Health Communication to Influence COVID-19 Vaccination Intent and Message Propagation

Study Overview
=================
Brief Summary
-----------------
This is a randomised controlled experiment in the form of a web based survey study which randomly exposes participants to different forms of public health messages, after which participants will be assessed on their intent to take up the COVID-19 vaccine, recommend the vaccine, and also willingness to propagate the exposed message.

Official Title
-----------------
Effective Public Health Communication to Influence COVID-19 Vaccination Intent and Message Propagation: A Randomized Controlled Experiment

Conditions
-----------------
COVID-19, Respiratory Disease, Vaccine Refusal, Infectious Disease, Coronavirus Infections, Behavior, Health, Pneumonia, Respiratory Tract Infections, Lung Diseases, Pneumonia, Viral

Intervention / Treatment
-----------------
* Behavioral: Health message exposure


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Willing and able to give informed consent for participation in the trial Malaysian nationality. Can understand either the English or Malay language. Aged 18 years or above Exclusion Criteria: Received at least one COVID-19 vaccination dose

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Descriptive Norm (70%)<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing that about 70% of Malaysians have expressed acceptance for the COVID-19 vaccine. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Descriptive Norm<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing that the COVID-19 vaccine has been widely tested including with the elderly and people with existing health conditions, while subsequently highlighting that the vaccine was already received by millions worldwide. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Healthcare worker (HCW) recommendation<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content highlights recommendation from Malaysian healthcare workers to get the vaccine, since majority of them has already received it, including the Malaysian Health Director General Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Negative attribute framing<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing the rate of side effects occurring with COVID-19 vaccination in a negative frame. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Positive attribute framing<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing the rate of side effects occurring with COVID-19 vaccination in a positive frame. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Risky choice framing (Safety)<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing a risky choice frame which compares the death rates occurring with COVID-19 vaccination versus contracting the virus itself. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Risky choice framing (Side effects)<br>Intervention in the form of a message likened to a social media post. Composed of 3 parts: Opening tag line highlighting the main concern that Malaysians have about the COVID-19 vaccine (safety and side effects) Message content describing a risky choice frame that compares the incidence rates of blood clots occurring with COVID-19 vaccination versus contracting COVID-19. Rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Control message<br>Control message containing only rally slogan: It's safe and effective! | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + Descriptive Norm<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + HCW recommendation<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + Negative attribute framing<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + Positive attribute framing<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + Risky choice framing (Safety)<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|
| Experimental: Combination message: Descriptive Norm (70%) + Risky choice framing (Side effects)<br>Participants received 2 messages which were exposed one at a time. Sequence of message appearing randomly rotated. | Behavioral: Health message exposure<br>* Participants exposed to a health message and requested to read it completely. Subsequently requested to answer post intervention questions that form basis for outcome measures.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in intent to accept the COVID-19 vaccine amongst the Malaysian adult population. | Outcome measure was assessed using a questionnaire answered through a 4 point ordinal scale. Scale ranges from 'Definitely no, Not sure, but probably no, Not sure, but probably yesto Definitely yes. | Immediately before and after message exposure during questionnaire administration. | 
| Change in intent to recommend the COVID-19 vaccine to healthy adults. | Outcome measure was assessed using a questionnaire answered through a 5 point ordinal scale. Scale ranges from Strongly disagree, Disagree, Not sure, Agree, and Strongly agree. | Immediately before and after message exposure during questionnaire administration. | 
| Change in intent to recommend the COVID-19 vaccine to elderly. | Outcome measure was assessed using a questionnaire answered through a 5 point ordinal scale. Scale ranges from Strongly disagree, Disagree, Not sure, Agree, and Strongly agree. | Immediately before and after message exposure during questionnaire administration. | 
| Change in intent to recommend the COVID-19 vaccine to people with existing health conditions. | Outcome measure was assessed using a questionnaire answered through a 5 point ordinal scale. Scale ranges from Strongly disagree, Disagree, Not sure, Agree, and Strongly agree. | Immediately before and after message exposure during questionnaire administration. | 
| Intent to share message on social media platform. | Outcome measure was assessed using a questionnaire answered through a 5 point ordinal scale.Scale ranges from Strongly disagree, Disagree, Not sure, Agree, and Strongly agree. | Immediately after message exposure during questionnaire administration. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Moderators of vaccination intent. | Outcome measure assessed using a series of questions answered through a 5 point ordinal scale. Scale ranges from Strongly disagree, Disagree, Not sure, Agree, and Strongly agree. | Immediately after message exposure during questionnaire administration. | 
| Reliability of various information sources about COVID-19. | Outcome measure assessed using a questionnaire that list out various types of information sources and having participants to rate the reliability for each source using a 5 point ordinal scale. Scale ranges from Strongly not reliable, Not reliable, Not sure, Reliable, and Strongly reliable. | Immediately after message exposure during questionnaire administration. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
message, messaging, propagation, intent, vaccine, recommend