1
|
Evans WD, Bingenheimer JB, Long MW, Ndiaye K, Donati D, Rao NM, Akaba S, Agha S. Randomised experimental evaluation of a social media campaign to promote COVID-19 vaccination in Nigeria. J Glob Health 2024; 14:05018. [PMID: 38779876 PMCID: PMC11112529 DOI: 10.7189/jogh.14.05018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has challenged public health and behaviour change programmes, and has led to the development of innovative interventions and research. In low -and middle-income countries (LMICs) such as Nigeria, new strategies to promote vaccination, increase pro-vaccination social norms, and reduce vaccine hesitancy have been deployed through social media campaigns and evaluated using digital media platforms. Methods We conducted two randomised experimental evaluations of social media content designed to promote COVID-19 vaccination and to complement research on a nationwide vaccination promotion campaign in Nigeria run in 2022. We conducted two studies in March and August 2022 among Nigerians drawn from 31 states that had not been targeted in the aforementioned nationwide campaign. We randomised the participants to either receive the pro-vaccination social media campaign or not and collected data at pre- and post-test time points to evaluate psychosocial predictors of vaccination and vaccination outcomes following the Theory of Change based on Diffusion of Innovations; the Social Norms Theory, and the Motivation, Opportunity, Ability (MOA) framework. Data were collected through a novel intervention delivery and data collection platform through social media. Results We found that pro-vaccination social norms and vaccination rates increased, while vaccine hesitancy decreased among participants randomised to the social media intervention study arm. Conclusions Social media campaigns are a promising approach to increasing vaccination at scale in LMICs, while social norms are an important factor in promoting vaccination, which is consistent with the Social Norms Theory. This study demonstrates the capability and potential of new social media-based data collection techniques. We describe implications for future vaccination campaigns and identify future research priorities in this area. Registration Pan African Clinical Trial Registry: PACTR202310811597445.
Collapse
Affiliation(s)
- William D Evans
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Jeffrey B Bingenheimer
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Michael W Long
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Khadidiatou Ndiaye
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Dante Donati
- School of Business, Columbia University, New York, USA
| | | | - Selinam Akaba
- Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Sohail Agha
- Behavioral Insights Lab, Seattle, Washington, USA
| |
Collapse
|
2
|
Lucia VC, Mascarenhas AK, Kelekar A, Afonso NM. Medical and dental student knowledge about COVID-19 and influenza vaccines impact opinions about vaccine advocacy and future practice. Front Public Health 2024; 12:1388894. [PMID: 38841661 PMCID: PMC11150818 DOI: 10.3389/fpubh.2024.1388894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/26/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction The World Health Organization has identified vaccine hesitancy as a global public health challenge. Healthcare providers are among the most influential and trusted figures for vaccine counseling. This article focuses on COVID-19 and influenza personal immunization behaviors, vaccine knowledge and opinions, and vaccine counseling confidence among future healthcare providers - dental and medical students. Methods A cross-sectional anonymous online survey was conducted at four dental schools and one allopathic medical school in the United States. Items included personal vaccination status for the COVID-19 and influenza vaccines and vaccine-specific items developed based on past research to assess knowledge, opinions, and behaviors. Results Two hundred and thirty-two medical and 221 dental students completed the survey. 68 and 55% scored average/above-average knowledge on COVID-19 and influenza vaccine items, respectively. There were significant differences between those with average/above-average and below-average knowledge scores regarding learning about, recommending, and advocating for vaccines and counseling vaccine-hesitant patients for both vaccines (p < 0.0001). Although higher-knowledge students had higher vaccination rates (p < 0.0001), many had insufficient knowledge about vaccines. Discussion Healthcare providers play a crucial role in vaccine advocacy. The identified knowledge gaps are significant as they impact quality of patient care. And opinions about future vaccination practice such as recommending, providing, and counseling about vaccines. Equipping students with knowledge and communication skills will enable them to be strong vaccine advocates to improve overall public health.
Collapse
Affiliation(s)
- Victoria C. Lucia
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | | | - Arati Kelekar
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
- Department of Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Nelia M. Afonso
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| |
Collapse
|
3
|
Kim S, Lilani A, Redemptus C, Campana K, Tozan Y. A pre-post evaluation study of a social media-based COVID-19 communication campaign to improve attitudes and behaviors toward COVID-19 vaccination in Tanzania. PLoS One 2024; 19:e0300206. [PMID: 38709712 PMCID: PMC11073716 DOI: 10.1371/journal.pone.0300206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/22/2024] [Indexed: 05/08/2024] Open
Abstract
In Tanzania, the One by One: Target COVID-19 campaign was launched nationally in July 2022 to address the prevalent vaccine hesitancy and lack of confidence in COVID-19 vaccines. The campaign mobilized social media influencers and viral content with the ultimate goal of increasing COVID-19 vaccine uptake in the country. The objective of this study was to empirically assess the impact of the campaign on three outcomes: vaccine confidence, vaccine hesitancy, and vaccination status. Using programmatic data collected through an online survey before and after the campaign, we conducted a difference-in-difference (DiD) analysis and performed a crude, adjusted, and propensity score-matched analysis for each study outcome. Lastly, to observe whether there was any differential impact of the campaign across age groups, we repeated the analyses on age-stratified subgroups. Data included 5,804 survey responses, with 3,442 and 2,362 responses collected before and after the campaign, respectively. Although there was only weak evidence of increased COVID-19 vaccine confidence in the campaign-exposed group compared to the control group across all age groups, we observed a differential impact among different age groups. While no significant change was observed among young adults aged 18-24 years, the campaign exposure led to a statistically significant increase in vaccine confidence (weighted/adjusted DiD coefficient = 0.76; 95% CI: 0.06, 1.5; p-value = 0.034) and vaccination uptake (weighted/adjusted DiD coefficient = 1.69.; 95% CI: 1.02, 2.81; p-value = 0.023) among young adults aged 25-34 years. Among adults aged 35 years and above, the campaign exposure led to a significant decrease in vaccine hesitancy (weighted/adjusted DiD coefficient = -15; 95% CI: -21, -8.3; p-value<0.001). The social media campaign successfully improved vaccine hesitancy, confidence, and uptake in the Tanzanian population, albeit to varying degrees across age groups. Our study provides valuable insights for the planning and evaluation of similar social media communication campaigns aiming to bolster vaccination efforts.
Collapse
Affiliation(s)
- Sooyoung Kim
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Asad Lilani
- The Access Challenge, New York, New York, United States of America
| | | | - Kate Campana
- The Access Challenge, New York, New York, United States of America
| | - Yesim Tozan
- School of Global Public Health, New York University, New York, New York, United States of America
| |
Collapse
|
4
|
McKeithen MC, Gilkey MB, Kong WY, Oh NL, Heisler-MacKinnon J, Carlson R, James G, Grabert BK. Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review. Pediatrics 2024; 153:e2023064692. [PMID: 38623635 PMCID: PMC11035154 DOI: 10.1542/peds.2023-064692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
CONTEXT US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. OBJECTIVE To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. DATA SOURCES PubMed, Embase, and Scopus databases. STUDY SELECTION Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. DATA EXTRACTION Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. RESULTS Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). LIMITATIONS Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. CONCLUSIONS Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.
