https://orcid.org/0000-0003-1336-1510
ABSTRACT
Identifying effective interventions to promote children’s vaccination acceptance is crucial for the health and wellbeing of communities. Many interventions can be implemented to increase parental awareness of the benefits of vaccination and positively influence their confidence in vaccines and vaccination services. One potential approach is using narratives as an intervention. This study aims to evaluate the effects of a narrative-based intervention on parents’ attitudes and vaccination intentions. In a pre-post experiment, 2,000 parents of young children recruited from an online pan-Canadian panel were randomly exposed to one of the three videos presenting narratives to promote childhood vaccination or a control condition video about the importance and benefits of physical activity in children. Pre-post measures reveal a relatively modest but positive impact of the narratives on parents’ attitudes and intention to vaccinate their child(ren). The results also suggest that narratives with more emotional content may be more effective in positively influencing vaccine attitudes than the more factual narrative. Using narratives to promote vaccination can positively influence parents’ views and intentions toward childhood vaccines, but research is still required to identify the best components of such interventions.
Introduction
In Canada, routinely recommended vaccines for children are publicly funded, and programs are under the responsibility of provinces and territories which results in slightly different schedules and policies. For example, Ontario and New Brunswick require immunization for diphtheria, tetanus, polio, measles, mumps, and rubella immunization at school entry, while Manitoba requires a measles vaccination.Citation1 In 2021, the childhood National Immunization Coverage Survey estimated that vaccine coverage among 2-year-old children ranged from 77% for receipt of at least four doses of a vaccine against diphtheria, pertussis, and tetanus (DTaP) to 92% for receipt of at least one dose of a vaccine against measlesCitation2 while 2% of children had not received any vaccine in their lifetime. This survey also reported that 6% of the parents of 2-year-olds (whose child had received at least one vaccine) were initially hesitant about vaccinating their child.Citation2 Mis- and disinformation are considered by experts to be a leading cause of or contributor to parental vaccine hesitancy.Citation3–5 To date, most studies on online vaccine misinformation have aimed to measure or quantify false information, used questionnaires to measure people’s belief in different false conspiracy theories, or tested the effect of misinformation on vaccine attitudes using experimental research designs.Citation6–12 While work in this area has begun, there is currently less evidence of effective strategies to counteract or build resilience against false information about vaccination.Citation13
In that context, a promising strategy is using narratives to promote vaccination.Citation14 Some meta-analyses have concluded that narratives are more effective than traditional fact-based educational or informational messages to increase the intention to adopt specific health behaviors.Citation15,Citation16 However, there is less evidence on how to use narratives as a public health strategy to promote vaccination.Citation17,Citation18 Thus, the objective of the study was to evaluate the effects of a narrative-based intervention on Canadian parents’ attitudes and vaccination intentions.
Materials and methods
Data collection/sample
Respondents were drawn from a Leger online panel, a national panel of 400,000 individuals across 10 Canadian provinces (excluding northern territories). Participants aged 18 years old or over who were also parents of at least one child aged 5 or younger and could answer in French or English were eligible to participate. The study was conducted in April and May 2022.
Study design
The study was conducted as a pre-post online experiment presenting narratives to promote childhood vaccination through short videos. Details on the development and pilot-testing of the narratives are reported elsewhere.Citation19
Respondents were introduced to the purpose of the study and were asked to consent to participate. Participants who consented then completed the pre-experiment survey questionnaire that included measures of vaccine attitudes and intention and a series of socio-demographic questions (i.e. province of residence, age, gender, etc.). For progressing through the questionnaire, parents were asked to provide the (real or fictitious) first name of their child under 5 years old (the youngest child if more than one was under 5), which was then used to personalize items on parental attitudes and behaviors regarding vaccination (e.g., Not including COVID-19 vaccines, have you ever refused any routine vaccinations recommended by your health-care provider for “CHILD’S NAME?”).
