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Akolkar N, Craigg DK, Fisher L. Building a Prevention Clinic at the Northport VA to Improve Pneumonia Vaccination Numbers. AJPM FOCUS 2024; 3:100263. [PMID: 39252816 PMCID: PMC11381438 DOI: 10.1016/j.focus.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Introduction Pneumonia vaccination rates have increased to >60% over the last 20 years. At the Long Island, New York, Northport VA Hospital, pneumonia vaccination data from 2021 showed a vaccination rate of 68.55%. The goal is a pneumonia vaccination rate of 85%. Pneumonia vaccines prevent invasive pneumococcal disease and pneumococcal pneumonia. The authors aimed to increase vaccination rates at Northport. Methods The authors established a weekly vaccine and prevention clinic aiming to vaccinate as many veterans as possible. Preventive medicine residents performed outreach, scheduling, vaccine administration, and Brief Action Planning. Motivational interviewing techniques were used in outreach calls and clinic visits to encourage behavioral change. Results From an outreach list >7,000 patients, 506 patients were contacted and counseled on pneumonia vaccination. A total of 130 patients were scheduled for clinic visits. Of these 130, 91 kept their appointments and were seen in the clinic, and 87 vaccines were administered, of which 56 were pneumonia vaccines. Data were collected and analyzed in 2022. Conclusions Implementing a dedicated vaccine and prevention clinic using motivational interviewing techniques in outreach and clinical visits allows for optimized patient vaccinations, enhanced information sharing, increased primary care retention, and increasing visibility of preventive medicine among patients and colleagues within the Veterans Affairs medical system.
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Affiliation(s)
- Namita Akolkar
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Danielle K Craigg
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York
| | - Lisa Fisher
- Northport VA Medical Center, East Northport, New York
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2
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Xia S, Nan X. Motivating COVID-19 Vaccination through Persuasive Communication: A Systematic Review of Randomized Controlled Trials. HEALTH COMMUNICATION 2024; 39:1455-1478. [PMID: 37254940 DOI: 10.1080/10410236.2023.2218145] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Vaccination is a vital defense against COVID-19 infections and outbreaks, yet vaccine hesitancy poses a significant threat to pandemic response and recovery. We conducted a systematic review of published randomized controlled trials (N = 47) assessing the persuasive effects of COVID-19 communication on COVID-19 vaccine acceptance. Individual vs. collective appeals and gain vs. loss frames are among the most frequently assessed message features, but they generally do not make a difference in persuasion. Normative messages that highlight higher (vs. lower) prevalence of vaccine acceptance are more persuasive. Message sources overall have limited impact on COVID-19 vaccine acceptance, but sources that have a shared identity with the message receivers tend to be persuasive. More engaging message channels such as interactive chatbots and videos are promising communication tools but are generally under-utilized and under-studied. Compared to no communication or irrelevant communication, COVID-19 vaccine messages generally have a small advantage in increasing COVID-19 vaccine acceptance. Messages that include 1) vaccine safety and/or efficacy information; 2) collective appeals combined with embarrassment appeals; and 3) political leaders' vaccine endorsement are among the most effective messaging strategies. There is no evidence of any backfire effects of COVID-19 vaccine messages. We discuss the implications of our findings for persuasive message design in pandemic vaccine communication.
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Affiliation(s)
- Shilin Xia
- Department of Communication, University of Maryland
| | - Xiaoli Nan
- Department of Communication, University of Maryland
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Kulle AC, Schumacher S, von Bieberstein F. Mobile vaccination units substantially increase COVID-19 vaccinations: evidence from a randomized controlled trial. J Public Health (Oxf) 2024; 46:151-157. [PMID: 37986235 DOI: 10.1093/pubmed/fdad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 08/04/2023] [Accepted: 10/15/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Governments around the world used mobile vaccination units (MVUs) to increase COVID-19 vaccine uptake, but the causal effect of MVUs has not yet been evaluated. METHODS In a randomized controlled trial (RCT) with 20 Swiss communities (10 treatment, 10 control) in August 2021, MVUs were sent to treatment communities for 4 hours on a single day. The experimental sample comprises 20 414 adults who were unvaccinated against COVID-19 at this point. The researchers designed the RCT and the government introduced the idea to test the effectiveness of MVUs and was responsible for administering the vaccines. RESULTS The vaccination rate in the sample of the treatment group surpassed the rate in the control group by a factor of 3.4 (+9.0 percentage points) over 3 weeks. The increase was present and highly statistically significant for women, men and for all age groups. We found no evidence of cannibalization of vaccinations at other service locations. CONCLUSIONS The offer of MVUs is highly effective in raising vaccination rates, even at a later point in the vaccination campaign. The absence of cannibalization effects suggests that MVUs reach more people overall, not just faster.
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Affiliation(s)
- Anna-Corinna Kulle
- Institute of Organization and Human Resource Management, University of Bern, 3012 Bern, Switzerland
| | - Stefanie Schumacher
- Institute of Organization and Human Resource Management, University of Bern, 3012 Bern, Switzerland
| | - Frauke von Bieberstein
- Institute of Organization and Human Resource Management, University of Bern, 3012 Bern, Switzerland
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4
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Robertson DA, Timmons S, Lunn PD. Behavioural evidence on COVID-19 vaccine uptake. Public Health 2024; 227:49-53. [PMID: 38104419 DOI: 10.1016/j.puhe.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/09/2023] [Accepted: 10/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The World Health Organization has declared that COVID-19 is no longer a public health emergency of international concern. Nevertheless, it remains a public health issue, and seasonal vaccinations, at the same time of year as influenza vaccinations, will be necessary. When the first vaccines were administered in 2020, decision-makers had to make assumptions about the best methods to communicate and administer vaccines to increase uptake. Now, a body of evidence can inform these decisions. STUDY DESIGN A narrative review written by three behavioural scientists who design research for policy. METHODS We searched the PubMed database for: (i) reviews of interventions to increase uptake of COVID-19 or influenza vaccines and (ii) empirical studies on uptake of COVID-19 and influenza vaccines. In addition, registered trials gathered by a Cochrane scoping review of interventions to increase uptake of COVID-19 vaccines were searched for updated results. RESULTS Results centre around two aspects of a vaccination campaign of interest to policymakers: communication and administration. Results suggest that communications highlighting the personal benefits of vaccination are likely to be more effective than those highlighting collective benefits. The efficacy of vaccination may be underestimated and stressing efficacy as a strong personal benefit may increase uptake. Keeping vaccines free, sending personalised messages, reminders and prebooked appointment times may also increase uptake. CONCLUSIONS There is now a body of evidence from behavioural science that suggests how vaccination campaigns for COVID-19 can be structured to increase uptake. These recommendations may be useful to policymakers considering seasonal vaccination campaigns and to researchers generating hypotheses for country-specific trials.
