Co-Designing a Mobile-Based Game to Improve Misinformation Resistance and Vaccine Knowledge in Uganda, Kenya, and Rwanda

Figures & data

Figure 1. Vaccine denial techniques within the FLICC framework.

Table 1. Frequency and description of vaccine-related fallacies from literature review (bracketed text is terminology for each fallacy used in the game)

Fallacy/Trick	Frequency	Description
Appeal to nature (Natural is best)	10	The view that something natural is inherently good while unnatural things are inherently bad (Howard & Reiss, 2018; Kata, 2012; Wawrzuta, Jaworski, Gotlib, & Panczyk, 2021). In the context of vaccines, this fallacy takes the form of assuming that because vaccines are man-made, they are unnatural and therefore potentially dangerous or inferior to natural immunity (Fasce et al., 2021; Stolle et al., 2020).
Post hoc (False cause)	10	Latin for “after this, therefore because of this,” this fallacy confuses correlation with causation. It involves incorrectly identifying two things as being causally associated without enough evidence to do so (CHOP, 2018; Stolle et al., 2020; Zimmerman et al., 2005). A common example is the claimed link between autism and the MMR vaccine (Stolle et al., 2020).
Evil intent	9	Suspicion about individuals, organizations, corporations, or overarching belief systems (e.g., doctors, the government, pharmaceutical companies, “Western medicine”) are an integral feature of anti-vaxxers and conspiracy theorists (Moran, Lucas, Everhart, Morgan, & Prickett, 2016). Conspiracy theorists consider healthcare and government systems untrustworthy because they believe they are corrupt and colluding with pharmaceutical companies, have conflicts of interest, and are deceiving the people (Fasce et al., 2021).
Anecdote (Personal stories)	7	This fallacy prioritizes personal experiences over scientific evidence, referring to first-hand “testimonies” and personal “narratives” as “evidence” that vaccines are injurious and harmful (Fasce et al., 2021). An example is a heart-breaking story from a mother about her child being hospitalized shortly after a vaccination (Moran, Lucas, Everhart, Morgan, & Prickett, 2016).
Ad Hominem (Personal attack)	5	Translated from Latin for “to the person,” ad hominems attempt to discredit a person’s arguments or science by personally attacking them (Cook, 2021). One type of ad hominem is genetic fallacy, where arguments are dismissed by their source of origin. For example, the fact that vaccines are made by pharmaceutical companies is enough to discredit them (Howard & Reiss, 2018).
Misrepresentation	6	Generally, the misrepresentation fallacy involves misrepresenting a situation or system in such a way as to distort scientific understanding. For example, the claim that vaccines can cause the diseases they are meant to prevent, or that vaccines contain active viruses (Fasce et al., 2021).
Cherry picking (Pick and choose)	5	This fallacy involves focusing on individual cases or data that seem to confirm a particular position, while ignoring a significant portion of related cases or data that may contradict that position (Howard & Reiss, 2018).
Conspiracy theories	5	Vaccine conspiracy theories involve governments, pharmaceutical companies, doctors, CDC/WHO, or the media, conspiring to deceive the public about vaccine dangers/adverse side effects from the public (Fasce et al., 2021). Conspiracy theories are an integral feature of the anti-vaccine movement (Howard & Reiss, 2018).
Impossible expectations	6	Unrealistic standards of safety or efficacy are often demanded when it comes to vaccine safety (Stolle et al., 2020). This involves the demand that vaccination should be 100% safe, and because absolute safety cannot be promised, vaccines are flawed and dangerous. (Fasce et al., 2021).
Fake experts	5	People are more likely to rely on ideas offered by expert sources but often lack the resources, knowledge, or time to resolve whether someone is an expert or not. This makes them vulnerable to the influence of “fake” experts, who represent themselves as possessing relevant knowledge and expertise when they have none (Lewandowsky et al., 2021). Appealing to fake expertise is also known as an argument from false authority (Howard & Reiss, 2018).

Figure 2. Onboarding script.

Table 2. Initial sketches through to final, amalgamated design of East African Cranky Uncle cartoon characters

	Selected Option	Option 2	Option 3	Final Design	Suggested Revisions
Cranky Uncle					He needed to appear more balding with gray hair Add a shirt pocket with pens Have him wear spectacles and a watch
Older woman					Head scarf style to change from West African to East African Add large shoulder handbag Change heeled shoes to flat slide sandals
Younger woman					Change hairstyle to braided hair in a bun with two hanging braids More form-fitted black vest top Change shoes to high heels Add make-up and earrings, small shoulder handbag, and mobile phone
Younger man					Make pants into distressed jeans Change shoes to sneakers Add cap and headphones
Health Worker					Have all-blue attire under white coat Remove stethoscope Add pocket holding thermometer Change hair from bun to tied up in a braid

The digitized Cranky Uncle and HW within the “option” columns were the characters included in the prototype of the game played during the co-design workshops.

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