Fact boxes that inform individual decisions may contribute to a more positive evaluation of COVID-19 vaccinations at the population level

Abstract

Objective: For an effective control of the SARS-CoV-2 pandemic with vaccines, most people in a population need to be vaccinated. It is thus important to know how to inform the public with reference to individual preferences-while also acknowledging the societal preference to encourage vaccinations. According to the health care standard of informed decision-making, a comparison of the benefits and harms of (not) having the vaccination would be required to inform undecided and skeptical people. To test evidence-based fact boxes, an established risk communication format, and to inform their development, we investigated their contribution to knowledge and evaluations of COVID-19 vaccines.

Methods: We conducted four studies (1, 2, and 4 were population-wide surveys with N = 1,942 to N = 6,056): Study 1 assessed the relationship between vaccination knowledge and intentions in Germany over three months. Study 2 assessed respective information gaps and needs of the population in Germany. In parallel, an experiment (Study 3) with a mixed design (presentation formats; pre-post-comparison) assessed the effect of fact boxes on risk perceptions and fear, using a convenience sample (N = 719). Study 4 examined how effective two fact box formats are for informing vaccination intentions, with a mixed experimental design: between-subjects (presentation formats) and within-subjects (pre-post-comparison).

Results: Study 1 showed that vaccination knowledge and vaccination intentions increased between November 2020 and February 2021. Study 2 revealed objective information requirements and subjective information needs. Study 3 showed that the fact box format is effective in adjusting risk perceptions concerning COVID-19. Based on those results, fact boxes were revised and implemented with the help of a national health authority in Germany. Study 4 showed that simple fact boxes increase vaccination knowledge and positive evaluations in skeptics and undecideds.

Conclusion: Fact boxes can inform COVID-19 vaccination intentions of undecided and skeptical people without threatening societal vaccination goals of the population.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Proportion of respondents according to their intention to get vaccinated against COVID-19 or indicating that they already had.

Independent samples were weighted at the time of their assessment. Error bars show 95% confidence intervals.

Fig 2. Number of correct items increased over two months according to respondents’ intention to get vaccinated against COVID-19.

The independent samples were weighted at the time of their assessment. Error bars show the standard error of the mean.

Fig 3. English translation of the simple fact box for people between the ages of 18 and 60 from Study 4.

Fig 4

Proportion of correct responses to five knowledge items according to different levels of education and household net income for respondents younger than 60 years of age (A) and 60 years of age and older (B). The sample is weighted. Error bars show the standard error of the mean.