Improving COVID-19 vaccine uptake: a message co-design process for a national mHealth intervention in Colombia

BACKGROUND

COVID-19 vaccination is a global priority. Latin American countries have some of the highest COVID-19 death rates worldwide with vaccination hampered by a variety of reasons, including mis- and disinformation, vaccine hesitancy, and vaccine supply constraints. Addressing vaccine hesitancy through effective messages has been found to help increase vaccine uptake. Participatory processes could be used to co-design health messages for this purpose.

OBJECTIVE

This article describes the methodology used to co-design evidence-based audio messages to be deployed in a cohort of individuals through an interactive voice response (IVR) mobile phone survey intervention, aimed towards increasing vaccination uptake in an adult population in Colombia.

METHODS

Participants of the COVID-19 vaccination message co-design process included a sample of the general population of the country, representatives of the funder organisation, and research team members. The co-design process consisted of four phases: (1) formative quantitative and qualitative research, (2) message drafting based on the results of the formative research, (3) message content evaluation, and (4) evaluation of the voices to deliver the audio messages; and was informed by reflexive meetings.

RESULTS

Three categories of evidence-based audio messages were co-designed, each corresponding to an arm of the mHealth intervention: (1) factual messages, (2) narrative messages, and (3) mixed messages. An additional fourth arm with no message was proposed for control. The iterative co-design process ended with a total of 14 audio messages recorded to be deployed via the intervention.

CONCLUSIONS

Co-developing health messages in response to health emergencies is possible. Adopting more context-relevant, participatory, people-centred, and reflexive multidisciplinary approaches could help develop solutions that are more responsive to the needs of populations and public health priorities. Investing resources in message co-design is deemed to have a greater potential for influencing behaviours and improving health outcomes.

How Emotional Shifts Effect Youth Perceptions of Opioid Risk and Efficacy: Testing a Know the Truth Campaign Narrative

Integrating the extended parallel process model (EPPM) and the emotional flow hypothesis, we tested the persuasive effect of emotional shifts during exposure to a Know the Truth anti-opioid campaign narrative in a sample of middle-school students (n = 480). Testing two emotional flow sequences (threat to efficacy and efficacy to threat) of the Know the Truth narrative against a static (threat-only) emotional condition, we found that youth exposed to any emotional flow narrative reported higher levels of hope and lower levels of fear than those exposed to a threat-only narrative. We also found that a threat to efficacy narrative elicited higher levels of self-efficacy than an efficacy to threat emotional flow condition, suggesting that the emotional sequence influences self-efficacy, a well-established predictor of health behavior change. We conclude that the traditional threat to efficacy emotional flow may be superior to its inverse (efficacy to threat) when communicating with young people about opioid addiction. Implications for message design are discussed.

Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook

BACKGROUND

Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic.

OBJECTIVE

This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19-related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies.

METHODS

We retrieved all COVID-19-related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter.

RESULTS

Distributions of message elements were largely similar across both sites. However, political figures (P<.001), experts (P=.01), and nonpolitical personalities (P=.01) were significantly more present on Facebook posts compared to Twitter. Infographics (P<.001), surveillance information (P<.001), and certain multimedia elements (eg, hyperlinks, P<.001) were more prevalent on Twitter. In general, Facebook posts received more (normalized) likes (0.19%) and (normalized) shares (0.22%) compared to Twitter likes (0.08%) and shares (0.05%). Elements with greater engagement on Facebook included expressives and collectives, whereas posts related to policy were more engaged with on Twitter. Science information (eg, scientific explanations) comprised 8.5% (73/851) of Facebook and 9.4% (78/826) of Twitter posts. Correctives of misinformation only appeared in 1.2% (11/851) of Facebook and 1.4% (12/826) of Twitter posts.

CONCLUSIONS

In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms.

Message Design Choices Don't Make Much Difference to Persuasiveness and Can't Be Counted On-Not Even When Moderating Conditions Are Specified

Persuaders face many message design choices: narrative or non-narrative format, gain-framed or loss-framed appeals, one-sided or two-sided messages, and so on. But a review of 1,149 studies of 30 such message variations reveals that, although there are statistically significant differences in persuasiveness between message forms, it doesn't make much difference to persuasiveness which option is chosen (as evidenced by small mean effect sizes, that is, small differences in persuasiveness: median mean rs of about 0.10); moreover, choosing the on-average-more-effective option does not consistently confer a persuasive advantage (as evidenced by 95% prediction intervals that include both positive and negative values). Strikingly, these results obtain even when multiple moderating conditions are specified. Implications for persuasive message research and practice are discussed.

