Acceptability of the H1N1 vaccine among older adults: the interplay of message framing and perceived vaccine safety and efficacy

"I Will Exercise to Look Great!": The Impact of Message Frame, Message Focus, and Age Label on Enhancing Older Adults' Physical Activity Intentions

Promoting physical activity (PA) in older adults is a long-standing and crucial aspect of public health. It is essential for improving quality of life and maintaining overall health as people age. This study aims to identify an effective message strategy for enhancing PA intentions in aging population. Using a between subjects, 2 [message frame: gain versus loss] × 2 [message focus: health versus appearance] × 2 [age label: presence versus absence] full factorial survey experiment, this study uncovered a significant main effect for message framing. Gain-framed messages elicited more positive PA attitudes than loss-framed messages among older adults, and this effect of message frame further varied upon different message focuses and age label conditions. Moreover, moderated mediation analyses showed that gain-framed messages exerted a stronger indirect effect on PA intentions through PA attitudes when older adults received appearance-focused messages with age labels than without. The theoretical and practical implications of tailoring health promotion messages targeting older adults were discussed.

Knowledge, attitudes, and intentions regarding COVID-19 vaccination in the general population and the effect of different framing messages for a brief video on intentions to get vaccinated among unvaccinated individuals in the United States during July 2021

OBJECTIVE

To identify knowledge, attitudes, and beliefs (KABs) associated with COVID-19 vaccination intentions and assess the impact of vaccine-promoting messages on vaccination intentions.

METHODS

Our nationally representative survey measured KABs of COVID-19 vaccination and incorporated a randomized experiment to assess the impact of different framing messages for a video encouraging vaccination intentions among unvaccinated adults in the US. Multivariable multinomial logistic regression models were fitted to investigate the relationships of KABs, trust in public health authorities (PHAs), and vaccine confidence with vaccination intentions. Difference-in-difference estimation was conducted to assess the impact of framing messages for a video on unvaccinated individuals' vaccination intentions.

RESULTS

We observed that people with increasingly favorable vaccine KABs, trust in PHAs, and vaccine confidence were more likely to be vaccinated or intend to get vaccinated against COVID-19. Difference-in-difference estimates indicated a positive impact of exposure to the video on vaccination intentions while framing messages in some cases appeared to lower vaccination intentions. Associations between the video and vaccination intentions were more pronounced among Black/African American and Hispanic/Latinx populations and Democrats; however, associations did not vary by trust in PHAs or vaccine confidence.

CONCLUSION

Videos that encourage people to get vaccinated may provide an efficient approach to nudge vaccine-hesitant individuals towards getting vaccinated. However, framing messages may negatively impact vaccination intentions and need to be developed carefully.

PRACTICE IMPLICATIONS

This study provides solid experimental evidence for the importance of tailoring message framing to the characteristics and experience of the audience, while cautioning potential negative impacts of framing that does not match its intended audience. Our findings are applicable to health communication strategies on the population level, such as mass media campaigns, and the use of framing for messages to encourage vaccination but may also be informative for healthcare professionals consulting hesitant individuals about COVID-19 vaccinations.

Message Effectiveness of Fear Appeals in Vaccination Communication Campaigns: A Systematic Review

This systematic review of 54 cross-disciplinary peer-reviewed causal empirical studies helps public health officials, researchers, and healthcare professionals better comprehend the effects of fear appeals in vaccine promotional campaigns on message processing, persuasion, vaccination attitudes, and vaccination intentions. This review documents inconsistent findings across studies, which it attempts to clarify by considering differences in research designs, sample populations, and outcomes measured. In general, we find that fear appeals increase risk perceptions, message involvement, and vaccination attitudes. However, fear appeals have less influence on vaccination intentions, especially among female and general adult populations or populations from the U.S. and other Western cultures. On the other hand, the effect of fear appeals on vaccination intentions is stronger among student populations and those from China (People's Republic of China and Hong Kong) and other non-Western cultures. Also, fear appeals are less persuasive when promoting COVID-19 vaccines and boosters than they are for other vaccines (e.g., HPV, influenza, MMR). Future research should compare fear appeal effectiveness in messages across vaccines or when combined with other executional elements, such as the endorser or type of evidence provided. Finally, future studies should explore other methodological approaches and measure underexplored message outcomes, such as vaccine uptake behavior, in more naturalistic settings.

Predicting vaccination hesitancy: The role of basic needs satisfaction and institutional trust

Autonomous motivation is considered a powerful driver of health behaviour, but less is known about the specific roles played by basic needs. Drawing on the context of the COVID-19 pandemic, this research examined basic needs as a motivational determinant of vaccination. We hypothesized that satisfaction of basic needs (autonomy, competence, relatedness) has both a direct and an indirect effect (through trust in science and government) on vaccine hesitancy. Two studies (Study 1: N = 968 French and British; Study 2, pre-registered: N = 716 Americans) tested our hypotheses and compared vaccinated and non-vaccinated individuals using multigroup structural equation models. We found positive direct (in both studies) and indirect (in Study 1) effects of autonomy satisfaction on vaccine acceptance. In contrast, competence satisfaction was directly and indirectly, via science mistrust, related to vaccine hesitancy, particularly among non-vaccinated people. Competence satisfaction also indirectly reduced the intention to vaccinate in both studies. We found no impact of relatedness. Complementing previous work on self-determination theory, our research demonstrates the importance of considering the distinct roles of basic needs. Moreover, we highlight that increasing autonomy and science trust may be an efficient strategy to improve vaccine acceptance and vaccination, even among reluctant individuals.

A study on the factors influencing the intention to receive booster shots of the COVID-19 vaccine in China based on the information frame effect

Introduction

In the response to and prevention and control of the Novel coronavirus pneumonia, the COVID-19 vaccine does not provide lifelong immunity, and it is therefore important to increase the rate of booster shots of the COVID-19 vaccine. In the field of information health science, research has found that information frames have an impact in changing individual attitudes and health behaviors.

Objective

This study focuses on the effects of different influencing factors on the public's willingness to receive the booster shots of the COVID-19 vaccine under two information frameworks.

Methods

An online questionnaire was conducted to explore the effects of demographic characteristics, personal awareness, social relationships, risk disclosure, perceived booster vaccination protection rate, and duration of protection under the assumption of an information framework. T test and one-way analysis were used to testing the effect of variables.

Results

(1) The persuasion effect under the gain frame is higher than that under the loss frame (B = 0.863 vs. B = 0.746); (2) There was no significant difference in subjects' intention of booster vaccination in terms of gender, age, income, occupation, educational background and place of residence. Whether family members received booster vaccination was strongly correlated with their intention of vaccination under the loss framework (p = 0.017, M = 4.63, SD = 0.664). (3) The higher the understanding of COVID-19, the higher the degree of compliance with the government's COVID-19 prevention and control measures, and the higher the willingness to strengthen vaccination; (4) Risk disclosure has a significant impact on people's willingness to receive COVID-19 booster shots (M = 2.48, under the loss framework; M = 2.44, under the gain framework); (5) Vaccine protection rate and duration of protection have an impact on people's willingness to vaccinate. Increased willingness to vaccinate when the protection rate of booster vaccine approaches 90% (M = 4.76, under the loss framework; M = 4.68, under the gain framework). When the vaccine protection period is 2 years, people are more willing to receive a booster vaccine; and the willingness to receive a booster shot is stronger under the loss framework (M = 4.60, SD = 0.721, p = 0.879).

