Framing Risk and Social Norms: Effective Communication Strategies to Increase COVID-19 Vaccine Uptake
DOI:
https://doi.org/10.61978/communica.v2i2.765Keywords:
COVID-19, Vaccine Hesitancy, Loss Framing, Communication Strategy, Health Behavior, Social Norms, Public Health MessagingAbstract
Effective communication strategies are essential to combat vaccine hesitancy and enhance public health outcomes, particularly during global health crises such as the COVID-19 pandemic. This study investigates the impact of various communication framings educational, loss vs. gain framing, and social normative appeals on COVID-19 vaccine uptake. The objective is to identify strategies that are psychologically and culturally attuned to diverse populations. Using a systematic review and meta-analysis of 49 randomized controlled trials (RCTs), alongside case studies from China and the UK, this study evaluates the effectiveness of message types in promoting vaccine acceptance. Data were synthesized using fixed- and random-effects models, and subgroup analysis was conducted based on framing strategy and psychological orientation. Results show that loss-framed and normative messages significantly outperform gain-framed or generic formats. Educational messages produced pooled risk ratios (RRs) of 1.23–1.28, while loss-framed messages achieved an RR of 1.45. Case studies highlighted that individual framing works better for audiences with low institutional trust, whereas community framing is more effective in collectivist cultures and among those with strong just-world beliefs. Message effectiveness also varied by education level and cultural context. These results underscore the importance of tailored, psychologically informed, and culturally contextualized communication. The study contributes a nuanced framework for vaccine promotion based on behavioral science and highlights the need for adaptive, inclusive public health messaging in future crises.
References
Ademu, L., Gao, J., Assis, J. R. d., Uduebor, A., & Atawodi, O. (2023). Taking a Shot: The Impact of Information Frames and Channels on Vaccination Willingness in a Pandemic. Vaccines, 11(1), 137. https://doi.org/10.3390/vaccines11010137 DOI: https://doi.org/10.3390/vaccines11010137
Bai, L., Rao, Q., Cai, Z., Lv, Y., Wu, T.-T., Shi, Z., Sharma, M., Zhao, Y., & Hou, X. (2019). Effects of Goal-Framed Messages on Mental Health Education Among Medical University Students: Moderating Role of Personal Involvement. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00371 DOI: https://doi.org/10.3389/fpubh.2019.00371
Barker, A. B., Leighton, P., & Ferguson, M. (2017). Coping Together With Hearing Loss: A Qualitative Meta-Synthesis of the Psychosocial Experiences of People With Hearing Loss and Their Communication Partners. International Journal of Audiology, 56(5), 297–305. https://doi.org/10.1080/14992027.2017.1286695 DOI: https://doi.org/10.1080/14992027.2017.1286695
Betsch, C., Böhm, R., & Chapman, G. B. (2015). Using Behavioral Insights to Increase Vaccination Policy Effectiveness. Policy Insights From the Behavioral and Brain Sciences, 2(1), 61–73. https://doi.org/10.1177/2372732215600716 DOI: https://doi.org/10.1177/2372732215600716
