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Background
Vaccination coverage needs to reach more than 80% to resolve the COVID-19 pandemic, but vaccine hesitancy, fuelled by misinformation, may jeopardize this goal. Unvaccinated older adults are not only at risk of COVID-19 complications but may also be misled by false information. Prebunking, based on inoculation theory, involves ‘forewarnin...
Context in source publication
Citations
... Of the 49 identified studies, 22 studies were conducted in the USA, 27-48 4 in the UK, [49][50][51][52] 4 studies were carried out in multiple country settings spanning countries globally, 3 in China, 53-55 2 in Canada, 56 57 2 in Italy, 58 59 2 in Japan, 60 61 2 in Jordan, 62 63 1 in Australia, 64 1 in Denmark, 65 1 in France, 66 1 in Germany, 67 1 in Ireland, 68 1 in Malaysia 69 and 1 in Pakistan. [70][71][72][73][74] 10 of the included studies took place before official approval of any COVID-19 vaccine in the region of interest, and all of them were conducted in 2020. ...
... Evidence suggests that an E&I strategy results in little to no impact on confidence (SMD 0.05, 95% CI −0.22 to 0.32; I²=54%; low-certainty evidence; online supplemental figure S7). Both studies 50 Robertson et al, 47 Thorpe et al, 40 Capasso et al, 58 Rinaldi et al, 73 Witus and Larson, 41 Vivion et al, 56 Freeman et al, 49 Helfers et al 67 31 Freeman et al, 67 Pink et al, 37 Okuhara et al, 61 Moehring et al, 74 Vlasceanu and coman 48 , Dai et al, 32 James et al, 34 Santos et al, 38 Sasaki et al 60 58 Barnes et al, 64 Sasaki et al 60 Capasso et al 58 58 Kerr et al, 50 Thorpe et al, 40 Barnes et al, 64 Santos et al, 38 Sasaki et al 60 Capasso et al, 58 Thorpe et al 40 Versus no intervention, no intervention alone or with placebo ...
Objective
This systematic review investigates the effectiveness of different communication strategies to increase COVID-19 vaccine uptake and willingness.
Design
Systematic review and meta-analysis of randomised controlled trials (RCTs), following recommendations from the Cochrane Handbook and reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.
Data sources
We searched the following databases until 27 July 2022: Cochrane COVID-19 Study Register, PsycINFO, CINAHL, Web of Science Core Collection and WHO COVID-19 Global literature.
Eligibility criteria for study selection
We included RCTs investigating, any population, communication-based interventions to increase COVID-19 vaccine uptake and comparing these with no intervention (with or without placebo), another communication strategy or another type of intervention.
Methods
Screening, data extraction and bias assessment, using the Cochrane ROB 1.0 tool, were conducted by two authors independently. We performed meta-analyses if studies were homogeneous using the Review Manager (RevMan 5) software, synthesised the remaining results narratively and assessed the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Results
We identified 49 studies reporting on the predefined four categories of communication interventions. Evidence from our meta-analyses shows that COVID-19 vaccine uptake may increase when education and information strategies are applied (risk ratio (RR) 1.23, 95% CI 1.17 to 1.28; high-certainty evidence) or social norms are communicated (RR 1.28, 95% CI 1.23 to 1.33; high-certainty evidence) compared with no intervention. The different communication strategies mostly have little to no impact on vaccine intention; however, there may be a slight increase in vaccine confidence when gain framing is applied compared with no intervention.
Conclusion
Overall, we found that education and information-based interventions or social norm-framing strategies are most effective compared with no intervention given. Our findings show that some of the investigated communication strategies might influence policy decision-making, and our results could be useful for future pandemics as well.
PROSPERO registration number
PROSPERO (CRD42021296618).
... Inoculation theory-based messaging has rarely been evaluated in RCTs for vaccine promotion 4,5 , though observational studies suggest it may reduce receptivity to misinformation, a possible pathway to greater vaccine willingness 14 . Only one similar trial has tested this approach for vaccine uptake, with inconclusive ndings, underscoring the need for further research 4,29 . Given our study took place years into the pandemic, the utility of inoculation messaging may be limited. ...
Uptake of the COVID-19 vaccine has been low in the US (~ 22% among adults in 2023 − 24 ¹ ) despite ongoing public health recommendations. This has been linked to many factors including pandemic fatigue, reduced risk perception, dis/misinformation, and recently, symptoms of depression and anxiety. Novel communication and messaging strategies are one potential approach to promote vaccine uptake. This randomized control trial tests two communication-based approaches compared to standard public health messaging on vaccine uptake in a cohort of adult US residents. We completed a 3-arm, parallel-group, assessor-blinded stratified-randomized trial between April-15-2024 and May-2-2024. Eligible individuals were ≥ 18 years old who: 1)had received at least one dose of the COVID-19 vaccine, but, 2)had not received COVID-19 vaccine doses since September-11-2023, and 3)had not been infected with SARS-CoV-2 in the past three months. We purposively sampled eligible individuals with and without symptoms of anxiety and depression. Participants were randomly allocated to: 1) attitudinal inoculation intervention; 2) CBT-kernels intervention; or 3) standard public health messaging intervention. At four-week follow up, these groups showed no meaningful differences in uptake (CBT- kernels:1.6% [95%CI:0.4–2.8]; Inoculation:0.9% [95%CI:0.0-1.8]; and Standard:1.3% [95%CI:0.3–2.4]) or level of vaccine willingness. Successful efforts to increase uptake of the COVID-19 vaccine via theory-enhanced messaging remain elusive.
