Predicting Vaccination Intention and Benefit and Risk Perceptions: The Incorporation of Affect, Trust, and Television Influence in a Dual-Mode Model

"No Medication Means No HIV Diagnosis": A Qualitative Study Based on Dual-System Theory on HIV Antiretroviral Therapy Initiation Decision-Making

At least 30% of newly diagnosed people living with HIV (PLHIV) have delayed antiretroviral therapy (ART) initiation globally, resulting in irreversible impaired immune function and increased risk of HIV transmission. This study aimed to explore the decision-making process of ART initiation in China. A phenomenological research design was used and semi-structured, in-depth interviews based on dual-system theory were conducted. Participants were selected using purposive sampling between December 11, 2021 and June 25, 2022. Interpretative phenomenological analysis (IPA) was performed utilizing the software NVivo 12. A total of 34 PLHIV were interviewed. The heuristic system and the analytic system were involved in the complex decision-making process for ART initiation. Acceptability, negative emotion, and stigma were all parts of the heuristic system. The analytic system included the perception of ART benefits, positive support, and misconception. Two systems interacted with each other in the decision-making of ART initiation. PLHIV's initiation decision was determined by the components of the dominant system. This theory-driven qualitative study provided valuable insights on the decision-making process of ART initiation among newly diagnosed PLHIV.

Heuristic Information Processing as a Mediating Factor in the Process of Exposure to COVID-19 Vaccine Information and Misinformation Sharing on Social Media

Social media use for risk communication during the COVID-19 pandemic has caused considerable concerns about an overabundance of information, particularly misinformation. However, how exposure to COVID-19 information on social media can lead to subsequent misinformation sharing during the pandemic has received little research attention. This study adopted the social amplification of risk framework to delineate how exposure to COVID-19 vaccine information on social media can be associated with individuals' misinformation sharing through heuristic information processing. The role of social media trust was also examined. Results from an online survey (N = 1488) of Chinese Internet users revealed that exposure to COVID-19 vaccine information on social media was associated with misinformation sharing, mediated by both affect heuristics (i.e., negative affect toward the COVID-19 pandemic in general) and availability heuristics (i.e., perceived misinformation availability). Importantly, both high and low levels of trust in social media strengthened the mediating associations. While a low level of trust strengthened the association between exposure to COVID-19 vaccine information on social media and the affect heuristics, a high level of trust strengthened its association with the availability heuristics, both of which were associated with misinformation sharing. Our findings suggest that heuristic information processing is essential in amplifying the spread of misinformation after exposure to risk information on social media. It is also suggested that individuals should maintain a middle level of trust in social media, being open while critical of risk information on social media.

Understanding hepatitis E vaccination intention among women of childbearing-age: A theory-based cross-sectional study

OBJECTIVES

The purpose of this study was to investigate the HEV vaccination intention, its determinants, and overall influence mechanisms among childbearing-age women.

METHOD

The current study was cross-sectional and conducted online from June 25, 2023 to September 25, 2023 in Nanjing, China. Logistic regression models were constructed to identify the intention-associated background factors. Technology Acceptance Model (TAM) and Theory of Planned Behavior (TPB) were integrated and expanded as TAM-TPB model to further investigate the determinants and overall influence mechanism of HEV vaccination intention among this population using structural equation modeling.

RESULTS

A total of 423 eligible participants were included in this study. High general HEV knowledge was independently associated with an increased intention to get HEV vaccination (OR = 1.97, 95 % CI: 1.11-3.58, P = 0.023). All the hypotheses proposed in the theoretical TAM-TPB model were supported, with perceived ease of use, perceived usefulness, attitude, subjective norm, and perceived behavioral control positively affecting the intention of HEV vaccination (all P values <0.05), while perceived risk (P = 0.003) exhibited an inverse association with HEV vaccination intention. The model achieved an acceptable fit, and the total explained variance of HEV vaccination intention was as high as 86.20 %. Moreover, no significant common method bias was observed.

CONCLUSION

This is the first theory-based study that explored the HEV vaccination intention, its determinants, and overall influence mechanism among childbearing-age women. The results of the current study are of great importance for improving the understanding of the HEV vaccination intention among females of childbearing age.