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Affiliation(s)
- D A Robertson
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - S Timmons
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - P D Lunn
- Behavioural Research Unit, Economic and Social Research Institute, Dublin, Ireland; Department of Economics, Trinity College Dublin, Dublin, Ireland
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Rios-Zertuche D, Daga G, Iorillo F, Aguilar Rivera AM, Diaz-Musa M, Largaespada Beer N, López Boo F, Sabido J. Factors associated with COVID-19 vaccination in Belize. Vaccine X 2023; 15:100380. [PMID: 37693845 PMCID: PMC10483062 DOI: 10.1016/j.jvacx.2023.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/20/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Abstract
Background We analyzed the factors associated with vaccine uptake, vaccination intention, and reasons for vaccine hesitancy in Belize. Methods We collected a nationally representative household survey of the population in Belize aged 15 years and older (September-October 2021). We compared potential correlates between vaccinated and unvaccinated people using Chi-square tests. Then, we performed logistic regression analysis to identify factors associated with vaccination uptake among all respondents and vaccination intention among the unvaccinated. Results Our analysis included data from 1261 interviews. Nearly four out of every five people reported being vaccinated, having received at least one dose. Adolescents and young adults were more likely to be unvaccinated. Significant differences were observed for most behavioral variables. Among the 41.7% of the unvaccinated respondents who said they would probably not or definitely not get vaccinated, the primary reason for their hesitation was fear of side effects. Additionally, almost one third of the unvaccinated individuals expressed a lack of trust in vaccines. Factors associated with increased likelihood of vaccination were efficacy beliefs, self-efficacy and vaccine attitudes. People who believed it was easy to get a vaccine were over 23 times (OR 23.63 [95% CI: 14.21-39.27]) more likely to be vaccinated, while those who believed in vaccine safety were 2.57 times [OR 95% CI: 1.52-4.35] more likely to be vaccinated. Among the unvaccinated, factors associated with intention to get vaccinated were self-identifying as Garifuna and having clear efficacy beliefs. Conclusions To our knowledge, this is the first study describing factors associated with COVID-19 vaccine uptake and vaccine hesitancy in Belize. Our findings revealed that accessibility has been the primary limitation in increasing vaccine coverage, and <7% of the eligible population have been strong vaccine deniers. To enhance vaccine uptake, targeted outreach efforts are necessary to address access barriers. Our results call for increased efforts improving self-efficacy, efficacy beliefs, and perceived norms.
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Affiliation(s)
| | - Giuliana Daga
- Inter-American Development Bank, Washington, DC, USA
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6
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Yang S, Tao R, Bhattar M, Shen L, Jones M, Garbacz A, Passmore SR. Designing and testing social media campaign messages to promote COVID-19 vaccine confidence among rural adults: A community-engaged approach featuring rural community leader and clinician testimonials. Prev Med Rep 2023; 36:102508. [PMID: 38116276 PMCID: PMC10728439 DOI: 10.1016/j.pmedr.2023.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
Despite the growing availability of effective COVID-19 vaccines in rural communities in the United States, widespread vaccine hesitancy delays COVID-19 vaccine coverage in rural communities and threatens to worsen pre-pandemic rural-urban disparities in other vaccination rates, including influenza and routine pediatric immunizations. Therefore, there is an urgent need to develop communication-based interventions to improve vaccine confidence in rural America. This study demonstrates the efficacy of a community-engaged approach to developing social media campaign messages in promoting COVID-19 vaccine uptake and pro-vaccine social diffusion among rural adults. Using a community-engaged approach, we developed social media campaign videos varying in (a) featured messengers (clinicians versus community leaders) and (b) the presence of personal testimonials. We conducted a national online experiment (N = 1,364 rural adults) in spring 2022. We found that videos featuring clinicians serving rural communities and their testimonials increased (a) vaccination intentions in the unvaccinated group (4-point scale, b = 0.23, p =.015) and (b) intention to discuss the messages with others (4-point scale, b = 0.14, p =.037), share the message (4-point scale, b = 0.15, p =.026), and promote the vaccines to others (9-point scale, b = 0.48, p =.013). Results suggest that vaccine promotional social media campaigns targeting rural populations can benefit from including clinician testimonials.
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Affiliation(s)
- Sijia Yang
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, United States
| | - Ran Tao
- School of Journalism and Mass Communication, University of Wisconsin-Madison, Madison, WI, United States
| | - Mahima Bhattar
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Liwei Shen
- Department of Communication Arts, University of Wisconsin-Madison, Madison, WI, United States
| | - Malia Jones
- Department of Community & Environmental Sociology, University of Wisconsin-Madison, Madison WI
| | - Andy Garbacz
- Department of Educational Psychology, School of Education, University of Wisconsin-Madison, United States
| | - Susan Racine Passmore
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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Alhajji M, Alzeer AH, Al-Jafar R, Alshehri R, Alyahya S, Alsuhaibani S, Alkhudair S, Aldhahiri R, Alhomaid A, Alali D, Alothman A, Alkhulaifi E, Alnashar M, Alalmaee A, Aljenaidel I, Alsaawi F. A national nudge study of differently framed messages to increase COVID-19 vaccine uptake in Saudi Arabia: A randomized controlled trial. Saudi Pharm J 2023; 31:101748. [PMID: 37662677 PMCID: PMC10472300 DOI: 10.1016/j.jsps.2023.101748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background During the COVID-19 pandemic, Saudi Arabia witnessed hesitancy from a proportion of the population toward taking the vaccine; thus, it was necessary to nudge them to uptake it. This study was conducted to assess the impact of using different types of messages to nudge the public to increase the proportion of vaccinated individuals. Methods This study is a multi-arm randomized controlled trial aiming to assess the efficacy of using differently framed messages that appear as pop-notifications in Sehatty application. Of those who preregistered to receive a COVID-19 vaccine but didn't take it according to the Saudi national vaccine registry (n = 1,291,686), 12,000 individuals were randomly recruited and randomly assigned to one of five intervention groups (commitment, loss aversion, salience, social norms, and ego) or a control group. To ensure the exposure occurred in the intervention groups, we included only those who received the notification, which was confirmed by checking the information technology system. We used the Chi-square test to compare each intervention group against the control group separately. Also, we used the same test to investigate whether sex and age influenced the percentage of booked appointments in the intervention groups. Results Social norms, ego, salience and loss aversion groups had higher percentages of booked appointments when compared to the control group (21.0%, p = 0.001; 19.1%, p = 0.011; 19.0%, p = 0.013; 18.4%, p = 0.034, respectively). Moreover, when combining the intervention groups, the percentage was higher than the control group (p < 0.001). The percentages of booked appointments made by Young adults (18-35 years old) were higher than that of adults over 35 years old in the social norms (22.6%, p = 0.016) and ego groups (21.0%, p = 0.010). At the same time, sex didn't affect the percentages of booked appointments in any group. Conclusion Using different framings of messages to nudge the public to take vaccines can help increase the percentage of immunized individuals in a community. Nudges can boost the public health of a population during an unusual spread of vaccine-preventable diseases. Findings might also inspire governmental responses to other public health situations.