After completing the pre-experiment survey, participants were randomly assigned into four groups of 500 participants (i.e., one of the three intervention groups or one control condition group). The randomization was automated in the web survey using pure random assignment between control and one of the three intervention groups. Respondents were unable to skip or advance the 2–4 min videos. After viewing the video, participants responded to several questions, including the same vaccine attitudes and intention questions, in addition to other questions related to their level of interest in the video, changes in their opinion toward vaccines, the impact of the COVID-19 pandemic on their vaccination behavior, and frequency of use of the Internet and social media for information about child(ren)’s health. The post-experiment survey collected data on participants’ level of interest in the video and perceived influence of the video on their opinions about childhood vaccination. At the end of the survey, an open-ended question allowed participants to write comments about the study.
The sample size necessary was estimated at 2,000 participants to detect a statistically significant difference of 5% in vaccine intention between the pre- and post-survey for all intervention and control groups (n = 500 for each group). The research firm was responsible for recruitment, survey administration, and ensuring quality (e.g., preventing multiple entries from the same individual and removing careless responses). A representative sample of participants in terms of province of residence was invited to participate. The research team had no access to personal identifying information on the participants.
Intervention and control conditions
Three narratives were tested: 1) Parents’ informed decision-making: an existing online video showing parents of young children explaining why they finally decided to have them vaccinated with routinely recommended vaccines after having first refused due to online negative information about vaccines (available in English, with translation and subtitles added by the team for the French version), 2) A mother’s story: an existing online video showing a mother and her disabled son where the mother of the consequences of a vaccine-preventable disease (VPD) (serogroup B meningococcal disease) for her son and call for action to vaccinate (available in French and in English with subtitles), and 3) A pediatrician’s story: a newly created and developed video involving a publicly known pediatrician and infectious diseases specialist’s account of cases of some VPD encountered in his work (both English and French versions recorded). During the pilot-testing phase of the study (seeCitation19), parents were critical of the healthcare professional’s story and had different suggestions on how to make the video more compelling (e.g., fewer facts and more personal tone). We developed this specific video casting the story of a bilingual Canadian pediatric infectious disease specialist who shared his past clinical experiences treating two children who died from VPDs.
These videos lasted approximately the same length (i.e., 2–4 min). The control condition (Control) consisted of a video involving pediatricians and family doctors explaining the importance and benefits of physical activity in children with images of parents and children physically active. The duration of the control video was similar to those used for the intervention conditions (English and French versions were slightly different, because they were involving characters who spoke only English or French).
Outcomes measures
The two main outcome measures were as follows: 1) intention to accept future routine vaccines and 2) vaccine attitudes. The vaccination intention question (Routine vaccines intention) measured parents’ willingness to accept future routine vaccines (other than COVID-19 vaccine) for their child, using a 6-point scale (very likely, somewhat likely, neither likely nor unlikely, somewhat unlikely, very unlikely and I do not know). Vaccine attitudes were measured using a 5-item validated scale (5C short Scale) developed by Betsch et al.Citation20 to assess vaccine hesitancy. Respondents had to indicate their level of agreement with five statements, using a 5-point scale (strongly disagree = 1, somewhat agree = 2, neither agree nor disagree = 3, somewhat disagree = 4, strongly agree = 5). A score of 3 was attributed to I do not know response.
Statistical analysis
Descriptive statistics were produced for all survey variables. Statistical analyses were conducted using SAS (version 9.4) at 5% significance level. The Routine vaccine Intention was dichotomized, i.e., those who express the intention to get vaccinated (likely-somewhat likely) vs. those who are uncertain or unlikely to get vaccinated (unlikely-somewhat unlikely-neither likely nor unlikely-Do not know).
For the first outcome (i.e., parents’ intention to accept future routine vaccines), a McNemar 2 × 2 table test was conducted to compare the pre- and post-experiment survey results for each intervention and control group. To assess the intervention’s effectiveness, a paired logistic regression analysis was performed.
For the second outcome (i.e., vaccine attitudes), a mean score was calculated for the 5C short Scale for each participant using the approach of Betsch et al.Citation20 Responses to each item were coded as described above. A total mean score was computed for each participant (score ranged 5–25). Differences in scores between the pre- and post-survey for each intervention and control condition were assessed, and a Wilcoxon’s signed-rank test and Kruskal–Wallis test were conducted by condition.