Conclusion

The impact of the information framework on COVID-19 vaccination intentions is different, and the disclosure of relevant health information should focus on the impact of the information framework and content on the public's behavior toward strengthening vaccination. Therefore, in the face of public health emergencies, public health departments, healthcare institutions, and other sectors can consider adopting the Gainful Information Framework tool to disseminate health information to achieve better persuasion and promote public health behavior change enhancing public health awareness, and promoting universal vaccination.

Behavioral interventions for vaccination uptake: A systematic review and meta-analysis

BACKGROUND

Human behavior and more specifically behavioral insight-based approaches to vaccine uptake have often been overlooked. While there have been a few narrative reviews indexed in Medline on behavioral interventions to increase vaccine uptake, to our knowledge, none have been systematic reviews and meta-analyses covering not just high but also low-and-middle income countries.

METHODS

We included 613 studies from the Medline database in our systematic review and meta-analysis categorizing different behavioral interventions in 9 domains: education campaigns, on-site vaccination, incentives, free vaccination, institutional recommendation, provider recommendation, reminder and recall, message framing, and vaccine champion. Additionally, considering that there is variability in the acceptance of vaccines among different populations, we assessed studies from both high-income countries (HICs) and low- to middle-income countries (LMICs), separately.

FINDINGS

Our results showed that behavioral interventions can considerably improve vaccine uptake in most settings. All domains that we examined improved vaccine uptake with the highest effect size associated with provider recommendation (OR: 3.4 (95%CI: 2.5-4.6); Domain: motivation) and on-site vaccination (OR: 2.9 (95%CI: 2.3-3.7); Domain: practical issues). While the number of studies conducted in LMICs was smaller, the quality of studies was similar with those conducted in HICs. Nevertheless, there were variations in the observed effect sizes.

INTERPRETATION

Our findings indicate that "provider recommendation" and "on-site vaccination" along with other behavioral interventions can be employed to increase vaccination rates globally.

Vaccine attitudes and acceptance among older adults in North Dakota: Understanding demographic characteristic variability

OBJECTIVES

Older adults face increased risks from infectious diseases which are often preventable with vaccines. The current study examines demographic variation in vaccine hesitancy among older adults in North Dakota.

METHODS

A mailed survey assessing age, gender, years of education, self-rated health, rurality, and political leaning as well as vaccine attitudes and vaccine acceptance was conducted with 739 older adults (65+), oversampled from rural counties.

RESULTS

Vaccine hesitant attitudes were significantly higher among rural and politically-conservative older adults; whereas, vaccine acceptance was significantly higher among older, healthier, and politically-liberal older adults. Vaccine attitudes were significantly associated with vaccine acceptance and mediated the association between political leaning and vaccine acceptance.

DISCUSSION

These findings highlight the demographic characteristics predictive of older adults' vaccine attitudes and acceptance. By better understanding the nuanced factors leading to hesitation to be vaccinated, practitioners can develop strategies to increase vaccination rates among this at-risk population.

Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study

BACKGROUND

Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide.

OBJECTIVE

The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance.

METHODS

This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term "" (vaccine), selected "" (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame.

RESULTS

The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, "political role" was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords "side effects," "vaccine associated deaths," and "vaccine protection" continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as "side effects" prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and "side effects" and "vaccine protection" during the period when multiple vaccines were available.

CONCLUSIONS

Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication.

Can Risk Communication Surveillance Prompt COVID-19 Vaccine Acceptance among Internet users? Applying the Situational Theory of Problem Solving: A Cross-Sectional Study

BACKGROUND

The World Health Organization has recently raised concerns about the low number of fully vaccinated people against COVID-19 among developing countries. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine-related infodemics as the significant risk perception factor that hinders mass vaccination campaigns.

OBJECTIVE

Given the ambiguous digital communication environment which has fostered infodemics, developing nations struggle to boost public willingness to get people fully vaccinated. Authorities have launched some risk communication-laden digital interventions in response to infodemics. However, the value of these risk communication strategies employed to tackle infodemics needs to be evaluated. The current research using the tenets of the situational theory of problem-solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception about COVID-19 vaccine safety and risk communication actions to intensify willingness to get fully vaccinated was examined.

METHODS

This research used a cross-sectional research design vis-à-vis nationally representative online survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after filling consent form and reading the ethical permissions. Responses were received over three months, from May 2022 to July 2022.

RESULTS

The results delineated that infodemics positively affect risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and search for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (e.g., digital interventions) using the situational context could predict robust willingness to get fully vaccinated against COVID-19.

CONCLUSIONS

The pioneering results offer strategic considerations for health authorities to effectively man-age the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using the situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underpinning problem (i.e., selection of appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response.

Predicting COVID-19 Vaccination Intention: The Roles of Institutional Trust, Perceived Vaccine Safety, and Interdependent Self-Construal

The purpose of this study is to explore the process through which institutional trust influences individuals' vaccination intentions for a coronavirus vaccine. We collected data from a national representative sample of the Spanish population (N = 500) from an online research panel to test the proposed conceptual model. Results revealed a positive association of institutional trust with coronavirus vaccination intentions. This effect was mediated by perceived vaccine safety and positive attitude toward the vaccine. Furthermore, findings corroborate the moderating effect of interdependent self-construal on the indirect relationship between institutional trust and vaccination intention, implying that this effect was stronger for individuals with higher levels of interdependent orientation. Findings have implications for the development of evidence-based health communication strategies for encouraging COVID-19 vaccination.

I Will Get Myself Vaccinated for Others: The Interplay of Message Frame, Reference Point, and Perceived Risk on Intention for COVID-19 Vaccine

The purpose of this study is to seek an effective strategy to promote COVID-19 vaccination among young adults. Given that COVID-19 is less deadly for young adults, this study explores whether highlighting potential benefits or disadvantages that others may experience as a result of one's vaccination increases young adults' intention to get vaccinated, particularly for those who have low perceived risk of COVID-19. To test this idea, we conducted an experiment and analyzed the effect of interaction between message frame (gain vs. loss) and reference point (self vs. others) on intention for vaccination by one's perceived risk (low vs. high). The results show that for those with low perceived risk of COVID-19, messages about potential negative consequences to others (e.g., family, friends, community members) from one's failure to get vaccinated led to message elaboration and favorable attitude toward vaccination, which in turn promoted one's intention to get vaccinated. We discuss practical implications of the findings for message strategies that target populations experiencing COVID-19 disparities.

Strengthening polio vaccine demand in Ghana: Understanding the factors influencing uptake of the vaccine and the effectiveness of different message frames

BACKGROUND

Ghana has experienced recent polio outbreaks. Behavioral insights can be used to understand behavior and create demand for the polio vaccine.

METHODS

This cross-sectional study is based on an interactive mobile phone survey that explored factors influencing the uptake of the polio vaccine among Ghanaian mothers with children younger than five years old. The survey also explores the mothers' intention to vaccinate their children in the future as well as an experiment with short polio vaccine voice message nudges to identify the most effective message frames in encouraging vaccination. The study sample was drawn from volunteers from a mobile service platform. Linear probability model regressions with Ordinary Least Squares (OLS) estimates were used to analyze the data.

