Effects of Framing Health Messages in Terms of Benefits to Loved Ones or Others: An Experimental Study

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

Using Short-Form Videos to Get Clinical Trial Newcomers to Sign Up: Message-Testing Experiment

BACKGROUND

Recruiting participants for clinical trials poses challenges. Major barriers to participation include psychological factors (eg, fear and mistrust) and logistical constraints (eg, transportation, cost, and scheduling). The strategic design of clinical trial messaging can help overcome these barriers. While strategic communication can be done through various channels (eg, recruitment advertisements), health care providers on the internet have been found to be key sources for communicating clinical trial information to US adults in the social media era.

OBJECTIVE

This study aims to examine how communication source (ie, medical doctors and peers) and message framing of TikTok videos (ie, psychological and logistical framing) influence clinical trial-related attitudes, perceptions, and sign-up behaviors under the guidance of the integrated behavioral model.

METHODS

This study used a 2 (source: doctor vs peer) × 2 (framing: psychological vs logistical) between-participant factorial design web-based experiment targeting adults in the United States who had never participated in clinical trials (ie, newcomers). A Qualtrics panel was used to recruit and compensate the study respondents (n=561). Participants viewed short-form videos with doctors or peers, using psychological or logistical framing. The main outcome measures included perceived source credibility, self-efficacy, attitude toward clinical trial participation, behavioral intention, and sign-up behavior. Structural equation modeling was used to analyze the direct and indirect effects of message factors on the outcome variables. Source (doctor=1; peer=0) and framing (psychological=1; logistical=0) were dummy-coded.

RESULTS

Doctor-featured messages led to greater perceived source credibility (β=.31, P<.001), leading to greater self-efficacy (95% CI 0.13-0.30), which in turn enhanced behavioral intention (95% CI 0.12-0.29) and clinical trial sign-up behavior (95% CI 0.02-0.04). Logistical barrier-framed messages led to greater self-efficacy (β=-.09, P=.02), resulting in higher intention to participate in clinical trials (95% CI -0.38 to -0.03) and improved sign-up behavior (95% CI -0.06 to -0.004). Logistical barrier-framed messages were also directly associated with an increased likelihood of signing up for a clinical trial (β=-.08, P=.03). The model accounted for 21% of the variance in clinical trial sign-up behavior. Attitude did not significantly affect behavioral intention in this study (β=.08, P=.14), and psychological and logistical barrier-framed messages did not significantly differ in attitudes toward clinical trial participation (β=-.04, P=.09).

CONCLUSIONS

These findings advance our understanding of how people process popular message characteristics in short-form videos and lend practical guidance for communicators. We encourage medical professionals to consider short-form video sites (eg, TikTok and Instagram Reels) as effective tools for discussing clinical trials and participation opportunities. Specifically, featuring doctors discussing efforts to reduce logistical barriers is recommended. Our measuring of actual behavior as an outcome is a rare and noteworthy contribution to this research.

COVID-19 Vaccine Boundary Work: The Case of Facebook Comments in Southeast Georgia

Although much research has considered the worldview of the vaccine hesitant, little attention has been given to the cultural conflict over what it means to be a person who takes vaccines. Through a qualitative content analysis of comments made on the Facebook pages of media outlets serving southeast Georgia, this analysis identifies both motives for rejecting the vaccine and outlines the symbolic boundaries that the vaccine hesitant have erected to distinguish themselves from vaccine advocates. The motives include perfunctory rejections, claims that the vaccine is ineffective, illegitimate, injurious in the short and long term, poisonous, infectious, particularly dangerous for children, and a component of conspiracy theories. These symbolic boundaries include distinguishing vaccine advocates from the vaccine hesitant by personal characteristics such as irrationality and authoritarianism. There are also social boundaries rooted in social locations - namely conservatives vs. liberals and non-elites vs. elites. This study also demonstrates how vaccine proponents engage with these symbolic boundaries. Vaccine proponents both contest and accept these boundaries. Likewise, pro-vaccine comments vary in terms of whether they stigmatize the boundary between vaccine user and non-user. This study adds to the literature on health communication and vaccines by confirming previous reports of the reasons for not taking the COVID-19 vaccine, indicating that public communication on vaccines is not regionally specific, and demonstrating the role that ostensible vaccine advocates might play in contributing to vaccine hesitancy.