... Several studies have found pre-bunking effectively lessens misinformation's effects in experimental settings (Hameleers, 2024). For instance, researchers found that pre-bunking successfully countered COVID-19 vaccine misinformation among Canadians over the age of 50 (Vivion et al., 2022). One potential drawback is that the healthy skepticism honed through pre-bunking messages may lead to a deeper skepticism of credible information (Hameleers, 2024). ...
... Strategies to fight disinformation that were effective with certain limitations include fact-checking and debunking (Arcos et al., 2022;Chan et al., 2017), inoculation (Lewandowsky & Linden, 2021;Vivion et al., 2022), and forewarning, which aim to expose and disprove misleading content (Arcos et al., 2022). Given the constantly evolving social media landscape, previous studies highlighted the role of educational actions in countering the disinformation phenomenon Nygren & Guath, 2022). ...
There is an ongoing debate among scholars on how to tackle disinformation. Media education initiatives to increase literacy are effective ways to counter disinformation. Hence, the European Commission (2022) published Guidelines for Teachers and Educators on Tackling Disinformation and Promoting Digital Literacy Through Education and Training. The present research looked at the role of social media literacy in increasing awareness of the role of social media in spreading disinformation. We developed an educational intervention based on the European Commission guidelines. We investigated its impact on perceived social media literacy, the intention to share fake news on social media, and general conspiracy beliefs. We conducted a within-subject (two times measurement: before the educational intervention and one week after) +1 experiment with = 127 young adults (aged 18 to 23). After filling in an initial survey, the experimental group received a 15-minute educational intervention on the role of social media for disinformation dissemination in complex digital information environments. One week later, all participants completed the second survey to assess perceived social media literacy and general conspiracy beliefs. In both surveys, participants saw three Instagram posts from a fictitious media outlet to express potential intentions to share on social media. Among the three posts, two showed false information. Findings showed that educational intervention produces a significant increase in perceived social media literacy and a decrease in general conspiracy beliefs. Intellectual humility moderates the impact of educational intervention on algorithmic awareness.
... Both prebunking and debunking interventions have been found to be effective in reducing the threat of misinformation 11,13,14,17,[21][22][23][24][25][26] . This paper addresses four main gaps in the literature, with four corresponding research questions. ...
Misinformation surrounding crises poses a significant challenge for public institutions. Understanding the relative effectiveness of different types of interventions to counter misinformation, and which segments of the population are most and least receptive to them, is crucial. We conducted a preregistered online experiment involving 5228 participants from Germany, Greece, Ireland, and Poland. Participants were exposed to misinformation on climate change or COVID-19. In addition, they were pre-emptively exposed to a prebunk, warning them of commonly used misleading strategies, before encountering the misinformation, or were exposed to a debunking intervention afterwards. The source of the intervention (i.e. the European Commission) was either revealed or not. The findings show that both interventions change four variables reflecting vulnerability to misinformation in the expected direction in almost all cases, with debunks being slightly more effective than prebunks. Revealing the source of the interventions did not significantly impact their overall effectiveness. One case of undesirable effect heterogeneity was observed: debunks with revealed sources were less effective in decreasing the credibility of misinformation for people with low levels of trust in the European Union (as elicited in a post-experimental questionnaire). While our results mostly suggest that the European Commission, and possibly other public institutions, can confidently debunk and prebunk misinformation regardless of the trust level of the recipients, further evidence on this is needed.
... Persuasive information can spread quickly from person to person, replicating and evolving to 'infect' as many people as possible [11]. The natural solution to a rapidly spreading virus is a vaccine, and as such inoculation theory has been used to successfully build resistance against climate change misinformation [12,13], anti-vaccine misinformation [14] and political misinformation [15]. ...
Inoculation theory research offers a promising psychological ‘vaccination’ against misinformation. But are people willing to take it? Expanding on the inoculation metaphor, we introduce the concept of ‘inoculation hesitancy’ as a framework for exploring reluctance to engage with misinformation interventions. Study 1 investigated whether individuals feel a need for misinformation inoculations. In a comparative self-evaluation, participants assessed their own experiences with misinformation and expectations of inoculation and compared them to those of the average person. Results exposed a better-than-average effect. While participants were concerned over the problem of misinformation, they estimated that they were less likely to be exposed to it and more skilful at detecting it than the average person. Their self-described likelihood of engaging with inoculation was moderate, and they believed other people would benefit more from being inoculated. In Study 2, participants evaluated their inclination to watch inoculation videos from sources varying in trustworthiness and political affiliation. Results suggest that participants are significantly less willing to accept inoculations from low-trust sources and less likely to accept inoculations from partisan sources that are antithetical to their own political beliefs. Overall, this research identifies motivational obstacles in reaching herd immunity with inoculation theory, guiding future development of inoculation interventions.
