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This study is a PhD project conducted by Ms. Hina Hakim, supervised by Dr. Holly O. Witteman, PhD, and co-supervised Dr. Daniel Reinharz, professors and researchers at the Faculty of Medicine at Laval University. The purpose of this study is to evaluate the effects of visualization conveying the concept of community immunity or herd immunity on risk perception (towards individual, family, community and vulnerable people in communities) (primary outcome) and on emotions, attitudes, knowledge, and behavioural intentions (secondary outcomes).
Visualization is a powerful communication mechanism that uses pre-attentive processing to communicate large amounts of information rapidly in understandable and compelling ways (Healey and Enns 2012). A systematic review demonstrates that there are some interventions available for conveying the concept of community immunity, and very few evaluate interventions for their effects on vaccine intentions and uptake as well as their precursors, such as knowledge, attitudes, knowledge and none on emotions (Hakim et al. 2018).
The purpose of this study is to evaluate the effects of visualization conveying the concept of community immunity on risk perception (to individual, family, community and vulnerable people in communities) (primary outcome) and on emotions, attitudes, knowledge, and behavioural intentions (secondary outcomes).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| controlgeneric | No Intervention | No intervention provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English and French. | |
| controlmeasles | No Intervention | No intervention provided. Participant answers outcome questions about measles. English and French. | |
| controlpertussis | No Intervention | No intervention provided. Participant answers outcome questions about pertussis. English and French. | |
| controlflu | No Intervention | No intervention provided. Participant answers outcome questions about flu. English and French. | |
| herdimmgeneric | Experimental | Web-based application (main intervention) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English and French. |
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| herdimmmeasles | Experimental | Web-based application (main intervention) provided. Participant answers outcome questions about measles. English and French. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| herdimm | Behavioral | In this visualization participants can build their own avatar representing themselves and 8 other avatars representing people around them, like their family or coworkers. Our visualization then uses these avatars in a brief narrated video explaining how herd immunity works. |
| Measure | Description | Time Frame |
|---|---|---|
| Risk perception | 6 items assessing risk perception (item 1 = risk perception as comprehension, scale 0-100, higher numbers better; items 2-5 = risk perception as feelings, scale 1-7, higher numbers better; complete list of items and response wording available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf) | immediately after intervention or control |
| Measure | Description | Time Frame |
|---|---|---|
| Emotions | 5 items (e.g., "I am worried about getting [disease]", "I would feel guilty if a vulnerable person (a baby, a young child, an older person, a cancer patient) got [disease] from me") with a 7-point Likert-type response scale ranging from "strongly disagree" to "strongly agree"; higher numbers may be better; complete list of items and response wording available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf |
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Inclusion Criteria:
Exclusion Criteria:
- No internet access
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| Name | Affiliation | Role |
|---|---|---|
| Holly Witteman, PhD | Laval University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Université Laval | Québec | G1V 0A6 | Canada |
Anonymized data (answers to questions in the survey including socio-demographic information) will be deposited in a public repository (Dataverse de l'Université Laval (Laval University)) which will allow data sharing with the scientific community. No information that would allow anyone to identify a person will be deposited in this public repository. Study protocol and statistical analysis plan have been deposited in Open Science Framework.
As soon as possible upon completion of the study and posting of a preprint with results.
Freely available.
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP_ICF | Yes | Yes | Yes | Study Protocol, Statistical Analysis Plan, and Informed Consent Form | Apr 1, 2019 | Aug 21, 2024 | Prot_SAP_ICF_000.pdf |
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| ID | Term |
|---|---|
| D000079263 | Vaccine-Preventable Diseases |
| ID | Term |
|---|---|
| D007239 | Infections |
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This study will be a multi-armed factorial randomized controlled trial. Each participant will be randomly allocated to focus on one of four possible vaccine-preventable diseases: measles, pertussis, flu (influenza), or a generic vaccine-preventable disease (hereby referred to as "generic"). All aspects of the study (visualization, questionnaire) will be focused on that one disease for that participant. The primary and secondary outcomes of the study which are risk perception, emotion, knowledge, trust in information provided, attitudes and a validated scale about vaccination (Betsch et al. 2018) will be assessed in an online questionnaire.
