Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial,The Lancet Public Health

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Effects of different types of written vaccination information on COVID-19 vaccine hesitancy in the UK (OCEANS-III): a single-blind, parallel-group, randomised controlled trial
The Lancet Public Health ( IF 25.4 ) Pub Date : 2021-05-13 , DOI: 10.1016/s2468-2667(21)00096-7
Daniel Freeman ₁ , Bao Sheng Loe ₂ , Ly-Mee Yu ₃ , Jason Freeman ₄ , Andrew Chadwick ₅ , Cristian Vaccari ₅ , Milensu Shanyinde ₃ , Victoria Harris ₃ , Felicity Waite ₁ , Laina Rosebrock ₆ , Ariane Petit ₆ , Samantha Vanderslott ₇ , Stephan Lewandowsky ₈ , Michael Larkin ₉ , Stefania Innocenti ₁₀ , Andrew J Pollard ₁₁ , Helen McShane ₁₂ , Sinéad Lambe ₆

Affiliation

Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
The Psychometrics Centre, University of Cambridge, Cambridge, UK.
Nuffield Department of Primary Care and Health Sciences, University of Oxford, Oxford, UK.
Department of Psychiatry, University of Oxford, Oxford, UK.
Online Civic Culture Centre, Department of Communication and Media, Loughborough University, Loughborough, UK.
Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
School of Psychological Science, University of Bristol, Bristol, UK.
Department of Psychology, Life and Health Sciences, Aston University, Birmingham, UK.
Smith School of Enterprise and the Environment, University of Oxford, Oxford, UK.
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.
The Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford, UK.

Background

The effectiveness of the COVID-19 vaccination programme depends on mass participation: the greater the number of people vaccinated, the less risk to the population. Concise, persuasive messaging is crucial, particularly given substantial levels of vaccine hesitancy in the UK. Our aim was to test which types of written information about COVID-19 vaccination, in addition to a statement of efficacy and safety, might increase vaccine acceptance.

Methods

For this single-blind, parallel-group, randomised controlled trial, we aimed to recruit 15 000 adults in the UK, who were quota sampled to be representative. Participants were randomly assigned equally across ten information conditions stratified by level of vaccine acceptance (willing, doubtful, or strongly hesitant). The control information condition comprised the safety and effectiveness statement taken from the UK National Health Service website; the remaining conditions addressed collective benefit, personal benefit, seriousness of the pandemic, and safety concerns. After online provision of vaccination information, participants completed the Oxford COVID-19 Vaccine Hesitancy Scale (outcome measure; score range 7–35) and the Oxford Vaccine Confidence and Complacency Scale (mediation measure). The primary outcome was willingness to be vaccinated. Participants were analysed in the groups they were allocated. p values were adjusted for multiple comparisons. The study was registered with ISRCTN, ISRCTN37254291.

Findings

From Jan 19 to Feb 5, 2021, 15 014 adults were recruited. Vaccine hesitancy had reduced from 26·9% the previous year to 16·9%, so recruitment was extended to Feb 18 to recruit 3841 additional vaccine-hesitant adults. 12 463 (66·1%) participants were classified as willing, 2932 (15·6%) as doubtful, and 3460 (18·4%) as strongly hesitant (ie, report that they will avoid being vaccinated for as long as possible or will never get vaccinated). Information conditions did not alter COVID-19 vaccine hesitancy in those willing or doubtful (adjusted p values >0·70). In those strongly hesitant, COVID-19 vaccine hesitancy was reduced, in comparison to the control condition, by personal benefit information (mean difference –1·49, 95% CI –2·16 to –0·82; adjusted p=0·0015), directly addressing safety concerns about speed of development (−0·91, –1·58 to –0·23; adjusted p=0·0261), and a combination of all information (−0·86, –1·53 to –0·18; adjusted p=0·0313). In those strongly hesitant, provision of personal benefit information reduced hesitancy to a greater extent than provision of information on the collective benefit of not personally getting ill (−0·97, 95% CI –1·64 to –0·30; adjusted p=0·0165) or the collective benefit of not transmitting the virus (−1·01, –1·68 to –0·35; adjusted p=0·0150). Ethnicity and gender were found to moderate information condition outcomes.