The Effects of Emotion, Spokesperson Type, and Benefit Appeals on Persuasion in Health Advertisements: Evidence from Macao

Enhancing public awareness for epidemic prevention is crucial for safeguarding public health. This experimental study investigated the effectiveness of a combined approach involving three persuasive elements in public health advertising. Specifically, the study examined the interplay between emotional appeals (fear messages versus efficacy messages) and spokesperson type on the public's response to health announcements. The results demonstrated that fear messages were more persuasive when conveyed by real human spokespersons (versus animated spokespersons), whereas efficacy messages were more acceptable when conveyed by animated spokespersons (versus real humans). Furthermore, the study revealed that the impact of emotional appeals and spokesperson type is moderated by benefit appeals (self-benefit or other-benefit). The joint effects of these persuasive variables on individuals' intention to adopt preventive measures indicated that the interactions significantly differed across the two types of benefit appeal. Taken together, the findings represent a pioneering contribution to the field of health communication by comparing the persuasive effects of different combinations of emotional appeals, spokesperson types, and benefit appeals on public behavior. These findings offer practical guidance for public communicators to design more appropriate health advertisements based on the results of this study, thereby enhancing public acceptance of disease prevention measures.

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.

Predicting COVID-19 and Influenza Vaccination Confidence and Uptake in the United States

This study investigates and compares the predictors of COVID-19 and influenza vaccination confidence and uptake in the U.S. Vaccine hesitancy is defined as the reluctance or refusal (i.e., less than 100% behavioral intention) to vaccinate despite the availability of effective and safe vaccines. Vaccine hesitancy is a major obstacle in the fight against infectious diseases such as COVID-19 and influenza. Predictors of vaccination intention are identified using the reasoned action approach and the integrated behavioral model. Data from two national samples (N = 1131 for COVID-19 and N = 1126 for influenza) were collected from U.S. Qualtrics panels. Tobit regression models were estimated to predict percentage increases in vaccination intention (i.e., confidence) and the probability of vaccination uptake (i.e., intention reaching 100%). The results provided evidence for the reasoned approach and the IBM model and showed that the predictors followed different patterns for COVID-19 and influenza. The implications for intervention strategies and message designs were discussed.

Physical Activity Message Framing and Ethnicity Before and During COVID-19

People of Black ethnicities are well known to be disproportionately burdened by coronavirus and have poorer health outcomes. Public health messages encouraged physical activity during the pandemic as it is evidenced to positively affect the immune system, however people of Black ethnicities are often reported as failing to achieve the recommended daily amount. Health message framing during COVID-19 specifically in relation to ethnicity and physical activity motivation has yet to be investigated. Two studies examined message frame effect on physical activity motivation prior to and at the onset of the pandemic and how this differed by ethnicity. Gain framed messages were found to positively affect physical activity motivation pre-COVID-19 and during the pandemic fear framed messages were found to positively affect physical activity motivation. Neither of these effects differed by ethnicity. Implications for future physical activity health message framing are discussed.

Promoting COVID-19 booster vaccines in Macao: A psychological reactance perspective

RATIONALE

The booster vaccine plays a key role in ending COVID-19 crisis. However, promoting COVID-19 booster vaccination often interferes with individuals' freedom of choice and leads to psychological reactance.

OBJECTIVE

To promote the public's intention to receive COVID-19 booster dose, this study aimed to investigate the effectiveness of different message designs from psychological reactance theory's perspective.

METHOD

A 2 × 2 × 2 factorial experiment was conducted in Macao in January 2022 (N = 469). Partial least squares structural equation modeling and a complementary three-way ANOVA were performed to examine the effects of message frame (gain frame vs. loss frame), freedom restoration postscripts (present vs. absent), and other-referencing cues (present vs. absent) on reducing psychological reactance.

RESULTS

The present study has successfully broadened the scope of the psychological reactance theory by examining its applicability to the context of COVID-19 booster vaccination promotion. Our findings indicate that the gain-framed promotion messages tend to be the most effective in reducing perceived reactance. However, freedom restoration postscripts, other-referencing cues, and mixed message design were found to be ineffective in alleviating reactance. Besides, the insignificance of direct effect from message frame to intention suggests that the message design itself cannot influence people's vaccination intentions; rather, it must rely on reducing perceived threat, reactance, and further improving vaccination intentions.