The impact of attitude toward COVID-19 vaccine on intention to receive influenza vaccination: a multi-group comparison based on the influence of presumed influence model and spillover effects

Introduction

Influenza vaccination is one of the most important strategies for preventing influenza. However, the influenza vaccination rate in China remains low. During the COVID-19 pandemic, people held different attitudes toward the COVID-19 vaccine. In the post-pandemic era, do the varying attitudes toward the COVID-19 vaccine affect the intention to receive influenza vaccination?

Methods

Based on the influence of presumed influence (IPI) model and spillover effects, this study employed structural equation modeling for multi-group comparison to analyze questionnaires from 613 participants, using instruments such as the Perceived Media Influence on Others Scale (PMIO), the Susceptibility to Influenza Scale (SI), and the Attitude toward Influenza Vaccine Scale (AIV).

Results

The key findings are as follows: (1) Information exposure to the influenza vaccine significantly influences perceived media influence on others. (2) Perceived media influence on others does not directly impact the intention to receive influenza vaccination but rather affects it through attitude toward the influenza vaccine. (3) Moreover, multi-group analyses revealed differences in the IPI model among audiences with different attitudes toward the COVID-19 vaccine. These differences demonstrated that prior attitudes toward the COVID-19 vaccine can influence attitudes toward similar influenza vaccines, thus demonstrating the existence of spillover effects.

Conclusion

Attitude toward the COVID-19 vaccine can influence the intention to receive the influenza vaccination. Those with a negative attitude toward the COVID-19 vaccine are significantly influenced by susceptibility to influenza. Perceived media influence affects the intention to receive the influenza vaccination among those with a positive attitude toward the COVID-19 vaccine.

Exploring and contextualizing the associations among political identification, vaccine risk and benefit perceptions, and vaccine acceptance

There is considerable research on the influence of political partisanship on vaccine acceptance. However, the current study is one of the first to investigate how political identification is related to risk and benefit perceptions vis-à-vis vaccines. Based on survey data collected in the United States regarding four different vaccines at three points in time (n = 383 for April-June 2012; n = 364 for March 2020; n = 334 for April-May 2020), Democrats were found to have more positive attitudes toward vaccinations in general and hold more favorable risk and benefit perceptions of pandemic and routine vaccines overall compared to Republicans. However, the onset of a pandemic can serve as an equalizing force and motivate similar risk and benefit perceptions across party lines, but this force can wane quickly when the information environment is politicized. For political partisans who are ideologically oriented to be more hesitant toward vaccines, two conditions can help sustain their favorable vaccine perceptions during a pandemic: (a) when they identify with the governing political party, and (b) when there are consistent reassurances of vaccine safety and effectiveness from their partisan leadership. Given that risk and benefit perceptions were found to be consistently associated with vaccine acceptance across contexts in this study, communication aimed at encouraging vaccinations should always address the risks and benefits of a vaccine in ways that are tailored for individuals with different political affiliations.

Associations between Vaccination Behavior and Trust in Information Sources Regarding COVID-19 Vaccines under Emergency Approval in Japan: A Cross-Sectional Study

We examined the association between COVID-19 vaccination behavior and trust in COVID-19-related information sources during the initial period of COVID-19 vaccination in Japan. A cross-sectional survey was conducted in August 2021, 5 months after the start of COVID-19 vaccination for the general public under emergency approval. Participants were recruited using non-probability quota sampling from among Japanese residents who were under a declared state of emergency. Sociodemographic data, vaccination behavior, and levels of trust in eight media sources of information and three interpersonal information sources were assessed using an online survey form. A total of 784 participants completed the survey. The results of multiple logistic regression analysis showed that age, household income, underlying medical conditions, and living with family were significantly associated with COVID-19 vaccination behavior. Regarding COVID-19 vaccine information sources, trust in public health experts as a source of media information and primary care physicians as a source of interpersonal information showed significantly positive associations with COVID-19 vaccination behavior (odds ratio [OR] = 1.157, 95% confidence interval [CI] 1.017-1.31; OR = 1.076; 95% CI 1.006-1.150, respectively). Increasing trust in public health experts and primary care physicians and disseminating vaccine information from these sources will help promote vaccination under emergency approval.