RESULTS

In total, data from 708 caregivers was assessed. Out of the sample, 35% (n = 250) had not vaccinated their children against polio, around 8% (n = 53) of respondents stated they did not plan to do so, while 28% expressed intent to do so during the next polio vaccination campaign. Higher vaccination of children against polio, i.e. better uptake of the polio vaccine, appeared to be associated with children's caregivers knowing that polio causes paralysis (with a coefficient of 0.13 (95% CI: 0.02, 0.24), i.e. 13% more likely than not to have their child vaccinated). Higher vaccine uptake also appeared to be associated with the perception that the polio vaccine is safe (with a coefficient of 0.11 (95% CI: 0.01, 0.22), i.e. 11% more likely than not to have their child vaccinated). Another factor in increasing vaccine uptake is whether caregivers receive support from healthcare workers with a coefficient of 0.11 (95% CI: 0.02, 0.20), i.e. 11% more likely than not to have their child vaccinated. Crucially, difficulty accessing the polio vaccine appeared to be associate with a negative change in vaccine uptake (with a coefficient of -0.16 (95% CI: -0.23, -0.08), i.e. 16% less likely to have their child vaccinated). Satisfaction with the information provided by vaccinators was also associated with better vaccine uptake (with a coefficient of 0.12 (95% CI: 0.05, 0.20) i.e. 12% more likely than not to have their child vaccinated); and having seen or heard something negative about the polio vaccine with a coefficient of 0.10 (95% CI: 0.03, 0.17), i.e. 10% more likely than not to have their child vaccinated. The social norms message frame was statistically significant with a coefficient of 0.06 (95% CI: -0.004, 012).

CONCLUSION

The findings from this study suggest that most women with children under the age of 5 appear to have vaccinated their children against polio. Many more caregivers express an intention to vaccinate their children, never having done so before. The behavior and the intention to vaccinate are both driven by a number of factors that must be addressed to create demand for the polio vaccine. Targeted message frames appeared to be statistically significant drivers of vaccine uptake. However, more research is required to understand how they impact vaccine behavior and future intention for vaccination.

What Motivates People to Receive Continuous COVID-19 Vaccine Booster Shots? An Expectation Confirmation Theory Perspective

(1) Background: Abundant evidence has shown that the COVID-19 vaccine booster is highly effective against the Omicron variant. It is of great practical significance to explore the factors influencing the intention to receive COVID-19 booster shots. (2) Methods: We introduced expectation confirmation theory as the basis to construct a model of the factors of the vaccination intention for COVID-19 vaccine boosters. We obtained two batches of questionnaires through Chinese social platforms, with a valid sample size of 572. To test the model, we used SmartPLS3.0 software for empirical analysis. (3) Results: In terms of the characteristics of the vaccine itself, perceived vaccine efficacy and perceived vaccine safety had significant positive effects on expectation confirmation. Regarding vaccination services, perceived vaccination convenience also had a significant positive effect on expectation confirmation. Expectation confirmation positively affected the vaccination intention for the COVID-19 vaccine boosters. Furthermore, the results showed two moderating effects: first, health consciousness negatively moderated the positive effect of perceived vaccine safety on expectation confirmation; second, the time interval since the last dose negatively moderated the positive effect of perceived vaccine efficacy on expectation confirmation. (4) Conclusions: Our research demonstrated that there is an expectation confirmation process for previous COVID-19 vaccines before people consider whether to obtain a booster shot. Perceived vaccine efficacy and perceived vaccine safety remained important factors in receiving COVID-19 booster shots, and our conclusions were consistent with previous literature. In this study, multiple dimensions such as distance and cost were used to measure perceived vaccination convenience. This new variable improve the explanatory power of the convenience of the vaccination service and enrich the variables of the factor model of vaccination intention. In addition, the moderating effects of health consciousness and time interval were found. The findings can provide a theoretical reference for public health institutions to help them understand the formation process of people's intention to receive the COVID-19 vaccine booster.

Trust in Doctors, Positive Attitudes, and Vaccination Behavior: The Role of Doctor-Patient Communication in H1N1 Vaccination

Although there is a wide variety of scientific evidence that demonstrates the benefits of vaccination on a multitude of diseases, vaccination rates remain low while misperceptions about vaccines are on the rise. The primary objective of the present study is to examine the role of doctor-patient communication and vaccination. We test the impact of doctor-patient communication on trust in doctors' vaccine recommendations as a mediator, to understand the mechanisms leading to positive vaccination attitudes, and ultimately leading to actual H1N1 vaccination behavior. We use data from a nationally representative U.S. sample from one of the Multimedia Audience Research Systems (MARS) data sets collected by Kantar Media. Our results demonstrate the crucial role of doctor-patient communication in building patients' trust in doctors, which in turn positively impact vaccination attitudes and H1N1 vaccination behavior. Unlike other preventive health measures, getting vaccines after a pandemic is a critical decision because these vaccines are previously unknown. Our finding implies that verified communication from the physician's office may be one of the effective strategies during or after a pandemic. Our findings have implications for public health organizations to incorporate effective vaccination communication and could have critical implications for the COVID-19 vaccination.

Black-and-white thinking and conspiracy beliefs prevent parents from vaccinating their children against COVID-19

Understanding predictors of parents' willingness to vaccinate their children appears fundamental to promote vaccine acceptability, especially in a pandemic scenario. The present study aimed to investigate the role of conspiracy beliefs and absolutist thinking in parental attitude toward COVID-19 vaccine, and the predictive role of parents' individual differences on decisions against children's vaccination. An online survey was administered to 415 parents of children aged 5-11, at the very beginning of the vaccination targeting this population in Italy. Results showed that absolutism predicted the tendency to believe in conspiracies, associated with a negative attitude toward the COVID-19 vaccine administration to children. Moreover, mothers were less willing to vaccinate children and parents of children aged 5-7 were more hesitant, or even against vaccination, than parents of older children. Finally, the worry about consequences of COVID-19 infection on children's health facilitated vaccine adherence. These findings contribute to deepening mechanisms regarding the vaccine acceptability.

Understanding CDC's Vaccine Communication during the COVID-19 Pandemic and Its Effectiveness in Promoting Positive Attitudes toward the COVID-19 Vaccine

The COVID-19 pandemic has imposed many communication challenges for public health authorities, especially communicating the safety, effectiveness, and importance of the COVID-19 vaccine. This study takes an integrative approach that includes a content analysis of COVID-19 vaccine-related messages from the CDC Facebook page and an experimental test of the effectiveness of the same types of vaccine-related messages on participants' attitudes toward the COVID-19 vaccine. Our findings from the content analysis show that gain-frame was used significantly more than loss-frame, and statistical evidence was more prevalent than narrative evidence in the CDC's COVID-19 vaccine-related messaging. Results from the experiment indicated that loss-framed, and messages with statistical evidence, may be more successful in promoting positive attitudes toward the COVID-19 vaccine.

I dream of socializing, sports, and serenity: Imagining a positive future-vaccinated self is associated with better attitudes toward COVID-19 vaccination

In the context of the COVID-19 pandemic, governments are attempting to vaccinate a large proportion of their adult population against the virus. While many people hurried to receive the vaccine, vaccination rates then started stagnating and governments are searching for solutions to motivate remaining citizens to receive the vaccine. Previous studies show that imagining oneself in the future can motivate health prevention behaviors, but our study is the first to use a future selves paradigm to study vaccination motivators. In two mixed methods studies we examine the effects of imagining of a future-vaccinated self (FVS) on vaccine attitudes, where participants were asked to think about what their life would be like once they had received the COVID-19 vaccine. In Study 1 (n = 114), we coded the most important categories of FVS. Several FVS were identified and related to increased social and leisure activities, reduced negative emotion and societal constraints, possible side effects of the vaccine, and societal changes. In Study 2 (n = 113), we used a 2 × 2 design in which participants' reflections on their FVS were guided or open and visualized from a first- or third-person perspective. The guided condition produced greater acceptance of the vaccine, and the first-person perspective produced greater behavioral intentions to be vaccinated. We discuss the effectiveness of future selves interventions for promoting vaccination in different societal contexts.

