A new study suggests that imagining how you might feel after skipping a flu shot might be key to actually getting one.
Primary author and SMU psychology professor Austin Baldwin and collaborators Catherine Rochefort and Alexander J. Rothman found that when college students wrote about why they might regret not getting the influenza vaccination, they were significantly more likely to follow through later.
At the heart of Baldwin’s research is a concept called anticipated regret — mentally jumping to the future to imagine skipping a behavior and how you might feel about the possible consequences.
Previous research has shown that people who anticipate regret are more likely to vaccinate, but Baldwin was concerned with how to turn that knowledge into action.
“It’s the way of thinking about a future outcome and the extent to which you regret a decision on what that outcome is,” said Baldwin. “In this case, the anticipated regret is the prompt to think about if you don’t get a flu shot and then you later got sick with the flu — to what extent would you regret that?”
Their findings, published recently in the Annals of Behavioral Medicine, also demonstrate how a brief reflection can make vaccination feel more like an autonomous choice rather than an obligation. It’s known as autonomous motivation, or doing something because it matters to you, not because someone else told you to.
Neighborhood Spotlight
Park Cities
Where the Park Cities Stay Connected.
“We know across all kinds of behaviors that all else being equal, people are more likely to engage in behaviors and do things that they find to be more personally important and meaningful,” Baldwin said. “And (they are) more likely to sustain those behaviors over time.”
The SMU team recruited 263 college students and divided them into three groups.
One group answered open-ended responses about why they might regret skipping a flu shot. Another simply answered clickable survey questions, while the control group received no prompts.
Students who generated their own responses showed a 39% increase in autonomous motivation compared to the control group, as well as a higher vaccination rate months later. The study showed that simply asking participants to rate how much regret they anticipated wasn’t enough.
According to Baldwin, it’s the act of writing that engages people more deeply.
“It is this kind of brief but sort of counter-factual thinking … imagining ‘what if I get sick and could have prevented it,’ — that seems to activate people’s sense of personal choice and control over their health,” he explained.
The study was conducted in fall 2020, during the early months of the COVID-19 pandemic. Flu vaccination rates were lower overall that year, which Baldwin attributes to nationwide lockdowns and reduced social interaction. Still, the results illustrated a clear picture of how self-reflection can influence behavior even amid uncertainty.
Baldwin suggests a similar approach could be applied to public health efforts. A quick open-ended response to a health questionnaire could encourage the same kind of reflection used in the study.
“It acknowledges autonomy in that decision-making,” he said.
For Baldwin, the lesson goes beyond public health. Imagining regret can help people follow through not just with a flu shot, but with any good intention — from unfinished projects to shelved dreams.
“People don’t always follow through on what they intend to do,” he said. “This could be a really helpful and simple way of helping.”