Because three online visualizations are available only in English whereas our study will be conducted in both English and French, we will use slightly different randomization patterns for English- and French-speaking participants.
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This will be a single-blinded study because we cannot mask participants to the fact that they have been randomized to a visualization e.g., about measles. However, participants will not necessarily know the purpose of the study arm to which they are assigned,and investigators will be blinded to study arm during data analysis (investigators are not aware of whether the next eligible participant will be receiving treatment or control intervention.)
|
| herdimmpertussis | Experimental | Web-based application (main intervention) provided. Participant answers outcome questions about pertussis. English and French. |
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| herdimmflu | Experimental | Web-based application (main intervention) provided. Participant answers outcome questions about flu. English and French. |
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| robertkochgeneric | Active Comparator | Web-based application (comparator) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English only. |
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| sbsnewsgeneric | Active Comparator | Video (comparator) provided. Participant answers outcome questions about an unnamed vaccine-preventable disease. English only. |
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| guardianmeasles | Active Comparator | Video (comparator) provided. Participant answers outcome questions about measles. English only. |
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| theotheredmundmeasles | Active Comparator | Video (comparator) provided. Participant answers outcome questions about measles. English only. |
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| publichealthagencycanadaflu | Active Comparator | Video (comparator) provided. Participant answers outcome questions about flu. English and French. |
|
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| guardianmeasles | Behavioral | A screen capture of an interactive visualization: https://www.theguardian.com/society/ng-interactive/2015/feb/05/-sp-watch-how-measles-outbreak-spreads-when-kids-get-vaccinated |
|
| theotheredmundmeasles | Behavioral | A gif showing measles spreading through populations with differing levels of vaccine coverage: https://imgur.com/gallery/8M7q8#J7LANQ4 |
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| sbsnewsgeneric | Behavioral | A video showing how herd immunity works in general: https://www.sbs.com.au/news/two-sydney-babies-too-young-to-be-vaccinated-infected-with-measles |
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| publichealthagencycanadaflu | Behavioral | A video showing how herd immunity works in the context of influenza: https://www.canada.ca/fr/sante-publique/services/video/la-grippe-n-en-passez-pas-les-maux.html |
|
| robertkochgeneric | Behavioral | A web-based application showing how herd immunity works in general: http://rocs.hu-berlin.de/D3/herd/ |
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| immediately after intervention or control |
| Knowledge | 15 items, with 2 multiple choice questions and 13 true/false questions, for a total possible score ranging from 0 to 18; higher numbers better; complete list of items available in uploaded questionnaire herdimm_phase3_questionnaire_2021-03-01.pdf | immediately after intervention or control |
| Trust in information | Single item (Control: "During your life, you may have seen information about vaccines. Thinking about the information you have seen, how trustworthy was it?" Treatment: "Earlier, you saw a {{video, website}} about herd immunity. Thinking about the {{video, website}} you saw earlier, how trustworthy was the information in it?") with Likert-type response options 1 = not at all trustworthy, 2 = moderately untrustworthy, 3 = slightly untrustworthy, 4 = neutral, 5 = slightly trustworthy, 6 = moderately trustworthy, 7 = strongly trustworthy | immediately after intervention or control |
| Vaccination intentions | Questions conditioned on whether the participant indicates they believe they are already immune to the disease in question, e.g., "Imagine you were not already immune to {{measles/pertussis/influenza/a vaccine preventable disease}}. If you were eligible to receive a free vaccine against {{measles/pertussis/influenza/a vaccine-preventable disease}}, how likely would you be to get vaccinated?" Response scale on a slider: 0 = extremely unlikely, I would definitely NOT be vaccinated; 100 = extremely likely, I would definitely BE vaccinated; higher numbers better. | immediately after intervention or control |
| 5C scale | "5C scale: 15-item validated scale measuring the psychological antecedents of vaccination (Betsch et al., 2018)" | immediately after intervention or control |