The Role of COVID-19 Vaccine Perception, Hope, and Fear on the Travel Bubble Program

The travel bubble program presented an appealing strategy for reopening international travel safely. However, a full vaccination regime is the foremost prerequisite of the program. Therefore, vaccination and the travel bubble are inextricably linked. This study investigated the roles of perceived vaccine efficacy, attitude towards the COVID-19 vaccine, and attitude toward the travel bubble on travel bubble intention. More importantly, the study also examined the mediating role of hope and fear among unvaccinated Korean adults between 20 and 29 years old. A total of 535 samples were collected to test the proposed conceptual model using structural equation modeling. In general, the results supported the proposed hypotheses. Notably, the intention to travel to a bubble destination was explained by 57% of the variance. Furthermore, hope mediated the relationship between vaccine attitude and travel bubble intention. Whereas fear mediated the relationship between perceived vaccine efficacy and intention. Hence, the findings suggest doubts around the vaccine efficacy and that a positive attitude towards the vaccine also install hope among the research samples.

Radio public service announcements to promote vaccinations for older adults: Effects of framing and distraction

This article investigates the effects of message framing and distraction on older adults' responses to a radio public service announcement (PSA) to promote influenza and pneumococci vaccinations. In detail, it addresses the message impact on recognition, attitudes toward the ad, and information-seeking intentions. The 2 × 2 online experiment was conducted in August 2019 in Germany. 378 participants aged 60 years and above received a radio PSA with either gain- or loss-framed messages (factor 1). Additionally, half of the participants completed a distraction task while listening (factor 2). Gain frames (η²_p =.02) and a non-distracted reception situation (η²_p =.04) positively influenced older adults' recognition accuracy. Recognition, in turn, was found to mediate the effect of framing and distraction on the intention to seek further information on the campaign (framing: b = -0.03, distraction: b = 0.05). We conclude that gain-framed radio PSAs are an appropriate tool to raise awareness for a vaccination campaign and its contents, especially when recipients are concentrated while listening to it. We suggest to implement them at the early stages of a health intervention to sensitize people about vaccination, followed by more in-depth information material (e.g., brochures) to create behavior change.

Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review

BACKGROUND AND AIMS

Although vaccines are considered the most effective and fundamental therapeutic tools for consistently preventing the COVID-19 disease, worldwide vaccine hesitancy has become a widespread public health issue for successful immunization. The aim of this review was to identify an up-to-date and concise assessment of potential factors influencing COVID-19 vaccine acceptance and refusal intention, and to outline the key message in order to organize these factors according to country count.

METHODS

A systematic search of the peer-reviewed literature articles indexed in reputable databases, mainly Pub Med (MEDLINE), Elsevier, Science Direct, and Scopus, was performed between21stJune 2021 and10th July 2021. After obtaining the results via careful screening using a PRISMA flow diagram, 47 peer-reviewed articles met the inclusion criteria and formed the basic structure of the review.

RESULTS

In total, 11 potential factors were identified, of which the greatest number of articles (n = 28) reported "safety" (34.46%; 95% CI 25.05─43.87) as the overarching consideration, while "side effects" (38.73%; 95% CI 28.14─49.32) was reported by 22 articles, which was the next common factor. Other potential factors such as "effectiveness" were identified in 19 articles (29.98%; 95% CI 17.09─41.67), followed by "trust" (n = 15 studies; 27.91%; 95% CI 17.1─38.73),"information sufficiency"(n = 12; 34.46%; 95% CI 35.87─63.07),"efficacy"(n = 8; 28.73%; 95% CI 9.72─47.74), "conspiracy beliefs" (n = 8; 14.30%; 95% CI 7.97─20.63),"social influence" (n = 6; 42.11%; 95% CI 14.01─70.21), "political roles" (n = 4; 16.75%; 95% CI 5.34─28.16), "vaccine mandated" (n = 4; 51.20%; 95% CI 20.25─82.15), and "fear and anxiety" (n = 3; 8.73%; 95% CI 0.59─18.05). The findings for country-specific influential vaccination factors revealed that, "safety" was recognized mostly (n = 14) in Asian continents (32.45%; 95% CI 19.60─45.31), followed by the United States (n = 6; 33.33%; 95% CI12.68─53.98). "Side effects" was identified from studies in Asia and Europe (n = 6; 35.78%; 95% CI 16.79─54.77 and 16.93%; 95% CI 4.70─28.08, respectively), followed by Africa (n = 4; 74.60%, 95% CI 58.08─91.11); however, public response to "effectiveness" was found in the greatest (n = 7) number of studies in Asian countries (44.84%; 95% CI 25─64.68), followed by the United States (n = 6; 16.68%, 95% CI 8.47─24.89). In Europe, "trust" (n = 5) appeared as a critical predictor (24.94%; 95% CI 2.32─47.56). "Information sufficiency" was identified mostly (n = 4) in articles from the United States (51.53%; 95% CI = 14.12─88.74), followed by Asia (n = 3; 40%; 95% CI 27.01─52.99). More concerns was observed relating to "efficacy" and "conspiracy beliefs" in Asian countries (n = 3; 27.03%; 95% CI 10.35─43.71 and 18.55%; 95% CI 8.67─28.43, respectively). The impact of "social influence" on making a rapid vaccination decision was high in Europe (n = 3; 23.85%, 95% CI -18.48─66.18), followed by the United States (n = 2; 74.85%). Finally, "political roles" and "vaccine-mandated" were important concerns in the United States.

CONCLUSIONS

The prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy varied globally; however, the global COVID-19 vaccine acceptance relies on several common factors related to psychological and, societal aspect, and the vaccine itself. People would connect with informative and effective messaging that clarifies the safety, side effects, and effectiveness of prospective COVID-19 vaccines, which would foster vaccine confidence and encourage people to be vaccinated willingly.

Message framing and COVID-19 vaccination intention: Moderating roles of partisan media use and pre-attitudes about vaccination

One of the ways to overcome the sheer devastation of the COVID-19 pandemic is to get vaccinated. However, vaccine hesitancy could be a significant barrier. The main purposes of the current study are to examine the impact of four types of theory-driven messages on COVID-19 vaccination intention and to understand the moderating role of partisan media use and vaccination attitudes. The study used a between-subject randomized online experiment with four conditions. The manipulation messages were presented as screenshots from the CDC's Facebook page. The total number of participants were 387 (female 43%, mean age 37 years). The participants were from the U.S. and older than 18 years. The findings show that loss vs. gain message frames did not have any impact on COVID-19 vaccine intention. The moderating effects of conservative media and attitudes show that in general, those who consumed lower conservative media and held positive attitudes were higher on vaccine intention, and individual vs. collective frames did not have a strong impact. However, among those participants who scored high on conservative media use, and held negative vaccination attitudes, the individual frame had a higher impact on vaccine intention. The current study experimentally tested the intertwined relationships among message frames, partisan media use, and attitudes on vaccine intention. These relationships are critical considering the political nature of the pandemic.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12144-022-02851-3.