CONCLUSIONS

Our study offered valuable insights from psychological reactance perspective, identifying message features that can be effective in health promotions. Furthermore, message design specifically aimed at reducing the threat to freedom may yield unexpected persuasive effects, an aspect currently overlooked in health promotion strategies.

Psychological profiles of COVID vaccine-hesitant individuals and implications for vaccine message design strategies

COVID-19 has caused tremendous consequences in the U.S., and combating the pandemic requires a significant number of Americans to receive COVID-19 vaccines. Guided by prominent health communication theories, this project took a formative evaluation approach and employed a national sample (N = 1041) in the U.S. to explore the potential differences between vaccine-inclined vs. -hesitant individuals and to generate profiles of hesitant individuals as the foundation for audience segmentation and message targeting. Five distinct profiles emerged in the sample. Characteristics of each profile were described, and appropriate messaging strategies were identified to target each group. Theoretical and practical implications were discussed.

Get Vaccinated for Loved Ones: Effects of Self-Other Appeal and Message Framing in Promoting HPV Vaccination among Heterosexual Young Men

HPV has long been constructed as a sex-specific virus. Boys and men largely perceive the virus as not related to themselves and thus develop a female-specific schema on HPV. The present study investigates message strategies for promoting HPV vaccination among heterosexual young men in the United States. Through an online experiment, this study examined the effects of reference point (self, other, vs. self-other) and message framing (gain vs. loss) on processing fluency, optimistic bias, and behavioral intentions. The findings showed a schema-matching pattern in facilitating information processing, and a schema-mismatching pattern in attenuating optimistic bias. Specifically, other-referencing messages that related the outcomes of getting vaccinated for HPV to the message recipients' sexual partners promoted processing fluency and widened the self-other gap in perceived susceptibility to HPV, regardless of the message frame. By contrast, self-other-referencing messages that highlighted the outcomes regarding themselves and their sex partners enhanced processing fluency and mitigated optimistic bias. Moreover, the attenuation in optimistic bias increased the participants' information seeking intentions and the likelihood that they would share the messages on social media. The implications for health message design are discussed from a schema-based, message-tailoring perspective.

Effect of communicating community immunity on COVID-19 vaccine-hesitant people from ethnically diverse backgrounds: an experimental vignette study in the UK

OBJECTIVES

Achieving high vaccination coverage is vital to the efforts of curbing the impact of the COVID-19 pandemic on public health and society. This study tested whether communicating the social benefit through community protection for friends and family members versus overall society, affects vaccination intention and perception among a sample enriched with respondents from black and ethnic minority backgrounds.

DESIGN

A web-based experimental survey was conducted. Eligible participants were individually randomised, with equal probability, to one of the three experimental vignettes.

SETTING

England.

PARTICIPANTS

We recruited 512 (212 white, 300 ethnically diverse) vaccine-hesitant members from an online panel.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the intention to get vaccinated against COVID-19. The secondary outcome consisted of a behavioural measure in the form of active interest in reading more about the COVID-19 vaccine. Additional measures included the perceived importance and expected uptake in others, as well as the attitudes towards vaccination.

RESULTS

Logistic regression models did not show an effect of the messages on intentions for the overall sample (society: adjusted OR (aOR): 128, 95% CI 0.88 to 1.88 and friends and family: aOR 1.32, 95% CI 0.89 to 1.94). The role of vaccination in achieving community immunity yielded higher vaccination intentions among study participants with white ethnic background (society: aOR: 1.94, 95% CI 1.07 to 3.51 and friends and family: aOR 2.07, 95% CI 1.08 to 3.96), but not among respondents from ethnically diverse backgrounds (society: aOR: 0.95, 95% CI 0.58 to 1.58 and friends and family: aOR 1.06, 95% CI 0.64 to 1.73). The messages, however, did not affect the perceived importance of the vaccine, expected vaccination uptake and active interest in reading more about the vaccine.

CONCLUSIONS

Thus, although highlighting the social benefits of COVID-19 vaccinations can increase intentions among vaccine non-intenders, they are unlikely to address barriers among ethnically diverse communities.