Betsch, C., Schmid, P., Heinemeier, D., Korn, L., Holtmann, C., & Böhm, R. (2018). Beyond Confidence: Development of a Measure Assessing the 5C Psychological Antecedents of Vaccination. Plos One, 13(12), e0208601. https://doi.org/10.1371/journal.pone.0208601 DOI: https://doi.org/10.1371/journal.pone.0208601
Bigaeva, E., Doorn, E. v., Liu, H., & Hak, E. (2016). Meta-Analysis on Randomized Controlled Trials of Vaccines With QS-21 or ISCOMATRIX Adjuvant: Safety and Tolerability. Plos One, 11(5), e0154757. https://doi.org/10.1371/journal.pone.0154757 DOI: https://doi.org/10.1371/journal.pone.0154757
Binder, A., Naderer, B., & Matthes, J. (2020). The Effects of Gain- And Loss-Framed Nutritional Messages on Children’s Healthy Eating Behaviour. Public Health Nutrition, 23(10), 1726–1734. https://doi.org/10.1017/s1368980019004683 DOI: https://doi.org/10.1017/S1368980019004683
Bir, C., & Widmar, N. O. (2021). Social Pressure, Altruism, Free-Riding, and Non-Compliance in Mask Wearing by U.S. Residents in Response to COVID-19 Pandemic. Social Sciences & Humanities Open, 4(1), 100229. https://doi.org/10.1016/j.ssaho.2021.100229 DOI: https://doi.org/10.1016/j.ssaho.2021.100229
Bugos, J. A., Lu, L., Chen, L., Torres, M. R., & Gbadamosi, A. A. (2023). The Effects of Active Music Interventions on Cognitive Function and Neuropsychiatric Symptoms in Patients With Dementia: A Systematic Review and Meta-Analysis. Musicae Scientiae, 28(1), 112–130. https://doi.org/10.1177/10298649231167519 DOI: https://doi.org/10.1177/10298649231167519
Cao, H., Zhang, H., Yang, L., Li, L., Wang, J., Zada, B., Li, M. X., Liu, W. J., Su, T., & Zhao, Y. (2021). Analysis of the Mediating Effect of Risk Perception on the Relationship Between Time Perception and Mental Health of College Students During the COVID-19 Epidemic. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.749379 DOI: https://doi.org/10.3389/fpsyt.2021.749379
Choi, D.-H., Yoo, W., Noh, G.-Y., & Park, K. (2017). The Impact of Social Media on Risk Perceptions During the MERS Outbreak in South Korea. Computers in Human Behavior, 72, 422–431. https://doi.org/10.1016/j.chb.2017.03.004 DOI: https://doi.org/10.1016/j.chb.2017.03.004
Dryhurst, S., Schneider, C. R., Kerr, J. R., Freeman, A. L. J., Recchia, G., Anne Marthe van der Bles, Spiegelhalter, D., & Linden, S. v. d. (2020). Risk Perceptions of COVID-19 Around the World. Journal of Risk Research, 23(7–8), 994–1006. https://doi.org/10.1080/13669877.2020.1758193 DOI: https://doi.org/10.1080/13669877.2020.1758193
Duan, G. Y., Arlene M. Ruiz de Luzuriaga, Schroedl, L., & Rosenblatt, A. E. (2022). Disparities in Telemedicine Use During the COVID‐19 Pandemic Among Pediatric Dermatology Patients. Pediatric Dermatology, 39(4), 520–527. https://doi.org/10.1111/pde.14982 DOI: https://doi.org/10.1111/pde.14982
Ferrer, R. A., & Klein, W. M. P. (2015). Risk Perceptions and Health Behavior. Current Opinion in Psychology, 5, 85–89. https://doi.org/10.1016/j.copsyc.2015.03.012 DOI: https://doi.org/10.1016/j.copsyc.2015.03.012
Gantiva, C., Jiménez‐Leal, W., & Urriago-Rayo, J. (2021). Framing Messages to Deal With the COVID-19 Crisis: The Role of Loss/Gain Frames and Content. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.568212 DOI: https://doi.org/10.3389/fpsyg.2021.568212