For both outcomes, data were adjusted by age, gender, income, and child’s medical condition (i.e., with or without chronic medical conditions).
Differences in level of interest and perceived change in participants’ opinions about childhood vaccination between each group were assessed. Sensitivity analyses were also conducted to explore the effect of the intervention when only participants with high reported level of vaccine hesitancy (i.e., those who responded “very hesitant or fearful” and “somewhat hesitant or fearful” to the item “How hesitant or fearful do you consider yourself to be about vaccinating your youngest child aged 0 to 5 with a routine recommended vaccine”) were included in analysis.
The Centre de recherche du CHU de Québec-Université Laval Ethics Committee approved this study.
Results
presents sample sociodemographics of participants by group. There were no differences in sociodemographic characteristics between groups, except that there were fewer participants born in Canada assigned to video 2, A mother’s story.
Table 1. Sample demographics by intervention condition and total (%).
Most participants were married or common law (87.6%) and identified as White (71.5%). The majority of participants were either working full-time (68.1%) or part-time (11.6%) (data not shown in the Table).
presents respondent’s child health status and vaccine attitudes and behaviors. At the pre-survey, a majority of the respondents (86.6%) indicated having a favorable intention to get their child any routine recommended vaccines other than the COVID-19 vaccine. Most participants held positive attitudes toward childhood vaccination and most children were vaccinated. Less than 20% reported being very or somewhat hesitant or fearful about vaccines (16.0%, n = 320).
Table 2. Health and vaccination attitudes and behaviors at baseline (%).
With regard to the first outcome, i.e., the effectiveness of the narratives in parents’ intention to accept future routine vaccines, no significant effect was observed post-survey in intervention groups (). Having been assigned to any intervention group condition did not increase participants’ intention to vaccinate when compared to the control condition (AOR = 1.2895, 95% CI [0.9459–1.7578], p = .1078). In sensitivity analysis, when excluding participants reporting a low level of vaccine hesitancy or fearfulness, an increase of 8.6% in intention to accept future vaccines was observed post-survey for the Pediatrician’s story intervention (p = 0,03) (data not shown in the Table).
Table 3. Effect of the videos on participants’ intention to vaccinate with routine recommended vaccines (%) and results of the multivariate analysis.
With regard to the second outcome, i.e., the effectiveness of the narratives to change parents’ attitudes toward vaccination, a slight but significant difference was observed in all intervention groups, except in the control (). In sensitivity analysis, when excluding participants reporting a low level of vaccine hesitancy or fearfulness, no significant change was observed in any groups (data not shown in the Table).
Table 4. Effect of the videos on participants’ attitudes toward childhood vaccines (5C score).
After viewing the allocated video, participants were also asked questions regarding their level of interest in the video they watched and perceived change in opinions about childhood vaccination (). Excluding the control condition, we observed that participants assigned to the Parent’s informed decision-making video were less likely to find the video interesting compared to other videos (p < .0001). When participants were asked if the video had changed their opinion about childhood vaccines, a higher proportion of participants assigned to A mother’s story video agreed compared to the other intervention groups (p < .0001). For most participants, the confidence about their vaccine decisions for their child increased after watching the video, except for participants in the Parent’s informed decision-making video; however, the decrease in confidence observed was not statistically significant.
Table 5. Participants’ level of interest in the video and perceived change in opinion about childhood vaccination (n, %).
A qualitative analysis of the comments left by the participants (n = 361) at the end of the questionnaire also yielded valuable insights regarding participants’ appreciation of the study. While most of the comments stated that respondents did not have additional thoughts to add about the study or the vaccination, we recorded some positive and negative comments related to the video the participant watched or vaccination in general. Some parents indicated having positive views toward vaccines in general but being distrustful of COVID-19 vaccines. Many parents also indicated the importance of educating and increasing parents’ awareness toward vaccines, including using the narratives used and developed for the research.