"Until I Know It's Safe for Me": The Role of Timing in COVID-19 Vaccine Decision-Making and Vaccine Hesitancy

Managing the COVID-19 pandemic-and other communicable diseases-involves broad societal uptake of vaccines. As has been demonstrated, however, vaccine uptake is often uneven and incomplete across populations. This is a substantial challenge that must be addressed by public health efforts. To this point, significant research has focused on demographic and attitudinal correlates with vaccine hesitancy to understand uptake patterns. In this study, however, we advance understandings of individual decision-making processes involved in vaccine uptake through a mixed-methods investigation of the role of timing in COVID-19 vaccine choices. In the first step, a survey experiment, we find the timing of vaccine rollout (i.e., when a vaccine becomes available to the respondent) has a significant impact on public decision-making. Not only is there a higher level of acceptance when the vaccine becomes available at a later time, but delayed availability is correlated with both lower levels of 'desire to wait' and 'total rejection' of the vaccine. In a second step, we explore associated qualitative data, finding that temporal expressions (i.e., professing a desire to wait) can serve as a proxy for underlying non-temporal rationales, like concerns around safety, efficacy, personal situations, or altruism. By identifying these patterns, as well as the complexities of underlying factors, through a mixed-methods investigation, we can inform better vaccine-related policy and public messaging, as well as enhance our understanding of how individuals make decisions about vaccines in the context of COVID-19.

The misunderstanding of vaccine efficacy

Although the efficacies of vaccines against SARS-CoV-2, i.e., the virus that causes Covid-19, have been publicized and praised, and although they are assumed to encourage vaccine compliance, little is known about how well these figures are understood by the general public. Our study aims to fill this gap by investigating whether laypeople have an adequate grasp of what vaccine efficacy means and, if not, which misconceptions and consequences are the most common. To this end, we carried out three online behavioral experiments involving 1800 participants overall. The first, exploratory experiment, with a sample of 600 UK participants, allowed us to document, by means of both an open-ended question and a multiple-choice question, a common misinterpretation of the efficacy of SARS-CoV-2 vaccines as the non-incidence rate among the vaccinated. We formally demonstrated that this error leads to a systematic overestimation of the probability of individuals who are vaccinated developing Covid-19. The second experiment confirmed the prevalence of this misinterpretation in a new sample of 600 UK and Italian participants, by means of a slightly different multiple-choice question that included more response options. Finally, in a third experiment, involving another 600 UK and Italian participants, we investigated the behavioral implications of the documented error and showed that it might undermine the general positive attitude toward vaccines as well as the intention to get vaccinated. On the whole, the results of this study reveal a general misunderstanding of vaccine efficacy that may have serious consequences for the perceived benefits of SARS-CoV-2 vaccines and, thus, the willingness to be vaccinated.

Information Framing Effect on Public's Intention to Receive the COVID-19 Vaccination in China

The aims of the study were (1) to explore information framing effect on the public's intention to receive the COVID-19 vaccination and (2) to understand the key factors influencing the intention of COVID-19 vaccinations in China. An online questionnaire survey was conducted to explore the influence of demographic characteristics, individual awareness, social relationship, risk disclosure, perceived vaccine efficacy, and protection duration under the assumptions of information framing. The results showed that (1) the persuasion effect under loss frame was higher than that under gain frame (B = 0.616 vs. 0.552); (2) there was no significant difference between sex, age, income, occupation, educational background and residence for the participants' intention to be vaccinated; whether family members/friends were vaccinated had a strong correlation with their vaccination intention under the gain frame; (3) the higher the understanding of COVID-19 and the compliance with government COVID-19 prevention and control measures were, the higher the vaccination intention was; (4) risk disclosure had the greatest impact on people's COVID-19 vaccination intention; (5) perceived vaccine effectiveness and duration of protection had little effect on people's intention to receive vaccination. The influence of information framing on the intention of COVID-19 vaccination is different. The publicity of relevant health information should pay attention to the influence of information framing and contents on the behavior of public vaccination, so as to enhance public health awareness and promote the vaccination of the whole population.

African American Parents' Perceived Vaccine Efficacy Moderates the Effect of Message Framing on Psychological Reactance to HPV Vaccine Advocacy

This experiment assessed how the frame of promotional vaccine messages elicited psychological reactance differently for African American parents according to their level of perceived vaccine efficacy. We found that those with low perceived HPV vaccine efficacy experienced more psychological reactance in response to loss-framed messages compared to gain-framed messages, whereas message framing made little difference for those with high perceived HPV vaccine efficacy. In addition, the interaction between frame and perceived HPV vaccine efficacy indirectly affected parents' intentions to vaccinate their child for HPV via reactance. These results support current theorizing about framing effects under defensive message processing specifically as it applies to psychological reactance.

COVID-19 Vaccination Attitudes and Intention: Message Framing and the Moderating Role of Perceived Vaccine Benefits

The United States is one of the hardest-hit countries by the COVID-19 pandemic and yet there is widespread hesitancy to take the vaccine. In order to address vaccine hesitancy and foster public understanding of the COVID-19 vaccine, it is necessary to strategize public health messages based on evidence. To this end, we use experimental data to examine the effects of four message frames on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. The primary purposes of this paper are to examine the 1) impact of loss vs. gain frames and individual vs. collective frames and 2) role of perceived benefits on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. Our findings show that participants with higher perceived benefits and exposed to the loss frame showed higher positive attitudes toward the COVID-19 vaccine and greater intention to vaccinate. Similar patterns were revealed in case of the individual frame message. Implications are discussed.

Risky behaviour and non-vaccination

Widespread vaccination acceptance is of critical import to society dealing with the continuing aftermath of the COVID-19 pandemic. The risky behaviours that predict whether individuals vaccinate for seasonal influenza can help policymakers fashion plans to improve vaccination rates and more reliably establish herd immunity. To this end, Canadian Community Health Survey (CCHS) data were employed to determine how an individual’s choice to engage in various risky behaviours relates with the likelihood that the same individual gets the seasonal influenza vaccine. Controls were included for demographic, geographic, and health insurance factors. In addition to controlling for these factors, regressions were further stratified based upon gender, the presence of children in the home, and age. I found that excess sun exposure, poor oral hygiene, smoking, and unhealthy diet choices correlated with reduced vaccination probability—both over the subsequent year and for that individual’s lifetime. These results have important implications for properly targeting individuals for widespread vaccinations.

Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model

OBJECTIVE

This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children.

DESIGN

Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality.

RESULTS

Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children.

CONCLUSION

These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.

Be Part of the Conversation: Audiology Messaging During a Hearing Screening

OBJECTIVES

The moment patients learn the results from a hearing assessment can be a critical juncture on their journey to rehabilitation. Message framing (e.g., the positive or negative manner in which information is presented) has been explored in a wide range of health contexts as a method for shaping patients' decision-making. This study investigated whether attitudes toward hearing loss treatment varied as a function of how messages about treatment were framed, and whether such attitudes differed as a function of participants being led to believe they had failed a hearing screening.

METHODS

Sixty-four participants (18 to 39 years of age) took the Hearing in Noise Test. In the sound booth, participants saw a poster bearing either a gain-framed or loss-framed message about hearing loss treatment. During the test, half the participants were interrupted by the researcher who stated that their performance appeared to suggest a hearing loss, with the caveat that it might be due to an equipment malfunction. While the researcher investigated the problem, the participants completed an 11-item questionnaire asking about their attitudes toward help seeking for hearing loss. Participants in the control group completed the same questionnaire with no interruption.