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Affiliation(s)
| | - Abdullah H. Alzeer
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Rami Al-Jafar
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
- School of Public Health, Imperial College London, London, UK
| | - Reem Alshehri
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Saad Alyahya
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
| | - Sara Alsuhaibani
- Nudge Unit, Ministry of Health, Riyadh, Saudi Arabia
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sarah Alkhudair
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Raghad Aldhahiri
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Ahmed Alhomaid
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | - Dalal Alali
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
| | | | | | | | | | | | - Fahad Alsaawi
- Data Services Sector, Lean Business Services, Riyadh, Saudi Arabia
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Golos AM, Buttenheim AM, Ritter AZ, Bair EF, Chapman GB. Effects Of An Employee COVID-19 Vaccination Mandate At A Long-Term Care Network. Health Aff (Millwood) 2023; 42:1140-1146. [PMID: 37549332 DOI: 10.1377/hlthaff.2022.01596] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
We assessed COVID-19 vaccination and employment status among employees of a long-term care network that announced an employee vaccination mandate on July 29, 2021. The day before the announcement, 1,208 employees were unvaccinated; of these workers, 56.2 percent subsequently were vaccinated, whereas 20.9 percent (3.7 percent of active employees) were terminated because of noncompliance with the mandate.
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Affiliation(s)
- Aleksandra M Golos
- Aleksandra M. Golos , University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | - Gretchen B Chapman
- Gretchen B. Chapman, Carnegie Mellon University, Pittsburgh, Pennsylvania
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9
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Frisch-Aviram N, Hasan-Aslih S, Halperin E. Communicating with ethnic minorities during COVID-19: An experimental test of the effect of self-, ingroup-, and intergroup-focused messages. Heliyon 2023; 9:e16629. [PMID: 37287611 PMCID: PMC10226279 DOI: 10.1016/j.heliyon.2023.e16629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
Developing messaging to encourage minorities to adhere to health recommendations has been a complex task for governments worldwide during the COVID-19 crisis. Here, we propose and tests a new typology of messages among minorities that can be used to mobilize compliance and engagement. This typology comprises three messaging treatments emphasizing personal, ingroup, and intergroup benefits. We examine, via an experimental field study, whether there is a difference in the effect of these messages on two policy outcomes, social distancing and vaccine hesitancy, among the Arab minority living in Israel. The findings suggest that social messages, i.e., ingroup and intergroup messages, positively affect social distancing, while self-messaging harms social distancing compliance. Regarding vaccine intake, within the social messages tested, intergroup-focused messages were more effective than ingroup-focused messages for vaccination intentions only among citizens with low trust in the government. We discuss the findings in detail and propose new avenues in theory and practice to foster health policy compliance among minorities.
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10
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Ryan GW, Goulding M, Borg A, Minkah P, Beeler A, Rosal MC, Lemon SC. Development and Beta-Testing of the CONFIDENCE Intervention to Increase Pediatric COVID-19 Vaccination. J Pediatr Health Care 2023; 37:244-252. [PMID: 36470798 PMCID: PMC9671697 DOI: 10.1016/j.pedhc.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Innovative strategies are needed to improve pediatric COVID-19 vaccination rates. We describe the process for developing a clinic-based intervention, CONFIDENCE, to improve pediatric COVID-19 vaccine uptake and present results of our beta-test for feasibility and acceptability. METHOD CONFIDENCE included communication training with providers, a poster campaign, and parent-facing educational materials. We assessed feasibility and acceptability through interviews and measured preliminary vaccine intention outcomes with a pre-post parent survey. Interviews were analyzed using rapid qualitative methods. We generated descriptive statistics for variables on the parent survey and used Fisher's exact test to assess pre-post differences. RESULTS Participating providers (n = 4) reported high levels of feasibility and acceptability. We observed positive trends in parents' (n = 69) reports of discussing vaccination with their provider and the parental decision to accept COVID-19 vaccination. DISCUSSION Our next steps will be to use more rigorous methods to establish the efficacy and effectiveness of the CONFIDENCE intervention.
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11
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Piper BJ, Sanchez BV, Madera JD, Sulzinski MA. Profiles of US Hispanics Unvaccinated for COVID-19. J Racial Ethn Health Disparities 2023; 10:553-559. [PMID: 35107819 PMCID: PMC8809210 DOI: 10.1007/s40615-022-01245-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately impacted Hispanics in the USA with increased rates of SARS-CoV-2 infections, hospitalizations, and deaths. The objective of this report was to characterize the demographics and beliefs of unvaccinated Hispanics to help address their concerns that lead to vaccine hesitancy. METHODS Of 1,011 potential participants from a national online panel, 22.3% (N = 225, 51.6% female, age = 40.5) met inclusion criteria of Hispanic adults and not receiving at least one dose of the COVID-19 vaccine. The 30-item survey included items about demographics, political affiliations, sources of news (e.g., Fox vs. CNN), reasons for being unvaccinated, and ratings (0 = strongly disagree, 100 = strongly agree) of 10 controversial statements regarding COVID-19. RESULTS Over three-fifths (62.6%) identified side effects and safety concerns, while almost one-third (30.5%) cited a lack of efficacy as their top reasons for being unvaccinated. Agreement to "The developers of the COVID-19 vaccine rushed the development and cut corners" was rated the highest (63.22) which was significantly (p < .001) higher than the other nine statements (e.g., "The COVID-19 vaccine does not work"). Many vaccine attitudes differed significantly by political party affiliation and some by gender and news source. Republicans (59.9 ± 4.2) scored higher than Democrats (38.5 ± 4.2, p ≤ .001) to "If I've already had COVID-19, I don't need the vaccine." CONCLUSIONS This study identified the heterogeneity in COVID-19 vaccine attitudes among Hispanics. Further research is needed to determine if the subgroups identified are differentially receptive to interventions to facilitate reconsideration of prior vaccination decisions.
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Affiliation(s)
- Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
- Center for Pharmacy Innovation and Outcomes, Forty Fort, PA, USA.
| | - Bianca V Sanchez
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Joshua D Madera
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Michael A Sulzinski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
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12
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Patel MS, Milkman KL, Gandhi L, Graci HN, Gromet D, Ho H, Kay JS, Lee TW, Rothschild J, Akinola M, Beshears J, Bogard JE, Buttenheim A, Chabris C, Chapman GB, Choi JJ, Dai H, Fox CR, Goren A, Hilchey MD, Hmurovic J, John LK, Karlan D, Kim M, Laibson D, Lamberton C, Madrian BC, Meyer MN, Modanu M, Nam J, Rogers T, Rondina R, Saccardo S, Shermohammed M, Soman D, Sparks J, Warren C, Weber M, Berman R, Evans CN, Lee SH, Snider CK, Tsukayama E, Van den Bulte C, Volpp KG, Duckworth AL. A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit. Am J Health Promot 2023; 37:324-332. [PMID: 36195982 PMCID: PMC10798571 DOI: 10.1177/08901171221131021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN Randomized, controlled trial. SETTING Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS 74,811 adults. INTERVENTIONS Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES Influenza vaccination. ANALYSIS Intention-to-treat. RESULTS Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.