Discussion
Since the popularization of the Internet in the 2000s, the ubiquity of “anti-vaccine” discourse online has been considered by many experts as a key driver of vaccine refusal.Citation5 The COVID-19 pandemic only reinforced the need for public health authorities to tackle online mis- and disinformation to build resilience and maintain vaccine confidence.Citation21 Given the noisy communication environment available on the Internet, with an increasing presence of false or misleading information about vaccines, it is imperative that public health use effective interventions to counterbalance these false discourses. Vaccine acceptance requires public trust in public health officials who are responsible for communicating accurate information and dispelling mis/disinformation.Citation22,Citation23
Responding to the call to use narratives in public health messaging,Citation24 we tested the impact of three short videos (2–4 minutes) on parents’ vaccination intentions and attitudes. Our findings indicate a relatively modest but positive impact on parents’ intention to vaccinate and the level of vaccine hesitancy. While this study did not measure the different features of the narratives that are likely to influence vaccine attitudes (e.g., loss vs gain frame, content/tone, views about the messengers, etc.), the persuasiveness of emotional over factual information is already recognized in the literature.Citation25,Citation26
However, many questions remain unanswered on how to convey emotional narratives in public health communication interventions effectively. For example, two meta-analysesCitation27,Citation28 reported that fear appeals in public health messaging are more persuasive and more effective in modifying attitudes and intention to adopt a recommended behavior. However, these meta-analyses were not specific to vaccination and the potential of a back-fire effect is often mentioned when emotional messages that highlight the potential severe outcomes of non-vaccination are developed.
Moreover, the backfire effect (i.e., a cognitive bias occurring when people’s existing beliefs become more entrenched when faced with contradictory evidence)Citation29 can especially occur in echo chambers where people are mostly sharing vaccine critical views.Citation30 Indeed, some studies highlight that preexisting attitudes toward vaccination can influence the perception of messages.Citation31–34 In our study, most participants held positive attitudes toward childhood vaccination and most children were vaccinated, which limited our analysis of the impact of the narratives based on preexisting attitudes. However, even amongst this relatively highly accepting population, more acceptance was seen post video likely showing evidence of reinforcement in those beliefs. In our qualitative work to develop and pilot-test the narratives, most parents considered “fear-based” messaging to be a legitimate public health strategy to counter the very emotional stories on vaccine risks used by most vaccine-critical content.Citation19
Another area for future research on narratives for vaccine promotion is the relationship between different types of characters showing different emotions. A literature review on narratives concluded that the description of the emotions experienced by the characters is a promising feature for changing health attitudes and intentions.Citation35 Findings of another review have highlighted that identification with the character is an important driver of the impact of that narrative on attitudes and behavior.Citation36–40 Findings from a recent meta-analysis indicated that narratives told in the first-person point of view increase identification with the main characters and led to higher levels of perceived susceptibility.Citation15 In our study, parents were exposed to only one of such narratives which limits exploring this question. However, findings of our qualitative study where parents saw all the narratives highlighted that parents are more likely to identify with other parents’ stories. However, advice from health-care providers about vaccines was reported to be more trustworthy. What remains to be explored is the potential differential impact of very emotional vaccine narratives from different characters (another parent, a health-care provider, a child).