Collapse
Affiliation(s)
| | - Melissa B. Gilkey
- Gillings School of Global Public Health
- Lineberger Comprehensive Cancer Center
| | | | - N. Loren Oh
- Gillings School of Global Public Health
- School of Medicine
| | | | - Rebecca Carlson
- Health Sciences Library
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Greeshma James
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Brigid K. Grabert
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|
5
|
Dang JHT, Gori A, Rios L, Rolon AM, Zhang J, Chen MS. "You Don't Know If It's the Truth or a Lie": Exploring Human Papillomavirus (HPV) Vaccine Hesitancy among Communities with Low HPV Vaccine Uptake in Northern California. Vaccines (Basel) 2024; 12:372. [PMID: 38675754 PMCID: PMC11053910 DOI: 10.3390/vaccines12040372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Vaccine hesitancy, delaying or refusing to vaccinate despite the availability of vaccines, impedes the progress of achieving optimal HPV vaccine coverage. Little is known about the sources of human papillomavirus (HPV) vaccine hesitancy among racially/ethnically and geographically diverse communities. The purpose of this paper is to explore HPV vaccine hesitancy among rural, Slavic, and Latino communities that reside in counties with low HPV vaccine uptake rates. METHODS Key informant interviews and focus groups were conducted with rural, Slavic, and Latino communities that reside within counties in California that have low HPV vaccine up to date rates (16-25%). Qualitative data were transcribed verbatim and analyzed using inductive and deductive thematic analysis. RESULTS A total of seven focus groups and 14 key informant interviews were conducted with 39 individuals from seven California counties. Salient themes that contributed to HPV vaccine hesitancy included the following: social media and the anti-vaccination movement; a strong belief in acquiring immunity naturally; prior vaccine experiences; and vaccine timing concerns. Participants suggested the provision of culturally appropriate, in-language, in-person easy to understand HPV vaccine education to mitigate HPV vaccine hesitancy. CONCLUSIONS Our findings can inform future interventions to increase HPV vaccine uptake among hesitant communities.
Collapse
Affiliation(s)
- Julie H. T. Dang
- Division of Health Policy and Management, Department of Public Health Sciences, School of Medicine, University of California, Davis, CA 95816, USA
| | - Alexandra Gori
- Comprehensive Cancer Center, University of California, Davis, CA 95816, USA; (A.G.); (A.M.R.)
| | - Lucy Rios
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, CA 95817, USA; (L.R.); (M.S.C.J.)
- Department of Public Health Sciences, University of California, Davis, CA 95817, USA
| | - Angelica M. Rolon
- Comprehensive Cancer Center, University of California, Davis, CA 95816, USA; (A.G.); (A.M.R.)
| | - Jingwen Zhang
- Department of Communication, Department of Public Health Sciences, University of California, Davis, CA 95616, USA;
| | - Moon S. Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, CA 95817, USA; (L.R.); (M.S.C.J.)
| |
Collapse
|
6
|
Hu Y, Yan R, Yin X, Gong E, Xin X, Gao A, Shi X, Wang J, Xue H, Feng L, Zhang J. Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake: A Cluster Randomized Trial. JAMA Netw Open 2024; 7:e243098. [PMID: 38526493 PMCID: PMC10964116 DOI: 10.1001/jamanetworkopen.2024.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Influenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake. Objective To evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students. Design, Setting, and Participants This cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination. Intervention The multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination). Main Outcomes and Measures The primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis. Results A total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06-1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12-1.99; P = .01) for the intervention group. Conclusions and Relevance In this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs. Trial registration Chinese Clinical Trial Registry: ChiCTR2200062449.
Collapse
Affiliation(s)
- Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Aiyu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Xiaoyan Shi
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Jing Wang
- Department of Infectious Disease, Dongcheng Center for Disease Control and Prevention, Beijing, China
| | - Hao Xue
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| |
Collapse
|
7
|
Beleites F, Adam M, Favaretti C, Hachaturyan V, Kühn T, Bärnighausen T, Barteit S. Evaluating the impact of short animated videos on COVID-19 vaccine hesitancy: An online randomized controlled trial. Internet Interv 2024; 35:100694. [PMID: 38149090 PMCID: PMC10750063 DOI: 10.1016/j.invent.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Addressing the global challenge of vaccine hesitancy, amplified during the COVID-19 pandemic due to misinformation propagated via social media, necessitates innovative health communication strategies. This investigation scrutinizes the efficacy of Short, Animated, Story-based (SAS) videos in fostering knowledge, behavioral intent, and engagement around COVID-19 vaccination. We conducted an online three-arm parallel randomized controlled trial (RCT) involving 792 adult participants (≥18 years, English-speaking) from the United States. The intervention group viewed a SAS video on COVID-19 vaccination, the attention placebo control group watched a SAS video on hope, and the control group received no intervention. Our primary objectives were to assess the influence of SAS videos on knowledge, behavioral intent, and engagement regarding COVID-19 vaccination. Participants in the intervention group displayed significantly higher mean knowledge scores (20.6, 95 % CI: 20.3-20.9) compared to both the attention placebo control (18.8, 95 % CI: 18.5-19.1, P < .001) and control groups (18.7, 95 % CI: 18.4-19.0, P < .001). However, SAS videos did not notably affect behavioral intent. Perception of COVID-19 as a significant health threat emerged as a strong predictor for engaging with the post-trial video without further incentives (OR: 0.44; 95 % CI: 0.2-0.96). The 35-44 age group exhibited the highest post-trial engagement (P = .006), whereas right-wing political inclination negatively associated with engagement (OR: 1.98; 95 % CI: 3.9-1.01). Vaccination status correlated significantly with self-efficacy (P < .001), perceived social norms (P < .001), and perceived response efficacy of the COVID-19 vaccine (P < .001), all heightened in the intervention group. These findings suggest that while SAS videos effectively amplify COVID-19 vaccination knowledge, their impact on behavioral intent is not direct. They do, however, affect determinants of vaccination status, thereby indirectly influencing vaccination behavior. The study highlights the appeal of SAS videos among younger audiences, but underscores the need for further examination of factors impeding vaccination engagement. As SAS videos closely mirror conventional social media content, they hold significant potential as a public health communication tool on these platforms. Trial Registration: Trial was registered at drks.de with the identifier DRKS00027938, on 5 January 2022.
Collapse
Affiliation(s)
- Ferdinand Beleites
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Maya Adam
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
| | - Caterina Favaretti
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
| | - Violetta Hachaturyan
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Tilman Kühn
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- University of Vienna, Department of Nutritional Sciences, Vienna, Austria
- Medical University of Vienna, Center for Public Health, Vienna, Austria
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa
- Harvard Center for Population and Development Studies, T.H. Chan School of Public Health, Cambridge, MA, United States
| | - Sandra Barteit
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| |
Collapse
|
8
|
Pan WKM. The application of behavioral change theories in addressing vaccine hesitancy: A Literature Review. Public Health Nurs 2024; 41:318-324. [PMID: 38246855 DOI: 10.1111/phn.13280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
Vaccination is vital in combating infectious diseases, including COVID-19. Nevertheless, vaccine hesitancy poses a substantial obstacle to achieving high vaccination rates. This study investigated the determinants of vaccine hesitancy using behavioral change theories and proposes a comprehensive conceptual framework to address this challenge.The paper conducted a review of several behavior change theories relevant to understanding vaccine hesitancy. The health belief model (HBM) highlighted the importance of individuals' perceptions of the effectiveness of health behaviors and their perceived susceptibility to illness. The social cognitive model (SCT) underscored the role of personal experiences, environmental factors, and social support in shaping health behaviors. The theory of reasoned action and planned behavior (TRA) suggested that attitudes and subjective norms are crucial in determining behavioral intentions. The transtheoretical model (TTM) outlined stages of behavior change, while the socio-ecological model (SEM) considered factors at individual, relationship, community, and societal levels. Comprehending vaccine hesitancy is essential for developing effective strategies to promote vaccine acceptance. This study, which examined vaccine hesitancy through various behavior change theories, sought to shed light on the factors influencing vaccine hesitancy among Filipinos. The resulting conceptual framework offers guidance for future interventions aimed at addressing vaccine hesitancy and ultimately improving vaccination rates.