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Affiliation(s)
- Mitesh S. Patel
- Department of Clinical Transformation and Behavioral Insights, Ascension, St. Louis, MO, USA
| | - Katherine L. Milkman
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Linnea Gandhi
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Heather N. Graci
- Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Dena Gromet
- Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Hung Ho
- Department of Marketing, The University of Chicago Booth School of Business, Chicago, IL, USA
| | - Joseph S. Kay
- Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy W. Lee
- School of Professional Studies, Northwestern University, Evanston, IL, USA
| | - Jake Rothschild
- Behavior Change for Good Initiative, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Modupe Akinola
- Department of Management, Columbia Business School, Columbia University, New York, NY, USA
| | - John Beshears
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Jonathan E. Bogard
- Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA
| | - Alison Buttenheim
- Department of Family and Community Health, The University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christopher Chabris
- Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA
| | - Gretchen B. Chapman
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - James J. Choi
- Department of Finance, Yale School of Management, Yale University, New Haven, CT, USA
| | - Hengchen Dai
- Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA
| | - Craig R. Fox
- Department of Management and Organization, Anderson School of Management, University of California Los Angeles, Los Angeles, CA, USA
| | - Amir Goren
- Behavioral Insights Team, Geisinger Health System, Danville, PA, USA
| | - Matthew D. Hilchey
- Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada
| | - Jillian Hmurovic
- Department of Marketing, Drexel University, Philadelphia, PA, USA
| | - Leslie K. John
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Dean Karlan
- Department of Finance, Kellogg School of Management, Northwestern University, Evanston, IL, USA
| | - Melanie Kim
- Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada
| | - David Laibson
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Cait Lamberton
- Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Brigitte C. Madrian
- Department of Finance, Marriott School of Business, Brigham Young University, Provo, UT, USA
| | - Michelle N. Meyer
- Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA
| | - Maria Modanu
- Department of Management, Columbia Business School, Columbia University, New York, NY, USA
| | - Jimin Nam
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Todd Rogers
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Renante Rondina
- Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada
| | - Silvia Saccardo
- Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Maheen Shermohammed
- Behavioral and Decision Sciences Program, Geisinger Health System, Danville, PA, USA
| | - Dilip Soman
- Department of Behavioural Science and Economics, University of Toronto, Toronto, ON, Canada
| | - Jehan Sparks
- Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA
| | - Caleb Warren
- Department of Marketing, Eller College of Management, University of Arizona, Tucson, AZ, USA
| | - Megan Weber
- Department of Behavioral Decision Making, Anderson School of Management, University of California, Los Angeles, CA, USA
| | - Ron Berman
- Department of Marketing, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Chalanda N. Evans
- Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Seung Hyeong Lee
- Negotiation, Organizations & Markets Unit, Harvard Business School, Harvard University, Boston, MA, USA
| | - Christopher K. Snider
- Center for Health Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Eli Tsukayama
- Business Administration Division, University of Hawaiì-West Òahu, Kapolei, HI, USA
| | | | - Kevin G. Volpp
- Penn Center for Health Incentives and Behavioral Economics, Departments of Medical Ethics and Health Policy and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela L. Duckworth
- Department of Operations, Information and Decisions, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
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13
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Moehring A, Collis A, Garimella K, Rahimian MA, Aral S, Eckles D. Providing normative information increases intentions to accept a COVID-19 vaccine. Nat Commun 2023; 14:126. [PMID: 36624092 PMCID: PMC9828376 DOI: 10.1038/s41467-022-35052-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/16/2022] [Indexed: 01/11/2023] Open
Abstract
Despite the availability of multiple safe vaccines, vaccine hesitancy may present a challenge to successful control of the COVID-19 pandemic. As with many human behaviors, people's vaccine acceptance may be affected by their beliefs about whether others will accept a vaccine (i.e., descriptive norms). However, information about these descriptive norms may have different effects depending on the actual descriptive norm, people's baseline beliefs, and the relative importance of conformity, social learning, and free-riding. Here, using a pre-registered, randomized experiment (N = 484,239) embedded in an international survey (23 countries), we show that accurate information about descriptive norms can increase intentions to accept a vaccine for COVID-19. We find mixed evidence that information on descriptive norms impacts mask wearing intentions and no statistically significant evidence that it impacts intentions to physically distance. The effects on vaccination intentions are largely consistent across the 23 included countries, but are concentrated among people who were otherwise uncertain about accepting a vaccine. Providing normative information in vaccine communications partially corrects individuals' underestimation of how many other people will accept a vaccine. These results suggest that presenting people with information about the widespread and growing acceptance of COVID-19 vaccines helps to increase vaccination intentions.
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Affiliation(s)
- Alex Moehring
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Avinash Collis
- McCombs School of Business, The University of Texas at Austin, Austin, TX, USA
| | - Kiran Garimella
- School of Communication and Information, Rutgers University, New Brunswick, NJ, USA
| | - M Amin Rahimian
- MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA.,Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sinan Aral
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA.,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA.,Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Dean Eckles
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA. .,MIT Initiative on the Digital Economy, Massachusetts Institute of Technology, Cambridge, MA, USA. .,Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge, MA, USA.
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14
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Sojati J, Murali A, Pressimone C, Dakroub A. A Cross-Sectional Factor Analysis of COVID-19 and Influenza Vaccination Decisions in a Racially Diverse Western Pennsylvania Community. J Prim Care Community Health 2023; 14:21501319231212287. [PMID: 37994782 PMCID: PMC10668581 DOI: 10.1177/21501319231212287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Influenza and COVID-19 vaccination rates remain suboptimal, demanding new community-centric approaches that improve targeted counseling and increase vaccine uptake. Notably, racially diverse communities show high vaccine hesitancy, yet most existing vaccine studies focus on white, college-educated cohorts. OBJECTIVE Here, we identify factors influencing vaccination decisions of patients at Turtle Creek Primary Care clinic in Turtle Creek, PA, a racially-diverse borough. DESIGN A retrospective mixed-methods study of the predominantly non-white patient population at Turtle Creek Primary Care clinic, a clinic caring for >70% minority patients. RESULTS Fourteen factors emerged that patients reported were crucial to vaccine decision-making. Of these factors, top reasons for COVID-19 vaccine hesitancy were trust in vaccines, vaccine side effects, perceived vaccine knowledge, and faith/religion. Top reasons for influenza vaccine hesitancy were perceived need, vaccine side effects, trust in vaccines, and habitual behaviors. We also uncovered correlations between vaccine decision factors and sociodemographic factors. Participants > 65-years-old were more likely to cite personal safety in choosing to get the COVID-19 vaccine, while non-white participants were more likely to cite others' safety. Participants > 65-years-old were also more likely to cite personal safety in influenza vaccine decision-making, and non-female participants were more likely to cite perceived need for influenza vaccines. CONCLUSIONS These data uncover targetable factors contributing to vaccine hesitancy and aid in developing community-centered, personalized vaccine education approaches in Turtle Creek and analogous minority communities.
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Affiliation(s)
- Jorna Sojati
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anjana Murali
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Allie Dakroub
- Department of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Orr CA, Gordon R. Using Health Behavior Theory to Address COVID-19 Vaccine Hesitancy: A Scoping Review of Communication and Messaging Interventions. THE AMERICAN BEHAVIORAL SCIENTIST 2022:00027642221138274. [PMCID: PMC9703017 DOI: 10.1177/00027642221138274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Vaccine hesitancy has been among the most vexing challenges during the COVID-19 pandemic, ultimately leading to maladaptive health behaviors such as vaccine delay and refusal. A variety of approaches have been employed to address this problem, including communication and messaging interventions targeting the underlying determinants of vaccine hesitancy. However, there exists no published evidence synthesis examining how such interventions are using health behavior theory to address COVID-19 vaccine hesitancy. The purpose of this study was to conduct a scoping review of health communication and messaging interventions aimed at addressing COVID-19 vaccine hesitancy, and to systematically evaluate the use of health behavior theory in the design of these interventions. The review followed a five-step iterative framework proposed by Levac and colleagues. Comprehensive searches using an exhaustive list of keyword combinations were used across three online databases to identify articles to screen for inclusion. A structured, validated coding scheme was then applied to assess the use of health behavior theory. Additional study data were extracted using a separate structured form. A total of 36 articles published between January 2020 and February 2022 met inclusion criteria and were included in the review. Ten studies (27.7%) did not mention or use health behavior theory at all. Most studies (n = 26) at least mentioned theory or theory-relevant constructs, with 26 different theories and 52 different theoretical constructs represented in the sample. Although theory and theoretical determinants of vaccination behavior were often mentioned, few studies used theory to specify and target causal pathways of behavior change, and only one study targeted misinformation as a determinant of vaccine hesitancy. The findings from this review provide critical insight into the state of theory-based intervention design and point to significant gaps in the literature to prioritize in future research.