Finally, the literature on effective interventions to address vaccine hesitancy and enhance vaccine acceptance is clear that there is no ‘one-size-fits-all’ strategy.Citation41 When used alone, interventions to inform and educate about vaccination are not sufficient to enhance vaccine acceptance and uptake.Citation41,Citation42 A recent review highlighted that factual information may increase be effective to increase uptake among parents with already positive attitudes but are unlikely to address hesitancy.Citation43 As the factors leading to vaccine acceptance or refusal are complex, context-specific, and likely to vary for different vaccines and over time, tailoring messages to preexisting attitudes and beliefs is of key importance. The most effective intervention to address vaccine hesitancy is one-on-one communication based on motivational interviewing techniques.Citation44 However, these interventions are time- and resources-intensive. In digital environment, storytelling and use of narratives are promising approach to share vaccination information in a meaningful approach that may resonate more than factual information that are typically used in public health messaging.Citation25,Citation45 The use of narratives was shown effective to enhance smoking cessation behaviors,Citation46 and two recent meta-analyses have concluded that narratives are more effective than traditional educational or informational messages to increase the intention to adopt specific health behaviors.Citation16,Citation47 Future experimental research should evaluate the effectiveness of narratives that are tailored to parents’ preexisting beliefs or that feature characters with which different parents relate compared with non-tailored ‘generic’ narratives. A user-centered design approach to develop future narrative-based interventions could allow such tailoring.Citation40,Citation48
Our findings should be interpreted in light of study limitations. First, our study was conducted in among a sample of Canadian parents and, although we achieved provincial and territorial representativeness, more mothers than fathers participated, and participants have higher level of education than the overall Canadian population. Our findings may thus not be generalizable to other Canadian parents or other health context. As mentioned, most of the participants began the study with preexisting positive attitudes toward vaccines, so we were not able to explore the association between preexisting attitudes and narrative effectiveness. Future research may include using sampling strategies to maximize variation in vaccine attitudes at baseline. Our outcome measures are self-reported. Our study collected data on immediate reactions to messages only; long-term effects of these messages on attitudes and behaviors were not explored. Exposing parents only once to such communications may not generate a lasting impact on vaccination decisions. We used a web-based panel, and although there were no differences in participants’ sociodemographic characteristics between groups, it is possible that our sample of parents is not representative of the diversity of parents in Canada. Finally, this study was conducted in the context of the COVID-19 pandemic and mass vaccination efforts. Studies conducted in Canada during the pandemic showed low parental intention to vaccinate their children against COVID-19.Citation49–51 However, findings on the impact of the pandemic on Canadian parents’ attitudes toward routine childhood vaccines are mixed, with some studies reporting minimal or no impactCitation2,Citation52 and others indicating a decrease in parents’ level of confidence.Citation53,Citation54 It is thus possible that this particular context has influenced the outcome of our project to some extent.
In conclusion, our findings suggest a small but positive impact of narratives on parents’ attitudes and intentions toward childhood vaccines. The interest in narrative persuasion research is growing, but further guidance is still required to empower public health organizations to harness this communication strategy.Citation55 In the aftermath of the COVID-19 pandemic, the need for effective strategies to build resilience against vaccine disinformation and foster vaccine confidence is clear.Citation21 Using narratives is a promising approach to communicating the importance of vaccination to parents that could be part of the public health communication toolkit for vaccination.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Additional information
Funding
References
- Walkinshaw E. Mandatory vaccinations: the Canadian picture. Cmaj. 2011 Nov 8;183(16):E1165–8. doi:10.1503/cmaj.109-3992.
- Government of Canada. Highlights from the 2021 childhood national immunization coverage survey (cNICS). 2024 [accessed 2024 Jun 6]. https://www.canada.ca/en/public-health/services/immunization-vaccines/vaccination-coverage/2021-highlights-childhood-national-immunization-coverage-survey.html#introduction.
- Betsch C, Renkewitz F, Haase N. Effect of narrative reports about vaccine adverse events and bias-awareness disclaimers on vaccine decisions: a simulation of an online patient social network. Med Decis Mak. 2013 Jan;33(1):14–25. doi:10.1177/0272989X12452342.
- Davies P. Antivaccination activists on the world wide web. Arch Dis Child. 2002 Jul;87(1):22–5. doi:10.1136/adc.87.1.22.
- Kata A. Anti-vaccine activists, web 2.0, and the postmodern paradigm–an overview of tactics and tropes used online by the anti-vaccination movement. Vaccine. 2012 May 28;30(25):3778–3789. doi:10.1016/j.vaccine.2011.11.112.
- de Saint Laurent C, Murphy G, Hegarty K, Greene CM. Measuring the effects of misinformation exposure and beliefs on behavioural intentions: a COVID-19 vaccination study. Cogn Res Princ Implic. 2022 Oct 1;7(1):87. doi:10.1186/s41235-022-00437-y.
- Moran MB, Lucas M, Everhart K, Morgan A, Prickett E. What makes anti-vaccine websites persuasive? A content analysis of techniques used by anti-vaccine websites to engender anti-vaccine sentiment. J Commun In Healthcare. 2016 Jul 2;9(3):151–163. doi:10.1080/17538068.2016.1235531.