Collapse
Affiliation(s)
- Warren Kemuel M Pan
- Graduate Student, University of the Philippines Manila College of Public Health Department of Health Promotion and Education, Manila, Philippines
- Faculty Member, University of Santo Tomas College of Nursing, Manila, Philippines
| |
Collapse
|
9
|
Yoon S, Kim H, An J, Jin SW. Exploring human papillomavirus vaccine hesitancy among college students and the potential of virtual reality technology to increase vaccine acceptance: a mixed-methods study. Front Public Health 2024; 12:1331379. [PMID: 38414894 PMCID: PMC10896851 DOI: 10.3389/fpubh.2024.1331379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 02/29/2024] Open
Abstract
Background Human papillomavirus (HPV) can cause cancers in men and women. Despite the availability of an effective vaccine, HPV vaccination coverage remains suboptimal among college students. Literature showed that hesitancy for HPV vaccination is a leading barrier to the uptake in this group. However, prior interventions have shown limitations in reducing HPV vaccine hesitancy in college students. Thus, this study examined a conventional educational approach using a vaccine information statement (VIS), and subsequently explored college students' HPV vaccine hesitancy and the potential of virtual reality (VR) technology to overcoming the limitations of interventional efforts. Methods We employed a mixed-methods design along with convenience sampling, constituting a one-way pre- and post-intervention (HPV VIS) survey (Study A) and individual interviews (Study B). All data collections occurred with 44 college students at an urban public university at the mid-south region of the U.S. between October 2022 and April 2023. Study A assessed changes in HPV vaccination outcomes including knowledge, beliefs/attitudes, vaccine hesitancy, and intentions. Study B measured college students' primary reasons for HPV vaccine hesitancy and preferred strategies for the vaccination promotion including VR-based education. We conducted paired t-test and Wilcoxon signed ranks test for quantitative data and framework analysis for qualitative data. Results Participants reported significant improvements in knowledge [t(43) = 6.68, p < 0.001] regarding HPV vaccination between before and after reading the HPV VIS. No change was observed in beliefs/attitudes, vaccine hesitancy, and intentions. The framework analysis revealed college students' reasons for HPV vaccine hesitancy, needed information, and preferred strategies along with the potential of VR technology for future HPV vaccination education. Conclusion The findings provided essential information on designing HPV vaccination information focused on vaccine hesitancy among college students. Future research should consider these findings in developing interventions including VR to increasing HPV vaccine acceptance among college students.
Collapse
Affiliation(s)
- Sangchul Yoon
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, Republic of Korea
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Heeyeon Kim
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Juhyeong An
- Center for Global Development, Yonsei lnstituite for Global Health, Yonsei University Health System, Seoul, Republic of Korea
| | - Seok Won Jin
- School of Social Work, The University of Memphis, Memphis, TN, United States
- Institute of Media Arts, Yonsei University, Seoul, Republic of Korea
| |
Collapse
|
10
|
Luo Y, Maafs‐Rodríguez AG, Hatfield DP. The individual-level effects of social media campaigns related to healthy eating, physical activity, and healthy weight: A narrative review. Obes Sci Pract 2024; 10:e731. [PMID: 38187123 PMCID: PMC10767147 DOI: 10.1002/osp4.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Social media are promising channels for health communication promoting positive weight-related behaviors, but no prior studies have synthesized evidence on the independent effects of social media campaigns focused on promoting healthy eating, physical activity (PA), and healthy weight. This study aimed to fill that gap and inform future social media-based obesity-prevention research and practice by reviewing findings from studies testing the effects of such campaigns on individual-level cognitive, behavioral, and anthropometric outcomes. Method The Web of Science and PubMed databases were searched for peer-reviewed articles published between 2012 and 2023 that explored the independent effects of social media campaigns related to healthy eating, PA, or weight management. Study characteristics and outcomes were extracted and summarized. Results Eleven studies were included in this review describing campaigns targeting healthy eating-related outcomes (e.g., fruit and vegetable consumption, meal preparation, nutrition label reading), PA, or weight management. Most campaigns (n = 7) were developed by universities or research centers. Priority audiences included parents, adult females, adolescents, college students, and adult government employees. The majority (n = 8) of the campaigns used single platforms, with the most common being Facebook, Instagram, blogs, and YouTube. Campaigns had mixed effects on cognitive outcomes (e.g., intention, attitude, knowledge), behavioral outcomes (e.g., food choices, PA), and anthropometric outcomes (e.g., weight, waist circumference). Conclusion Social media campaigns focused on promoting healthy eating, PA, and healthy weight had mixed effects on individual-level cognitive, behavioral, and anthropometric outcomes. Various limitations of the included studies make it difficult to ascertain which factors influence campaign effectiveness. Advancing knowledge in this area is important, particularly given social media's widespread use and potential for broad reach. New research with features such as rigorous study designs, larger and more diverse samples, and strong theoretical foundations may provide important insights into what types of interventions are effective or not and under what conditions.
Collapse
Affiliation(s)
- Yajing Luo
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Ana G. Maafs‐Rodríguez
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- ChildObesity180Tufts UniversityBostonMassachusettsUSA
| | - Daniel P. Hatfield
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
- ChildObesity180Tufts UniversityBostonMassachusettsUSA
- FHI 360DurhamNorth CarolinaUSA
| |
Collapse
|
11
|
Hansen RK, Baiju N, Gabarron E. Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review. J Med Internet Res 2023; 25:e50276. [PMID: 38147375 PMCID: PMC10777282 DOI: 10.2196/50276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs. OBJECTIVE This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children. METHODS The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12). CONCLUSIONS The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.
Collapse
Affiliation(s)
- Rita-Kristin Hansen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nikita Baiju
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elia Gabarron
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| |
Collapse
|
12
|
Degarege A, Watanabe-Galloway S, Mansilla K, Sileshi RM, Peters ES. Evaluation of Theoretical Frameworks to Detect Correlates of HPV Vaccination in the Midwest, US, Using Structural Equation Modeling. Vaccines (Basel) 2023; 11:1856. [PMID: 38140259 PMCID: PMC10747226 DOI: 10.3390/vaccines11121856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Knowledge of a valid, well-designed, and targeted theory-based framework helps better characterize reasons for HPV vaccine hesitancy and identify promising approaches to increase vaccination rates for eligible individuals. This study evaluated health theories in explaining factors affecting HPV vaccination and used a theoretical framework to identify direct and indirect predictors and mediators of HPV vaccination. A cross-sectional survey regarding HPV vaccine uptake and related factors was conducted among 1306 teenagers and young adults in the Midwest, US, in March and April 2023. Structural equation modeling confirmed fit of the framework based on the Integrated Health Theory (IHT) to the HPV vaccine data (Comparative Fit Index = 0.93; Tucker-Lewis Index = 0.92; Root Mean Square Error of Approximation = 0.053). While willingness to uptake the HPV vaccine directly predicted increased uptake (p < 0.001), perceived benefits (p < 0.001) and barriers (p < 0.023) about the vaccine indirectly predicted increased and decreased uptake, respectively. In turn, beliefs about susceptibility (p = 0.005) and severity (p < 0.001) of HPV infection and associated cancers and barriers to vaccination in general (p < 0.001) indirectly predicted willingness to uptake the vaccine. In conclusion, IHT can be appropriate in examining predictors of HPV vaccine uptake in teenagers and young adults in the US, particularly in the Midwest.
