An Evaluation of a Dynamic Web-Based Visualization of Community Immunity

This study is a PhD project conducted by Ms. Hina Hakim, supervised by Dr. Holly O. Witteman, PhD, and co-supervised Dr. Daniel Reinharz, professors and researchers at the Faculty of Medicine at Laval University. The purpose of this study is to evaluate the effects of visualization conveying the concept of community immunity or herd immunity on risk perception (towards individual, family, community and vulnerable people in communities) (primary outcome) and on emotions, attitudes, knowledge, and behavioural intentions (secondary outcomes).

Study Overview

• Status: Completed
• Conditions: Vaccine-Preventable Diseases
• Intervention / Treatment: Behavioral: herdimm; Behavioral: robertkochgeneric; Behavioral: sbsnewsgeneric; Behavioral: guardianmeasles; Behavioral: theotheredmundmeasles; Behavioral: publichealthagencycanadaflu

Detailed Description

Visualization is a powerful communication mechanism that uses pre-attentive processing to communicate large amounts of information rapidly in understandable and compelling ways (Healey and Enns 2012). A systematic review demonstrates that there are some interventions available for conveying the concept of community immunity, and very few evaluate interventions for their effects on vaccine intentions and uptake as well as their precursors, such as knowledge, attitudes, knowledge and none on emotions (Hakim et al. 2018).

The purpose of this study is to evaluate the effects of visualization conveying the concept of community immunity on risk perception (to individual, family, community and vulnerable people in communities) (primary outcome) and on emotions, attitudes, knowledge, and behavioural intentions (secondary outcomes).

• Study Type: Interventional
• Enrollment (Actual): 5516
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Québec, Canada, G1V 0A6
    • Université Laval

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Members of the general population in Canada
• At least 18 years old
• Able to provide free and informed consent
• Able to read and understand French or English
• Able to use a computer

Exclusion Criteria:

- No internet access

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Factorial Assignment
• Masking: Single

Number of Arms

13

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: controlgeneric; No intervention provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English and French.
No Intervention: controlmeasles; No intervention provided. Participant answers outcome questions about measles. English and French.
No Intervention: controlpertussis; No intervention provided. Participant answers outcome questions about pertussis. English and French.
No Intervention: controlflu; No intervention provided. Participant answers outcome questions about flu. English and French.
Experimental: herdimmgeneric; Web-based application (main intervention) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English and French.	Behavioral: herdimm; In this visualization participants can build their own avatar representing themselves and 8 other avatars representing people around them, like their family or coworkers. Our visualization then uses these avatars in a brief narrated video explaining how herd immunity works.
Experimental: herdimmmeasles; Web-based application (main intervention) provided. Participant answers outcome questions about measles. English and French.	Behavioral: herdimm; In this visualization participants can build their own avatar representing themselves and 8 other avatars representing people around them, like their family or coworkers. Our visualization then uses these avatars in a brief narrated video explaining how herd immunity works.
Experimental: herdimmpertussis; Web-based application (main intervention) provided. Participant answers outcome questions about pertussis. English and French.	Behavioral: herdimm; In this visualization participants can build their own avatar representing themselves and 8 other avatars representing people around them, like their family or coworkers. Our visualization then uses these avatars in a brief narrated video explaining how herd immunity works.
Experimental: herdimmflu; Web-based application (main intervention) provided. Participant answers outcome questions about flu. English and French.	Behavioral: herdimm; In this visualization participants can build their own avatar representing themselves and 8 other avatars representing people around them, like their family or coworkers. Our visualization then uses these avatars in a brief narrated video explaining how herd immunity works.
Active Comparator: robertkochgeneric; Web-based application (comparator) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English only.	Behavioral: robertkochgeneric; A web-based application showing how herd immunity works in general: http://rocs.hu-berlin.de/D3/herd/
Active Comparator: sbsnewsgeneric; Video (comparator) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English only.	Behavioral: sbsnewsgeneric; A video showing how herd immunity works in general: https://www.sbs.com.au/news/two-sydney-babies-too-young-to-be-vaccinated-infected-with-measles
Active Comparator: guardianmeasles; Video (comparator) provided. Participant answers outcome questions about measles. English only.	Behavioral: guardianmeasles; A screen capture of an interactive visualization: https://www.theguardian.com/society/ng-interactive/2015/feb/05/-sp-watch-how-measles-outbreak-spreads-when-kids-get-vaccinated
Active Comparator: theotheredmundmeasles; Video (comparator) provided. Participant answers outcome questions about measles. English only.	Behavioral: theotheredmundmeasles; A gif showing measles spreading through populations with differing levels of vaccine coverage: https://imgur.com/gallery/8M7q8#J7LANQ4
Active Comparator: publichealthagencycanadaflu; Video (comparator) provided. Participant answers outcome questions about flu. English and French.	Behavioral: publichealthagencycanadaflu; A video showing how herd immunity works in the context of influenza: https://www.canada.ca/fr/sante-publique/services/video/la-grippe-n-en-passez-pas-les-maux.html

