Interventions to help people understand community immunity: A systematic review

Abstract

296/300 words Background: The dynamic relationships between individual-and community-level behaviors and outcomes are at the heart of public health. Herd immunity, or community immunity, offers an example of such a relationship. Community immunity occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. Knowledge of such relationship varies among the general public. Methods: We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. Results: We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating the effects of the interventions; of these 10, 4 reported increased knowledge about immunization, 3 reported shifts of attitudes in favour of vaccination, 1 reported an increase in intentions to vaccinate among participants who viewed an visual simulation. Conclusions:A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to do this may be important, because some evidence 6 suggests that effective communication about community immunity can increase vaccine intentions. Highlights (3-5 bullet points, max 85 characters each including spaces)• Little evidence is available about the effects of communicating about community immunity.• Effective communication about community immunity may increase vaccine intentions.• Future research should focus on how to communicate this concept effectively.

A Web Application About Herd Immunity Using Personalized Avatars: Development Study

“…Our project builds on the limited previous literature on visualization to convey the concept of community immunity. On the basis of our systematic review [ 13 ], Betsch et al [ 10 ] are the only team to have developed and evaluated such an interactive visualization. Their visualization increased vaccination intentions and demonstrated the promise of this medium for conveying the concept of community immunity.…”

“…Emotions play an important role in health decision making [ 17 ], especially when deciding on behalf of loved ones [ 64 ], as is the case when deciding about vaccinating one’s children [ 65 ]. To the best of our knowledge, no previous study has considered emotions in developing a tool to explain community immunity [ 13 ]. In keeping with the Affect Heuristic within our framework, our study explicitly considered emotion, as expressed in verbal feedback and measured with psychophysiological data.…”

“…A systematic review identified visualization as a promising avenue for communicating the complex concept of community immunity [ 13 ]. By visualization, we mean the visual presentation of data or information.…”

Practice nurses’ perceptions of their immunization role and strategies used to promote measles, mumps, and rubella vaccine uptake in 2014 – 2018: A qualitative study

“…In a systematic review to explore interventions used to assist populations to understand herd immunity, in two of three interventions about community immunity increases in intention to vaccinate were found suggesting potential benefits of such communication (Hakim et al, 2019). Given this, development of strategies to clearly convey the principles and benefits of herd immunity are warranted.…”

“…There are direct and indirect benefits of herd immunity, the former includes protection of the vaccinated individual, resulting in a reduced chance of infection, whilst the latter relates to the protective effects observed in unvaccinated populations (Kim et al., 2011). In a systematic review to explore interventions used to assist populations to understand herd immunity, in two of three interventions about community immunity increases in intention to vaccinate were found suggesting potential benefits of such communication (Hakim et al., 2019). Given this, development of strategies to clearly convey the principles and benefits of herd immunity are warranted.…”