Participatory Environmentally Friendly Message Design: Influence of Message Features and User Characteristics

Labels and declarations are one of the tools of environmental management aimed at improving human behavior with regard to the environment. The development process of environmental labels and declarations has been strongly recommended to include participatory consultation with users. Research studies on participatory design of environmentally friendly messages, however, have never been seen. The purpose of this study was to examine participatory environmentally friendly message design with consideration for the effects of message characteristics and user factors. Forty Hong Kong Chinese people adopted a participatory draw-and-tell approach by drawing 26 environmentally friendly messages related to eco-products, energy conservation, and recycling and waste management, and then verbally described their design drawings. The results showed that environmentally friendly messages which were familiar, concrete, easy to visualize, and contained clear context were favored by users, and users with high object imagery preference benefited most from the participatory design through the draw-and-tell approach. This study fills the gap in the literature about participatory design in environmental labels and declarations which are used for promoting eco-friendly behavior in daily life. The findings should help facilitate the participatory development process of environmentally friendly messages for conveying pro-environmental actions.

Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis

OBJECTIVES

This study aimed to identify, assess and summarize available scientific evidence on tailored text messaging interventions focused on type 2 diabetes self-management. The systematic review concentrated on message design and delivery features, and tailoring strategies. The meta-analysis assessed the moderators of the effectiveness of tailored text messaging interventions.

METHODS

A comprehensive search strategy included major electronic databases, key journal searches and reference list searching for related studies. PRISMA and Cochrane Collaboration's guidelines and recommended tools for data extraction, quality appraisal and data analysis were followed. Data were extracted on participant characteristics (age, gender, ethnicity), and interventional and methodological characteristics (study design, study setting, study length, choice of modality, comparison group, message type, format, content, use of interactivity, message frequency, message timing, message delivery, tailoring strategies and theory use). Outcome measures included diet, physical activity, medication adherence and glycated hemoglobin data (HbA1C). Where possible, a random effects meta-analysis was performed to pool data on the effectiveness of the tailored text messaging interventions and moderator variables.

RESULTS

The search returned 13 eligible trials for the systematic review and 11 eligible trials for the meta-analysis. The majority of the studies were randomized controlled trials, conducted in high-income settings, used multi-modalities, and mostly delivered informative, educational messages through an automated message delivery system. Tailored text messaging interventions produced a substantial effect (g = 0.54, 95% CI = 0.08-0.99, p < 0.001) on HbA1C values for a total of 949 patients. Subgroup analyses revealed the importance of some moderators such as message delivery (Q B = 18.72, df = 1, p = 0.001), message direction (Q B = 5.26, df = 1, p = 0.022), message frequency (Q B = 18.72, df = 1, p = 0.000) and using multi-modalities (Q B = 6.18, df = 1, p = 0.013).

CONCLUSIONS

Tailored mobile text messaging interventions can improve glycemic control in type 2 diabetes patients. However, more rigorous interventions with larger samples and longer follow-ups are required to confirm these findings and explore the effects of tailored text messaging on other self-management outcomes.

Using the integrative model of behavioral prediction to understand college students' STI testing beliefs, intentions, and behaviors

OBJECTIVES

To identify salient behavioral determinants related to STI testing among college students by testing a model based on the integrative model of behavioral (IMBP) prediction.

PARTICIPANTS

265 undergraduate students from a large university in the Southeastern US.

METHODS

Formative and survey research to test an IMBP-based model that explores the relationships between determinants and STI testing intention and behavior.

RESULTS

of path analyses supported a model in which attitudinal beliefs predicted intention and intention predicted behavior. Normative beliefs and behavioral control beliefs were not significant in the model; however, select individual normative and control beliefs were significantly correlated with intention and behavior.

CONCLUSIONS

Attitudinal beliefs are the strongest predictor of STI testing intention and behavior. Future efforts to increase STI testing rates should identify and target salient attitudinal beliefs.