Collapse
Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (S.W.-G.); (K.M.); (R.M.S.); (E.S.P.)
| | | | | | | | | |
Collapse
|
13
|
Li L, Yang L, Wang Q, Wood CE, Kostkova P. Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study. Hum Vaccin Immunother 2023; 19:2290798. [PMID: 38111087 PMCID: PMC10760351 DOI: 10.1080/21645515.2023.2290798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.
Collapse
Affiliation(s)
- Lan Li
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Liuqing Yang
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, PR China
- Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, UK
| | - Caroline E Wood
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| |
Collapse
|
14
|
Karloh M, Matias TS, de Oliveira JM, de Lima FF, Araújo Pinheiro DH, Barbosa GB, Furlanetto KC, Carvalho CRF. Breaking barriers to rehabilitation: the role of behavior change theories in overcoming the challenge of exercise-related behavior change. Braz J Phys Ther 2023; 27:100574. [PMID: 38056192 PMCID: PMC10749239 DOI: 10.1016/j.bjpt.2023.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Promoting exercise-related behavior change in rehabilitation is a challenge. The lack of integration between rehabilitation program prescriptions, behavior change interventions, and behavioral change theories is profound. Using behavior change theories properly is crucial for better adherence and promoting positive outcomes. Therefore, it is essential to bring theories that support the understanding of exercise-related behavioral change to the attention of rehabilitation practitioners. OBJECTIVE This masterclass article aims to provide the theoretical background of theories and strategies for exercise behavior change within the physical therapy context based on acknowledged behavioral change theoretical models. METHODS This is a narrative review that examines six behavior theories; five of them well-established, and a new (and promising) theory that has exhibited the most favorable outcomes in rehabilitation settings. The development process for this masterclass included conversations between authors, reviewing behavior theories, summarizing and discussing the theories' concepts and strategies for physical therapy. RESULTS The included theories were self-determination theory, social-cognitive theory, the transtheoretical model, the theory of planned behavior, the health belief model, and the unifying theory of physical activity. Each theory offers a unique perspective on exercise behavior change within rehabilitation, exploring constructs such as motivation, self-efficacy, stages of change, behavioral intention, perceived threat, and the core elements of physical activity expression. CONCLUSION These theoretical models provide a foundation for understanding and developing strategies for promoting exercise behavior change in rehabilitation. Knowing and using these theories is important for respecting the patient's individuality.
Collapse
Affiliation(s)
- Manuela Karloh
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab). Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Graduate Program in Physical Therapy, Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil.
| | - Thiago Sousa Matias
- Department of Physical Education, School of Sports, Graduate Program in Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil; Graduate Program in Public Health, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Joice Mara de Oliveira
- Laboratory of Research in Respiratory Physical Therapy (LFIP), Department of Physical Therapy, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Pitágoras-Unopar (UNOPAR), Londrina, PR, Brazil
| | - Fabiano Francisco de Lima
- Physical Therapy Department, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Graziele Besen Barbosa
- Center for Assistance, Teaching and Research in Pulmonary Rehabilitation (NuReab). Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil; Graduate Program in Physical Therapy, Center for Health Sciences and Sport (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC, Brazil
| | - Karina Couto Furlanetto
- Laboratory of Research in Respiratory Physical Therapy (LFIP), Department of Physical Therapy, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil; Graduate Program in Rehabilitation Sciences, Universidade Pitágoras-Unopar (UNOPAR), Londrina, PR, Brazil
| | - Celso R F Carvalho
- Physical Therapy Department, School of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| |
Collapse
|
15
|
Barakat M, Abdaljaleel M, Atawneh N, Alkhazaleh R, Aburumman D, Hamed E, Sallam M. Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan. Vaccines (Basel) 2023; 11:1672. [PMID: 38006004 PMCID: PMC10674877 DOI: 10.3390/vaccines11111672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.
Collapse
Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan;
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Maram Abdaljaleel
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Nada Atawneh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Rawan Alkhazaleh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dana Aburumman
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Eman Hamed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| |
Collapse
|
16
|
Winters M, Christie S, Lepage C, Malik AA, Bokemper S, Abeyesekera S, Boye B, Moini M, Jamil Z, Tariq T, Beresh T, Kazymyrova G, Palamar L, Paintsil E, Faller A, Seusan A, Bonnevie E, Smyser J, Khan K, Gulaid M, Francis S, Warren JL, Thomson A, Omer SB. Persuasive COVID-19 vaccination campaigns on Facebook and nationwide vaccination coverage in Ukraine, India, and Pakistan. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002357. [PMID: 37756298 PMCID: PMC10529538 DOI: 10.1371/journal.pgph.0002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023]
Abstract
Social media platforms have a wide and influential reach, and as such provide an opportunity to increase vaccine uptake. To date, there is no large-scale, robust evidence on the offline effects of online messaging campaigns. We aimed to test whether pre-tested, persuasive messaging campaigns from UNICEF, disseminated on Facebook, influenced COVID-19 vaccine uptake in Ukraine, India, and Pakistan. In Ukraine, we deployed a stepped-wedge randomized controlled trial (RCT). Half of the 24 oblasts (provinces) received five weeks of the intervention, the other half ten weeks of the intervention. In India, an RCT with an augmented synthetic control was conducted in five states (Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan), whereby 40 out of 174 districts were randomized to receive six weeks of intervention. In Pakistan we deployed a pre-post design, whereby 25 city districts received six weeks of the intervention. Weekly COVID-19 vaccination data was sourced through government databases. Using Poisson regression models, the association between the intervention and vaccine uptake was estimated. In Ukraine we conducted a survey among Facebook users at three time points during the RCT, to ascertain vaccination intentions and trust in vaccines. The campaigns reached more than 110 million Facebook users and garnered 2.9 million clicks. In Ukraine, we found that the intervention did not affect oblast-level vaccination coverage (Relative Risk (RR): 0.93, 95% Confidence Interval (CI) 0.86-1.01). Similarly, in India and Pakistan we found no effect of our intervention (India: RR 0.85, 95% CI 0.70-1.04; Pakistan: RR 0.64, 95% CI 0.01-29.9). The survey among Facebook users in Ukraine showed that trust in vaccines and information sources was an important predictor of vaccination status and intention to get vaccinated. Our campaigns on Facebook had a wide reach, which did not translate in shifting behaviours. Timing and external events may have limited the effectiveness of our interventions.
