Understanding and addressing vaccine hesitancy in the context of COVID-19: development of a digital intervention

Abstract

Objectives Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. Study Design & Method: We report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines in the UK. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. Discussion The digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.

How to Motivate SARS-CoV-2 Convalescents to Receive a Booster Vaccination? Influence on Vaccination Willingness

“…On the other hand, the experience of an asymptomatic or moderate SARS-CoV-2 course may reduce the fear of vaccination side effects. Studies on the general population confirm that fear of side effects, or a lack of confidence in vaccine safety, results in a lower willingness to vaccinate [ 36 , 37 , 38 , 40 , 42 , 43 , 46 , 47 ]. Furthermore, a high level of trust in the vaccination effectiveness positively influences the willingness to vaccinate in the general population [ 36 , 38 , 40 , 56 ].…”

“…Until now, influencing factors and reasons for the low vaccination willingness of SARS-CoV-2 convalescents are still unclear. Therefore, preliminary considerations on this issue need to be based on general behavioral models, psychological models of vaccination behavior [ 34 , 35 ], or refer to pandemic studies of the general population [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ].…”

“…Since the onset of the SARS-CoV-2 pandemic, numerous systematic reviews examined factors influencing SARS-CoV-2 vaccination willingness in the general population [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Influencing factors are sociodemographic aspects, vaccine-related aspects (such as fear of adverse vaccination reactions), and political beliefs, trust in government, or pre-existing diseases [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Interestingly, SARS-CoV-2 infection itself may also be an influencing factor on vaccination willingness [ 37 ].…”

“…Influencing factors are sociodemographic aspects, vaccine-related aspects (such as fear of adverse vaccination reactions), and political beliefs, trust in government, or pre-existing diseases [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ]. Interestingly, SARS-CoV-2 infection itself may also be an influencing factor on vaccination willingness [ 37 ]. In a study from the UK ( n = 762) on the general population, three SARS-CoV-2 convalescents stated that they had already been infected with SARS-CoV-2 and therefore there was no longer need to receive a booster vaccination for SARS-CoV-2 [ 37 ].…”

“…Interestingly, SARS-CoV-2 infection itself may also be an influencing factor on vaccination willingness [ 37 ]. In a study from the UK ( n = 762) on the general population, three SARS-CoV-2 convalescents stated that they had already been infected with SARS-CoV-2 and therefore there was no longer need to receive a booster vaccination for SARS-CoV-2 [ 37 ]. This indicates that factors influencing the vaccination willingness of SARS-CoV-2 convalescents may differ from those of the general population [ 33 ].…”