A Web Application About Herd Immunity Using Personalized Avatars: Development Study
Authors: Hakim Hina , Bettinger Julie A. , Chambers Christine T. , Driedger S. Michelle , Dubé Ève , Gavaruzzi Teresa , Giguere Anik , Kavanaugh Eric , Leask Julie , MacDonald Shannon , Orji Rita , Parent Élizabeth , Paquette Jean-Sébastien , Roberge Jacynthe , Sander Beate , Scherer Aaron M , Tremblay-Breault Martin , Wilson Kumanan , Reinharz Daniel , Witteman Holly 
Published: May 2020

Background: ‘Herd immunity’ or ‘community immunity’ refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving understanding of community immunity may increase intentions to get vaccinated.Objective: We aimed to design a web application about community immunity and optimize it based on viewers’ cognitive and emotional responses.Methods: Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them; for example, their family or coworkers. The application integrates these avatars in a 2-minute visualization showing how different parameters (e.g., vaccine coverage, contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, a public library.) Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, electroencephalogram) to assess participants’ cognitive and affective (emotional) responses to the visualization, and verbal reports to assess their interpretations of the visualization’s content and messaging.Results and analysis: Participants across all four cycles (N=110 in total) were 62% women and 35% men (4% not reported), with mean age 38 years (SD 17). Fifty-nine percent of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using colour and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Third and finally, evaluating users’ emotional responses during the design process, in addition to their cognitive responses, offers insights and findings that help inform the final design of an intervention. Conclusions: Visualizations with personalized avatars may help people understand their individual roles in population health. Our application showed promise as a method of communicating the relationship between individual behaviour and community health. Next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential roadmap for designing health communication materials for complex topics such as community immunity.