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Risk perception	6 items assessing risk perception (item 1 = risk perception as comprehension, scale 0-100, higher numbers better; items 2-5 = risk perception as feelings, scale 1-7, higher numbers better; complete list of items and response wording available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf)	immediately after intervention or control

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emotions	5 items (e.g., "I am worried about getting [disease]", "I would feel guilty if a vulnerable person (a baby, a young child, an older person, a cancer patient) got [disease] from me") with a 7-point Likert-type response scale ranging from "strongly disagree" to "strongly agree"; higher numbers may be better; complete list of items and response wording available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf	immediately after intervention or control
Knowledge	15 items, with 2 multiple choice questions and 13 true/false questions, for a total possible score ranging from 0 to 18; higher numbers better; complete list of items available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf	immediately after intervention or control
Trust in information	Single item (Control: "During your life, you may have seen information about vaccines. Thinking about the information you have seen, how trustworthy was it?" Treatment: "Earlier, you saw a {{video, website}} about herd immunity. Thinking about the {{video, website}} you saw earlier, how trustworthy was the information in it?") with Likert-type response options 1 = not at all trustworthy, 2 = moderately untrustworthy, 3 = slightly untrustworthy, 4 = neutral, 5 = slightly trustworthy, 6 = moderately trustworthy, 7 = strongly trustworthy	immediately after intervention or control
Vaccination intentions	Questions conditioned on whether the participant indicates they believe they are already immune to the disease in question, e.g., "Imagine you were not already immune to {{measles/pertussis/influenza/a vaccine preventable disease}}. If you were eligible to receive a free vaccine against {{measles/pertussis/influenza/a vaccine-preventable disease}}, how likely would you be to get vaccinated?" Response scale on a slider: 0 = extremely unlikely, I would definitely NOT be vaccinated; 100 = extremely likely, I would definitely BE vaccinated; higher numbers better.	immediately after intervention or control
5C scale	"5C scale: 15-item validated scale measuring the psychological antecedents of vaccination (Betsch et al., 2018)"	immediately after intervention or control

Collaborators and Investigators

• Sponsor: Laval University
• Investigators: Principal Investigator: Holly Witteman, PhD, Laval University

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2021
• Primary Completion (Actual): July 1, 2021
• Study Completion (Actual): July 1, 2021

Study Registration Dates

• First Submitted: March 4, 2021
• First Submitted That Met QC Criteria: March 4, 2021
• First Posted (Actual): March 9, 2021

Study Record Updates

• Last Update Posted (Actual): August 29, 2024
• Last Update Submitted That Met QC Criteria: August 27, 2024
• Last Verified: August 1, 2024

More Information

Terms related to this study

• Keywords: web-based application; herd immunity; visualization; community immunity
• Additional Relevant MeSH Terms: Infections; Vaccine-Preventable Diseases
• Other Study ID Numbers: herdimm

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Anonymized data (answers to questions in the survey including socio-demographic information) will be deposited in a public repository (Dataverse de l'Université Laval (Laval University)) which will allow data sharing with the scientific community. No information that would allow anyone to identify a person will be deposited in this public repository. Study protocol and statistical analysis plan have been deposited in Open Science Framework.
• IPD Sharing Time Frame: As soon as possible upon completion of the study and posting of a preprint with results.
• IPD Sharing Access Criteria: Freely available.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No