When do persuasive messages on vaccine safety steer COVID-19 vaccine acceptance and recommendations? Behavioural insights from a randomised controlled experiment in Malaysia
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Abstract
Vaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions.
Methods
A randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes.
Results
We found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms.
Conclusion
Message frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions.
Trial registration number
NCT05244356 .
Article activity feed
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SciScore for 10.1101/2022.04.17.22273942: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Studies have shown that there is strong associations between education level and extent of COVID-19 related knowledge, both factual and perceived.[74,75] Coupled with a lesser perceived severity of the virus by more educated individuals, these messages may have been interpreted with a risk benefit analysis to suggest healthy individuals …
SciScore for 10.1101/2022.04.17.22273942: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Studies have shown that there is strong associations between education level and extent of COVID-19 related knowledge, both factual and perceived.[74,75] Coupled with a lesser perceived severity of the virus by more educated individuals, these messages may have been interpreted with a risk benefit analysis to suggest healthy individuals not requiring the vaccine.[75] Limitations: Our experiment exhibits the following limitations. Study outcomes measured how messages affect intent and do not really indicate whether participants would actually receive or recommend the vaccine in reality. Although actual vaccination behaviour should be the prime outcome of interest, intent has been shown to be a strong predictor for behavioural actions over various contexts, even for actual vaccination uptake.[76] However, significant intention-behavior gaps for vaccination has been shown to exist,[77] with a study even concluding that nudges are ineffective at significantly raising actual COVID-19 vaccination rates.[18] Previous research have also shown differing results when applying behavioral nudges to promote COVID-19 vaccination under experimental conditions versus in the field.[78] These findings underscore the need to field test behavioural interventions that are proven successful in survey experiments to confirm their true effectiveness under real world conditions. The extent of misinformation that participants were exposed to prior to our experiment was not measured. Misinformation has...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT05244356 Completed Health Communication to Influence COVID-19 Vaccination Inten… 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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