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

Abstract

ImportanceHesitancy toward COVID-19 vaccination is a major factor in stagnating uptake rates and in the risk of health care systems becoming overwhelmed.ObjectiveTo compare an interactive risk ratio simulation (intervention) with a conventional text-based risk information format (control) and analyze change in participants’ COVID-19 vaccination intention and benefit-to-harm assessment.Design, Setting, and ParticipantsCross-sectional study conducted online with 1255 COVID-19 vaccine–hesitant adult residents of Germany in April and May 2022, surveyed using a probability-based internet panel maintained by respondi, a research and analytics firm. Participants were randomized to 1 of 2 presentations on the benefits and adverse events associated with vaccination.ExposureParticipants were randomized to a text-based description vs an interactive simulation presenting age-adjusted absolute risks of infection, hospitalization, ICU admission, and death after exposure to coronavirus in vaccinated vs unvaccinated individuals relative to the possible adverse effects as well as additional (population-level) benefits of COVID-19 vaccination.Main Outcomes and MeasuresAbsolute change in respondents’ COVID-19 vaccination intention category and benefit-to-harm assessment category.ResultsParticipants were 1255 COVID-19 vaccine–hesitant residents of Germany (660 women [52.6%]; mean [SD] age, 43.6 [13.5] years). A total of 651 participants received a text-based description, and 604 participants received an interactive simulation. Relative to the text-based format, the simulation was associated with greater likelihood of positive change in vaccination intentions (19.5% vs 15.3%, respectively; absolute difference, 4.2%; adjusted odds ratio [aOR], 1.45; 95% CI, 1.07-1.96; P = .01) and benefit-to-harm assessments (32.6% vs 18.0%; absolute difference, 14.6%; aOR, 2.14; 95% CI, 1.64-2.80; P < .001). Both formats were also associated with some negative change. However, the net advantage (positive – negative change) of the interactive simulation over the text-based format was 5.3 percentage points for vaccination intention (9.8% vs 4.5%) and 18.3 percentage points for benefit-to-harm assessment (25.3% vs 7.0%). Positive change in vaccination intention (but not in benefit-to-harm assessment) was associated with some demographic characteristics and attitudes to COVID-19 vaccination; negative changes were not.Conclusions and RelevanceIn this cross-sectional study, vaccine-hesitant adults presented with an interactive risk ratio simulation were more likely to show positive change in COVID-19 vaccination intention and benefit-to-harm assessment than those presented with a conventional text-based information format. These findings suggest that the interactive risk communication format can be an important tool in addressing vaccination hesitancy and fostering public trust.

The impact of nontransparent health communication during the COVID-19 pandemic on vaccine-hesitant people’s perception of vaccines

“…The tabular structure makes it easy to compare the benefits, risks, and uncertainties associated with each outcome, typically expressed as the number of individuals per 1,000 or 10,000; it also ensures that the evidence is clear and substantiated by ample supporting data ( 28 , 29 ). Also, tested communication examples exist that help public health communicators to receptively explain scientific uncertainty to the public ( 8 , 19 ). Especially people who are skeptical of the certitude conveyed by public officials have been found to be most responsive to an open communication about uncertainties ( 8 , 19 ).…”

“…No official statistics are available on the gender, age, ethnicity, and education of COVID-19 vaccine-hesitant individuals in Germany, so a quota sampling method to gain representativeness regarding demographics was not possible. Data presented within this manuscript were retrieved as a supplementary poll on subjective risk communication perception during the second survey wave of a larger vaccine-hesitancy project, for which the sample size calculation and the inclusion and exclusion criteria can be found elsewhere ( 19 ). The vaccine-hesitancy project was approved by the Institutional Review Board (IRB) of the Charité – Universitätsmedizin Berlin (EA1/360/21).…”

“…Omissions of relevant information [e.g., of actual magnitude, harm, or denominator ( 14–17 )] or misrepresentations [e.g., spurious precision, neglect of uncertainty ( 8 , 14 )] are frequent problems that, due to the nature of the pandemic, also arose repeatedly in public health communication during the COVID-19 pandemic. The use of nontransparent reporting techniques may be owed to the unprecedented dilemma politicians and public health experts faced: balancing transparent and truthful communication with the potential negative consequences of disclosing harms ( 1 , 8 , 18 , 19 ). Nontransparency, however, carries both short- and long-term risks.…”

“…In the short term, it may backfire and make people more, not less, reluctant to comply with public health measures. In the long term, incomplete or nontransparent information decreases trust in health authorities ( 20 ) and can foster the spread of conspiracy beliefs ( 1 , 19 ). Some research communities therefore called for full transparent disclosure of COVID-19 information—including degrees of scientific uncertainties and the potential limitations of vaccines ( 8 , 21 , 22 )—arguing that the negative impact on uptake caused by a public discovery of obfuscated facts post-rollout could be far worse than any negative impact arising from transparent communication upfront about negative or complicating factors ( 23 ).…”

“…Some research communities therefore called for full transparent disclosure of COVID-19 information—including degrees of scientific uncertainties and the potential limitations of vaccines ( 8 , 21 , 22 )—arguing that the negative impact on uptake caused by a public discovery of obfuscated facts post-rollout could be far worse than any negative impact arising from transparent communication upfront about negative or complicating factors ( 23 ). Vaccine-hesitant people—characterized by a strong need for information on both benefits and harms and a potential willingness to get vaccinated if information is convincing ( 19 , 24 )—can be especially deterred by nontransparent messaging.…”