Collapse
Affiliation(s)
- Maike Winters
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Sarah Christie
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | | | - Amyn A. Malik
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
| | - Scott Bokemper
- Institution for Social and Policy Studies, Yale University, New Haven, Connecticut, United States of America
- Center for the Study of American Politics, Yale University, New Haven, Connecticut, United States of America
| | | | - Brian Boye
- UNICEF Country Office India, New Delhi, India
| | | | - Zara Jamil
- UNICEF Country Office, Karachi, Pakistan
| | - Taha Tariq
- UNICEF Country Office, Karachi, Pakistan
| | | | | | | | - Elliott Paintsil
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
| | - Alexandra Faller
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Andreea Seusan
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Erika Bonnevie
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Joe Smyser
- The Public Good Projects, Alexandria, Virginia, United States of America
| | - Kadeem Khan
- Meta Platforms Inc., Menlo Park, California, United States of America
| | - Mohamed Gulaid
- Meta Platforms Inc., Menlo Park, California, United States of America
| | - Sarah Francis
- Team Upswell, Seattle, Washington, United States of America
| | - Joshua L. Warren
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, Texas, United States of America
| | | | - Saad B. Omer
- Yale Institute for Global Health, Yale University, New Haven, Connecticut, United States of America
- Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern, Dallas, Texas, United States of America
| |
Collapse
|
17
|
Lin Y, Liu X. Trust Associated with South Korean Sojourners' Chinese COVID-19 Vaccination Intent and Concerns: A Qualitative Study. J Epidemiol Glob Health 2023; 13:435-443. [PMID: 37261712 PMCID: PMC10234244 DOI: 10.1007/s44197-023-00123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
People's willingness to get vaccinated determines whether the campaigns against the COVID-19 pandemic can be successful in part. Considering the fact that both foreigners and its nationals are exposed to the risk of infection in China, the Chinese government has taken measures favorable to foreigners in terms of the vaccination, yet South Korean sojourners were reluctant to get China-developed COVID-19 vaccines. This study employed the trust in institutions and trust in media as a theoretical framework and seeks to analyze how these two affect South Korean sojourners' intention to get Chinese COVID-19 vaccines. 25 South Korean sojourners living in Beijing participated in semi-structured interviews. The results showed that the mistrust South Korean sojourners have in China's institutions and media, both traditional and social media, led to their reluctance to get Chinese COVID-19 vaccines. In addition, South Korean sojourners' higher interpersonal trust in their peers also influenced their willingness to get vaccines. This study further interpreted such results from the perspective of cultural traits and national properties.
Collapse
Affiliation(s)
- Yujun Lin
- School of Journalism and Communication, Shandong University, Jinan, China.
| | - Xiaoli Liu
- School of Foreign Languages, Ludong University, Yantai, China
| |
Collapse
|
18
|
Diaz-Infante S, Acuña-Zegarra MA, Velasco-Hernández JX. Modeling a traffic light warning system for acute respiratory infections. APPLIED MATHEMATICAL MODELLING 2023; 121:217-230. [PMID: 37193366 PMCID: PMC10165461 DOI: 10.1016/j.apm.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
The high morbidity of acute respiratory infections constitutes a crucial global health burden. In particular, for SARS-CoV-2, non-pharmaceutical intervention geared to enforce social distancing policies, vaccination, and treatments will remain an essential part of public health policies to mitigate and control disease outbreaks. However, the implementation of mitigation measures directed to increase social distancing when the risk of contagion is a complex enterprise because of the impact of NPI on beliefs, political views, economic issues, and, in general, public perception. The way of implementing these mitigation policies studied in this work is the so-called traffic-light monitoring system that attempts to regulate the application of measures that include restrictions on mobility and the size of meetings, among other non-pharmaceutical strategies. Balanced enforcement and relaxation of measures guided through a traffic-light system that considers public risk perception and economic costs may improve the public health benefit of the policies while reducing their cost. We derive a model for the epidemiological traffic-light policies based on the best response for trigger measures driven by the risk perception of people, instantaneous reproduction number, and the prevalence of a hypothetical acute respiratory infection. With numerical experiments, we evaluate and identify the role of appreciation from a hypothetical controller that could opt for protocols aligned with the cost due to the burden of the underlying disease and the economic cost of implementing measures. As the world faces new acute respiratory outbreaks, our results provide a methodology to evaluate and develop traffic light policies resulting from a delicate balance between health benefits and economic implications.
Collapse
Affiliation(s)
- Saul Diaz-Infante
- Departamento de Matemáticas, CONACYT - Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Col. Centro, Sonora, C.P. 83000, México
| | - M Adrian Acuña-Zegarra
- Departamento de Matemáticas, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N, Hermosillo, Col. Centro, Sonora, C.P. 83000, México
| | - Jorge X Velasco-Hernández
- Instituto de Matemáticas, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Querétaro, C.P. 76230, México
| |
Collapse
|
19
|
Baldé T, Billaud A, Beadling CW, Kartoglu N, Anoko JN, Okeibunor JC. The WHO African Region Initiative on Engaging Civil Society Organizations in Responding to the COVID-19 Pandemic: Best Practices and Lessons Learned for a More Effective Engagement of Communities in Responding to Public Health Emergencies. Disaster Med Public Health Prep 2023; 17:e445. [PMID: 37551088 DOI: 10.1017/dmp.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Engaging communities is a key factor in efficient response to public health emergencies (PHE). Previous and recent outbreaks have shown that civil society organizations (CSOs) can mobilize the communities to better prepare and respond to a PHE. Consequently, the World Health Organization (WHO) Regional Office for Africa (AFRO) implemented an initiative to partner with community leaders by engaging CSOs. The Civil Society Organization Initiative (CSO Initiative) aims to work directly with well-established community-based organizations to accelerate whole-of-society preparation and response. Twenty-three CSOs from 12 WHO African Region Member States have been supported financially and technically to implement effective community-based interventions to respond to the coronavirus disease (COVID-19) pandemic. After 1 year of implementation (2021), the successes, challenges, and recommendations for maximizing future engagements with CSOs are outlined. As the COVID-19 outbreak is again underlining, partnering with established CSOs to engage diverse social groups from various communities can help provide a timely and efficient response to a PHE.
Collapse
Affiliation(s)
- Thierno Baldé
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Anthony Billaud
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Charles W Beadling
- Military and Emergency Medicine, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Nellie Kartoglu
- WHO, Country Readiness Strengthening Department, Geneva, Switzerland
| | - Julienne Ngoundoung Anoko
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| | - Joseph Chukwudi Okeibunor
- World Health Organization (WHO), Regional Office for Africa, Emergency Preparedness and Response Programme, COVID-19 Incident Management Support Team, Brazzaville, Congo
| |
Collapse
|
20
|
Rubinstein EB, Rayel H, Crawford EC, Larson M. Using a rapid ethnographic assessment to explore vaccine hesitancy on a public university campus in the Upper Midwest. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-9. [PMID: 37399535 DOI: 10.1080/07448481.2023.2225628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/27/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023]
Abstract
Objective: This exploratory study examined campus attitudes toward vaccines to guide subsequent development of context-relevant interventions for increasing vaccine acceptance and uptake. Participants: We gathered ethnographic data on a convenience sample of campus community members (students, faculty, staff) at a public university over six weeks in spring 2022. Methods: Student researchers conducted a rapid ethnographic assessment across campus locations. Weekly team debriefs enabled ongoing, iterative refinement of instruments and supplemented observational fieldnotes. Data analysis was inductive and oriented toward practical recommendations for intervention development. Results: Four themes, and attendant recommendations, emerged: 1) social identities and social roles influence health-related beliefs, including vaccination; 2) vaccine knowledge influences vaccination behaviors; 3) language surrounding vaccines (sometimes) matters; 4) vaccines aren't considered part of general health and wellness and can't be forced. Conclusions: Findings highlight the need to address individual, social, and institutional contexts when designing campus-based behavioral interventions for vaccine uptake.