Framing Effects on US Adults’ Reactions to COVID-19 Public Health Messages: Moderating Role of Source Trust

Increasing politicization of health guidance and fluctuating trust in public health institutions have challenged effective coronavirus disease 2019 (COVID-19) public health communication in the United States. Applying the extended parallel process model, this research reports findings from two online survey experiments conducted at different points in the pandemic regarding two advocated risk reduction behaviors. Analyses test US adults’ emotional and argument strength reactions to experimental tweets attributed to the Centers for Disease Control (CDC) and Prevention which vary with regards to advocated behavior (social distancing; vaccination), emotional appeal, wellbeing orientation (individual vs. collective), and content frame (health vs. economic outcomes). Trust in the CDC is treated as a potential moderator. Results of path analyses indicated that emotional appeal and content frame had little impact on emotional or cognitive responses to the social distancing tweets, though unvaccinated adults with low trust in the CDC experienced greater hope and fear responses to tweets emphasizing collective benefits of vaccination. Hope reactions in both studies predicted greater perceived response efficacy for the advocated behavior, particularly among those with low CDC trust, while message annoyance undermined efficacy among low trust participants. Particularly among adults with low trust in the CDC, fear reactions led to reduced efficacy. Perceived efficacy of vaccination predicted greater intention to receive a COVID-19 vaccine, controlling for prior intention. Messages which inspire hope with regards to risk reduction behaviors and include sound arguments may be more motivating than fear-appeal messages, particularly among individuals with low levels of trust in public health institutions.

You vs. us: framing adaptation behavior in terms of private or social benefits

Private actions to mitigate and adapt to climate change may have benefits to both the individual and society. In some cases, an individual may be motivated by appeals that highlight benefits to others, rather than to oneself. We test whether such prosocial framing influences information-seeking behavior to address wildfire risk among homeowners. In a field experiment across ten communities in western Colorado, property owners (n = 2977) received a postcard from their local fire department highlighting the impact of risk mitigation to either "your property" (private benefits) or "our community" (social benefits). The postcard directed recipients to visit a personalized webpage on wildfire risk. Overall, 10.5% of property owners visited their personalized risk webpage. There was little difference in webpage visitation between those who received the social (11.3%) rather than the private (9.7%) benefits message (χ ² = 1.74, p = 0.19). However, response may depend on a property owner's relationship to the community. Those who reside within the community (as opposed to out-of-town owners) or who were in an evacuation zone during a recent wildfire were more likely to visit their webpages after receiving the social benefits message. How homeowners view their contributions to shared risk and whether simple changes in messaging influence prosocial behavior can inform efforts to address climate-exacerbated hazards.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10584-022-03400-4.

How COVID-19 can promote workplace cheating behavior via employee anxiety and self-interest - And how prosocial messages may overcome this effect

While scholars have debated whether environmental factors (e.g., air pollution) can prompt unethical behavior (e.g., crime), we argue that the COVID-19 pandemic provides a unique opportunity to inform this theoretical debate by elaborating on why these effects may occur, identifying how they can be overcome, and addressing methodological issues. Drawing on appraisal theories of emotion, we argue that appraising COVID-19 (i.e., an environmental factor) as a threat can elicit anxiety. This can focus employees on their own self-interest and prompt cheating behavior (i.e., unethical workplace behavior). However, we propose that these detrimental effects can be attenuated by prosocial messages (i.e., highlighting the meaningful and positive impact that employees' work can have on others). Our predictions were supported using a two-wave survey (N = 396) and an experiment (N = 163) with samples of full-time employees during the COVID-19 pandemic. Theoretically, our studies inform this ongoing debate by highlighting the importance of state anxiety and self-interest as key mechanisms and that drawing peoples' attention towards others can serve as a boundary condition. Practically, we provide insight into the ethical costs of COVID-19 in the workplace and identify a simple yet effective strategy that organizations can use to curtail workplace cheating behavior.

Examining reactions to smoking and COVID-19 risk messages: An experimental study with people who smoke

BACKGROUND

Smoking cigarettes worsens COVID-19 outcomes, and news media and health agencies have been communicating about that. However, few studies have examined how these messages affect attitudes, beliefs, and behavioral intentions of people who smoke. These are critical variables that can inform public health campaigns to motivate quitting smoking during the COVID-19 crisis.

METHODS

In August 2020, we conducted an online experiment in the U.S. with 1,004 adults who smoke. Participants were randomized to one of four message conditions: COVID-19 risk, smoking risk, combined risk of smoking for COVID-19 severity, or a non-risk control. Outcomes were message reactions (emotions and reactance), attitudes and beliefs (severity, susceptibility, self-efficacy, response efficacy for smoking and COVID-19, and conspiracy beliefs), and behavioral intentions (smoking intentions, COVID-protective intentions, and information-seeking).