- Muric G, Wu Y, Ferrara E. COVID-19 vaccine hesitancy on social media: building a public twitter data set of antivaccine content, vaccine misinformation, and conspiracies. JMIR Public Health Surveill. 2021 Nov 17;7(11):e30642. doi:10.2196/30642.
- Pullan S, Dey M. Vaccine hesitancy and anti-vaccination in the time of COVID-19: a Google Trends analysis. Vaccine. 2021 Apr 1;39(14):1877–1881. doi:10.1016/j.vaccine.2021.03.019.
- Rochel de Camargo K. Here we go again: the reemergence of anti-vaccine activism on the internet. Cad Saude Publica. 2020;36(Suppl 2):e00037620. doi:10.1590/0102-311x00037620.
- Smith N, Graham T. Mapping the anti-vaccination movement on facebook. Inf Commun Soc. 2019;22(9):1310–1327. doi:10.1080/1369118X.2017.1418406.
- Yiannakoulias N, Slavik CE, Chase M. Expressions of pro- and anti-vaccine sentiment on YouTube. Vaccine. 2019 Apr 3;37(15):2057–2064. doi:10.1016/j.vaccine.2019.03.001.
- Lewandowsky S, van der Linden S. Countering misinformation and fake news through inoculation and prebunking. Eur Rev Soc Phychol. 2021 Jul 3;32(2):348–384. doi:10.1080/10463283.2021.1876983.
- Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007 Oct;34(5):777–792. doi:10.1177/1090198106291963.
- Chen M, Bell RA. A meta-analysis of the impact of point of view on narrative processing and persuasion in health messaging. Psychol Health. 2022 May;37(5):545–562. doi:10.1080/08870446.2021.1894331.
- Zebregs S, van den Putte B, Neijens P, de Graaf A. The differential impact of statistical and narrative evidence on beliefs, attitude, and intention: a meta-analysis. Health Commun. 2015;30(3):282–289. doi:10.1080/10410236.2013.842528.
- Gesser-Edelsburg A. Using narrative evidence to convey health information on social media: the case of COVID-19. J Med Internet Res. 2021 Mar 15;23(3):e24948. doi:10.2196/24948.
- Kuru O, Stecula D, Lu H, Ophir Y, Chan MPS, Winneg K, Hall Jamieson K, Albarracín D. The effects of scientific messages and narratives about vaccination. PLOS ONE. 2021;16(3):e0248328. doi:10.1371/journal.pone.0248328.
- Dubé E, Trottier ME, Gagnon D, Bettinger JA, Greyson D, Graham J, MacDonald NE, MacDonald SE, Meyer SB, Witteman HO, et al. Exploring parents’ views of the use of narratives to promote childhood vaccination online. PLOS ONE. 2023;18(7):e0284107. doi:10.1371/journal.pone.0284107.
- Betsch C, Schmid P, Heinemeier D, Korn L, Holtmann C, Böhm R. Beyond confidence: development of a measure assessing the 5C psychological antecedents of vaccination. PLOS ONE. 2018;13(12):e0208601. doi:10.1371/journal.pone.0208601.
- Pluviano S, Watt C, Della Sala S, Moore AC. Misinformation lingers in memory: failure of three pro-vaccination strategies. PLOS ONE. 2017;12(7):e0181640. doi:10.1371/journal.pone.0181640.
- Dubé È, Gagnon D. Trust, information sources and the impact on decision-making. In: Paganelli C, editor. Confidence and legitimacy in Health information and communication. London: ISTE Editions; 2018. p. 61–73.
- Dubé E, Gagnon D, MacDonald N, Bocquier A, Peretti-Watel P, Verger P. Underlying factors impacting vaccine hesitancy in high income countries: a review of qualitative studies. Expert Rev Vaccines. 2018 Nov;17(11):989–1004. doi:10.1080/14760584.2018.1541406.
- Olson O, Berry C, Kumar N. Addressing parental vaccine hesitancy towards childhood vaccines in the United States: a systematic literature review of communication interventions and strategies. Vaccines (Basel). 2020 Oct 8;8(4):590. doi:10.3390/vaccines8040590.