Interpretation

In the approximately 10% of the population who are strongly hesitant about COVID-19 vaccines, provision of information on personal benefit reduces hesitancy to a greater extent than information on collective benefits. Where perception of risk from vaccines is most salient, decision making becomes centred on the personal. As such, messaging that stresses the counterbalancing personal benefits is likely to prove most effective. The messaging from this study could be used in public health communications. Going forwards, the study highlights the need for future health campaigns to engage with the public on the terrain that is most salient to them.

Funding

National Institute for Health Research (NIHR) Oxford Biomedical Research Centre and NIHR Oxford Health Biomedical Research Centre.

中文翻译：

英国不同类型的书面疫苗接种信息对 COVID-19 疫苗犹豫的影响 (OCEANS-III)：一项单盲、平行组、随机对照试验

背景

COVID-19 疫苗接种计划的有效性取决于大众参与：接种疫苗的人数越多，人群面临的风险就越小。简洁、有说服力的信息至关重要，特别是考虑到英国对疫苗的犹豫不决。我们的目的是测试除了功效和安全性声明之外，哪些类型的有关 COVID-19 疫苗接种的书面信息可能会提高疫苗的接受度。

方法

对于这项单盲、平行组、随机对照试验，我们的目标是招募 15 000 名英国成年人，并对他们进行配额抽样以使其具有代表性。参与者被随机分配到按疫苗接受程度（愿意、怀疑或强烈犹豫）分层的十种信息条件中。控制信息条件包括取自英国国家卫生服务网站的安全性和有效性声明；其余条件涉及集体利益、个人利益、疫情的严重性和安全问题。在线提供疫苗接种信息后，参与者完成了牛津 COVID-19 疫苗犹豫量表（结果衡量；分数范围 7-35）和牛津疫苗信心和自满量表（调解衡量）。主要结果是接种疫苗的意愿。参与者按其分配的组进行分析。调整p值以进行多重比较。该研究已在 ISRCTN 注册，ISRCTN37254291。

发现

2021年1月19日至2月5日，招募了15014名成年人。对疫苗犹豫的比例从上一年的 26·9% 减少到 16·9%，因此招募时间延长至 2 月 18 日，另外招募了 3841 名对疫苗犹豫不决的成年人。 12 463 (66·1%) 参与者被分类为愿意，2932 (15·6%) 被分类为怀疑，3460 (18·4%) 被分类为强烈犹豫（即报告他们将尽可能长时间地避免接种疫苗）或永远不会接种疫苗）。信息条件并没有改变那些愿意或怀疑的人对 COVID-19 疫苗的犹豫（调整后的 p 值>0·70）。在那些强烈犹豫的人中，与对照条件相比，个人受益信息减少了对 COVID-19 疫苗的犹豫（平均差 –1·49，95% CI –2·16 至 –0·82；调整后的 p=0· 0015），直接解决有关开发速度的安全问题（−0·91，–1·58 至 –0·23；调整后的 p=0·0261），以及所有信息的组合（−0·86，–1· 53 至 –0·18；调整 p=0·0313）。对于那些非常犹豫的人来说，提供个人福利信息比提供个人未患病的集体利益信息更能减少犹豫（−0·97，95% CI –1·64 至 –0·30；调整后的 p =0·0165）或不传播病毒的集体利益（−1·01，–1·68 至 –0·35；调整后的 p=0·0150）。研究发现种族和性别可以调节信息条件结果。

解释

大约 10% 的人群对 COVID-19 疫苗非常犹豫，提供个人利益信息比提供集体利益信息更能减少犹豫。在对疫苗风险的认知最为突出的地方，决策就以个人为中心。因此，强调平衡个人利益的信息可能被证明是最有效的。这项研究的信息可用于公共卫生传播。展望未来，该研究强调未来的健康运动需要在对公众最重要的领域与公众进行接触。