Gürsoy, D., Ekinci, Y., Can, A. S., & Murray, J. C. (2022). Effectiveness of Message Framing in Changing COVID-19 Vaccination Intentions: Moderating Role of Travel Desire. Tourism Management, 90, 104468. https://doi.org/10.1016/j.tourman.2021.104468 DOI: https://doi.org/10.1016/j.tourman.2021.104468
Hameleers, M. (2020). Prospect Theory in Times of a Pandemic: The Effects of Gain Versus Loss Framing on Policy Preferences and Emotional Responses During the 2020 Coronavirus Outbreak. https://doi.org/10.31235/osf.io/7pykj DOI: https://doi.org/10.31235/osf.io/7pykj
Han, W., Zhang, Z., Zhang, X., & Li, H. (2021). Farmland Rental Participation, Agricultural Productivity, and Household Income: Evidence From Rural China. Land, 10(9), 899. https://doi.org/10.3390/land10090899 DOI: https://doi.org/10.3390/land10090899
Hossain, Md. J., Soma, M. A., Bari, Md. S., Emran, T. B., & Islam, Md. R. (2021). COVID-19 and Child Marriage in Bangladesh: Emergency Call to Action. BMJ Paediatrics Open, 5(1), e001328. https://doi.org/10.1136/bmjpo-2021-001328 DOI: https://doi.org/10.1136/bmjpo-2021-001328
Ida, S., Murata, K., & Kaneko, R. (2017). Effects of Pioglitazone treatment on Blood Leptin Levels in Patients With Type 2 Diabetes. Journal of Diabetes Investigation, 9(4), 917–924. https://doi.org/10.1111/jdi.12783 DOI: https://doi.org/10.1111/jdi.12783
Jun, H., & Lee, Y.-I. (2019). The Role of Risk Tolerance in Publics’ Health Risk Perception and Responses. Proceedings of the International Crisis and Risk Communication Conference, 2(2019), 20–22. https://doi.org/10.30658/icrcc.2019.6 DOI: https://doi.org/10.30658/icrcc.2019.6
Kahn, S. R., Diendéré, G., Morrison, D., Piché, A., Filion, K. B., Klil‐Drori, A. J., Douketis, J. D., Emed, J., Roussin, A., Tagalakis, V., Morris, M., & Geerts, W. (2019). Effectiveness of Interventions for the Implementation of Thromboprophylaxis in Hospitalised Patients at Risk of Venous Thromboembolism: An Updated Abridged Cochrane Systematic Review and Meta-Analysis of Randomised Controlled Trials. BMJ Open, 9(5), e024444. https://doi.org/10.1136/bmjopen-2018-024444 DOI: https://doi.org/10.1136/bmjopen-2018-024444
Kim, J.-H., Song, H.-Y., Park, J., Kang, P., & Lee, H.-J. (2022). A Study on the COVID-19 Preventive Behaviors of Automobile Manufacturing Workers in South Korea. Healthcare, 10(10), 1826. https://doi.org/10.3390/healthcare10101826 DOI: https://doi.org/10.3390/healthcare10101826
Kumar, D., Chandra, R., Mathur, M., Samdariya, S., & Kapoor, N. (2016). Vaccine Hesitancy: Understanding Better to Address Better. Israel Journal of Health Policy Research, 5(1). https://doi.org/10.1186/s13584-016-0062-y DOI: https://doi.org/10.1186/s13584-016-0062-y
Law, M. A., Wilbiks, J. M. P., Roach, S. P., & Best, L. A. (2022). Remember the Past, Plan for the Future: How Interactions Between Risk Perception and Behavior During the COVID-19 Pandemic Can Inform Future Canadian Public Health Policy. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.784955 DOI: https://doi.org/10.3389/fpubh.2022.784955
Lejarraga, T., & Hertwig, R. (2021). Three Theories of Choice and Their Psychology of Losses. Perspectives on Psychological Science, 17(2), 334–345. https://doi.org/10.1177/17456916211001332 DOI: https://doi.org/10.1177/17456916211001332
MacDonald, N. E. (2015). Vaccine Hesitancy: Definition, Scope and Determinants. Vaccine, 33(34), 4161–4164. https://doi.org/10.1016/j.vaccine.2015.04.036 DOI: https://doi.org/10.1016/j.vaccine.2015.04.036