Segmentation of intentions towards COVID-19 vaccine acceptance through political and health behaviour explanatory models

BACKGROUND

Management of the COVID-19 pandemic has been plagued by an online 'infodemic', not least on the topic of vaccine safety. Failure to vaccinate is often addressed with corrective, factually based information. However, this may be overly simplistic. European vaccine hesitancy levels correlate closely with popularity of populist parties while scientific populism refers specifically to populist distrust in scientific expertise.

AIMS AND METHOD

Combining an evaluation of risk through the health belief model and the cognitive constructs from the theory of planned behaviour, with the influence of populist statements, anticipated regret, trust, and past healthcare behaviour, an online survey explored the components of vaccine decisions amongst a demographically representative Irish adult sample (N = 1995).

RESULTS

The regression model accounted for a large proportion of variance amongst the total sample. A primary set of influences suggests a considered risk evaluative decision-making approach while a second tier of weaker influences incorporates a broader set of values beyond cost-benefit analysis. Six ideological subsets were identified through K-means analysis. Segments were differentiated by subjective norms attitudes (particularly around social media), populist political attitudes, self-efficacy, perceptions of COVID-19 severity, and susceptibility to the condition.

CONCLUSIONS

While the 'right thing to do' is clear when viewed through a lens of scientific expert advice, this is precisely the paradigm which populist movement rejects. Segmentations, such as the outputs from this study, validate the importance of proactively engaging with diverse communities both on and offline and afford a framework for developing and evaluating more refined, targeted, policies and interventions.

Factors influencing COVID-19 vaccination intention: The roles of vaccine knowledge, vaccine risk perception, and doctor-patient communication

OBJECTIVE

This study aims to investigate factors influencing COVID-19 vaccination intention in the United States.

METHODS

A cross-sectional survey was conducted with 800 respondents recruited from an online panel managed by a survey company. Path analysis was employed to examine the relationships between the study variables.

RESULTS

First, perceived susceptibility to COVID-19 vaccine side effects was negatively associated with vaccination intention whereas perceived severity did not show any significant impact. Second, vaccine-related knowledge was not directly related to vaccination intention, but it had an indirect and positive effect on vaccination intention via decreasing perceived susceptibility. Third, doctor-patient communication strengthened the negative effect of vaccine knowledge on perceived susceptibility and severity.

CONCLUSION

The results of this study offer insights on how to increase people's vaccination intention and reduce their psychological concerns when making COVID-19 vaccine-related decisions.

PRACTICE IMPLICATIONS

Government agencies should actively promote the effectiveness and importance of vaccination, while addressing concerns about vaccine safety in the public; Health initiatives also need to enhance the level of knowledge about COVID-19 vaccines through various media channels; Doctors can start the conversations about COVID-19 vaccination with their patients at the point of care and/or via online communication platforms.

Use of a language intervention to reduce vaccine hesitancy

Vaccine hesitancy is a major global challenge facing COVID-19 immunization programs. Its main source is low public trust in the safety and effectiveness of the vaccine. In a preregistered experimental study, we investigated how using a foreign language when communicating COVID-19 vaccine information influences vaccine acceptance. Hong Kong Chinese residents (N = 611) received COVID-19 vaccine information either in their native Chinese or in English. English increased trust in the safety and effectiveness of the vaccine and, as a result, reduced vaccine hesitancy. This indicates that language can impact vaccine attitudes and demonstrate the potential of language interventions for a low cost, actionable strategy to curtail vaccine hesitancy amongst bilingual populations. Language interventions could contribute towards achieving the United Nations Sustainable Development Goal of health and well-being.

Priming with social benefit information of vaccination to increase acceptance of COVID-19 vaccines

Vaccine hesitancy can be heightened due to increasing negative reports about vaccines. Emphasizing the social benefits of vaccination may shift individual attention from individual to social benefit of vaccination and hence promote prosocial vaccination. In six rounds of a population-based survey conducted over one major community epidemic of coronavirus disease 2019 (COVID-19) in Hong Kong from June to November 2020, we manipulated the question asking about acceptance of a COVID-19 vaccine with or without emphasizing the social benefit of vaccination against COVID-19 (prosocial priming) and monitored the changes of vaccine confidence by news media sentiment on vaccines. Population-weighted percentages of accepting COVID-19 vaccines by priming condition and vaccine confidence were compared across survey rounds. Logit regression models assessed the main effect of prosocial priming and the modification effects of vaccine confidence and perceived personal risk from COVID-19 on acceptance of COVID-19 vaccines. We found that prosocial priming significantly increased acceptance of COVID-19 vaccines across all survey rounds except for Round 3 when incidence of COVID-19 reached a peak. Vaccine confidence significantly declined in Round 6 when news media sentiment on vaccines became predominantly negative. The effect of prosocial priming on promoting vaccine acceptance was significantly greater in participants with low vaccine confidence and those perceiving the severity of COVID-19 to be mild/very mild. Our study suggests that packaging vaccination against COVID-19 as a prosocial behaviour can help overcome low vaccine confidence and promote prosocial vaccination particularly when disease incidence temporarily declines and the public perceive low severity of COVID-19.