RESULTS

Statistical analyses revealed no significant interaction effect between message type and experimenter feedback condition, though a significant main effect was present for message type. Post hoc testing showed medium to large effect sizes as a function of message type on five of the 11-questionnaire items. These data indicated that participants were more likely to endorse health-positive responses (i.e., greater interest in hearing treatment) when exposed to the gain-framed message than the loss-framed message.

CONCLUSIONS

The greater likelihood of health-positive responses in the presence of the gain-framed message suggests that this framing strategy may have a positive influence on attitudes toward hearing health behaviors among individuals under 40 years of age with no history of hearing loss.

Free flu shots vs herd immunity in flu vaccination advertising: the interaction of attribute type and message sidedness on flu vaccination judgment

Purpose

This study aims to examine how the relative importance of a search versus a credence attribute, strategically addressed in a flu vaccination advertisement, varies as a function of message sidedness. A search attribute was designed to highlight the affordability of flu shots, and a credence attribute addressed the potential health benefits of flu vaccination.

Design/methodology/approach

Two experiments were designed to explore how the relative persuasiveness of search versus credence attributes varies as a function of message sidedness in the context of flu vaccination advertising. In Experiment 1, the search–credence attribute type was manipulated by addressing either the affordability (e.g. “Get free flu shots”) or indirect health benefits of flu vaccines (e.g. “Improve herd immunity/community health”). In Experiment 2, an individual-level credence attribute (e.g. “Strengthen your immune system”) was created and compared to the other two attribute conditions used in Experiment 1: a search versus a societal credence versus an individual credence attribute.

Findings

Experiment 1 (N = 114) revealed the relative advantage of a search attribute (free flu shots) in the two-sided persuasion. Experiment 2 (N = 193) indicated that the persuasive impact of a societal credence attribute (herd immunity/community health) was greater in the two-sided message condition (vs one-sided message condition).

Originality/value

Relatively little research has examined how consumers respond to strategic flu prevention and vaccination messages promoting either credence or search attributes. Motivated by the need to investigate the relative effectiveness of stressing “herd immunity” versus “free flu shots” in flu vaccination advertising, this study examines how the effects of these distinct attributes on flu vaccination judgments differ between two-sided (e.g. “No vaccine is 100% effective”) and one-sided persuasion.

A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic

Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.

A Select Bibliography of Actions to Promote Vaccine Literacy: A Resource for Health Communication

In this bibliography, the researchers provide an introduction to the available evidence base of actions to promote vaccine literacy. The research team organized interventions to create a tool that can inform health communicators and practitioners seeking a resource focused on strategy and implementation design for actions that support vaccine literacy. This scoping bibliography is honed specifically to respond to the urgency of the current pandemic, when supporting and increasing vaccine literacy offers promise for achieving the critically needed high levels of vaccination. Over the course of the coming months and year, this bibliography will be a dynamic and "living" document hosted and maintained on vaccineliteracy.com.

Health Information Sources and the Influenza Vaccination: The Mediating Roles of Perceived Vaccine Efficacy and Safety

Although the influenza vaccine is widely recognized as an effective preventive measure, influenza vaccination rates among U.S. adults remain low. Moreover, influenza-related respiratory illnesses may increase the risk of adverse outcomes of COVID-19. Thus, this study examines the mechanisms involved in influenza vaccination uptake. Specifically, this study investigates how health information sources are associated with perceived vaccine efficacy and safety, which, in turn, associated with influenza vaccine uptake. Analyzing cross-sectional survey data from a national U.S. adult sample (N = 19,420), mediation analyses were conducted. Results revealed that considering vaccine efficacy, health information seekers who assigned more value to medical professionals, medical journals, and newspaper articles were more likely to perceive a vaccine as effective, thus being more likely to receive the influenza vaccine. By contrast, individuals who placed more value in social media were less likely to perceive vaccine efficacy, and, in turn, were less likely to get the influenza vaccine. Turning to vaccine safety, the value ascribed to medical professionals was positively associated with vaccine safety, which, in turn, related to influenza vaccine uptake. By contrast, social media, family or friends, and promotions were negatively associated with vaccine safety, and then influenza vaccine uptake.

Is flu vaccination opt-out feasible? Evidence from vaccination programme implementers and managers in the English National Health Service

BACKGROUND

In 2018/19, English NHS trusts (NHSTs) implemented an 'opt-out' policy for seasonal flu vaccination in frontline healthcare workers (HCWs). HCWs declining the vaccination were asked to sign an opt-out form and provide a reason for their decision. In addition, HCWs working in higher risk hospital environments (e.g. oncology) were asked to inform their manager about their declination decision. The policy aimed to provide greater insight into reasons for vaccination decline and information from HCWs in higher risk areas was intended for use in considering HCW redeployment. This study investigated the feasibility, acceptability, and perceived value of the policy during the 2018/19 flu vaccination season.

METHODS

We conducted semi-structured interviews across 9 NHSTs in England with different levels of HCW flu vaccination uptake in 2017/18. We interviewed 30 vaccination programme implementers and 27 managers.

FINDINGS

The purpose of the policy was poorly understood, and interviewees did not know how data on decliners was being used. Most NHSTs tried to collect the personal details of decliners and, in some instances, these were recorded in Electronic Staff Records and reported to line-managers for action. This created strain on employer-employee relationships, leading to decliners refusing to complete opt-out forms and some vaccinators not implementing the policy. None of the NHSTs had a redeployment policy for decliners, arguing that this was impractical due to strain on staffing levels.

CONCLUSION

A flu-vaccination opt-out approach for HCWs did not appear acceptable in our sampled NHSTs, due to a lack of clear messaging about its purpose and complicated implementation. To promote an opt-out approach effectively, there needs to be clear communication of its purpose, which should be to explore reasons for decline rather than identify and 'push' decliners to vaccinate, so as not to damage staff relationships. NHSTs should involve their workforce in developing flu vaccination approaches.

Effects of Facebook Comments on Attitude Toward Vaccines: The Roles of Perceived Distributions of Public Opinion and Perceived Vaccine Efficacy

This study investigated if and how exposure to Facebook comments about vaccines influences one's attitude toward the vaccines. In this investigation, comments were examined in light of their effect on attitude toward vaccines through perceived distribution of public opinion on vaccines, and perceived vaccine efficacy was tested as a factor moderating relative effects of comments on perception of public opinion distributions. Results from an experimental study (N = 271) showed that exposure to a greater number of comments in a thread expressing (un)favorable opinions on the flu vaccine led to (un)favorable attitude toward the flu vaccine through a change in perceived distribution of public opinions on the vaccination. The indirect effect of comments on attitude toward the flu vaccine through perceived public opinion distributions was greater among participants with lower levels of perceived vaccine efficacy, while the direct effect of comments on attitude was not significant.

A path model of psychosocial constructs predicting future Zika vaccine uptake intent

OBJECTIVE

The recent Zika virus outbreak, while no longer an international public health emergency, is still a serious threat, particularly to pregnant women and babies born to pregnant women infected with the virus. This study examined the predictive effects of psychosocial constructs on self-reported intent to get a future Zika vaccine among women of reproductive age.

METHODS

Data were collected using an online survey with a representative sample of 339 women ages 18-49 from the continental United States. The survey addressed variables originating with the Extended Parallel Processing Model (EPPM) as related to future Zika vaccine uptake intent.