- McCall B, Shallcross L, Wilson M. Storytelling as a research tool used to explore insights and as an intervention in public health: a systematic narrative review. Int J Public Health. 2021;66:1604262. doi:10.3389/ijph.2021.1604262.
- Piltch-Loeb R, Su M, Hughes B, Testa M, Goldberg B, Braddock K, Miller-Idriss C, Maturo V, Savoia E. Testing the efficacy of attitudinal inoculation videos to enhance COVID-19 vaccine acceptance: quasi-experimental intervention trial. JMIR Public Health Surveill. 2022 Jun 20;8(6):e34615. doi:10.2196/34615.
- Tannenbaum MB, Hepler J, Zimmerman RS, Saul L, Jacobs S, Wilson K, Albarracín D. Appealing to fear: a meta-analysis of fear appeal effectiveness and theories. Psychol Bull. 2015 Nov;141(6):1178–1204. doi:10.1037/a0039729.
- Witte K, Allen M. A meta-analysis of fear appeals: implications for effective public health campaigns. Health Educ Behav. 2000 Oct;27(5):591–615. doi:10.1177/109019810002700506.
- Swire-Thompson B, DeGutis J, Lazer D. Searching for the backfire effect: measurement and design considerations. J Appl Res Mem Cogn. 2020 Sep;9(3):286–299. doi:10.1016/j.jarmac.2020.06.006.
- Schmidt AL, Zollo F, Scala A, Betsch C, Quattrociocchi W. Polarization of the vaccination debate on facebook. Vaccine. 2018 Jun 14;36(25):3606–12. doi:10.1016/j.vaccine.2018.05.040.
- Bender FL, Rief W, Brück J, Wilhelm M. Effects of a video-based positive side-effect information framing: an online experiment. Health Psychol. 2023 Aug; 42(8):593–602. doi:10.1037/hea0001263.
- Eger J, Kaplan LC, Sternberg H. How to reduce vaccination hesitancy? The relevance of evidence and its communicator. Vaccine. 2023 Jun 19;41(27):3964–3975. doi:10.1016/j.vaccine.2023.03.026.
- Lubis TA, Gunardi H, Herqutanto, Soedjatmiko S, Satari HI, Alatas FS, Pulungan AB. Educational videos to address vaccine hesitancy in childhood immunization. Vaccine. 2022 Sep 29; 40(41):5965–5970. doi:10.1016/j.vaccine.2022.08.044.
- Nyhan B, Reifler J, Richey S, Freed GL. Effective messages in vaccine promotion: a randomized trial. Pediatrics. 2014 Apr;133(4):e835–e842. doi:10.1542/peds.2013-2365.
- de Graaf A, Sanders J, Hoeken H. Characteristics of narrative interventions and health effects: a review of the content, form, and context of narratives in health-related narrative persuasion research. Rev Commun Res. 2016;4:88–131. doi:10.12840/issn.2255-4165.2016.04.01.011.
- Green MC, Brock TC. The role of transportation in the persuasiveness of public narratives. J Pers Soc Psychol. 2000 Nov;79(5):701–721. doi:10.1037/0022-3514.79.5.701.
- Moyer-Gusé E. Toward a theory of entertainment persuasion: explaining the persuasive effects of entertainment-education messages. Commun Theory. 2008;18(3):407–425. doi:10.1111/j.1468-2885.2008.00328.x.
- Moyer-Gusé E, Rader K, Lavis S. Transportation into an entertainment narrative about the MMR vaccine: an investigation of self-referencing and issue-related thoughts in narrative persuasion. J Health Commun. 2022 Aug 3;27(8):585–592. doi:10.1080/10810730.2022.2138641.
- Phelps A, Rodriguez-Hernandez Y, Murphy ST, Valente TW. A culturally tailored narrative decreased resistance to COVID-19 vaccination among latinas. Am J Health Promot. 2023 Mar;37(3):381–385. doi:10.1177/08901171221129538.
- Slater MD, Rouner D. Entertainment-education and elaboration likelihood: understanding the processing of narrative persuasion. Commun Theory. 2002;12(2):173–191. doi:10.1111/j.1468-2885.2002.tb00265.x.