Acceptance of a COVID-19 Vaccine Before it is Available in China During the Pandemic

Objectives: China was believed to be the country with the world’s highest acceptance rate of the COVID-19 vaccine following several investigations. This study aims to explore the Chinese acceptance of a COVID-19 vaccine before it is made available, including its determinants.

Methods: A cross-national online survey was conducted covering all 31 provinces of mainland China. The survey consists of the demographic variables, acceptance of a self-paid COVID-19 vaccine as the dependent variable, and the 3Cs factors (i.e., confidence, convenience, and complacency) as the independent variables.

Results: Among the 1,532 participants, 57.9% accepted to get a self-paid COVID-19 vaccine. COVID-19 vaccine acceptors were more likely to be concerned about the effectiveness of the vaccines, believe that they were at risk of COVID-19 infection, have a high perceived susceptibility of COVID-19, and trust in the health care system.

Conclusion: Findings indicate that the critical task in the early stage of the COVID-19 vaccine development in China is to increase the tolerance to some intuitive concerns about the vaccines, put more emphasis on the communication of the saliency of the disease threats, and effectively translate people’s trust in the government into vaccine acceptance.

Unsusceptible to Social Communication? The Fixture of the Factors Predicting Decisions on Different Vaccinations

Protection Motivation Theory (PMT) holds that individuals under threat base their protection decisions on threat and coping appraisals. In the case of preventable communicable diseases, the theory holds that motivation for vaccination will be higher the more alarming a person's threat appraisals and the more promising her coping appraisals are. This study aims at describing how the influence model of PMT accommodates different changes and conditions: the addition of new factors such as knowledge, health literacy, and attitudes, and the inclusion of several highly similar threats in the form of different communicable diseases. The question raised is: Do people, when making vaccination decisions, think of vaccination as a unified entity or as separate units? In the first case, they would show similar factors across different vaccinations, probably thinking of the common biomedical functioning of vaccination. In the latter case, the predictors would change from vaccination to vaccination, and people might have different treatments of the subject in public communication on their minds. Data came from a representative survey among adult Swiss residents. Among the results are the following: PMT is affirmed; people show a unified way of determining their motivation to vaccinate; knowledge contributes strongly to protection motivation; and neither public discussion of threats nor experiences among acquaintances shows much of an impact.

Predictors of Willingness to Receive the COVID-19 Vaccine after Emergency Use Authorization: The Role of Coping Appraisal

The current study aims to identify psychosocial factors based on protection motivation theory (PMT) influencing Chinese adults’ willingness to receive the COVID-19 vaccine after the emergency use authorization of the New Coronavirus Inactivated Vaccine in China. A cross-sectional online survey was conducted among Chinese residents aged 18–59 years, and 2528 respondents from 31 provinces and autonomous regions were included in the current study. Based on PMT, threat appraisals and coping appraisals were measured. Hierarchical multiple regressions and multivariate logistic regressions were used to identify the relationships between the PMT constructs and vaccination willingness after other covariates were controlled for. A total of 1411 (55.8%) respondents reported being willing to receive the COVID-19 vaccine. The PMT model explained 26.6% (p < 0.001) of the variance in the vaccine willingness. The coping appraisals, including response efficacy, self-efficacy, and response costs, were significantly correlated with the willingness to receive the COVID-19 vaccine, and response efficacy was the strongest influencing factor (adjusted OR = 2.93, 95% CI: 2.42–3.54). In conclusion, the coping appraisals for vaccination, instead of threat appraisals regarding the pandemic itself, mainly influenced people’s willingness to get vaccinated after the emergency use authorization of the COVID-19 vaccine in China. These findings are helpful for developing education and interventions to promote vaccination willingness and enhance public health outcomes during a pandemic.

