The impact of side effect framing on COVID-19 booster vaccine intentions in an Australian sample
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Abstract
Objective
To evaluate the effect of presenting positively attribute-framed side effect information on COVID-19 booster vaccine intention relative to standard negatively-framed wording and a no-intervention control.
Design setting and participants
A representative sample of Australian adults ( N =1,204) were randomised to one of six conditions within a factorial design: Framing (Positive; Negative; Control) * Vaccine (Familiar (Pfizer); Unfamiliar (Moderna)).
Intervention
Negative Framing involved presenting the likelihood of experiencing side effects (e.g., heart inflammation is very rare, 1 in every 80,000 will be affected), whereas Positive Framing involved presenting the same information but as the likelihood of not experiencing side effects (e.g., 79,999 in every 80,000 will not be affected).
Primary Outcome
Booster vaccine intention measured pre- and post-intervention.
Results
Positive Framing ( M =75.7, SE =0.9, 95% CI[73.9, 77.4]) increased vaccine intention relative to Negative Framing ( M =70.7, SE =0.9, 95% CI[68.9, 72.4]) overall ( F (1, 1192)=4.68, p =.031, η p 2 =.004). Framing interacted with Vaccine and Baseline Intention ( F (2, 1192)=6.18, p =.002, η p 2 =.01). Positive Framing was superior, or at least equal, to Negative Framing and Control at increasing Booster Intention, irrespective of the participants pre-intervention level of intent. Side effect worry and perceived severity mediated the effect of Positive vs. Negative Framing across vaccines.
Conclusion
Positive framing of side effect information appears superior for increasing vaccine intent relative to the standard negative wording currently used.
Pre-registration
See: aspredicted.org/LDX_2ZL
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SciScore for 10.1101/2022.05.09.22274840: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: All procedures in this pre-registered study (aspredicted.org/LDX_2ZL) were approved by the University of Sydney Human Research Ethics Committee (reference, 2021/871), and all participants provided informed consent.
Consent: All procedures in this pre-registered study (aspredicted.org/LDX_2ZL) were approved by the University of Sydney Human Research Ethics Committee (reference, 2021/871), and all participants provided informed consent.Sex as a biological variable not detected. Randomization Stratification and randomisation (via random number generation) occurred via inbuilt code. Blinding not detected. Power Analysis Sample size was calculated via an a priori power analysis (95% power, … SciScore for 10.1101/2022.05.09.22274840: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: All procedures in this pre-registered study (aspredicted.org/LDX_2ZL) were approved by the University of Sydney Human Research Ethics Committee (reference, 2021/871), and all participants provided informed consent.
Consent: All procedures in this pre-registered study (aspredicted.org/LDX_2ZL) were approved by the University of Sydney Human Research Ethics Committee (reference, 2021/871), and all participants provided informed consent.Sex as a biological variable not detected. Randomization Stratification and randomisation (via random number generation) occurred via inbuilt code. Blinding not detected. Power Analysis Sample size was calculated via an a priori power analysis (95% power, alpha=.05, effect size f2=0.02) for a separate concurrent study run that contained more predictors (N=9), and therefore required more power (see study pre-registration). Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Limitations of the study include the measurement of intention, but not uptake. While intention has been found to predict vaccination21-24, longitudinal research is needed to directly assess the role of framing on actual uptake, as well as the longevity of the framing effect among those yet to receive a booster vaccine. Relevant to the lag in booster uptake in Australia25, the present research focused on increasing intention among those already receiving a primary course of COVID-19 vaccination. However, these results do not speak to the effect of framing on those never vaccinated. Investigation of framing on vaccine intention at all points of the vaccination programme would provide a more comprehensive account of the effect of framing on vaccine intentions in general. In summary, a brief online intervention engaging participants in side effect estimation before presenting positively framed side effect information can increase booster vaccine intention. Given the ease with which Positive Framing can be implemented, combined with the fact that the presentation of statistical information in this format does not violate patient informed consent9, the potential exists for framing of this type to make a real difference in improving societal protection from COVID-19 through reduced vaccine hesitancy.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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