Collapse
Affiliation(s)
- Ellen B Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, North Dakota, USA
| | - Hannah Rayel
- Department of Public Health, North Dakota State University, Fargo, North Dakota, USA
| | - Elizabeth C Crawford
- Department of Communication, North Dakota State University, Fargo, North Dakota, USA
| | - Mary Larson
- Department of Public Health, North Dakota State University, Fargo, North Dakota, USA
| |
Collapse
|
21
|
Seal A, Jelle M, Hassan MY, Farah DA, Musili FM, Micheni J, Asol GS, Bhandari M, Nemeth B. COVID-19 Prevention Behaviours and Vaccine Acceptability, and Their Association with a Behaviour Change Campaign in Somalia: Analysis of a Longitudinal Cohort. Vaccines (Basel) 2023; 11:vaccines11050972. [PMID: 37243076 DOI: 10.3390/vaccines11050972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Somalia experienced its first wave of COVID-19 infections in March 2020 and has experienced fluctuating infection levels since. Longitudinal data on suspected cases of COVID-19, attitudes, and behaviours were collected by telephone interviews of cash-transfer programme beneficiaries from June 2020-April 2021. A multi-media Social and Behaviour Change Communication (SBCC) campaign was designed and implemented from February 2021 to May 2021. Between the end of the first wave and the onset of the second the perceived threat from COVID-19 increased, with the proportion of respondents viewing it as a major threat increasing from 46% to 70% (p = 0.021). Use of face coverings increased by 24% (p < 0.001) and hand shaking and hugging for social greeting decreased, with 17% and 23% more people abstaining from these practices (p = 0.001). A combined preventative behaviour score (PB-Score) increased by 1.3 points (p < 0.0001) with a higher score in female respondents (p < 0.0001). During wave 2, vaccine acceptance was reported by 69.9% (95% CI 64.9, 74.5), overall. Acceptance decreased with increasing age (p = 0.009) and was higher in males (75.5%) than females (67.0%) (p = 0.015). Awareness of the SBCC campaign was widespread with each of the 3 key campaign slogans having been heard by at least 67% of respondents. Awareness of 2 specific campaign slogans was independently associated with an increased use of face coverings (aOR 2.31; p < 0.0001) and vaccine acceptance (aOR 2.36; p < 0.0001). Respondents reported receiving information on the pandemic from a wide range of sources with mobile phones and radio the most common. Trust in different sources ranged widely.
Collapse
Affiliation(s)
- Andrew Seal
- UCL Institute for Global Health, London WC1N 1EH, UK
- Evidence for Change (e4c), Nairobi 00100, Kenya
| | - Mohamed Jelle
- UCL Institute for Global Health, London WC1N 1EH, UK
- Evidence for Change (e4c), Nairobi 00100, Kenya
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Jin SW, Lee Y, Brandt HM. Human Papillomavirus (HPV) Vaccination Knowledge, Beliefs, and Hesitancy Associated with Stages of Parental Readiness for Adolescent HPV Vaccination: Implications for HPV Vaccination Promotion. Trop Med Infect Dis 2023; 8:tropicalmed8050251. [PMID: 37235299 DOI: 10.3390/tropicalmed8050251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
The vaccination against human papillomavirus (HPV) has shown effectiveness in preventing six different types of cancer. Despite a safe, effective HPV vaccine, vaccination coverage for adolescents remains suboptimal, especially in the Memphis, Tennessee metropolitan area. Parents/Guardians have a substantial influence on adolescent vaccination, but little is known about parental cognitive factors contributing to intent on adolescent HPV vaccination in this region. Thus, this study examined factors associated with stages of parental readiness for adolescent HPV vaccination by applying the transtheoretical model. A cross-sectional, online survey was conducted to collect quantitative data on sociodemographic characteristics; health-related information; HPV vaccination knowledge, beliefs, and hesitancy; and stages of readiness for adolescent HPV vaccination among parents. Convenience sampling was performed to recruit a total of 497 parents of adolescents aged 11-17 years in Shelby and Tipton Counties in Tennessee and DeSoto County in Mississippi. Binary logistic regression analyses showed that greater knowledge of HPV vaccination, greater perceived susceptibility to HPV, and lower levels of HPV vaccination hesitancy, respectively, distinguished higher from lower stages of parental readiness for adolescent HPV vaccination after controlling for other variables. The findings provide implications for developing readiness for stage-specific interventions targeted to effectively influence the parental decision-making process regarding HPV vaccination for adolescents.
Collapse
Affiliation(s)
- Seok Won Jin
- School of Social Work, The University of Memphis, 119 McCord Hall, Memphis, TN 38152, USA
- Department of Medical Humanities and Social Science, College of Medicine, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Yeonggeul Lee
- Social Science Research, University of Seoul, 163 Seoulsiripdaero, Dongdaemun-gu, Seoul 02504, Republic of Korea
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| |
Collapse
|
23
|
Yildiz Durak H, Şimşir Gökalp Z, Saritepeci M, Dilmaç B, Durak A. Investigation of personal variables, technology usage, vaccine-related variables, social media-specific epistemological beliefs, media literacy, social impact strategies variables affecting vaccine hesitancy beliefs in the Covid-19 pandemic. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-14. [PMID: 37361268 PMCID: PMC10013284 DOI: 10.1007/s10389-023-01872-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
Aim In this study, personal variables, technology use cases, vaccine-related variables, social media-specific epistemological beliefs, media literacy, and social influence strategies were examined as predictors of Covid-19 vaccination hesitancy (VH) beliefs. Subject and methods The prediction design research model is used to detect the predictors of the dependent variable. The study group consists of 378 participants. Five different scales were used together with the self-description form as a data collection tool. Results According to the results of the research, individuals who have positive perceptions about the safety of Covid-19 vaccines and who have received the Covid-19 vaccine have lower anti-vaccine beliefs. It is another situation that prevents the opposition to vaccination of those who research the source of information on social media. As a result, age, education and income level, social media usage experience, media literacy, and social influence strategies were not effective on the participants' anti-vaccine beliefs. Conclusion According to the findings of the study, positive perceptions about the safety of Covid-19 vaccines, being vaccinated against Covid-19, and researching a source of information on social media variables seem to be effective in laying the foundations for constructive interventions such as using anti-vaccine beliefs to guide, reduce or eliminate negative beliefs about vaccines.
Collapse
Affiliation(s)
- Hatice Yildiz Durak
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Zeynep Şimşir Gökalp
- Faculty of Education, Department of Educational Sciences, Selçuk University, Konya, Turkey
| | - Mustafa Saritepeci
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Bülent Dilmaç
- Eregli Faculty of Education, Department of Educational Science, Necmettin Erbakan University, Konya, Turkey
| | - Aykut Durak
- Eregli Faculty of Education, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
24
|
Wang Q, Yang L, Li L, Liu C, Jin H, Lin L. Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2023; 9:e43893. [PMID: 36892937 PMCID: PMC10037179 DOI: 10.2196/43893] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. OBJECTIVE We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. METHODS A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. RESULTS Of the 26,942 identified records, 13 (0.05%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74% (95% CI 40.85%-70.13%). Of adults aged ≥50 years, 56.06% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39%. The willingness rate was more than 70% in the Eastern Mediterranean Region and approximately 55% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. CONCLUSIONS Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs.
Collapse
Affiliation(s)
- Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Liuqing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Lan Li
- Centre for Digital Public Health in Emergencies, Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
| | - Chang Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, China
| | - Leesa Lin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong, China
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
25
|
Development and Evaluation of an Index to Measure the Ability to Get Vaccinated for COVID-19. Vaccines (Basel) 2023; 11:vaccines11020342. [PMID: 36851220 PMCID: PMC9966146 DOI: 10.3390/vaccines11020342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
The COVID-19 pandemic has been an historic challenge to public health, and to behavior change programs. There have been challenges in promoting vaccination in LMICs, including Nigeria. One important hypothesis deserving consideration is the ability to obtain vaccination as a potential barrier to vaccination uptake. The MOA (motivation, opportunity, and ability) framework, as illustrated by multiple theories such as COM-B, EAST, and the Fogg model, is a primary theoretical basis for the evaluation of this ability as a factor in vaccination uptake. There is little research on measuring the ability to get vaccinated in LMICs, including on the role of all of the MOA framework. The aim of this study was to develop and evaluate an ability factors index measured through social media-based data collected in Nigeria in late 2021 and early 2022. We present findings from an online survey of 8574 Nigerians and highlight new social media-based data collection techniques in this research. This study found that a new ability factors index comprising 12 items was associated with vaccine uptake independent of measures capturing other components of the MOA framework. This index may serve as a valuable research instrument for future studies. We conclude that a person's perceived ability to get vaccinated, measured by a newly validated index, is related to vaccination uptake and hesitancy, and that more research should be conducted in this area.
