The COVID-19 breakthrough we have all been waiting for came this week: a vaccine. If this vaccination is approved, it would allow the world to return to normality. In order for this vaccine to be most effective and herd immunity to be in place, we need 60-70% of the population to be vaccinated. So far, there are mixed views regarding vaccine-uptake; a recent paper published in Nature surveyed 13,426 people in 19 countries and reported that 71.5% would be very or somewhat likely to get a vaccine. However, this likelihood varies across countries. For example, only 55% of respondents in Russia positively responded to the vaccine. Meanwhile, a survey conducted in the UK identified concerns regarding the initial side-effects and the long-term impact. As a result, it is crucial that careful consideration is put into the vaccine communication strategy to overcome these barriers. There are many factors which can impact the likelihood of vaccine-uptake, such as the freedom to choose to be vaccinated, trust in health providers and also trust in the safety and efficacy of the vaccination itself. Another area, from behavioural science, that should be considered in the communication is message framing, which refers to the manipulation of information to signify the gains or losses of carrying out a certain behaviour.
Over the last 20 years, there has been a lot of research into message framing and health communication, primarily looking at framing outcomes of particular health behaviour in terms of a gain or a loss. A gain-frame portrays a positive valence and refers to the benefit of adopting a behaviour, whereas a loss-frame focuses on the costs of not adopting a behaviour. For example, a gain frame for vaccinations would be “you reduce the chances of getting flu if you vaccinate”, whereas a loss frame would be “you increase the chances of getting flu if you do not vaccinate”. These two statements have the same meaning, yet their wording can influence the effectiveness and make one frame more persuasive than another.
This concept is based on the Nobel Prize-winning theory, Prospect Theory, proposed by Daniel Kahneman and Amos Tversky. This theory proposes that, due to loss aversion, losses have a more severe psychological impact than gains of the same amount. For example, a loss of £10 means more than gaining the same value. As a result, individuals are more risk-seeking when losses are emphasised in order to avoid this loss, whilst being risk-averse to retain their gains when gains are emphasised. As a result, it is important to know the conditions in which one frame is more influential in altering intentions and attitudes for health behaviours, as this can result in more effective targeting on health interventions.
When it comes to encouraging healthy behaviours, they can be classified as prevention (such as flossing) or detection (such as mammograms). This is an important distinction because gain and loss frames are differentially effective, depending on whether a behaviour is for prevention or detection. Specifically, loss frames are thought to be more effective for detection behaviours, whilst gain frames are more effective for prevention behaviours. This is because there is an increased risk with detection behaviours, compared to prevention, because the outcome could result in a diagnosis of a health condition.
In the case of vaccinations, although they are a preventative behaviour as they reduce the risk of contracting illnesses, they also carry a higher level of risk compared to other preventative behaviours like applying sunscreen or exercising. Specifically, many people are afraid of needles and the side-effects of vaccinations, such as fever and swelling. As a result, the message framing effects for vaccinations are not the same as other prevention methods. In fact, researchers have more frequently identified loss-frames to be more effective than gain-frames when looking at vaccinations, such as Measles Mumps Rubella (MMR) and Human Papillomavirus (HPV). In the case of COVID-19, this is something to be considered in the communication of the benefits of the vaccination.
In addition to testing different framing strategies before implementing the final COVID-19 vaccine communication, it is also important to test the framed communications in different contexts, as these frames can be more effective depending on the message recipient and situational factors. For example, vaccination communication strategies harnessing a loss frame have been found to be particularly effective when the vaccination is personally relevant to the individual and when the individuals are present-minded, in a positive mood and seeking to avoid negative stimuli. In the case of COVID-19, this would mean that a loss-framed campaign may be more suitable for vulnerable individuals, for example, older generations who are more at risk from the virus, compared to younger generations. This emphasises that generic communication is not likely to be successful, and messages need to be tailored to different individuals.
The COVID-19 vaccine promises to make radical changes throughout the world and is the first step for returning to normality, but in order for the population to be willing to receive the vaccine, local authorities must consider some tools from behavioural science, including how to frame the message, and thoroughly pre-test the messages to ensure they will be well received.
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