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Affiliation(s)
- Caroline A. Orr
- Applied Research Laboratory for Intelligence and Security (ARLIS), University of Maryland, College Park, MD, USA
| | - Ruthanna Gordon
- Applied Research Laboratory for Intelligence and Security (ARLIS), University of Maryland, College Park, MD, USA
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16
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Barnes K, Colagiuri B. Drivers of the Intention to Receive a COVID-19 Booster Vaccine: Insights from the UK and Australia. Vaccines (Basel) 2022; 10:1730. [PMID: 36298595 PMCID: PMC9607201 DOI: 10.3390/vaccines10101730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
As the global pandemic perpetuates, keeping the population vaccinated will be imperative to maintain societal protection from the SARS-CoV-2 (COVID-19) virus. However, while empirical evidence regarding predictors of the intention to receive a first COVID-19 vaccine has amassed, our understanding regarding the psychological and behavioral drivers of continued COVID-19 vaccination remains limited. In this pre-registered study (UK: AsPredicted#78370|Australia: AsPredicted#81667), factors predicting the intention to receive a COVID-19 booster vaccine were investigated in two adult samples from the UK (N = 1222) and Australia (N = 1197) that were nationally representative on factors of age, gender, and geographic location. High levels of booster intent were found (73% and 67%, respectively). Exploratory Structural Equation Modelling (ESEM) revealed three key predictors of the intention to receive a booster vaccine that emerged across both UK and Australian samples: concern regarding the COVID-19 virus, positive perceptions of the COVID-19 vaccines, and the perceived severity of side effects experienced to the last COVID-19 vaccine dose. Several additional factors (age, months since the last COVID-19 vaccine, familiarity with side effects, and regularly receiving the influenza vaccine) were present in the Australian dataset. These findings provide important evidence that targeting psychological perceptions of the COVID-19 vaccine and virus may serve to maintain participation in the COVID-19 vaccination programme, paving the way for future behavioural research in this area.
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Affiliation(s)
- Kirsten Barnes
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
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17
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Jacobson M, Chang TY, Shah M, Pramanik R, Shah SB. Can financial incentives and other nudges increase COVID-19 vaccinations among the vaccine hesitant? A randomized trial. Vaccine 2022; 40:6235-6242. [PMID: 36137900 PMCID: PMC9424519 DOI: 10.1016/j.vaccine.2022.08.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022]
Abstract
Despite rapid initial uptake, COVID-19 vaccinations in the United States stalled within a few months of widespread rollout in 2021. In response, many state and local governments, employers and health systems used public health messaging, financial incentives and creative scheduling tools to increase vaccine uptake. Although these approaches drew on evidence from influenza and other vaccination efforts, they were largely untested in the context of SARS-CoV-2. In mid-2021, months after vaccines were widely available, we evaluated vaccination intentions and vaccine uptake using a randomized control trial. To do this, we recruited unvaccinated members of a Medicaid managed care plan in California (n = 2,701) and randomly assigned them to different public health messages, $10 or $50 financial incentives for vaccination, a simple vaccination appointment scheduler, or control. While messages increased vaccination intentions, none of the interventions increased vaccination rates. Estimates for financial incentives rule out even relatively small increases in vaccination rates. Small financial incentives and other behavioral nudges do not meaningfully increase COVID-19 vaccination rates amongst the vaccine hesitant.
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Affiliation(s)
- Mireille Jacobson
- Leonard Davis School of Gerontology, University of Southern California & NBER, 3715 McClintock Ave, Los Angeles, CA 90230, United States; Leonard Schaeffer Center for Health Policy & Economics, University of Southern California, United States.
| | - Tom Y Chang
- Marshall School of Business, University of Southern California, United States
| | - Manisha Shah
- Department of Public Policy, University of California, Los Angeles & NBER, United States
| | - Rajiv Pramanik
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
| | - Samir B Shah
- Contra Costa Regional Medical Center & Health Centers, Contra Costa Health Services, United States
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18
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Sudharsanan N, Favaretti C, Hachaturyan V, Bärnighausen T, Vandormael A. Effects of side-effect risk framing strategies on COVID-19 vaccine intentions: a randomized controlled trial. eLife 2022; 11:e78765. [PMID: 35971757 PMCID: PMC9381035 DOI: 10.7554/elife.78765] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 01/02/2023] Open
Abstract
Background Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. A large literature in the behavioral and communication sciences finds that how risks are framed and presented to individuals affects their judgments of its severity. However, it remains unknown whether such framing changes can affect COVID-19 vaccine behavior and be deployed as policy solutions to reduce hesitancy. Methods We conducted a pre-registered randomized controlled trial among 8998 participants in the United States and the United Kingdom to examine the effects of different ways of framing and presenting vaccine side-effects on individuals' willingness to get vaccinated and their perceptions of vaccine safety. Results Adding a descriptive risk label ('very low risk') next to the numerical side-effect and providing a comparison to motor-vehicle mortality increased participants' willingness to take the COVID-19 vaccine by 3.0 percentage points (p=0.003) and 2.4 percentage points (p=0.049), respectively. These effects were independent and additive and combining both framing strategies increased willingness to receive the vaccine by 6.1 percentage points (p<0.001). Mechanistically, we find evidence that these framing effects operate by increasing individuals' perceptions of how safe the vaccine is. Conclusions Low-cost side-effect framing strategies can meaningfully affect vaccine intentions at a population level. Funding Heidelberg Institute of Global Health. Clinical trial number German Clinical Trials Registry (#DRKS00025551).