Maternal Factors Predicting Loss to Follow-Up from Newborn Hearing Screenings in New Jersey

Because hearing loss in children can result in developmental deficits, early detection and intervention are critical. This article identifies a constellation of maternal factors that predict loss to follow-up (LTF) at the point of rescreening-the first follow-up for babies who did not pass the hearing screening performed at birth-through New Jersey's early hearing detection and intervention program. Maternal factors are critical to consider, as mothers are often the primary decision makers around children's health care. All data were obtained from the state's department of health and included babies born between June 2015 and June 2017. Logistic regression was used to predict LTF. Findings indicate that non-Hispanic Black mothers, younger mothers, mothers with previous live births, and mothers with obesity were more likely to be LTF. Hispanic mothers and those enrolled in the state's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program were less likely to be LTF. Mothers most at risk for LTF should be targeted for intervention to help children with hearing loss achieve the benefits from early intervention. Being a WIC recipient is a protective factor for LTF; therefore, elements of WIC could be used to reduce the state's LTF rate.

Trust and Risk Perception: A Critical Review of the Literature

Many studies in the field of risk perception and acceptance of hazards include trust as an explanatory variable. Despite this, the importance of trust has often been questioned. The relevant issue is not only whether trust is crucial but also the form of trust that people rely on in a given situation. In this review, I discuss various trust models and the relationship between trust and affect heuristics. I conclude that the importance of trust varies by hazard and respondent group. Most of the studies use surveys that provide limited information about causality. Future research should focus more on experiments that test whether trust is a consequence of people's attitudes or influences their attitudes toward a technology. Furthermore, there is a need for a better understanding about the factors that determine which heuristics people rely on when evaluating hazards.

How heuristics and cognitive biases affect vaccination decisions

Immunization, the most successful public health intervention to date, can only be effective if eligible individuals or their legal representatives have access to vaccines and subsequently comply with their use. Under-vaccination stems from multiple causes: access, affordability, awareness, acceptance and activation. In this paper, we focus on acceptance and, specifically, on factors pertaining to individual or parental compliance, specifically the psychology of judgment and decision making. We describe how heuristics and cognitive biases - a facet of thoughts and feelings - affect vaccination decision making. Additionally, we address when and how social processes play a role and how attitudes towards vaccines might reflect a more general underlying attitude or ideology. The understanding of how decision making, with regards to vaccines occurs, and the role played by heuristics and cognitive biases can help inform more appropriate public health interventions.

What makes people intend to take protective measures against influenza? Perceived risk, efficacy, or trust in authorities

BACKGROUND

Influenza outbreaks occur annually across the world, causing a global health challenge. This study aims to explore the association between risk perception (perceived severity and perceived probability), perceived efficacy (individual's efficacy and government's efficacy), trust in authorities, and intention to implement influenza protective behaviors.

METHODS

The data (N = 1,372) used in this paper comes from the 2013 Taiwan Social Change Survey dataset. Six intentions of protective behaviors (getting vaccinated, wearing a mask, washing hands, avoiding going to public settings, sanitizing home, and eating nutritional supplements) were investigated. Tobit and ordered logistic regressions were used to conduct data analysis.

RESULTS

Respondents were most inclined to washing hands, followed by wearing a mask, avoiding going to public settings, getting vaccine, sanitizing their homes, and eating nutritional supplements. Perceived severity and individual's efficacy were positively correlated with all 6 behavioral intentions. Trust in authorities has positive effect on all the protective behaviors except sanitizing home. Moreover, perceived probability has positive relationships with overall intention, intention to wear mask, and intention to wash hands. Government's efficacy was only positively correlated with eating nutritional supplements.

CONCLUSIONS

Perceived severity and perceived response efficacy towards flu, as well as trust in authorities were relatively important factors in motivating people's intention to adopt influenza protective behaviors.

Assessing the Intention to Provide Human Genetic Resources: An Explanatory Model

BACKGROUND

Human genetic resources are an important material component for life science research and have strategic significance for medical science and technological innovation. In this study, we employ frameworks from social psychology and the science of human behavior to study human genetic resource providers.

AIMS

We used structural equation techniques to explain factors affecting the intention to provide human genetic resources and the mechanisms for providing such resources.