RESULTS

Multivariate analysis of covariance (MANCOVA) showed that combined risk messages elicited higher perceived severity of smoking-related disease than control messages. Similarly, the combined risk condition resulted in greater intentions to quit smoking in the next month (vs. COVID-19 risk condition) and intentions to reduce smoking in the next 6 months (vs. smoking risk and control; ps < .05). Multivariate logistic regression found that exposure to the combined risk messages (vs. control as referent) was associated with higher odds of mask-wearing intentions in the next 2 weeks (AOR = 1.97).

CONCLUSIONS

Health agencies can possibly use messages that communicate about the combined risk of smoking and COVID-19 as a novel strategy to motivate people who smoke to quit and take protective action for COVID-19.

Effects of Living Conditions, Political Orientation, and Empathy on Behaviors and Attitudes During the COVID-19 Pandemic: a Study in the Brazilian Context

For a year now, the world has been facing the pandemic of COVID-19, which has affected many sectors of society in an unprecedented proportion. The main objective of this paper was to investigate whether there are relationships between empathy, prosocial behavior, and adherence to measures to fight COVID-19 in a sample of Brazilian participants. Results point to the influence of education, living conditions, political orientation, and empathy on the adoption of measures to contain the virus, and on personal impressions regarding the disease. Specifically, participants with more years of education, with better conditions of practice social distancing, and those who identified themselves as leftist or center-leftist were more favourable to adopting virus containment measures and to practicing physical distancing. Higher levels of empathy were also associated to more positive attitudes concerning those measures. It is argued that political polarization and divergences between discourses by scientists, health authorities, politicians, and the Brazilian rulers may be reinforcing the perception of division in society. This, in turn, inhibits the building of a collectivistic view concerning COVID-19, which would be crucial to cope with the pandemic.

Nudges for COVID-19 voluntary vaccination: How to explain peer information?

Vaccination promotion is a crucial strategy to end the COVID-19 pandemic; however, individual autonomy should also be respected. This study aimed to discover other-regarding information nudges that can reinforce people's intention to receive the COVID-19 vaccine without impeding their autonomous decision-making. In March 2021, we conducted an online experiment with 1595 people living throughout Japan, and randomly assigned them either of one control group and three treatment groups that received messages differently describing peer information: control, comparison, influence-gain, and influence-loss. We compared each message's effects on vaccination intention, autonomous decision-making, and emotional response. We found that the influence-gain nudge was effective in increasing the number of older adults who newly decided to receive the vaccine. The comparison and influence-loss nudges further reinforced the intention of older adults who had already planned to receive it. However, the influence-loss nudge, which conveys similar information to the influence-gain nudge but with loss-framing, increased viewers' negative emotion. These messages had no promoting effect for young adults with lower vaccination intentions at baseline. Based on the findings, we propose governments should use different messages depending on their purposes and targets, such as comparison instead of influence-loss, to encourage voluntary vaccination behavior.

Effect of Nudges on Downloads of COVID-19 Exposure Notification Apps: A Randomized Clinical Trial

This randomized clinical trial examines the effect of digital contact tracing using smartphone app nudges to increase downloads of Pennsylvania’s COVID Alert PA app.

COVID-19. Effect of Moral Messages to Persuade the Population to Stay at Home in Spain, Chile, and Colombia

Analyze whether the content of three moral messages (deontological, ethical utilitarianism, ethical virtue) and a control message differentially affect the probability of engaging in four behaviors: Washing their hands, participating in public gatherings, staying at home/avoiding social contact, and forwarding the message to inform more people. In our study, the sender of the message is a university professor. These variables are measured in terms of their behavioral intentions and others' behavioral intentions (beliefs about others' behavior). Randomized Controlled Trial. Our study includes the analysis of the possible moderating effect of the country of residence (Spain n = 1,122, Chile n = 1,107, and Colombia n = 1,433). The message with content referring to ethical virtue and staying at home obtains statistically significant lower scores on the probability of carrying out public health behaviors and sharing the message received. Regarding beliefs about the behavior of others, the message of ethical virtue has the same negative effect, but only on the likelihood of other people washing their hands, staying at home, and sharing the public health message. Institutional messages aimed at promoting public health behaviors are necessary in a pandemic situation. Our recommendation is to use deontological and utilitarian, or non-moral, content.

