Fact boxes that inform individual decisions may contribute to a more positive evaluation of COVID-19 vaccinations at the population level

Abstract

Objective For an effective control of the SARS-CoV-2 pandemic with vaccines, most people in a population need to be vaccinated. It is thus important to know how to inform the public with reference to individual preferences–while also acknowledging the societal preference to encourage vaccinations. According to the health care standard of informed decision-making, a comparison of the benefits and harms of (not) having the vaccination would be required to inform undecided and skeptical people. To test evidence-based fact boxes, an established risk communication format, and to inform their development, we investigated their contribution to knowledge and evaluations of COVID-19 vaccines. Methods We conducted four studies (1, 2, and 4 were population-wide surveys with N = 1,942 to N = 6,056): Study 1 assessed the relationship between vaccination knowledge and intentions in Germany over three months. Study 2 assessed respective information gaps and needs of the population in Germany. In parallel, an experiment (Study 3) with a mixed design (presentation formats; pre-post-comparison) assessed the effect of fact boxes on risk perceptions and fear, using a convenience sample (N = 719). Study 4 examined how effective two fact box formats are for informing vaccination intentions, with a mixed experimental design: between-subjects (presentation formats) and within-subjects (pre-post-comparison). Results Study 1 showed that vaccination knowledge and vaccination intentions increased between November 2020 and February 2021. Study 2 revealed objective information requirements and subjective information needs. Study 3 showed that the fact box format is effective in adjusting risk perceptions concerning COVID-19. Based on those results, fact boxes were revised and implemented with the help of a national health authority in Germany. Study 4 showed that simple fact boxes increase vaccination knowledge and positive evaluations in skeptics and undecideds. Conclusion Fact boxes can inform COVID-19 vaccination intentions of undecided and skeptical people without threatening societal vaccination goals of the population.

Vaccination Intention Following Receipt of Vaccine Information Through Interactive Simulation vs Text Among COVID-19 Vaccine–Hesitant Adults During the Omicron Wave in Germany

“…In our cross-sectional study of 1255 COVID-19 unvaccinated, vaccine-hesitant residents of Germany, we found that conventional text-based information formats may be less helpful in reaching vaccine-hesitant people than interactive risk ratio The outcomes of behavioral interventions in increasing the understanding and/or uptake of vaccination have been tested previously, also in the context of COVID-19 vaccine. 9,12,18 However, these studies did not limit the analysis to declared vaccine-hesitant respondents or test an We also observed some negative changes in vaccination intention and benefit-to-risk assessment in both groups. Because reasons for change were not assessed, we can only speculate as to why this occurred.…”

“…The outcomes of behavioral interventions in increasing the understanding and/or uptake of vaccination have been tested previously, also in the context of COVID-19 vaccine . However, these studies did not limit the analysis to declared vaccine-hesitant respondents or test an experience-based format (interactive risk simulation) against a conventional text-based risk format.…”

How Communicating Vaccine Benefits and Harms in Fact Boxes Affects Risk Perceptions

“…It is an integral component of many health behavior models in terms of the “possibility of loss” (van der Pligt, 1996, p. 34). A study of the risk perception in fact boxes, with a focus on the benefit aspect of vaccination (i.e., preventing the disease), showed that providing a fact box can decrease the estimated probability of COVID-19 but did not affect the fear of contraction or the perceived severity of the infection (Rebitschek et al, 2022). Since adequate risk perceptions are crucial for health decision-making (Sheeran et al, 2014), the present study aimed to provide more insights into this aspect…”

“…It summarizes the best available clinical evidence about an intervention's most important benefits and harms, comparing a treatment to a control group (e.g., a vaccine vs. placebo vaccine; Harding Center for Risk Literacy, 2019). Fact boxes are well understood, enable knowledge gain and an easier comparative assessment of two behavioral options than text-based summaries (Brick et al, 2020;McDowell et al, 2019;Rebitschek et al, 2022;Schwartz et al, 2007Schwartz et al, , 2009. However, the impact of fact boxes on people's risk perceptions deserves more attention.…”

How to convince the vaccine‐hesitant? An ease‐of‐access nudge, but not risk‐related information increased Covid vaccination‐related behaviors in the unvaccinated

“…A facts box provides absolute risk information on the benefits and harms of a medical intervention, adjusted to the same denominator, for both a control and an intervention group in a tabular format (Brick et al, 2020; Eddy, 1990; McDowell et al, 2016; Schwartz et al, 2007). Such a tabular provision of information has been shown to facilitate both the understanding of the benefit and harm information and the correct recall of both flu and COVID vaccination facts (Brick et al, 2020; Rebitschek et al, 2022).…”