Photo-sharing social media for eHealth: analysing perceived message effectiveness of sexual health information on Instagram

Health professionals increasingly use social media to communicate health information, but it is unknown how visual message presentation on these platforms affects message reception. This study used an experiment to analyse how young adults (n = 839) perceive sexual health messages on Instagram. Participants were exposed to one of four conditions based on visual message presentation. Messages with embedded health content had the highest perceived message effectiveness ratings. Additionally, message sensation value, attitudes and systematic information processing were significant predictors of perceived message effectiveness. Implications for visual message design for electronic health are discussed.

Designing Skin Cancer Prevention Messages: Should We Emphasize Gains or Losses? Message Framing, Risk Type, and Prior Experience

PURPOSE

To test whether message framing (ie, gain vs. loss) and risk type (ie, health vs appearance risk) in skin cancer prevention messages interact with one's prior experience.

DESIGN

Two experiments with a 2 (message framing: gain vs loss) × 2 (risk type: health vs appearance risk) factorial design were conducted.

SETTING

The participants were given a URL to the experiment website via e-mail. On the first page of the website, the participants were told that they would be asked to evaluate a skin cancer print public service announcement (PSA): Online experiments.

PARTICIPANTS

A total of 397 individuals participated (236 for experiment 1 and 161 for experiment 2). Apparatus: Four versions of the skin cancer print PSAs were developed. Four PSAs were identical except for the 2 manipulated components: message framing and risk type.

MEASURES

Measures were adopted from Cho and Boster (message framing), Jones and Leary and Kiene et al. (risk type), De Vries, Mesters, van't Riet, Willems, and Reubsaet and Knight, Kirincich, Farmer, and Hood (prior experience), and Hammond, Fong, Zanna, Thrasher, and Borland and Hoffner and Ye (behavioral intent).

ANALYSIS

General linear models were used to test hypotheses.

RESULTS

Three-way interactions among message framing, risk type, and prior experience were found: When the intent of the message was to encourage sunscreen use, the effects of message framing and risk type were shown to be the exact opposite directions from when the intent was to discourage indoor/outdoor tanning.

CONCLUSION

To discourage tanning among those with prior experience, messages emphasizing losses in terms of one's health will work better. For those with no prior experience, messages emphasizing potential appearance losses will work better for discouraging tanning while messages emphasizing gains like improving appearance will do a better job in encouraging sunscreen use.

Information Presentation in Decision and Risk Analysis: Answered, Partly Answered, and Unanswered Questions

For the last 30 years, researchers in risk analysis, decision analysis, and economics have consistently proven that decisionmakers employ different processes for evaluating and combining anticipated and actual losses, gains, delays, and surprises. Although rational models generally prescribe a consistent response, people's heuristic processes will sometimes lead them to be inconsistent in the way they respond to information presented in theoretically equivalent ways. We point out several promising future research directions by listing and detailing a series of answered, partly answered, and unanswered questions.

Modeling message preferences: an adaptive conjoint analysis of persuasive messaging to increase fruit and vegetable consumption

Few past studies have used conjoint analysis to assess message design features and even fewer have looked at health issues. This research applies conjoint analysis to the quest to design motivational messages for African Americans at risk for diet-related adverse health outcomes (e.g., heart disease) in Kentucky. African American health in the state of Kentucky can benefit from a diet high in fruit and vegetable consumption, but little past research has been conducted with African American Kentuckians to explore the best message structure for communicating about increased fruit and vegetable consumption. This study reports on the outcome of the final phase of formative campaign research. We use an adaptive conjoint analysis to identify the most important elements of message design for this group of Kentucky residents. Results indicate that the message's source (i.e., the person delivering the message) is the most important design element for creating persuasive health messaging about fruit and vegetables for African Americans in Kentucky, followed by the stated benefit of eating more fruit and vegetables and the manner in which the behavior is described, respectively. To our knowledge, this study is the first to treat campaign message features as the subject of a conjoint analysis in order to identify which combination of features might be most motivating for a specific target audience. Recommendations for future health communication campaign application, as well as future research are discussed.