RESULTS

Three quarters of all respondents reported intention to get a future Zika vaccine. Path modeling revealed a direct effect of perceived susceptibility, self-efficacy, and response efficacy on future Zika vaccine uptake intent, as well as an indirect effect of perceived susceptibility through both self-efficacy and response efficacy. In addition, the final model showed an indirect effect of perceived severity on Zika vaccine uptake intent through self-efficacy and response efficacy and accounted for 54.6% of the variance in vaccination intent.

CONCLUSIONS

These findings have implications for future Zika vaccine promotion campaigns. This study confirms the importance of perceived susceptibility, self-efficacy, and response efficacy for use in Zika vaccine uptake campaigns; in addition, when using perceived severity, both self-efficacy and response efficacy should be considered in message design.

Adult vaccination as part of a healthy lifestyle: moving from medical intervention to health promotion

As the global population ages, there is concern about the effect of an increased proportion of older individuals on the economic sustainability of healthcare systems and the social effects of an older society. Health authorities and advocacy groups in countries at the forefront of this trend are now developing strategies to ameliorate the social and financial effects of an ageing population. There is broad agreement that for both society and for the individuals, it is important to ensure that increasing lifespans are matched with increased "healthspans" - the number of years spent in good health. There is also growing consensus that vaccination is one of the tools that can play an important role in improving adult health - though currently vaccination coverage is often poor. This review focuses on two issues that consistently appear to be associated with under-vaccination: the low awareness of risk (and potential consequences) for vaccine-preventable diseases and a poor understanding of the value of improved vaccination coverage for adults. We suggest that understanding of vaccination as a health-promoting activity, rather than a medical intervention designed to prevent the spread of a specific pathogen - is a crucial step to improve vaccination uptake among adults (see Supplementary video abstract ). Key messages As populations age globally, we are seeing an increasing burden of vaccine-preventable disease in adults. Adult vaccination against some common diseases has been shown to dramatically improve health and quality of life for older people. Despite the attested benefits, vaccination coverage is almost always poor in adults, even in countries where access is free at point of care. In this article, we discuss what appears to a neglected issue in adult vaccination, that of personal autonomy. We argue that adult vaccination will only be successful if it respects individual autonomy and that this requires treating the choice to vaccinate as a public health issue akin to smoking cessation, exercise and healthy diet.

Effects of Message Framing on Influenza Vaccination: Understanding the Role of Risk Disclosure, Perceived Vaccine Efficacy, and Felt Ambivalence

The current study examined the effects of framing in promotional health messages on intention to vaccinate against seasonal influenza virus. The findings of an experimental study (N = 86) indicated that exposure to both benefits and side effects of vaccination (gain-framed with risk disclosure message) led to lower intention to receive the flu vaccine. This relationship was mediated by both perceived vaccine efficacy and felt ambivalence in a serial order, revealing the underlying psychological mechanisms important for understanding health-related behaviors. Theoretical implications of constructing sub-framed messages are discussed and the concept of second-order framing is introduced.

Knowledge, attitudes and practices related to the influenza virus and vaccine among older adults in Eastern China

BACKGROUND

This study aims to assess the association between socio-demographic and health characteristics of older adults in Eastern China and knowledge, attitudes, and practices (KAP) about the influenza virus and vaccine.

METHODS

A prospective cohort of 1506 older adults (aged ≥60 years) was enrolled from November to December 2015 in Jiangsu Province. We examined the association between demographics, health and functional status, and cognitive impairment at enrollment with awareness of influenza virus and vaccine and KAP items focused on five Health Belief Model domains. At a 12-month follow-up interview we assessed change in awareness and readiness to be vaccinated.

RESULTS

One in five older adults was aware of the influenza virus (21%) or vaccine (20%); even fewer reported having at least "a little" knowledge of the virus and vaccine (7% and 4%, respectively); less than 1% reported ever receiving an influenza vaccine. Retirement, higher education and income, and normal cognitive status were consistently associated with both awareness and knowledge of influenza virus. The odds of having at least "a little" knowledge of the vaccine was 2.9-fold (95% CI = 1.6-5.3) higher among older adults with at least some secondary schooling. Among the 108 with knowledge of the virus, 55% said they "worry about getting the flu this season." Among the 73 with knowledge of the vaccine, 92% believed the vaccine was at least somewhat effective and less than half (43%) thought that influenza vaccination was safe. At a 12-month follow-up interview, 33% (442/1333) increased from no knowledge to at least "a little".

CONCLUSIONS

If and when influenza vaccines become widely available to older adults in China, our results indicate that influenza vaccination campaigns with basic information on the virus and vaccine could be beneficial for all older adults, especially those with less education and/or more cognitive impairment.

Message Framing in Vaccine Communication: A Systematic Review of Published Literature

Suboptimal vaccination rates are a significant problem in many countries today, in spite of improved access to vaccine services. As a result, there has been a recent expansion of research on how best to communicate about vaccines. The purpose of the present article is to provide an updated review of published, peer-reviewed empirical studies that examined the effectiveness of gain versus loss framing (i.e., goal framing) in the context of vaccine communication. To locate studies, we examined the reference list from the previous meta-analytic review (O'Keefe & Nan, 2012), and we conducted systematic searches across multiple databases. We included 34 studies in the qualitative synthesis. The relative effectiveness of goal-framed vaccine messages was often shown to depend on characteristics of the message recipient, perceived risk, or situational factors, yet most effects were inconsistent across studies, or simply limited by an insufficient number of studies. Methodological characteristics and variations are noted and discussed. The review points to several directions concerning moderators and mediators of framing effects where additional rigorous studies would be needed.

Framing and visual type: Effect on future Zika vaccine uptake intent

Introduction

The Zika virus is associated with the birth defect microcephaly, and while a vaccine was not available in early- 2017, several were under development. This study's purpose was to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age.

Design and methods

In order to study the effects of Zika message framing (gain vs. loss) and visual type (photo vs. infographic) on future Zika vaccine uptake intent, a 2×2 between-subjects experiment was performed via an online survey in 2017 among 339 U.S. women of reproductive age (18-49 years). Participants were exposed to one of four messages, all resembling Instagram posts: gain-framed vs. loss-framed infographic, and gain-framed vs. loss-framed photo. These messages were followed by questions about Zika vaccine uptake intent as well as intermediate psychosocial variables that could lead to intent.

Results

There was no interaction between framing and visual type (P=0.116), and there was no effect for framing (P=0.185) or visual type (P=0.724) on future Zika vaccine uptake intent, which is likely indicative of insufficient dosage of the intervention. However, when focusing on intermediate psychosocial constructs that are known to influence behavior and intent, gain-framed messages were more effective in increasing subjective norms (P=0.005) as related to a future Zika vaccine, as well as perceived benefits (P=0.016) and self-efficacy (P=0.032).

Conclusions

Gain-framed messages seem to be more effective than loss-framed messages to increase several constructs that could, in turn, affect future Zika vaccine uptake intent. This is a novel finding since, traditionally, loss-framed messages are considered more beneficial in promoting vaccine-related health behaviors.

Effectiveness of message framing on women's intention to perform cytomegalovirus prevention behaviors: a cross-sectional study

Background

The purpose of this study was to evaluate the effect of message framing on women’s intention to perform cytomegalovirus (CMV) prevention behaviors involving handwashing, not sharing food and eating utensils, not kissing a child on the lips and not placing a pacifier in the mouth after it was in a child’s mouth.