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Affiliation(s)
- Nikkil Sudharsanan
- Assistant Professorship of Behavioral Science for Disease Prevention and Health Care,Technical University of MunichMunichGermany
- Heidelberg Institute of Global Health, Heidelberg UniversityHeidelbergGermany
| | - Caterina Favaretti
- Assistant Professorship of Behavioral Science for Disease Prevention and Health Care,Technical University of MunichMunichGermany
- Heidelberg Institute of Global Health, Heidelberg UniversityHeidelbergGermany
| | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg UniversityHeidelbergGermany
| | - Alain Vandormael
- Heidelberg Institute of Global Health, Heidelberg UniversityHeidelbergGermany
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19
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Andreas M, Iannizzi C, Bohndorf E, Monsef I, Piechotta V, Meerpohl JJ, Skoetz N. Interventions to increase COVID-19 vaccine uptake: a scoping review. Cochrane Database Syst Rev 2022; 8:CD015270. [PMID: 35920693 PMCID: PMC9347311 DOI: 10.1002/14651858.cd015270] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Vaccines are effective in preventing severe COVID-19, a disease for which few treatments are available and which can lead to disability or death. Widespread vaccination against COVID-19 may help protect those not yet able to get vaccinated. In addition, new and vaccine-resistant mutations of SARS-CoV-2 may be less likely to develop if the spread of COVID-19 is limited. Different vaccines are now widely available in many settings. However, vaccine hesitancy is a serious threat to the goal of nationwide vaccination in many countries and poses a substantial threat to population health. This scoping review maps interventions aimed at increasing COVID-19 vaccine uptake and decreasing COVID-19 vaccine hesitancy. OBJECTIVES To scope the existing research landscape on interventions to enhance the willingness of different populations to be vaccinated against COVID-19, increase COVID-19 vaccine uptake, or decrease COVID-19 vaccine hesitancy, and to map the evidence according to addressed populations and intervention categories. SEARCH METHODS We searched Cochrane COVID-19 Study Register, Web of Science (Science Citation Index Expanded and Emerging Sources Citation Index), WHO COVID-19 Global literature on coronavirus disease, PsycINFO, and CINAHL to 11 October 2021. SELECTION CRITERIA We included studies that assess the impact of interventions implemented to enhance the willingness of different populations to be vaccinated against COVID-19, increase vaccine uptake, or decrease COVID-19 vaccine hesitancy. We included randomised controlled trials (RCTs), non-randomised studies of intervention (NRSIs), observational studies and case studies with more than 100 participants. Furthermore, we included systematic reviews and meta-analyses. We did not limit the scope of the review to a specific population or to specific outcomes assessed. We excluded interventions addressing hesitancy towards vaccines for diseases other than COVID-19. DATA COLLECTION AND ANALYSIS Data were analysed according to a protocol uploaded to the Open Science Framework. We used an interactive scoping map to visualise the results of our scoping review. We mapped the identified interventions according to pre-specified intervention categories, that were adapted to better fit the evidence. The intervention categories were: communication interventions, policy interventions, educational interventions, incentives (both financial and non-financial), interventions to improve access, and multidimensional interventions. The study outcomes were also included in the mapping. Furthermore, we mapped the country in which the study was conducted, the addressed population, and whether the design was randomised-controlled or not. MAIN RESULTS We included 96 studies in the scoping review, 35 of which are ongoing and 61 studies with published results. We did not identify any relevant systematic reviews. For an overview, please see the interactive scoping map (https://tinyurl.com/2p9jmx24) STUDIES WITH PUBLISHED RESULTS Of the 61 studies with published results, 46 studies were RCTs and 15 NRSIs. The interventions investigated in the studies were heterogeneous with most studies testing communication strategies to enhance COVID-19 vaccine uptake. Most studies assessed the willingness to get vaccinated as an outcome. The majority of studies were conducted in English-speaking high-income countries. Moreover, most studies investigated digital interventions in an online setting. Populations that were addressed were diverse. For example, studies targeted healthcare workers, ethnic minorities in the USA, students, soldiers, at-risk patients, or the general population. ONGOING STUDIES Of the 35 ongoing studies, 29 studies are RCTs and six NRSIs. Educational and communication interventions were the most used types of interventions. The majority of ongoing studies plan to assess vaccine uptake as an outcome. Again, the majority of studies are being conducted in English-speaking high-income countries. In contrast to the studies with published results, most ongoing studies will not be conducted online. Addressed populations range from minority populations in the USA to healthcare workers or students. Eleven ongoing studies have estimated completion dates in 2022. AUTHORS' CONCLUSIONS: We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research. AUTHORS CONCLUSIONS We were able to identify and map a variety of heterogeneous interventions for increasing COVID-19 vaccine uptake or decreasing vaccine hesitancy. Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID-19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID-19 vaccine uptake. A research gap was shown for studies conducted in low and middle-income countries and studies investigating policy interventions and improved access, as well as for interventions addressing children and adolescents. As COVID-19 vaccines become more widely available, these populations and interventions should not be neglected in research.
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Affiliation(s)
- Marike Andreas
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claire Iannizzi
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Bohndorf
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane Haematology, Cologne, Germany
| | - Vanessa Piechotta
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicole Skoetz
- Cochrane Haematology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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20
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Hing NYL, Woon YL, Lee YK, Kim HJ, Lothfi NM, Wong E, Perialathan K, Ahmad Sanusi NH, Isa A, Leong CT, Costa-Font J. When do persuasive messages on vaccine safety steer COVID-19 vaccine acceptance and recommendations? Behavioural insights from a randomised controlled experiment in Malaysia. BMJ Glob Health 2022; 7:e009250. [PMID: 35906015 PMCID: PMC9344599 DOI: 10.1136/bmjgh-2022-009250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Vaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions. METHODS A randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes. RESULTS We found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms. CONCLUSION Message frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions. TRIAL REGISTRATION NUMBER NCT05244356.
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Affiliation(s)
- Nicholas Yee Liang Hing
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Shah Alam, Selangor, Malaysia
| | - Yuan Liang Woon
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Shah Alam, Selangor, Malaysia
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hyung Joon Kim
- United Nations Children's Fund Malaysia, Putrajaya, Malaysia
| | - Nurhyikmah M Lothfi
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Elizabeth Wong
- United Nations Children's Fund Malaysia, Putrajaya, Malaysia
| | - Komathi Perialathan
- Centre for Health Communication and Informatics Research, Institute for Health Behavioural Research, National Institutes of Health, Shah Alam, Selangor, Malaysia
| | - Nor Haryati Ahmad Sanusi
- Centre for Health Communication and Informatics Research, Institute for Health Behavioural Research, National Institutes of Health, Shah Alam, Selangor, Malaysia
| | - Affendi Isa
- Health Education Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Chin Tho Leong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Shah Alam, Selangor, Malaysia
| | - Joan Costa-Font
- Department of Health Policy, The London School of Economics and Political Science, London, UK
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21
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Peterson CJ, Lee B, Nugent K. COVID-19 Vaccination Hesitancy among Healthcare Workers-A Review. Vaccines (Basel) 2022; 10:948. [PMID: 35746556 PMCID: PMC9227837 DOI: 10.3390/vaccines10060948] [Citation(s) in RCA: 88] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic and its associated vaccine have highlighted vaccine hesitancy among healthcare workers (HCWs). Vaccine hesitancy among this group existed prior to the pandemic and particularly centered around influenza vaccination. Being a physician, having more advanced education, and previous vaccination habits are frequently associated with vaccine acceptance. The relationship between age and caring for patients on COVID-19 vaccination is unclear, with studies providing opposing results. Reasons for hesitancy include concerns about safety and efficacy, mistrust of government and institutions, waiting for more data, and feeling that personal rights are being infringed upon. Many of these reasons reflect previous attitudes about influenza vaccination as well as political beliefs and views of personal autonomy. Finally, several interventions to encourage vaccination have been studied, including education programs and non-monetary incentives with the most effective studies using a combination of methods.