Collapse
|
26
|
Whitehead HS, French CE, Caldwell DM, Letley L, Mounier-Jack S. A systematic review of communication interventions for countering vaccine misinformation. Vaccine 2023; 41:1018-1034. [PMID: 36628653 PMCID: PMC9829031 DOI: 10.1016/j.vaccine.2022.12.059] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people's attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2). METHODS We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2). RESULTS Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine 'intervention approaches' were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other 'scare tactics', use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results. CONCLUSION This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.
Collapse
Affiliation(s)
- Hannah S. Whitehead
- NIHR Health Protection Research Unit in Vaccines and Immunisation, Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Clare E. French
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Deborah M. Caldwell
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Sandra Mounier-Jack
- NIHR Health Protection Research Unit in Vaccines and Immunisation, Department of Global Health Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom,Corresponding author at: London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| |
Collapse
|
27
|
Choi J, Tamí-Maury I, Cuccaro P, Kim S, Markham C. Digital Health Interventions to Improve Adolescent HPV Vaccination: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020249. [PMID: 36851127 PMCID: PMC9963303 DOI: 10.3390/vaccines11020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Digital technologies are being increasingly utilized in healthcare to provide pertinent and timely information for primary prevention, such as vaccination. This study aimed to conduct a systematic review to describe and assess current digital health interventions to promote HPV vaccination among adolescents and parents of adolescents, and to recommend directions for future interventions of this kind. Using appropriate medical subject headings and keywords, we searched multiple databases to identify relevant studies published in English between 1 January 2017 and 31 July 2022. We screened and selected eligible studies for inclusion in the final analysis. We reviewed a total of 24 studies, which included interventions using text messages (4), mobile apps (4), social media and websites (8), digital games (4), and videos (4). The interventions generally improved determinants of HPV vaccination, such as HPV-related knowledge, vaccine-related conversations, and vaccination intentions. In particular, text message and social media interventions targeted improved vaccine uptake behaviors, but little meaningful change was observed. In conclusion, digital health interventions can cost-effectively provide education about HPV vaccination, offer interactive environments to alleviate parental vaccine hesitancy, and ultimately help adolescents engage in HPV vaccine uptake.
Collapse
Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Irene Tamí-Maury
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sooyoun Kim
- Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Correspondence:
| |
Collapse
|
28
|
Nguyen T, Boey L, Van Riet C, Dielen S, Dodion H, Giles-Vernick T, Vandaele N, Larson HJ, Peeters Grietens K, Gryseels C, Heyerdahl LW. Embracing context: Lessons from designing a dialogue-based intervention to address vaccine hesitancy. Front Public Health 2023; 11:1069199. [PMID: 36891336 PMCID: PMC9986323 DOI: 10.3389/fpubh.2023.1069199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/01/2023] [Indexed: 02/22/2023] Open
Abstract
Dialogue with people who are vaccine hesitant has been recommended as a method to increase vaccination uptake. The process of cultivating dialogue is shaped by the context in which it occurs, yet the development of interventions addressing vaccine hesitancy with dialogue often overlooks the role of context and favors relatively fixed solutions. This reflexive paper shares three key lessons related to context for dialogue-based interventions. These lessons emerged during a participatory research project to develop a pilot intervention to create open dialogue among healthcare workers in Belgium about COVID-19 vaccination concerns. Through a mixed methods study consisting of in-depth interviews, focus group discussions, and surveys, we engaged healthcare workers in the design, testing, and evaluation of a digital platform featuring text-based and video-based (face-to-face) interactions. The lessons are: (1) what dialogue means, entails, and requires can vary for a population and context, (2) inherent tension exists between helping participants voice (and overcome) their concerns and exposing them to others' ideas that may exacerbate those concerns, and (3) interactional exchanges (e.g., with peers or experts) that matter to participants may shape the dialogue in terms of its content and form. We suggest that having a discovery-orientation-meaning to work not only inductively and iteratively but also reflexively-is a necessary part of the development of dialogue-based interventions. Our case also sheds light on the influences between: dialogue topic/content, socio-political landscape, population, intervention aim, dialogue form, ethics, researcher position, and types of interactional exchanges.
Collapse
Affiliation(s)
- ToTran Nguyen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Department of Work and Organisation Studies, KU Leuven, Leuven, Belgium
| | - Lise Boey
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Carla Van Riet
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Stef Dielen
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hélène Dodion
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tamara Giles-Vernick
- Anthropology and Ecology of Disease Emergence Unit, Department of Global Health, Institut Pasteur, Paris, France
| | - Nico Vandaele
- Access-To-Medicines Research Centre, KU Leuven, Leuven, Belgium
| | - Heidi J Larson
- Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Koen Peeters Grietens
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Charlotte Gryseels
- Socio-Ecological Health Research Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Leonardo W Heyerdahl
- Anthropology and Ecology of Disease Emergence Unit, Department of Global Health, Institut Pasteur, Paris, France
| |
Collapse
|
29
|
Strategies to Increase Willingness to Receive a COVID-19 Vaccine among Nursing Home Staff. Infect Dis Rep 2022; 15:34-42. [PMID: 36648858 PMCID: PMC9844423 DOI: 10.3390/idr15010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nursing home (NH) staff and residents have been prioritized to receive COVID-19 vaccinations. However, NH staff have been hesitant. This study explored what strategies were used to overcome this hesitancy and which of these were found to be important by NH staff to increase their willingness to take a COVID-19 vaccine. METHODS This study employed a sequential exploratory qualitative design. The COVID-19 MINUTES study aimed to describe the challenges presented by, responses to, and impact of the COVID-19 pandemic in NHs. The minutes of COVID-19 outbreak teams (COTs) in Dutch long-term care organizations (n = 41) were collected and coded using content analysis. Textual units from December 2020 to April 2021 that regarded strategies to increase staff's vaccination willingness (n = 67) were selected. Subsequently, to validate these data, two panels of NH healthcare workers (HCWs) and policy workers (PWs) (n = 8) selected, discussed, and ranked the strategies that they found to be important using a modified nominal group technique. RESULTS The strategies described in the minutes included financial reimbursements, personal contact, story sharing, logistics support, role models, visual information, and written information. Except for financial reimbursement, all these strategies were considered important or very important by the panel participants. Some organizations combined multiple strategies. CONCLUSION The strategies that were found important in combination may be used more broadly and should be developed further with the involvement of HCWs.
