoods often have access to “social safety net” immunization services that provide free vaccinations. But socioeconomic status can also influence one’s likelihood to follow a medical professional’s recommendation—while those on the lower end of the socioeconomic spectrum tend to heed their doctor’s advice without question, more educated and higher income families may be more distrustful and more likely to consult outside sources when it comes to immunization decisions.
Going into this project, I fully expected to confirm this hypothesis. I have done vaccination research before, and have led discussions of upper middle class mothers whose aversions toward vaccines go hand in hand with their militaristic adherence to buying only organic, farm-fresh food and locally-made, chemical-free soaps and laundry detergents. That is, their rejection of vaccinations was part of an overall lifestyle or philosophy about what people should and should not put into or on their bodies.
The focus group respondents for this particular project were recruited in two different suburban parts of New York state. The lower socioeconomic status groups included those who did not have a college degree and had a family income below the median income for the area (based on Census data). The cut-off in both locations was $80,000. In looking at the mix of respondents in both groups, the income gap between the two groups was not huge, but the main difference was in education level—most in the lower socioeconomic status group were high school graduates or had technical degrees while those in the higher socioeconomic status group were college graduates and many had their Master’s, Doctorates, or law degrees.
During the fieldwork, the client and I were both shocked to discover that not only could we not confirm our hypothesis, we would need to soundly reject it. In fact, our research indicated that parents of lower socioeconomic status were actually less likely to vaccinate their pre-teens against HPV. Of course, this was qualitative research, so we cannot generalize these findings to the larger population of New York state parents, but our findings do point to a general tendency of lower SES parents being more skeptical of the vaccine compared to high SES parents.
We spent a lot of time dissecting these findings, which conflict with prior research. After much analysis, we concluded that our study is not just an anomaly, but perhaps one of the first studies to observe some of the patterns and behaviors of the changing working class. That is, the meanings associated with being a person with less education and income are shifting, and how factors like education and income affect one’s behavior are changing. One only needs to look at voting patterns to know this is true in politics, and it makes sense that these dynamics would filter down to other decisions, including ones related to health.
We theorized that parents of lower SES were less willing to vaccinate their children for the following reasons:
1. They are more likely to be generally distrustful and skeptical of information.
2. They tend to have weaker relationships with medical professionals.
3. They subscribe to an ideology of individualism.
Lower SES parents in this research tended to have lower trust of information in general. They are more skeptical toward information, including that which is health-related. This is different than being uninformed. Even in the face of facts, some parents will still distrust the information and allow their skepticism to dominate. Consider the following quotes from the focus groups:
• “There are a lot of gaps in the research. How am I supposed to know what's going to happen 20, 50 years down the line? Their ability to have children? How am I supposed to know what’s in them? How do the doctors know?”
• “I just feel like I need more information before I could make a decision.”
Moderator: “This focus group presented a lot of information. What other questions about the HPV vaccine do you have?”
“I don’t know, I just need to research it more.”
Weaker relationships with doctors
Higher SES parents tend to trust doctors more, and part of this may have to do with their relationships. If higher SES parents have stronger relationships with their doctors, then they also likely have more trust between them. Many parents in the higher SES groups talked about going to the same doctor for 20 years and building solid, trusting relationships. These differences may be partly attributable to the quality of healthcare—lower SES parents may not have as high of quality of care, which could contribute to weaker relationships with medical professionals.
The Ideology of Individualism
Parents of lower socioeconomic statuses in this research tended to believe in an ideology predicated on individualism. In the context of health decisions, this means that parents believe they can protect their children themselves, without having to vaccinate them. Some parents talked about teaching their children abstinence or safe sex practices to shield them from HPV and other diseases. Their strong sense of personal responsibility may make them less likely to vaccinate. Consider the following quotes:
· “This says protect my kids from cancer, but I feel like I’m protecting my kids by NOT giving them the vaccine.”
· “Cervical cancer is not life threatening…I’m going to teach her to prevent it, but if she did get it it’s not that serious.”
More research is needed to fully examine the ways in which the changing characteristics of the working class are affecting their healthcare decisions. The implications of such are important: this research suggested that the way public health campaigns communicate with and reach parents might vary according to their socioeconomic status. That is, we may have to adjust the message for parents of lower SES to effectively resonate and motivate them to action.
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