A National Survey Assessing SARS-CoV-2 Vaccination Intentions: Implications for Future Public Health Communication Efforts

"Several SARS-CoV-2 vaccines are in development....Public health and medical practitioners must prepare to promote acceptance of these vaccines."

To ensure high vaccination coverage for the eventual SARS-CoV-2 (COVID-19) vaccine, future public health communication campaigns must be grounded in evidence about the population(s) they intend to reach, including factors that may influence vaccination intentions and acceptance. Otherwise, there is a risk of disseminating counterproductive messaging that may reinforce vaccine hesitancy. Therefore, this group of researchers undertook a national survey of adults in the United States (US) to investigate SARS-CoV-2 vaccine behavioural intentions (also when a healthcare provider recommends the vaccine) and the factors associated with those intentions.

Data were collected between May 4 and May 11 2020 through an online survey. The final analytic sample included 3,159 participants who reported no previous COVID-19 diagnosis. In addition to demographic information, the study team collected data on participants' vaccine behavioural intentions, sociocultural beliefs, experiences with COVID-19, and health beliefs regarding personal risk and threat of COVID-19.

When asked how likely they were to get the SARS-CoV-2 vaccine, the mean score was 5.24 on a 7-point scale. The researchers believe that "this suggests strong support for a vaccine, more so because no vaccine has been fully tested and made available to the public." Furthermore, this average intention increased to a mean score of 5.48 if their healthcare provider were to strongly recommend the vaccine; almost one-quarter of the sample (n = 730; 23.1%) became more likely to receive the vaccine if a provider recommended it.

Hierarchical linear regression showed that less education was associated with lower intent. Education is often associated with health literacy, suggesting the importance of educating the public on the role of vaccines in reducing COVID-19 prevalence through herd immunity, including messages about how herd immunity works. On the other hand, liberal political views (likely linked to the complex and often partisan US political environment), altruism (which could indicate a potential message design strategy), and COVID-19-related health beliefs were associated with higher intent. On the latter, referencing the health belief model (HBM), the researchers found that, as perceived threat to physical health increased, likelihood of receiving a SARS-CoV-2 vaccine increased. Those who believed COVID-19 was a major problem in their community had higher likelihood of receiving a SARS-CoV-2 vaccine compared with those who did not. Worry was most strongly associated with SARS-CoV-2 vaccine intent; as worry increased, intent likewise increased. Communication scientists could possibly capitalise on these findings by exploring messaging strategies that address individuals' fears about COVID-19.

Speaking to communication scholars, the researchers suggest that social normative messaging could capitalise on the high level of vaccine intention identified in the study. Social norms campaigns use descriptive norms (i.e., perceptions about what people typically do) to correct or reinforce the frequency with which others are performing a behaviour, with the assumption that individuals seek to conform to the pressures of societal norms (i.e., subjective norms). For example, social norms messages can address SARS-CoV-2 vaccine hesitancy by highlighting the high intentions to vaccinate expressed by the majority of people in one's social network. Per the researchers, this approach will require communication scientists to engage in formative research to develop and test messages with different audiences, especially given the differences in intention across subgroups of population found in this study.

The study's finding that provider recommendation makes a difference coheres with previous research indicating that providers are the most trusted source of health information for patients, which may be important once a SARS-CoV-2 vaccine becomes widely available. Vaccine promotion campaigns may need to emphasise the importance of talking with a healthcare provider about the vaccine, including asking for information to address any concerns or questions. Healthcare providers may need support and training in fostering such conversations.

In conclusion: "When a vaccine (or vaccines) become available for the public, we must use evidence-based strategies for designing our educational and promotional messaging. The current study provides a starting point for SARS-CoV-2 vaccine communication research in the United States."