Effects of Message Framing, Sender Authority, and Recipients' Self-Reported Trait Autonomy on Endorsement of Health and Safety Measures during the Early COVID-19 Pandemic

In the COVID-19 pandemic, human solidarity plays a crucial role in meeting this maybe greatest modern societal challenge. Public health communication targets enhancing collective compliance with protective health and safety regulations. Here, we asked whether authoritarian/controlling message framing as compared to a neutral message framing may be more effective than moralizing/prosocial message framing and whether recipients' self-rated trait autonomy might lessen these effects. In a German sample (n = 708), we measured approval of seven regulations (e.g., reducing contact, wearing a mask) before and after presenting one of three Twitter messages (authoritarian, moralizing, neutral/control) presented by either a high-authority sender (state secretary) or a low-authority sender (social worker). We found that overall, the messages successfully increased participants' endorsement of the regulations, but only weakly so because of ceiling effects. Highly autonomous participants showed more consistent responses across the two measurements, i.e., lower response shifting, in line with the concept of reactive autonomy. Specifically, when the sender was a social worker, response shifting correlated negatively with trait autonomy. We suggest that a trusted sender encourages more variable responses to imposed societal regulations in individuals low in autonomy, and we discuss several aspects that may improve health communication.

Message Framing Effects on Individuals' Social Distancing and Helping Behavior During the COVID-19 Pandemic

This research responds to urgent calls to fill knowledge gaps on COVID-19 (new coronavirus) in communicating social distancing messages to the public in the most convincing ways. The authors explore the effectiveness of framing social distancing messages around prosocial vs. self-interested appeals in driving message compliance and helping behavior. The results show that when a message emphasizes benefits for everyone in society, rather than solely for the individual, citizens find the message more persuasive to engage in social distancing, and also more motivating to help others. The results further demonstrate that the proposed effects are higher for individuals who have a lower locus of control and lower fear of coronavirus as prosocial messages lead them to feel a joint responsibility in protecting from the pandemic. Theoretical and practical implications of the results are discussed.

Emotional responses to prosocial messages increase willingness to self-isolate during the COVID-19 pandemic

The COVID-19 pandemic may be one of the greatest modern societal challenges that requires widespread collective action and cooperation. While a handful of actions can help reduce pathogen transmission, one critical behavior is to self-isolate. Public health messages often use persuasive language to change attitudes and behaviors, which can evoke a wide range of negative and positive emotional responses. In a U.S. representative sample (N = 955), we presented two messages that leveraged either threatening or prosocial persuasive language, and measured self-reported emotional reactions and willingness to self-isolate. Although emotional responses to the interventions were highly heterogeneous, personality traits known to be linked with distinct emotional experiences (extraversion and neuroticism) explained significant variance in the arousal response. While results show that both types of appeals increased willingness to self-isolate (Cohen's d = 0.41), compared to the threat message, the efficacy of the prosocial message was more dependent on the magnitude of the evoked emotional response on both arousal and valence dimensions. Together, these results imply that prosocial appeals have the potential to be associated with greater compliance if they evoke highly positive emotional responses.

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.

Effect of prosocial public health messages for population behaviour change in relation to respiratory infections: a systematic review protocol

INTRODUCTION

The COVID-19 pandemic represents a major societal challenge that requires large-scale behaviour change, widespread collective action and cooperation to reduce viral transmission. Existing literature indicates that several messaging approaches may be effective, including emphasising the benefits to the recipient, aligning with the recipient's moral values and focusing on protecting others. Current research suggests that prosocial public health messages that highlight behaviours linked to societal benefits (eg, protecting 'each other'), rather than focusing on behaviours that protect oneself (eg, protecting 'yourself'), may be a more effective method for communicating strategies related to infectious disease. To investigate this we will conduct a systematic review that will identify what messages and behaviour change techniques have the potential to optimise the effect on population behaviour in relation to reducing transmission of respiratory infections.

METHODS AND ANALYSIS

A systematic literature search of published and unpublished studies (including grey literature) in electronic databases will be conducted to identify those that meet our inclusion criteria. The search will be run in four electronic databases: MEDLINE, EMBASE, PsycINFO and Scopus. We will also conduct supplementary searches in databases of 'grey' literature such as PsycEXTRA, Social Science Research Network and OSF PREPRINTS, and use the Google Scholar search engine. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Titles, abstracts and full texts for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using the Cochrane Risk of Bias Tool and the Risk of Bias in Non-randomized Studies-of Interventions tool. Disagreements will be resolved by a consensus procedure.