Tips from Former Smokers: A Content Analysis of Persuasive Message Features

Years of research on message design and effects provides insight regarding the most persuasive message appeals. The purpose of this study was to evaluate the content of the messages being presented in the Centers for Disease Control and Prevention's Tips from Former Smokers campaign. A content analysis of persuasive message design features was conducted to critically examine campaign content. Campaign materials were coded for the presence of message variables including emotional appeals, evidence presentation, message framing, attitude functions, and source characteristics. Four independent coders analyzed 122 campaign messages, including video, print, and social media posts. Results from this content analysis indicate that the campaign contained more fear and guilt appeals, than other emotions. Evidence was typically presented in the form of a narrative from sources with firsthand experience. Suggestions for persuasive message design in large-scale public health communication campaigns are discussed.

Telling stories, saving lives: creating narrative health messages

Increasingly, health communication practitioners are exploring the use of narrative storytelling to convey health information. For this study, a narrative film was produced to provide information about the human papillomavirus (HPV) and cervical cancer prevention. The storyline centered on Lupita, a young woman recently diagnosed with HPV who informs her family about HPV and the availability of the HPV vaccine for her younger sister. The objective was to examine the roles of identification with characters and narrative involvement (made up of three dimensions: involvement, perceived relevance, and immersion) on perceived response efficacy, perceived severity, and perceived susceptibility to HPV and behavior (discussing the HPV vaccine with a health care provider). A random sample of 450 European American, Mexican American, and African American women between the ages of 25 and 45 years, living in the Los Angeles area, was surveyed by phone before, 2 weeks after, and 6 months after viewing the film. The more relevant women found the narrative to their own lives at 2 weeks, the higher they perceived the severity of the virus and the perceived response efficacy of the vaccine to be. Also at 2 weeks, identifying with characters was positively associated with perceived susceptibility to HPV but negatively associated with perceived severity. At 6 months, identification with specific characters was significantly associated with perceived threat and behavior. These findings suggest that different aspects of narrative health messages should be manipulated depending on the specific beliefs and behaviors being targeted. Implications for narrative message design are discussed.

Introduction to the special issue: message design in health communication research

Message design is one of the most complex and vibrant research areas in the communication discipline. Based on the preconference of the 2014 Kentucky Conference on Health Communication, this special issue of Health Communication is focused on a broad range of message design concerns. It features 10 original articles addressing topics ranging from fundamental questions related to theory and method to questions of message adaptation for translation and dissemination. Together, these articles reflect the rich variety of health behaviors addressed by health communication researchers and the breadth and depth of theoretical, methodological, and practical approaches to be considered in message design research.

The role of implied motion in engaging audiences for health promotion: encouraging naps on a college campus

OBJECTIVE

Lack of sleep among college students negatively impacts health and academic outcomes. Building on research that implied motion imagery increases brain activity, this project tested visual design strategies to increase viewers' engagement with a health communication campaign promoting napping to improve sleep habits.

PARTICIPANTS

PARTICIPANTS (N = 194) were recruited from a large southwestern university in October 2012.

METHODS

Utilizing an experimental design, participants were assigned to 1 of 3 conditions: an implied motion superhero spokes-character, a static superhero spokes-character, and a control group.

RESULTS

The use of implied motion did not achieve the hypothesized effect on message elaboration, but superheroes are a promising persuasive tool for health promotion campaigns for college audiences.

CONCLUSIONS

Implications for sleep health promotion campaigns and the role of implied motion in message design strategies are discussed, as well as future directions for research on the depiction of implied motion as it relates to theoretical development.

Effects of ethnic targeting on the perceived effectiveness of cancer prevention messages among latinas and non-latina white women

In general, efforts to target Latinos are made through Spanish-language messages, yet 75% of U.S. Latinos are bilingual or English dominant. Acculturation (adapting mainstream traits) is associated with increased lifestyle-related risk behaviors. Latinos maintain cultural traits and ethnic identification even as they appear to acculturate (e.g., through language). This raises questions about how to communicate health information to more-acculturated Latinos who are not reached by traditional Spanish outreach yet may not identify with general-market messages. This study tested the relative efficacy of English-language messages targeted to Latinas, compared with general-market messages, among highly acculturated Latina women and non-Latina White women. In this pair of online experiments, Latinas (n = 715) and non-Latina White women (n = 704) rated the perceived effectiveness of general-market versus Latina-targeted Pap smear and mammogram public service announcements. In 1 of 2 experiments ethnically targeted messages were rated relatively more effective for the intended audience and equally effective for the general audience. The author discusses implications for how campaigns reach U.S. Latinos across the acculturation spectrum.