Testing the Effectiveness of Message Framing and Episodic Future Thinking in Promoting HPV Vaccination via Anticipated Regret

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.

Temporal Distance, Message Framing, and Consideration of Future Consequences: Parents' Willingness to Vaccinate Children Aged 5-11 Against COVID-19

Based on the construal level theory (CLT), this experiment employed a 2 (message framing: gain vs. loss) × 2 (temporal framing: proximal vs. distal) × 2 (consideration of future consequences: low vs. high) between-subjects factorial design. Parents (N = 409) of 5- to 11-year-old children in the United States from a pool of candidates pre-screened by Qualtrics participated in this study. Results indicated that parents with high CFC-Future were more receptive to messages advocating getting their children vaccinated against COVID-19. Parents with high CFC-Future reported higher risk perception in response to the proximal messages compared to the distal messages. For parents focusing on more distant outcomes, proximal messages generated more positive attitude and greater intention compared to distal messages in the loss-framed condition. The difference was not significant in the gain-framed condition. Theoretical and practical implications were discussed. Limitations and directions for future research were outlined.

Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial

BACKGROUND

Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear.

OBJECTIVE

We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message-based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories.

METHODS

We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a "helpfulness" message, while the text survey tested frame types informed by behavior economics ("gain," "loss," and "helpfulness") and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated.

RESULTS

Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the "helpfulness" frame compared with the "gain" frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and "loss" frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05).

CONCLUSIONS

We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using "gain" or "loss" framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy.

How Message Frames Promote People’s Willingness to Get Vaccinated? The Mediation Role of Perceived Net Benefits

Objectives: This study aims to evaluate the association among framed messages (egoism-, altruism-, and loss-framed information), perceived net benefits (PNB), and willingness to receive a COVID-19 vaccine.

Methods: A between-subject survey experiment was designed to assess the above association. A total of 1,316 individuals were included in this study. The participants were randomly assigned to one control group (receiving non-framed information) and three experimental groups (receiving egoism-, altruism-, and loss-framed information). The participants then reported their vaccination willingness and perceived effectiveness and side effects of vaccination. PNB was determined by subtracting the perceived side effects from perceived effectiveness.

Results: Compared with the control group, participants in the experimental groups exhibited stronger vaccination willingness. Higher PNB levels were associated with enhanced vaccination willingness. However, only loss-framed messages indirectly affected vaccination willingness through PNB.

Conclusion: PNB can mediate the impact of message framing on vaccination willingness. However, the mediation effect of PNB was only found in the relationship between loss-framed messages and vaccination willingness.

Anticipated Affect That Encourages or Discourages Human Papillomavirus Vaccination: A Scoping Review

We reviewed studies that examined the anticipated affects associated with human papillomavirus (HPV) vaccination to identify gaps in the literature and the currently available practice implications for encouraging HPV vaccination. We systematically searched MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycArticles, Academic Search Complete, Scopus, and Web of Science to find English articles that quantitatively and qualitatively examined anticipated affects associated with HPV vaccination. A total of twenty-one studies were identified. Seventeen studies examined the anticipated inaction regret (i.e., not being vaccinated). Most of the included studies reported that anticipated inaction regret had a significantly positive association with HPV vaccination outcomes, such as vaccination behavior, intention, willingness, and acceptability. Furthermore, seven studies reported that anticipated inaction regret had a significantly positive and stronger association with vaccination outcomes than cognitive beliefs, such as vaccine effectiveness and safety, and perceived susceptibility and severity. The present review indicated that the stronger the participants' anticipated inaction regret, the more likely they were to receive the HPV vaccine. Messages targeting the anticipated affect may be as effective as or more effective than messages targeting cognitive beliefs in encouraging HPV vaccination among people. However, most of the studies included in the present review adopted a cross-sectional design with vaccination intention and willingness as outcomes. Therefore, future studies should examine the influence of anticipated affects on the utilization of HPV vaccines using experimental designs to accumulate stronger evidence.

Effectiveness of message framing in changing COVID-19 vaccination intentions: Moderating role of travel desire

This research examines the effectiveness of message framing, message appeal and information content in changing respondents' COVID-19 vaccination intentions through influencing their vaccine risk perceptions. Furthermore, the moderating effect of travel desire on the relationship between vaccine risk perceptions and changing vaccination intentions is examined. In doing so, two rounds of data that were collected from the same respondents. The first survey recorded respondents' vaccination intentions, travel desire and socio demographics. A follow up survey tested cause-and-effect relationships on the proposed relationships using a 2 (message frame: gain, loss) x 2 (message appeal: rational, emotional) ×2 (information content: subjective, objective) between-subjects online experimental design. Findings suggest that loss-framed messages are more effective than gain-framed and emotional-rational messages in reducing risk perceptions and, thus, changing vaccination intentions. Travel desire is found to moderate the effect of vaccine risk perception on vaccination intentions by weakening the negative effect of vaccine risk perception on vaccination intention. Findings show the importance of travel desire along with message framing and message appeal on changing individuals' COVID-19 vaccination intentions in public health communications.

Social media-assisted interventions on human papillomavirus and vaccination-related knowledge, intention and behavior: a scoping review

Social media holds the potential to engage adolescents and young adults and to facilitate interventions improving Human Papillomavirus Vaccine (HPVV). This article systematically reviewed the literature on Cochrane Library, PubMed, Web of Science, EMBASE, Scopus and CINAHL. Interventions delivered or facilitated by social media with outcomes of HPV-related knowledge, awareness, attitude, vaccination intention and behavior were included. Standardized forms were used to abstract the basic characteristics, settings, guiding theories and key findings of the interventions. Twenty-four studies met the eligibility criteria. Sixteen were educational interventions, and the other eight investigated the effect of social media message contents on improving Human Papillomavirus (HPV)-related outcomes. The studies were published between 2015 and 2021. The most frequently used social media platforms were Facebook, and the most commonly adopted theory was the health belief model (HBM). Existing interventions have shown preliminary but promising effects in improving HPV awareness and knowledge. Still, such improvements have not always been translated to improved behavioral intentions and vaccination rates. The contents and phrasing of social media messages and pre-existing individual characteristics of social media users moderated intervention effectiveness. Social media could be a valuable tool for engaging participants and delivering HPV interventions. Future interventions should apply stronger theory bases.

Death Narratives, Negative Emotion, and Counterarguing: Testing Fear, Anger, and Sadness as Mechanisms of Effect

Narrative messaging research has demonstrated that story outcome (e.g., whether the main character lives or dies) can impact audience behavior, but more research explicating and testing mechanistic pathways is needed. The current study tests fear, anger, and sadness as mechanisms of persuasion, assessing effects on counterarguing, reading flow, and behavioral intention. The current study utilized a 2 (story outcome: death vs. survivor) × 4 (story character: Marla, Erin, Don, and Ray) between-participants experiment (N = 735) to test the effect of story outcome on behavioral intentions via discrete emotion. Death narratives generated greater fear, anger, and sadness. Fear was related to greater behavioral intention and reading flow and diminished counterarguing. Sadness had the opposite effect. Anger produced a mixed persuasive effect, increasing both counterarguing and reading flow. Results have implications for discrete emotions theorizing and underscore the importance of conceptualizing narrative stimuli along multiple affective dimensions rather than single dimensions.

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.