... Other researchers have found that critical appraisal is often absent when vaccine-hesitant individuals share "scientific evidence" on the web, which often includes citations that blur the line between legitimate scientific publications and fraudulent studies [98]. However, there is little evidence of communication across networks, despite repeated calls from public health communication experts to prebunk and debunk vaccine misinformation on the web [99,100]. Notably, both communities share a retracted paper, but their framing of the paper varies. ...
Background
Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy.
Objective
In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities.
Methods
To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities.
Results
We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community.
Conclusions
Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively.
... Much information about COVID-19 has also been posted as fake news, which are "false stories that appear to be news, spread on the internet or using other media, usually created to influence political views or as a joke" and without proper medical evidence to support the claims they make [19]. The best way to deal with misinformation and fake news is to use pre-bunking and debunking techniques -the former to warn people about what they might be getting as information, and the latter to reassure people that they have responded correctly to a false claim or fact [20,21]. It is not an easy task to debunk fake news or misinformation once it has been established, as Klein (2023) discusses using the MMR-autism relationship as an example: "The persistent appeal of the vaccine-autism myth, no matter how many times and in how many ways it has been debunked, is that it gives parents who see difference as tragedy something external to blame."[16p200] ...
... Zoran Milosavljević као информација, а ове друге да се људи увере да су правилно одговорили на лажну тврдњу или чињеницу [20,21]. Није лак задатак разоткрити лажне вести или погрешне информације једном када се чврсто укорене, као што разматра Клајн (2023) кроз пример везе ММР и аутизма: ...
This article problematises similarities in social responses to two different types of prevention-antiretrovirals in the form of pre-exposure pro-phylaxis (PrEP) against HIV transmission, and the emerging COVID-19 vaccines against the SARS-COV2 virus. For the purpose of this article, I have revisited the work of Mary Douglas, British social anthropologist (1921-2007) on risk and social responses to risk. In the late 1980s, Mary Douglas described patterns and modalities of social response to risk in emerging epidemics. The same pattern of social dynamics and response could be followed in relation to two pandemics of the 21st century-first, an HIV pandemic that started in the early 80s and in which prevention breakthrough occurred in 2012 with the introduction of pre-exposure prophylaxis-PrEP; and second, the COVID-19 pandemic that started in early 2020 with newly developed vaccines in 2021 as public health response to it.
... 66,69 An example of argument-based prebunking is delivering messages that caution people about anticipated false claims regarding the safety of mRNA vaccines or the rapid approval of COVID-19 vaccines, which are based on actual instances of misinformation found on social media. 79 Tertiary prevention: acute responses to minimise negative effects of infodemics Tertiary prevention in public health and preventive medicine involves preventing disease progression or alleviating symptoms. Similarly, in our proposed framework, tertiary prevention aims to reduce the negative effect of infodemics on public health. ...
The COVID-19 pandemic has highlighted how infodemics (defined as an overabundance of information, including misinformation and disinformation) pose a threat to public health and could hinder individuals from making informed health decisions. Although public health authorities and other stakeholders have implemented measures for managing infodemics, existing frameworks for infodemic management have been primarily focused on responding to acute health emergencies rather than integrated in routine service delivery. We review the evidence and propose a framework for infodemic management that encompasses upstream strategies and provides guidance on identifying different interventions, informed by the four levels of prevention in public health: primary, secondary, tertiary, and primordial prevention. On the basis of a narrative review of 54 documents (peer-reviewed and grey literature published from 1961 to 2023), we present examples of interventions that belong to each level of prevention. Adopting this framework requires proactive prevention and response through managing information ecosystems, beyond reacting to misinformation or disinformation.
... Both prebunking and debunking interventions have been found to be effective in reducing the threat of misinformation 11,13,14,17,[21][22][23][24][25][26] . This paper addresses four main gaps in the literature, with four corresponding research questions. ...
Misinformation surrounding crises poses a significant challenge for public institutions. Understanding the relative effectiveness of different types of interventions to counter misinformation and understanding which segments of the population are most or least receptive to them, is crucial. We conduct a preregistered online experiment involving 5,228 participants from Germany, Greece, Ireland, and Poland. Participants were exposed to misinformation on climate change or Covid-19. In addition, they were pre-emptively exposed to a prebunk, warning them of commonly used misleading strategies, before encountering the misinformation, or a debunking intervention afterward. The source of the intervention (i.e. the European Commission) was either revealed or not. Findings show that both interventions effectively change the four outcome variables in the desired direction in almost all cases, with debunks sometimes being more effective than prebunks. Moreover, revealing the source of the interventions does not significantly impact their overall effectiveness. Although one case of undesirable effect heterogeneity – debunks with revealed source were less effective in decreasing credibility of misinformation for people with low trust in the European Union – was observed, the results mostly suggest that the European Commission, and possibly other institutions, can confidently debunk and prebunk misinformation regardless of the trust level of its recipients.