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Affiliation(s)
- Christopher J. Peterson
- School of Medicine, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430, USA;
| | - Benjamin Lee
- School of Medicine, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430, USA;
- College of Engineering, Texas Tech University, 2500 Broadway, Lubbock, TX 79409, USA
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430, USA;
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22
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Bartoš V, Bauer M, Cahlíková J, Chytilová J. Communicating doctors' consensus persistently increases COVID-19 vaccinations. Nature 2022; 606:542-549. [PMID: 35650433 PMCID: PMC9200639 DOI: 10.1038/s41586-022-04805-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
The reluctance of people to get vaccinated represents a fundamental challenge to containing the spread of deadly infectious diseases1,2, including COVID-19. Identifying misperceptions that can fuel vaccine hesitancy and creating effective communication strategies to overcome them are a global public health priority3-5. Medical doctors are a trusted source of advice about vaccinations6, but media reports may create an inaccurate impression that vaccine controversy is prevalent among doctors, even when a broad consensus exists7,8. Here we show that public misperceptions about the views of doctors on the COVID-19 vaccines are widespread, and correcting them increases vaccine uptake. We implement a survey among 9,650 doctors in the Czech Republic and find that 90% of doctors trust the vaccines. Next, we show that 90% of respondents in a nationally representative sample (n = 2,101) underestimate doctors' trust; the most common belief is that only 50% of doctors trust the vaccines. Finally, we integrate randomized provision of information about the true views held by doctors into a longitudinal data collection that regularly monitors vaccination status over 9 months. The treatment recalibrates beliefs and leads to a persistent increase in vaccine uptake. The approach demonstrated in this paper shows how the engagement of professional medical associations, with their unparalleled capacity to elicit individual views of doctors on a large scale, can help to create a cheap, scalable intervention that has lasting positive impacts on health behaviour.
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Affiliation(s)
- Vojtěch Bartoš
- Department of Economics, University of Munich, Munich, Germany.
- Department of Economics, Management and Quantitative Methods, University of Milan, Milan, Italy.
| | - Michal Bauer
- CERGE-EI, a joint workplace of Charles University and the Economics Institute of the Czech Academy of Sciences, Prague, Czech Republic
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Jana Cahlíková
- Department of Public Economics, Max Planck Institute for Tax Law and Public Finance, Munich, Germany
| | - Julie Chytilová
- CERGE-EI, a joint workplace of Charles University and the Economics Institute of the Czech Academy of Sciences, Prague, Czech Republic
- Institute of Economic Studies, Faculty of Social Sciences, Charles University, Prague, Czech Republic
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Mehta SJ, Mallozzi C, Shaw PA, Reitz C, McDonald C, Vandertuyn M, Balachandran M, Kopinsky M, Sevinc C, Johnson A, Ward R, Park SH, Snider CK, Rosin R, Asch DA. Effect of Text Messaging and Behavioral Interventions on COVID-19 Vaccination Uptake: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2216649. [PMID: 35696165 PMCID: PMC9194662 DOI: 10.1001/jamanetworkopen.2022.16649] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE COVID-19 vaccine uptake among urban populations remains low. OBJECTIVE To evaluate whether text messaging with outbound or inbound scheduling and behaviorally informed content might increase COVID-19 vaccine uptake. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial with a factorial design was conducted from April 29 to July 6, 2021, in an urban academic health system. The trial comprised 16 045 patients at least 18 years of age in Philadelphia, Pennsylvania, with at least 1 primary care visit in the past 5 years, or a future scheduled primary care visit within the next 3 months, who were unresponsive to prior outreach. The study was prespecified in the trial protocol, and data were obtained from the intent-to-treat population. INTERVENTIONS Eligible patients were randomly assigned in a 1:20:20 ratio to (1) outbound telephone call only by call center, (2) text message and outbound telephone call by call center to those who respond, or (3) text message, with patients instructed to make an inbound telephone call to a hotline. Patients in groups 2 and 3 were concurrently randomly assigned in a 1:1:1:1 ratio to receive different content: standard messaging, clinician endorsement (eg, "Dr. XXX recommends"), scarcity ("limited supply available"), or endowment framing ("We have reserved a COVID-19 vaccine appointment for you"). MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients who completed the first dose of the COVID-19 vaccine within 1 month, according to the electronic health record. Secondary outcomes were the completion of the first dose within 2 months and completion of the vaccination series within 2 months of initial outreach. Additional outcomes included the percentage of patients with invalid cell phone numbers (wrong number or nontextable), no response to text messaging, the percentage of patients scheduled for the vaccine, text message responses, and the number of telephone calls made by the access center. Analysis was on an intention-to-treat basis. RESULTS Among the 16 045 patients included, the mean (SD) age was 36.9 (11.1) years; 9418 (58.7%) were women; 12 869 (80.2%) had commercial insurance, and 2283 (14.2%) were insured by Medicaid; 8345 (52.0%) were White, 4706 (29.3%) were Black, and 967 (6.0%) were Hispanic or Latino. At 1 month, 14 of 390 patients (3.6% [95% CI, 1.7%-5.4%]) in the outbound telephone call-only group completed 1 vaccine dose, as did 243 of 7890 patients (3.1% [95% CI, 2.7%-3.5%]) in the text plus outbound call group (absolute difference, -0.5% [95% CI, -2.4% to 1.4%]; P = .57) and 253 of 7765 patients (3.3% [95% CI, 2.9%-3.7%]) in the text plus inbound call group (absolute difference, -0.3% [95% CI, -2.2% to 1.6%]; P = .72). Among the 15 655 patients receiving text messaging, 118 of 3889 patients (3.0% [95% CI, 2.5%-3.6%]) in the standard messaging group completed 1 vaccine dose, as did 135 of 3920 patients (3.4% [95% CI, 2.9%-4.0%]) in the clinician endorsement group (absolute difference, 0.4% [95% CI, -0.4% to 1.2%]; P = .31), 100 of 3911 patients (2.6% [95% CI, 2.1%-3.1%]) in the scarcity group (absolute difference, -0.5% [95% CI, -1.2% to 0.3%]; P = .20), and 143 of 3935 patients (3.6% [95% CI, 3.0%-4.2%]) in the endowment group (absolute difference, 0.6% [95% CI, -0.2% to 1.4%]; P = .14). CONCLUSIONS AND RELEVANCE There was no detectable increase in vaccination uptake among patients receiving text messaging compared with telephone calls only or behaviorally informed message content. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04834726.
