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

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

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.

Study Overview

• Status: Completed
• Conditions: Vaccine Refusal
• Intervention / Treatment: Behavioral: Trust boost

• Study Type: Interventional
• Enrollment (Actual): 4039
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom
    • Qualtrics. The data is gathered via an online platform.

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

16

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control sender + control content; 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; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Control sender + Medium trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Control sender+ high trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Low trust boost Sender + control content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Low trust boost Sender + low trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Low trust boost Sender + medium trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Low trust boost sender + high trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Medium trust boost Sender + control content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Medium trust boost sender + low trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Medium trust boost sender + Medium trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: Medium trust boost Sender+ high trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: High trust boost sender + control content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: High trust boost sender + low trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: High trust boost Sender + medium trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.
Experimental: High trust boost sender + high trust boost content; 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; The investigators adapt the wording of the vaccination invitation to foster trust and increase vaccination acceptance.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: University of Essex
• Collaborators: University of Southern California; Kingston University; Department of Health and Social Care
• Investigators: Study Chair: Marie Juanchich, PhD, University of Essex

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2022
• Primary Completion (Actual): February 28, 2022
• Study Completion (Actual): March 5, 2022

Study Registration Dates

• First Submitted: February 1, 2022
• First Submitted That Met QC Criteria: February 11, 2022
• First Posted (Actual): February 14, 2022

Study Record Updates

• Last Update Posted (Actual): May 24, 2022
• Last Update Submitted That Met QC Criteria: May 17, 2022
• Last Verified: May 1, 2022

More Information

Terms related to this study

• Keywords: vaccine hesitancy; trust; COVID-19 vaccination acceptance; health inequality; racial/ethnicity
• Additional Relevant MeSH Terms: Coronavirus Infections; Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Pneumonia, Viral; Pneumonia; Lung Diseases; COVID-19
• Other Study ID Numbers: ETH2122-0265

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: The data of the study will be shared on the Open Science Framework after publication.
• IPD Sharing Time Frame: The data and the study protocol will be shared after the main scientific output is accepted (possibly pending revision). The investigators anticipate this would be early 2023.
• IPD Sharing Access Criteria: The data and study protocol will be free to access to the public
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)

Drug and device information, study documents

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