Mays, D., & Evans, W. D. (2017). The Effects of Gain-, Loss-, and Balanced-Framed Messages for Preventing Indoor Tanning Among Young Adult Women. Journal of Health Communication, 22(7), 604–611. https://doi.org/10.1080/10810730.2017.1332119 DOI: https://doi.org/10.1080/10810730.2017.1332119
Mays, D., Turner, M. M., Zhao, X., Evans, W. D., Luta, G., & Tercyak, K. P. (2014). Framing Pictorial Cigarette Warning Labels to Motivate Young Smokers to Quit. Nicotine & Tobacco Research, 17(7), 769–775. https://doi.org/10.1093/ntr/ntu164 DOI: https://doi.org/10.1093/ntr/ntu164
Morrison, B. W., Sasaki, M. M., & Morrison, N. M. V. (2020). The Relative Efficacy of Positively and Negatively Valenced Road Safety Campaign Messages in Improving Dangerous Driving Attitudes. Journal of Road Safety, 31(4), 13–25. https://doi.org/10.33492/jrs-d-19-00230 DOI: https://doi.org/10.33492/JRS-D-19-00230
Murayama, H., Sasaki, S., Yuta, T., Takase, M., & Taguchi, A. (2023). Message Framing Effects on Attitude and Intention Toward Social Participation in Old Age. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-16555-1 DOI: https://doi.org/10.1186/s12889-023-16555-1
Nagaya, K. (2021). Why and Under What Conditions Does Loss Aversion Emerge?1. Japanese Psychological Research, 65(4), 379–398. https://doi.org/10.1111/jpr.12385 DOI: https://doi.org/10.1111/jpr.12385
Nie, W., Bo, H., Liu, J., & Li, T. (2021). Influence of Loss Aversion and Income Effect on Consumer Food Choice for Food Safety and Quality Labels. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.711671 DOI: https://doi.org/10.3389/fpsyg.2021.711671
Niederdeppe, J., Roh, S., & Shapiro, M. A. (2015). Acknowledging Individual Responsibility While Emphasizing Social Determinants in Narratives to Promote Obesity-Reducing Public Policy: A Randomized Experiment. Plos One, 10(2), e0117565. https://doi.org/10.1371/journal.pone.0117565 DOI: https://doi.org/10.1371/journal.pone.0117565
Okuhara, T., Ishikawa, H., Okada, H., & Kiuchi, T. (2014). Identification of Gain- And Loss-Framed Cancer Screening Messages That Appeared in Municipal Newsletters in Japan. BMC Research Notes, 7(1), 896. https://doi.org/10.1186/1756-0500-7-896 DOI: https://doi.org/10.1186/1756-0500-7-896
Pattison, A. B., Reinfelde, M., Chang, H., Chowdhury, M., Cohen, E., Malahy, S., O’Connor, K., Sellami, M., Smith, K. L., Stanton, C., Voets, B., & Wei, H. (2022). Finding the Facts in an Infodemic: Framing Effective COVID-19 Messages to Connect People to Authoritative Content. BMJ Global Health, 7(2), e007582. https://doi.org/10.1136/bmjgh-2021-007582 DOI: https://doi.org/10.1136/bmjgh-2021-007582
Presti, S. L., Mattavelli, G., Canessa, N., & Gianelli, C. (2022). Risk Perception and Behaviour During the COVID-19 Pandemic: Predicting Variables of Compliance With Lockdown Measures. Plos One, 17(1), e0262319. https://doi.org/10.1371/journal.pone.0262319 DOI: https://doi.org/10.1371/journal.pone.0262319
Richardson, M., Garner, P., & Donegan, S. (2016). Cluster Randomised Trials in Cochrane Reviews: Evaluation of Methodological and Reporting Practice. Plos One, 11(3), e0151818. https://doi.org/10.1371/journal.pone.0151818 DOI: https://doi.org/10.1371/journal.pone.0151818
