Understanding and Overcoming the Racial/Ethnic Inequalities in COVID-19 Vaccination Acceptance

Study Overview
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Brief Summary
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With the constant threat of new epidemic waves and the emergence of variants, COVID-19 resilience can only be attained when a sufficient level of immunity is achieved. Yet, in the US and the UK, COVID-19 vaccination campaigns have failed to secure consistent vaccination acceptance in racial/ethnic minority communities. Despite racial/ethnic minorities being more at risk from COVID-19, they are less vaccinated than the White majority. The investigators propose that current vaccination invitation messages are deemed less trustworthy by racial/ethnic minorities than the White majority and that this might partly explain reduced vaccination acceptance. To provide causal evidence of the role of trust and actionable insights, the investigators will experimentally assess the benefits of new invitation messages to receive the COVID-19 booster dose in large, racially/ethnically diverse samples in the US and the UK. Results will evidence how to increase message and source trustworthiness to foster trust and vaccination acceptance across racial/ethnic groups.

Official Title
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Mind the Vaccination Gap: Understanding and Overcoming the Racial/Ethnic Inequalities in COVID-19 Vaccination Acceptance

Conditions
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Vaccine Refusal

Intervention / Treatment
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* Behavioral: Trust boost


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Exclusion Criteria: if participants complete the study in less than 5 minutes if participants complete the study without paying attention (as indicated by their answers to two attention check questions)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: In a 4 x 4 experimental design, the investigators will manipulate the content of the vaccination invitation message in within-subject and the message source in between-subjects. Each participant will hence read four versions of the COVID-19 booster vaccination invitation message sent by one of the four possible sources.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control sender + control content<br>Participants will read the following text in an online survey: You are invited to book your COVID-19 booster vaccination. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | |
| Experimental: Control sender + Low trust boost content<br>Participants will read the following text in an online survey: You are invited to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Control sender + Medium trust boost content<br>Participants will read the following text in an online survey: You are invited to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Control sender+ high trust boost content<br>Participants will read the following text in an online survey: You are invited to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. This vaccination is especially important for people who are at higher risk from COVID such as older individuals or those from ethnic minorities. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, a fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Low trust boost Sender + control content<br>Participants will read the following text in an online survey: As your local GP, I would like to invite you to book your COVID-19 booster vaccination. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Low trust boost Sender + low trust boost content<br>Participants will read the following text in an online survey: As your local GP, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Low trust boost Sender + medium trust boost content<br>Participants will read the following text in an online survey: As your local GP, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Low trust boost sender + high trust boost content<br>Participants will read the following text in an online survey: As your local GP, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. This vaccination is especially important for people who are at higher risk from COVID such as older individuals or those from ethnic minorities. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, a fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Medium trust boost Sender + control content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Medium trust boost sender + low trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Medium trust boost sender + Medium trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: Medium trust boost Sender+ high trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. This vaccination is especially important for people who are at higher risk from COVID such as older individuals or those from ethnic minorities. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, a fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: High trust boost sender + control content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 Dr Sanjay Kumar | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: High trust boost sender + low trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 Dr Sanjay Kumar | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: High trust boost Sender + medium trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 Dr Sanjay Kumar | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|
| Experimental: High trust boost sender + high trust boost content<br>Participants will read the following text in an online survey: As your local GP and a health expert who cares for the local community, I would like to invite you to book your COVID-19 booster vaccination. The vaccine reduces your chance of becoming infected and protects you against severe forms of the illness. It also protects your loved ones by reducing the risk that you infect others. COVID can be severe, don't risk it. This vaccination is especially important for people who are at higher risk from COVID such as older individuals or those from ethnic minorities. Vaccines may cause side effects, but the benefits outweigh the risks. The most common side effects are very mild (e.g., sore arm, a fever) and severe side effects are very rare (e.g., allergic reaction). Click here to book an appointment: accurx.thirdparty.nhs.uk/r/aafwaczmd5 Dr Sanjay Kumar | Behavioral: Trust boost<br>* The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Trust perception | Perceived trustworthiness of the vaccine invitation. Participants will rate how trustworthy is the invitation message on a 5 point Likert scale (1: Untrustworthy 3: Not sure, 5: Trustworthy) | immediately after intervention | 
| Vaccination appointment booking | Likelihood to book a vaccination appointment via the message. Participants will report if they would use the link in the message to book their vaccination appointment on a 5 point Likert scale (1: No, I would not, 3: Not sure/maybe later, 5: Yes, I would) | immediately after intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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COVID-19 vaccination acceptance, vaccine hesitancy, trust, health inequality, racial/ethnicity