- Dubé E, Gagnon D, MacDonald NE. Strategies intended to address vaccine hesitancy: review of published reviews. Vaccine. 2015 Aug 14;33(34):4191–4203. doi:10.1016/j.vaccine.2015.04.041.
- Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing vaccination: putting psychological science into action. Psychol Sci Public Interest. 2017 Dec;18(3):149–207. doi:10.1177/1529100618760521.
- Tuckerman J, Kaufman J, Danchin M. Effective approaches to combat vaccine hesitancy. Pediatr Infect Dis J. 2022 May 1;41(5):243–245. doi:10.1097/INF.0000000000003499.
- Gagneur A, Lemaître T, Gosselin V, Farrands A, Carrier N, Petit G, Valiquette L, De Wals P. A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study. BMC Public Health. 2018 June 28;18(1):811. doi:10.1186/s12889-018-5724-y.
- Wilhelm E, Tran H, Jones T. Understanding community information needs through stories. 2024 [accessed 2024 Jun 6]. https://communitystoriesguide.org/the-guide/.
- Cherrington A, Williams JH, Foster PP, Coley HL, Kohler C, Allison JJ, Kiefe CI, Volkman JE, Houston TK. Narratives to enhance smoking cessation interventions among African-American smokers, the ACCE project. BMC Res Notes. 2015 Oct 14;8(1):567. doi:10.1186/s13104-015-1513-1.
- Shen F, Sheer VC, Li R. Impact of narratives on persuasion in health communication: a meta-analysis. J Advertising. 2015;44(2):105–113. doi:10.1080/00913367.2015.1018467.
- Vaisson G, Provencher T, Dugas M, Trottier M-È, Chipenda Dansokho S, Colquhoun H, Fagerlin A, Giguere AMC, Hakim H, Haslett L, et al. User involvement in the design and development of patient decision aids and other personal health tools: a systematic review. Med Decis Mak. 2021 Apr;41(3):261–274. doi:10.1177/0272989X20984134.
- Humble RM, Sell H, Dubé E, MacDonald NE, Robinson J, Driedger SM, Sadarangani M, Meyer SB, Wilson S, Benzies KM, et al. Canadian parents’ perceptions of COVID-19 vaccination and intention to vaccinate their children: results from a cross-sectional national survey. Vaccine. 2021 Dec 20;39(52):7669–7676. doi:10.1016/j.vaccine.2021.10.002.
- Humble RM, Sell H, Wilson S, Sadarangani M, Bettinger JA, Meyer SB, Dubé È, Lemaire-Paquette S, Gagneur A, MacDonald SE, et al. Parents’ perceptions on COVID-19 vaccination as the new routine for their children ≤11 years old. Prev Med. 2022 Aug;161:107125. doi:10.1016/j.ypmed.2022.107125.
- Public Health Agency of Canada. Evidence brief on parental and adolescent acceptance of COVID-19 vaccine for those aged 1–17. 2021 [accessed 2024 Jun 6]. https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/2019-novel-coronavirus-infection/canadas-reponse/summaries-recent-evidence/covid-19-vaccine-aged-1-17-eng.pdf.
- Humble RM, Scott SD, Dubé E, Olson J, MacDonald SE. The impact of the COVID-19 pandemic on parents’ perceptions and acceptance of routine childhood vaccination in Canada: a national longitudinal study. Vaccine. 2023 Jan 9;41(2):407–415. doi:10.1016/j.vaccine.2022.11.052.
- Angus Reid Institute. Parental opposition to childhood vaccination grows as Canadian worry about harms of anti-vax movement. 2024 [accessed 2024 Jun 7]. https://angusreid.org/canada-vaccines-childhood-vaccinations-anti-vax-mandates-covid-19-flu-mmr-side-effects/.
- United Nations Children’s Fund. The state of the World’s children 2023: for every child, vaccination. Florence, Italy: UNICEF Innocenti – Global Office of Research and Foresight; 2023.
- Okuhara T, Okada H, Goto E, Kiuchi T. Intervention studies to encourage vaccination using narrative: a systematic scoping review protocol. BMJ Open. 2022 Apr 21;12(4):e053870. doi:10.1136/bmjopen-2021-053870.