Salimi, A., ElHawary, H., Diab, N., & Smith, L. (2020). The North American Layman’s Understanding of COVID-19: Are We Doing Enough? Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00358 DOI: https://doi.org/10.3389/fpubh.2020.00358
Shin, M., Werner, A., Strosnider, H., Hines, L. B., Balluz, L. S., & Yip, F. (2019). Public Perceptions of Environmental Public Health Risks in the United States. International Journal of Environmental Research and Public Health, 16(6), 1045. https://doi.org/10.3390/ijerph16061045 DOI: https://doi.org/10.3390/ijerph16061045
Shook, N. J., Sevi, B., Lee, J., Oosterhoff, B., & Fitzgerald, H. N. (2020). Disease Avoidance in the Time of COVID-19: The Behavioral Immune System Is Associated With Concern and Preventative Health Behaviors. Plos One, 15(8), e0238015. https://doi.org/10.1371/journal.pone.0238015 DOI: https://doi.org/10.1371/journal.pone.0238015
Silva, F. M., Adegboye, A. R. A., Lachat, C., Curioni, C. C., Gomes, F. d. S., Collins, G. S., Kac, G., Beyer, J. A. d., Cook, J., Ismail, L. C., Page, M. J., Khandpur, N., Lamb, S. E., Hopewell, S., Kirtley, S., Durão, S., Vorland, C. J., & Schlüssel, M. M. (2023). Completeness of Reporting in Diet- And Nutrition-Related Randomized Controlled Trials and Systematic Reviews With Meta-Analysis: Protocol for 2 Independent Meta-Research Studies. Jmir Research Protocols, 12, e43537. https://doi.org/10.2196/43537 DOI: https://doi.org/10.2196/43537
Songsore, E., & Buzzelli, M. (2016). Ontario’s Experience of Wind Energy Development as Seen Through the Lens of Human Health and Environmental Justice. International Journal of Environmental Research and Public Health, 13(7), 684. https://doi.org/10.3390/ijerph13070684 DOI: https://doi.org/10.3390/ijerph13070684
Tian, P., Fu, X., Li, Z., Sun, X., & Ma, X. (2015). Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion for Multilevel Cervical Degenerative Disc Diseases: A Meta-Analysis. Scientific Reports, 5(1). https://doi.org/10.1038/srep13454 DOI: https://doi.org/10.1038/srep13454
Xie, T., Wang, Y., & Cheng, Y. (2023). Social Media Overload as a Predictor of Depressive Symptoms Under the COVID-19 Infodemic: A Cross-Sectional Survey From Chinese University Students. International Journal of Public Health, 68. https://doi.org/10.3389/ijph.2023.1606404 DOI: https://doi.org/10.3389/ijph.2023.1606404
Yanagisawa, T., Kawada, T., Quhal, F., Bekku, K., Laukhtina, E., Rajwa, P., Deimling, M. v., Majdoub, M., Chłosta, M., Pradère, B., Mori, K., Kimura, T., Schmidinger, M., Karakiewicz, P. I., & Shariat, S. F. (2023). Impact of Sex on the Efficacy of Immune Checkpoint Inhibitors in Kidney and Urothelial Cancers: A Systematic Review and Meta-Analysis. World Journal of Urology, 41(7), 1763–1774. https://doi.org/10.1007/s00345-023-04412-0 DOI: https://doi.org/10.1007/s00345-023-04412-0
Zhang, W., Mei, J., Evans, R., & Wu, H. (2023). The Effects of Information Framing on Self-Protective Behavior: Evidence From the COVID-19 Vaccine Uptake. Digital Health, 9. https://doi.org/10.1177/20552076231210655 DOI: https://doi.org/10.1177/20552076231210655
Zhao, S., Zhu, L., & Li, D. (2015). Microplastic in Three Urban Estuaries, China. Environmental Pollution, 206, 597–604. https://doi.org/10.1016/j.envpol.2015.08.027 DOI: https://doi.org/10.1016/j.envpol.2015.08.027