Collapse
|
30
|
Moore R, Purvis RS, Willis DE, Worley KC, Hervey D, Reece S, Yeates A, McElfish PA. The vaccine hesitancy continuum among hesitant adopters of the COVID-19 vaccine. Clin Transl Sci 2022; 15:2844-2857. [PMID: 36330587 PMCID: PMC9747130 DOI: 10.1111/cts.13385] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022] Open
Abstract
Vaccination is a strategy for mitigating the impact of coronavirus disease 2019 (COVID-19) at both the individual and population levels. Vaccine hesitancy is identified as a significant threat to global health by the World Health Organization (WHO). Vaccine hesitancy has been theorized as a continuum encompassing a range of attitudes, beliefs, emotional orientations, ideologies, and health-seeking behaviors. Individuals who received the COVID-19 vaccine but also indicated some level of hesitancy about vaccination, or "hesitant adopters," remain an understudied group. This study uses a qualitative descriptive design to understand motivations to receive the COVID-19 vaccine among hesitant adopters at various self-reported levels of hesitancy. We conducted interviews with hesitant adopters (n = 49) to analyze the elements of vaccine hesitancy corresponding to reported levels of COVID-19 vaccine hesitancy (i.e., "little hesitant," "somewhat hesitant," and "very hesitant"). Concerns about side effects are shared across the continuum but are articulated differently at each level of hesitancy. The "little hesitant" relate fears of side effects to their health and a lack of clear information to inform their health decision making, whereas the "very hesitant" articulate the risks of side effects within the frame of conspiracies related to the development, approval, and economics of the COVID-19 vaccine. Additionally, conspiracy theories generally increase in salience across the continuum, with the "very hesitant" reporting conspiracy theories as the most salient element of vaccine hesitancy. This research presents opportunities for developing targeted interventions for different levels of vaccine hesitancy.
Collapse
Affiliation(s)
- Ramey Moore
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Rachel S. Purvis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Don E. Willis
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | | | | | - Sharon Reece
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Aimee Yeates
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| | - Pearl A. McElfish
- College of MedicineUniversity of Arkansas for Medical Sciences NorthwestFayettevilleArkansasUSA
| |
Collapse
|
31
|
Charbonneau E, Mellouli S, Chouikh A, Couture LJ, Desroches S. The Information Sharing Behaviors of Dietitians and Twitter Users in the Nutrition and COVID-19 Infodemic: Content Analysis Study of Tweets. JMIR INFODEMIOLOGY 2022; 2:e38573. [PMID: 36188421 PMCID: PMC9511036 DOI: 10.2196/38573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Abstract
Background
The COVID-19 pandemic has generated an infodemic, an overabundance of online and offline information. In this context, accurate information as well as misinformation and disinformation about the links between nutrition and COVID-19 have circulated on Twitter since the onset of the pandemic.
Objective
The purpose of this study was to compare tweets on nutrition in times of COVID-19 published by 2 groups, namely, a preidentified group of dietitians and a group of general users of Twitter, in terms of themes, content accuracy, use of behavior change factors, and user engagement, in order to contrast their information sharing behaviors during the pandemic.
Methods
Public English-language tweets published between December 31, 2019, and December 31, 2020, by 625 dietitians from Canada and the United States, and Twitter users were collected using hashtags and keywords related to nutrition and COVID-19. After filtration, tweets were coded against an original codebook of themes and the Theoretical Domains Framework (TDF) for identifying behavior change factors, and were compared to reliable nutritional recommendations pertaining to COVID-19. The numbers of likes, replies, and retweets per tweet were also collected to determine user engagement.
Results
In total, 2886 tweets (dietitians, n=1417; public, n=1469) were included in the analyses. Differences in frequency between groups were found in 11 out of 15 themes. Grocery (271/1417, 19.1%), and diets and dietary patterns (n=507, 34.5%) were the most frequently addressed themes by dietitians and the public, respectively. For 9 out of 14 TDF domains, there were differences in the frequency of usage between groups. “Skills” was the most used domain by both groups, although they used it in different proportions (dietitians: 612/1417, 43.2% vs public: 529/1469, 36.0%; P<.001). A higher proportion of dietitians’ tweets were accurate compared with the public’s tweets (532/575, 92.5% vs 250/382, 65.5%; P<.001). The results for user engagement were mixed. While engagement by likes varied between groups according to the theme, engagement by replies and retweets was similar across themes but varied according to the group.
Conclusions
Differences in tweets between groups, notably ones related to content accuracy, themes, and engagement in the form of likes, shed light on potentially useful and relevant elements to include in timely social media interventions aiming at fighting the COVID-19–related infodemic or future infodemics.
Collapse
Affiliation(s)
- Esther Charbonneau
- Centre Nutrition, Santé et Société Institute of Nutrition and Functional Foods Université Laval Quebec City, QC Canada
- School of Nutrition Université Laval Quebec City, QC Canada
| | - Sehl Mellouli
- Centre Nutrition, Santé et Société Institute of Nutrition and Functional Foods Université Laval Quebec City, QC Canada
- Faculty of Business Administration Université Laval Quebec City, QC Canada
| | - Arbi Chouikh
- Faculty of Business Administration Université Laval Quebec City, QC Canada
| | | | - Sophie Desroches
- Centre Nutrition, Santé et Société Institute of Nutrition and Functional Foods Université Laval Quebec City, QC Canada
- School of Nutrition Université Laval Quebec City, QC Canada
| |
Collapse
|
32
|
Naqvi M, Li L, Woodrow M, Yadav P, Kostkova P. Understanding COVID-19 Vaccine Hesitancy in Ethnic Minorities Groups in the UK. Front Public Health 2022; 10:917242. [PMID: 35844884 PMCID: PMC9284000 DOI: 10.3389/fpubh.2022.917242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022] Open
Abstract
COVID-19 vaccines have been developed and administered at record pace in order to curtail the impact of the COVID-19 pandemic. Vaccine hesitancy has impacted uptake unequally across different groups. This study explores the drivers for vaccine hesitancy in ethnic minority groups in the UK, the impact of social media on vaccine hesitancy and how vaccine hesitancy may be overcome. Twelve semi-structured interviews were conducted, coded and thematically analyzed with participants from ethnic minority groups in the UK who identified as vaccine hesitant. Social media played a significant role in vaccine hesitancy. For those who considered themselves healthy, seeing misinformation of extreme side effects relating to COVID-19 vaccinations on social media resulted in the opinion that the risk of vaccination is greater than risk from COVID-19 infection. For women, misinformation on social media regarding fertility was a reason for delaying or not getting vaccinated. Participants who had sources of information they trusted in outside of social media were more likely to choose to get vaccinated. This study identified the broad spectrum of views on vaccine hesitancy in ethnic minority groups in the UK. Enabling factors such as a desire to travel, and positive public health messaging can increase vaccine uptake, whereas a lack of trusted sources of information may cause vaccine hesitancy. Further research is required to combat misinformation and conspiracy theories. Effective methods include actively responding and disproving the misinformation. For an inclusive vaccination programme that reduces health inequality, policy makers should build trust amongst marginalized communities and address their concerns through tailored public health messaging.
Collapse
Affiliation(s)
- Maryam Naqvi
- Department of Civil, Environmental and Geomatic Engineering, Univeristy College London, London, United Kingdom
| | - Lan Li
- Institute of Disaster Risk Reduction, University College London, London, United Kingdom
- *Correspondence: Lan Li
| | - Michael Woodrow
- Department of Civil, Environmental and Geomatic Engineering, Univeristy College London, London, United Kingdom
| | - Punam Yadav
- Institute of Disaster Risk Reduction, University College London, London, United Kingdom
| | - Patty Kostkova
- Institute of Disaster Risk Reduction, University College London, London, United Kingdom
| |
Collapse
|
33
|
Kaushal A, Bravo C, Duffy S, Lewins D, Möhler R, Raine R, Vlaev I, Waller J, von Wagner C. Development of Reporting Guidelines for Social Media Research (RESOME) using a modified Delphi Method: Study protocol (Preprint). JMIR Res Protoc 2021; 11:e31739. [PMID: 35532999 PMCID: PMC9127642 DOI: 10.2196/31739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
Collapse
Affiliation(s)
- Aradhna Kaushal
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Caroline Bravo
- Ontario Health (Cancer Care Ontario), Toronto, ON, Canada
| | - Stephen Duffy
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Douglas Lewins
- Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Ivo Vlaev
- Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom
| | - Jo Waller
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| |
Collapse
|