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Affiliation(s)
- Shivan J. Mehta
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | | | - Pamela A. Shaw
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia
| | - Catherine Reitz
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Caitlin McDonald
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Matthew Vandertuyn
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Mohan Balachandran
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Michael Kopinsky
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Christianne Sevinc
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - Aaron Johnson
- Penn Medicine, University of Pennsylvania, Philadelphia
| | - Robin Ward
- Penn Medicine, University of Pennsylvania, Philadelphia
| | - Sae-Hwan Park
- Penn Medicine, University of Pennsylvania, Philadelphia
| | | | - Roy Rosin
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
| | - David A. Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania, Philadelphia
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Lieu TA, Elkin EP, Escobar PR, Finn L, Klein NP, Durojaiye C, Prausnitz S, Quesenberry CP, Sawyer D, Teran S, Goler N, Parodi SM, Chen YFI. Effect of Electronic and Mail Outreach From Primary Care Physicians for COVID-19 Vaccination of Black and Latino Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2217004. [PMID: 35713906 PMCID: PMC9206195 DOI: 10.1001/jamanetworkopen.2022.17004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/23/2022] [Indexed: 12/02/2022] Open
Abstract
Importance COVID-19 morbidity is highest in Black and Latino older adults. These racial and ethnic groups initially had lower vaccination uptake than others, and rates in Black adults continue to lag. Objectives To evaluate the effect of outreach via electronic secure messages and mailings from primary care physicians (PCPs) on COVID-19 vaccination uptake among Black and Latino older adults and to compare the effects of culturally tailored and standard PCP messages. Design, Setting, and Participants This randomized clinical trial was conducted from March 29 to May 20, 2021, with follow-up surveys through July 31, 2021. Latino and Black individuals aged 65 years and older from 4 Kaiser Permanente Northern California (KPNC) service areas were included. Data were analyzed from May 27, 2021, to September 28, 2021. Interventions Individuals who had not received COVID-19 vaccination after previous outreach were randomized to electronic secure message and/or mail outreach from their PCP, similar outreach with additional culturally tailored content, or usual care. Outreach groups were sent a secure message or letter in their PCP's name, followed by a postcard to those still unvaccinated after 4 weeks. Main Outcomes and Measures The primary outcome was time to receipt of COVID-19 vaccination during the 8 weeks after initial study outreach. KPNC data were supplemented with state data from external sources. Intervention effects were evaluated via proportional hazards regression. Results Of 8287 included individuals (mean [SD] age, 72.6 [7.0] years; 4665 [56.3%] women), 2434 (29.4%) were Black, 3782 (45.6%) were Latino and preferred English-language communications, and 2071 (25.0%) were Latino and preferred Spanish-language communications; 2847 participants (34.4%) had a neighborhood deprivation index at the 75th percentile or higher. A total of 2767 participants were randomized to culturally tailored PCP outreach, 2747 participants were randomized to standard PCP outreach, and 2773 participants were randomized to usual care. Culturally tailored PCP outreach led to higher COVID-19 vaccination rates during follow-up compared with usual care (664 participants [24.0%] vs 603 participants [21.7%]; adjusted hazard ratio (aHR), 1.22; 95% CI, 1.09-1.37), as did standard PCP outreach (635 participants [23.1%]; aHR, 1.17; 95% CI, 1.04-1.31). Individuals who were Black (aHR, 1.19; 95% CI, 1.06-1.33), had high neighborhood deprivation (aHR, 1.17; 95% CI, 1.03-1.33), and had medium to high comorbidity scores (aHR, 1.19; 95% CI, 1.09-1.31) were more likely to be vaccinated during follow-up. Conclusions and Relevance This randomized clinical trial found that PCP outreach using electronic and mailed messages increased COVID-19 vaccination rates among Black and Latino older adults. Trial Registration ClinicalTrials.gov Identifier: NCT05096026.
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Affiliation(s)
- Tracy A. Lieu
- Division of Research, Kaiser Permanente Northern California, Oakland
- The Permanente Medical Group, Oakland, California
| | - Eric P. Elkin
- Division of Research, Kaiser Permanente Northern California, Oakland
- TPMG Consulting Services, Oakland, California
| | | | - Lucy Finn
- TPMG Consulting Services, Oakland, California
| | - Nicola P. Klein
- Division of Research, Kaiser Permanente Northern California, Oakland
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Cimone Durojaiye
- Division of Research, Kaiser Permanente Northern California, Oakland
| | | | | | - Debora Sawyer
- The Permanente Medical Group, Oakland, California
- TPMG Consulting Services, Oakland, California
| | - Silvia Teran
- The Permanente Medical Group, Oakland, California
- TPMG Health Engagement Consulting Services, Oakland, California
| | - Nancy Goler
- The Permanente Medical Group, Oakland, California
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25
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Rabb N, Swindal M, Glick D, Bowers J, Tomasulo A, Oyelami Z, Wilson KH, Yokum D. Evidence from a statewide vaccination RCT shows the limits of nudges. Nature 2022; 604:E1-E7. [PMID: 35388200 DOI: 10.1038/s41586-022-04526-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/01/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Nathaniel Rabb
- The Policy Lab at Brown University, Providence, RI, USA.
| | - Megan Swindal
- Rhode Island Department of Health, Providence, RI, USA
| | - David Glick
- The Policy Lab at Brown University, Providence, RI, USA.,Department of Political Science, Boston University, Boston, MA, USA
| | - Jake Bowers
- The Policy Lab at Brown University, Providence, RI, USA.,Department of Political Science, University of Illinois, Urbana-Champaign, IL, USA
| | - Anna Tomasulo
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | - David Yokum
- The Policy Lab at Brown University, Providence, RI, USA
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26
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Batteux E, Mills F, Jones LF, Symons C, Weston D. The Effectiveness of Interventions for Increasing COVID-19 Vaccine Uptake: A Systematic Review. Vaccines (Basel) 2022; 10:386. [PMID: 35335020 PMCID: PMC8949230 DOI: 10.3390/vaccines10030386] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
Vaccination is vital to protect the public against COVID-19. The aim of this systematic review is to identify and evaluate the effectiveness of interventions to increase COVID-19 vaccine uptake. We searched a range of databases (Embase, Medline, Psychology & Behavioral Science, PsycInfo, Web of Science and NIH Preprints Portfolio) from March 2020 to July 2021 for studies which reported primary quantitative or qualitative research on interventions to increase COVID-19 vaccine uptake. Outcome measures included vaccination uptake and reported intention to vaccinate. Reviews, position papers, conference abstracts, protocol papers and papers not in English were excluded. The NHLBI quality assessment was used to assess risk of bias. In total, 39 studies across 33 papers met the inclusion criteria. A total of 28 were assessed as good quality. They included interventions relating to communication content, communication delivery, communication presentation, policy or vaccination delivery, with 7 measuring vaccination uptake and 32 measuring vaccination intention. A narrative synthesis was conducted, which highlighted that there is reasonable evidence from studies investigating real behaviour suggesting that personalising communications and sending booking reminders via text message increases vaccine uptake. Findings on vaccination intention are mixed but suggest that communicating uncertainty about the vaccine does not decrease intention, whereas making vaccination mandatory could have a negative impact. Although much of the research used experimental designs, very few measured real behavioural outcomes. Understanding which interventions are most effective amongst vaccine-hesitant populations and in the context of booster vaccinations will be important as vaccine roll outs continue across the world.
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Affiliation(s)
- Eleonore Batteux
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury SP4 0JG, UK; (E.B.); (L.F.J.); (C.S.); (D.W.)
- Centre for the Study of Decision-Making Uncertainty, University College London, London WC1E 6BT, UK
| | - Freya Mills
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury SP4 0JG, UK; (E.B.); (L.F.J.); (C.S.); (D.W.)
| | - Leah Ffion Jones
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury SP4 0JG, UK; (E.B.); (L.F.J.); (C.S.); (D.W.)
| | - Charles Symons
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury SP4 0JG, UK; (E.B.); (L.F.J.); (C.S.); (D.W.)
| | - Dale Weston
- Behavioural Science and Insights Unit, UK Health Security Agency, Salisbury SP4 0JG, UK; (E.B.); (L.F.J.); (C.S.); (D.W.)
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