Pregnant women’s mental images are directly linked to vaccine hesitancy and uptake

A new study explored whether women visualised a vaccine would have a positive or negative impact on their babies and if that affected their decision to be vaccinated

Pregnant woman meeting with health care professional

Pregnant women’s mental images are directly linked to vaccine hesitancy and uptake

A new study explored whether women visualised a vaccine would have a positive or negative impact on their babies and if that affected their decision to be vaccinated

Mr Alan Williams

Media and Communications Manager

Corporate Communications (Marketing and Communications)

5 May 2026

When pregnant women think about vaccinations, many experience vivid mental images – such as a sick baby in hospital – that have a direct link to their opinion of the vaccine and whether they ultimately have it, new research has shown.

The international study is the first known work to investigate the prevalence of vaccination-related mental imagery and to link it to both vaccine hesitancy and vaccination behaviour during pregnancy.

It was carried out with more than 400 pregnant women in Perth, Western Australia, who completed a brief survey while they were waiting for appointments in a maternity hospital.

The women were asked for their perceptions of risks relating to whooping cough, influenza, and COVID-19, and whether they experienced any mental images relating to the diseases or the vaccinations for these diseases.

Verified vaccine uptake data was subsequently obtained through official immunisation records at the end of participants’ pregnancy to examine whether and when each vaccine was received, if at all.

The findings, published in the journal Social Science & Medicine, showed that mental images were common and – depending on whether that mental image was a positive or negative one, and about the impacts of diseases or the vaccine itself – could be used in some cases to predict if and when the women ultimately became vaccinated during pregnancy.

Pregnancy is a sensitive period when health decisions carry extra emotional and psychological weight.

Our results suggest that vivid emotional mental scenes that pop to mind when someone is thinking about vaccination are not just incidental, they may be meaningfully linked to how people feel about vaccines, and in some cases, whether and when they get vaccinated.

Dr Julie Ji
Lecturer in Psychology and lead author on the study

The study’s key findings included that women who reported negative mental images about vaccines – such as worrying scenarios of harm or side effects – also tended to report greater hesitancy towards the whooping cough and influenza vaccines, particularly if they had not yet been vaccinated.

This pattern was observed even after taking into account women’s general attitudes towards receiving government-recommended vaccines during pregnancy, suggesting mental images capture a unique aspect of how vaccine decisions are psychologically experienced, rather than simply reflecting general maternal vaccination attitudes.

When the researchers looked at what women actually did, a different pattern emerged. Those who reported positive mental images about vaccines, such as imagining antibodies being passed through the umbilical cord, were more likely to receive the whooping cough vaccine, and to get it earlier in their pregnancies.

This highlights the potential importance of positive mental imagery in vaccine decision-making and behaviour, such as being able to imagine how vaccines offer protection for oneself and one’s baby. Again, these effects were not simply a reflection of general maternal vaccination attitudes or disease-specific hesitancy levels.

By the end of their pregnancy, participants were most likely to receive the whooping cough vaccine (82.1% vaccinated), with lower uptake for influenza (60.1%) and very low uptake for COVID-19 (7.2%). At a time when hesitancy and suboptimal vaccine uptake pose significant threats to public health, the study highlights the importance of examining modifiable psychological factors involved in maternal vaccination decision-making.

The study builds on extensive work on the cognitive, emotional, and motivational impacts of mental imagery by leading mental imagery researchers at the University of Plymouth.

A lot of research, including that done here in Plymouth, shows that mental imagery makes memories and future thoughts feel real. These images can powerfully influence our emotions and beliefs, and motivate helpful or unhelpful behaviours. Because mental imagery is something we know how to work with from mental health research, understanding its role in vaccine decision making during vulnerable periods like pregnancy is an important step towards developing new ways to support both individual and public health.

Dr Julie Ji

The study was conducted by an interdisciplinary team of researchers spanning psychology, midwifery, paediatrics and infectious diseases, and social science, across institutions in Australia and the UK. It was funded by the Telethon Channel 7 Western Australia Child Research Fund, supporting work focused on improving health outcomes for children and families.

This unique collaboration brought together expertise in mental health and cognitive science with clinical knowledge of pregnancy care and vaccination, as well as population‑level insights into vaccine policy and uptake.

The authors say this interdisciplinary approach was critical to examining vaccine decision‑making during pregnancy using real‑world behavioural data, and they are now exploring how mental imagery can be harnessed to support informed decision-making during pregnancy.

Dr Julie Ji is a Lecturer at the University of Plymouth's School of Psychology and Centre for the Psychology of Health and Wellbeing, and Adjunct Research Fellow at the University of Western Australia School of Psychological Science.

The full study – Ji et al.: Vaccine hesitancy and uptake during pregnancy: investigating the role of emotional mental imagery – is published in Social Science & Medicine, DOI: https://doi.org/10.1016/j.socscimed.2026.119302

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