Methods

An online panel of women 18–40 years, who were pregnant or planning a pregnancy were randomized in a 2 × 2 factorial design to receive 1 of 4 CMV fact sheets. The fact sheets were framed as either what could be gained or be lost by following (or not) the recommendations and the likelihood of being affected by CMV (i.e., small chance or one of the most common infections in infants). The questionnaire measured CMV knowledge, participation in CMV risk or prevention behaviors, perceived severity of and susceptibly to CMV, and the perceived control over and the efficacy of recommended prevention behaviors. The dependent variable, intention to modify behavior, was an index score that ranged from 0 to 16 with higher values indicating greater intention. Linear regression was used to evaluate the association between all independent variables and overall behavioral intention.

Results

The sample included 840 women; 15.5% were familiar with CMV. Behavioral intention was high (M = 10.43; SD = 5.13) but did not differ across the message frames (p = 0.23). Overall, behavioral intention was predicted by CMV knowledge, message credibility, perceived severity of CMV, perceived behavioral control and response efficacy. Significant interactions with gain vs. loss frame were observed for perceived behavioral control (p = 0.03) and response efficacy (p = .003).

Conclusions

Framing CMV messages by what women stand to gain or lose interacts with perceived behavioral control and response efficacy to influence behavioral intention. Perceived behavioral control and response efficacy were most predictive of behavioral intention overall regardless of frame. Messaging that focuses on these two variables, particularly for avoiding kissing a child on the lips and sharing food, cups and utensils, may result in greater gains in intention to participate in CMV prevention behaviors.

Women's attitudes toward practicing cytomegalovirus prevention behaviors

Congenital cytomegalovirus (CMV) infection causes severe disabilities and developmental delays. Women's awareness of CMV is low. Only about half of healthcare providers report counseling women about behaviors to reduce CMV risk and public health education is limited. Routine CMV counseling is not recommend. Providers may lack time to counsel women; other conditions may take priority for counseling; there may be a perception that women are reluctant to follow advice. This cross-sectional descriptive study examined women's attitudes toward CMV prevention behaviors. Data were collected from an online panel of 840 U.S. women 18–40 years of age, who had a child < 5 years of age, and were pregnant or planning a pregnancy in the next 12 months. Questions assessed CMV awareness, frequency of past behaviors that transmit CMV, and attitudes toward eight CMV prevention behaviors. Only 15.5% of women were somewhat or very familiar with CMV. Very few women (6.1%) reported hearing from their provider about CMV. Women held positive attitudes toward the CMV prevention behaviors and perceived them as feasible. Least positive attitudes were toward not kissing a child on the lips and not sharing foods. Predictors of positive attitudes were CMV awareness, past behavior, talking to a healthcare provider, and perceived risk reduction. Healthcare providers and public health practitioners should collaborate to increase CMV awareness. Encouraging behaviors to reduce saliva sharing may result in greater gains in reducing CMV infection.

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Overall, women hold favorable attitudes toward CMV prevention behaviors.

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Women hold less favorable attitudes toward not kissing a child on the lips.

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Women also hold less favorable attitudes toward not sharing food with a child.

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Positive attitudes predicted by belief that their risk of infection would be reduced.

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Providers and public health practitioners need to work together to increase awareness.

Message Framing, Perceived Susceptibility, and Intentions to Vaccinate Children Against HPV Among African American Parents

This research examines the interaction effect of message framing (gain vs. loss) and perceived susceptibility (i.e., perceived likelihood that one's child is at risk of contracting HPV) on African American parents' intentions to vaccinate their children against HPV. Results of an experiment (N = 193) in which parents were exposed to either a gain-framed or loss-framed message about HPV vaccination revealed a significant interaction between message framing and perceived susceptibility when parents were required to pay for the vaccine. The specific pattern of interaction suggested that parents who perceived their children to be at high risk of contracting HPV were more persuaded by the gain-framed message, whereas those who believed their children to be at low risk of contracting HPV were more persuaded by the loss-framed message. Implications of the findings for HPV vaccination messaging are discussed.

Nudges or mandates? The ethics of mandatory flu vaccination

According to the CDC report for the 2012-2013 influenza season, there was a modest increase in the vaccination coverage rate among healthcare workers from 67% in 2011-2012, to 72% in 2012-2013 to the current 75% coverage. This is still far from reaching the US National Healthy People 2020 goal of 90% hospitals vaccination rates. The reported increase in coverage is attributed to the growing number of healthcare facilities with vaccination requirements with average rates of 96.5%. However, a few other public health interventions stir so much controversy and debate as vaccination mandates. The opposition stems from the belief that a mandatory flu shot policy violates an individual right to refuse unwanted treatment. This article outlines the historic push to achieve higher vaccination rates among healthcare professionals and a number of ethical issues arising from attempts to implement vaccination mandates. It then turns to a review of cognitive biases relevant in the context of decisions about influenza vaccination (omission bias, ambiguity aversion, present bias etc.) The article suggests that a successful strategy for policy-makers and others hoping to increase vaccination rates is to design a "choice architecture" that influences behavior of healthcare professionals without foreclosing other options. Nudges incentivize vaccinations and help better align vaccination intentions with near-term actions.

Biased assimilation and need for closure: examining the effects of mixed blogs on vaccine-related beliefs

This study examines the effect of mixed online information, in the form of user-generated blogs, related to the HPV vaccine on perceived efficacy and safety of this vaccine. Guided by the theoretical frameworks of biased assimilation and need for closure, this research hypothesizes that exposure to mixed blogs about the HPV vaccine will lead to polarization of HPV vaccine-related beliefs among individuals with opposing prior opinions about vaccination and that the polarizing effects will be most pronounced among those high in need for closure. A controlled experiment (N = 338) found support for the hypotheses with regard to efficacy beliefs but not with regard to safety beliefs. Implications for health communication research and practice are discussed.

Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy

BACKGROUND

The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria.

METHOD

Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion.

RESULTS

Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making.

CONCLUSIONS

Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.

Determinants of refusal of A/H1N1 pandemic vaccination in a high risk population: a qualitative approach

BACKGROUND

Our study analyses the main determinants of refusal or acceptance of the 2009 A/H1N1 vaccine in patients with cystic fibrosis, a high-risk population for severe flu infection, usually very compliant for seasonal flu vaccine.

METHODOLOGY/PRINCIPAL FINDINGS

We conducted a qualitative study based on semi-structured interviews in 3 cystic fibrosis referral centres in Paris, France. The study included 42 patients with cystic fibrosis: 24 who refused the vaccine and 18 who were vaccinated. The two groups differed quite substantially in their perceptions of vaccine- and disease-related risks. Those who refused the vaccine were motivated mainly by the fears it aroused and did not explicitly consider the 2009 A/H1N1 flu a potentially severe disease. People who were vaccinated explained their choice, first and foremost, as intended to prevent the flu's potential consequences on respiratory cystic fibrosis disease. Moreover, they considered vaccination to be an indirect collective prevention tool. Patients who refused the vaccine mentioned multiple, contradictory information sources and did not appear to consider the recommendation of their local health care provider as predominant. On the contrary, those who were vaccinated stated that they had based their decision solely on the clear and unequivocal advice of their health care provider.

CONCLUSIONS/SIGNIFICANCE

These results of our survey led us to formulate three main recommendations for improving adhesion to new pandemic vaccines. (1) it appears necessary to reinforce patient education about the disease and its specific risks, but also general population information about community immunity. (2) it is essential to disseminate a clear and effective message about the safety of novel vaccines. (3) this message should be conveyed by local health care providers, who should be involved in implementing immunization.