METHODS

We conducted an online survey with respondents from ethnic minorities (n = 912). Our model integrates key variables informed by the theory of planned behavior (TPB), the theory of benefit and risk assessment (BRA), as well as variables that represent the policy and political system.

RESULTS

Our results show that the factors affecting the intention to provide human genetic resources, ranked from highly influential to less influential, are perceived benefits, privacy risk, attitudes toward providing human genetic resources, perceived behavioral efficacy, psychological risk, subjective norms, and physical risk. The variables informed by the TPB all have a significant positive effect on the intention to provide human genetic resources. With the exception of physical risk, the variables informed by the theory of BRA have a significant effect on the intention to provide human genetic resources. Respondents with different health conditions have significantly different levels of physical risk.

CONCLUSIONS

The results of our study provide insights into how to improve people's intention to provide human genetic resources. We also proposed ways to protect such resources globally.

Using protection motivation theory to predict intention to adhere to official MMR vaccination recommendations in Switzerland

Switzerland has not yet reached the measles vaccination coverage of 95 percent that is recommended by the World Health Organization to achieve herd immunity. Within the overall objective of informing effective ways to promote the combined Measles, Mumps, Rubella (MMR) vaccination in Switzerland, the aim of this study was to identify predictors of parents' intention to adhere to official MMR vaccination recommendations. Between October 2012 and January 2013, we surveyed 554 parents of middle school students aged 13 to 15 in Ticino, Switzerland. Guided by Protection Motivation Theory (PMT), the survey covered predictors related to threat and coping appraisal with regards to measles and the MMR vaccine, MMR-related social attitudes and social norms, past experience with the disease and the vaccine, and information sources in the MMR vaccine context. Data were analyzed using Structural Equation Modelling. Among central PMT concepts describing people's threat and coping appraisal, only response (vaccination) efficacy showed to be directly related to parents' intention to adhere to MMR vaccination recommendations (B = .39, p < .001). In addition, social attitudes (B = .38, p < .001) were a direct predictor. Furthermore, social attitudes, social norms, knowing somebody who experienced MMR vaccination side effects, and having sought MMR information from public health institutions, all indirectly predicted parents' intention to adhere to MMR recommendations by activating different threat and coping appraisal mechanisms. To conclude, future communication measures from public health institutions should highlight the altruistic aspect (herd immunity) of the immunization practice as well as present evidence on the high effectiveness of the vaccination in reducing the risk at both the individual and collective levels of getting infected with measles.

Vaccine promotion: impact of risk level on attitudes

Purpose

The purpose of this paper is to examine the impact of personal relevance, source credibility and advertising appeal type on the emotional and cognitive processing of a direct to consumer pharmaceutical ad for a meningitis vaccine.

Design/methodology/approach

A 2 × 2 experiment was used, and path analysis was undertaken to test the hypotheses.

Findings

Resultant models indicated that unvaccinated (more at risk) and vaccinated (less at risk) participants are persuaded through different pathways. More specifically, vaccinated participants rely more on message credibility than creative strategy to form their cognitive evaluation of the message, whereas non-vaccinated subjects’ cognitive evaluations of the message depend on creative strategy (advertising appeal type) more than message credibility. Differences between individuals who were certain of the vaccine status and those who were not certain of their vaccine status were also apparent. Implications and areas for future research are also presented.

Practical implications

When using direct to consumer pharmaceutical ad for a vaccine, advertisers should take into account the perceived risk level of and relevance to audience members.

Originality/value

Personal relevance and risk are issues which impact the effectiveness of different types of advertising appeals, but less prior research has focused on this aspect of the target audience for direct to pharmaceutical vaccine advertisements.

Public Understanding of Medical Countermeasures

Medical countermeasures, including new drugs and vaccines, are necessary to protect the public's health from novel diseases and terrorist threats. Experience with the 2001 anthrax attack and the 2009 H1N1 pandemic suggest that there is limited willingness to accept such drugs and that minority groups may respond differently from others. We conducted 148 intercept interviews in the metropolitan Washington, DC, area, examining 2 hypothetical scenarios: a new respiratory virus and public exposure to high levels of radiation. Findings provide insights into key factors that affect whether diverse members of the public comply with recommended protective actions like taking emergency authorized vaccines. These insights can help improve how public health practitioners communicate during uncertain times.