ETHICS AND DISSEMINATION

This protocol has been registered with PROSPERO. No ethical approval is required, as there will be no collection of primary data. The synthesised findings will be disseminated through peer-reviewed publication.

PROSPERO REGISTRATION NUMBER

CRD42020198874.

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.

Americans' Views of Voluntary Protective Actions Against Zika Infection: Conceptual and Measurement Issues

Understanding factors affecting decisions by people to protect themselves, or not, is critical to designing supportive communications. Here, threat, protective-action, and stakeholder perceptions were evaluated for effects on mainland Americans' behavioral intentions regarding Zika in April 2017, as postulated by the Protective Action Decision Model. Although all three perception types (including a novel resource sufficiency measure) affected intentions, these relationships varied widely depending upon the method used to measure adoption of actions (e.g., total count of all behaviors adopted vs. behavior-specific analyses), the behaviors involved, and whether analysis focused on the full sample or only on people who had a reasonable opportunity to enact the behavior or who believed it relevant to their lives. There was a general contrast between mosquito control actions (removal of mosquito breeding areas and pesticide spraying) and travel-related behaviors (avoiding travel to areas of local transmission of the virus, protecting oneself from mosquito bites after potential exposure, and practicing safe sex after potential exposure). Reported action or inaction during the 2016 mosquito season, and stages of behavior change, were both elicited in January-February 2017; both drove intentions in April 2017 for the upcoming season, although direct and indirect effects varied widely. Collectively these findings present theoretical, measurement, and practical implications for understanding, tracking, and promoting voluntary protective actions against hazards.

Differences Between Florida and the Rest of the United States in Response to Local Transmission of the Zika Virus: Implications for Future Communication Campaigns

For those at risk for Zika virus infection, prevention requires an approach that includes individual, interpersonal, and community-level support for behavior change. In August 2016, the announcement of local Zika transmission in Florida provided an opportunity to determine whether Zika-related knowledge, attitudes, and behaviors might be affected differentially in Florida compared to the rest of the nation. From August 8-October 3, 2016, we conducted nationally representative weekly surveys (N = 12,236), oversampling Florida residents, measuring Zika virus news exposure, knowledge about transmission and prevention of the infection, and attitudes and behaviors toward prevention. We tested two classes of models: those focused on individual Zika risk perceptions (e.g., protection motivation theory) and one focused on community action beyond those directly at risk (social consensus model). Analyses assessed differences between Florida and the rest of the nation by survey week. Consistent with both models, Floridians demonstrated significantly higher levels of perceived susceptibility and knowledge, more positive attitudes toward Zika virus prevention, and higher likelihood of engaging in protective behavior than non-Floridians. Consistent with theories of individual risk perception, response was greater among respondents who saw themselves at risk of infection. However, consistent with the SCM, irrespective of personal risk, response was greater among Floridians. Nevertheless, more than half of the public took no direct action to prevent the spread of Zika. Communities at increased risk for a novel infection such as Zika may quickly acquire Zika-related knowledge, attitudes, and behavior, but large-scale community-wide response might be difficult without further community-level public education.

It's Complicated: The 2014-2015 U.S. Measles Outbreak and Parents' Vaccination Beliefs, Confidence, and Intentions

While it seems intuitive that highly visible vaccine-preventable disease outbreaks should impact perceptions of disease risk and facilitate vaccination, few empirical studies exist to confirm or dispel these beliefs. This study investigates the impact of the 2014-2015 Disneyland measles outbreak on parents' vaccination attitudes and future vaccination intentions. The analysis relies on a pair of public opinion surveys of American parents with at least one child under the age of six (N = 1,000 across each survey). Controlling for basic demographics, we found higher levels of reported confidence in the safety and efficacy of childhood vaccinations in our follow-up data collection. However, this confidence was also accompanied by elevated levels of concern toward childhood vaccines among American parents. We then examined how different subgroups in the population scored on these measures before and after the outbreak. We found that parents with high levels of interest in the topic of vaccines and a child who is not fully upto date with the recommended vaccination schedule reported more supportive attitudes toward vaccines. However, future intentions to follow the recommended vaccination schedule were not positively impacted by the outbreak. Possible explanations for these results and implications for vaccination outreach are discussed.