Testing Theory-Enhanced Messaging to Promote COVID-19 Vaccination Among Adults: Randomized Controlled Trial.

Area of Science:

• Public Health
• Behavioral Science
• Vaccinology

Background:

• Low COVID-19 vaccine uptake in the US is linked to pandemic fatigue, reduced risk perception, misinformation, and mental health symptoms.
• Novel communication strategies are explored to enhance vaccine acceptance.
• Research is needed to address barriers to vaccination.

Purpose of the Study:

• To evaluate the effectiveness of attitudinal inoculation and cognitive behavioral therapy (CBT) kernel messaging compared to standard public health messaging on COVID-19 vaccine uptake.
• To assess the impact of these interventions on vaccine willingness.
• To examine differences based on anxiety and depression symptoms.

Main Methods:

• A 3-arm, assessor-blinded, randomized controlled trial was conducted with adult US residents.
• Participants received either attitudinal inoculation, CBT kernel messaging, or standard public health messaging.
• Eligibility criteria included prior COVID-19 vaccination but no recent doses or SARS-CoV-2 infection.

Main Results:

• Overall COVID-19 vaccine uptake was low (1.2%) and did not significantly differ between the intervention arms and the standard messaging arm.
• Neither the attitudinal inoculation nor the CBT kernel intervention showed a significant increase in vaccine uptake compared to standard messaging.
• Willingness to receive a vaccine dose remained similar across groups and was not influenced by mental health status.

Conclusions:

• Theory-enhanced messaging strategies have not yet proven successful in increasing COVID-19 vaccine uptake.
• Behavioral shifts through messaging alone are challenging due to declining public trust and a diminished sense of urgency.
• Further research is required to identify and overcome informational and behavioral barriers to vaccination.