Community led health promotion to counter stigma and increase trust amongst priority populations: lessons from the 2022-2023 UK mpox outbreak.

BACKGROUND: Stigma, lack of trust in authorities, and poor knowledge can prevent health-seeking behaviour, worsen physical and mental health, and undermine efforts to control transmission during disease outbreaks. These factors are particularly salient with diseases such as mpox, for which 96% of cases in the 2022-2023 UK outbreak were identified among gay, bisexual, queer and men who have sex with men (MSM). This study explored stigma and health-seeking behaviour in Liverpool through the lens of the recent mpox outbreak. METHODS: Primary sources of data were interviews with national and regional key informants involved in the mpox response, and participatory workshops with priority populations. Workshop recruitment targeted Grindr users (geosocial dating/hookup app) and at risk MSM; immigrant, black and ethnic minority MSM; and male sex workers in Liverpool. Data were analysed using a deductive framework approach, building on the Health Stigma and Discrimination Framework. RESULTS: Key informant interviews (n = 11) and five workshops (n = 15) were conducted. There were prevalent reports of anticipated and experienced stigma due to mpox public health messaging alongside high demand and uptake of the mpox vaccine and regular attendance at sexual health clinics. Respondents believed the limited impact of stigma on health-seeking behaviour was due to actions by the LGBTQ + community, the third sector, and local sexual health clinics. Key informants from the LGBTQ + community and primary healthcare felt their collective action to tackle mpox was undermined by central public health authorities citing under-resourcing; a reliance on goodwill; poor communication; and tokenistic engagement. Mpox communication was further challenged by a lack of evidence on disease transmission and risk. This challenge was exacerbated by the impact of the COVID-19 pandemic on the scientific community, public perceptions of infectious disease, and trust in public health authorities. CONCLUSIONS: The LGBTQ + community and local sexual health clinics took crucial actions to counter stigma and support health seeking behaviour during the 2022-2023 UK mpox outbreak. Lessons from rights based and inclusive community-led approaches during outbreaks should be heeded in the UK, working towards more meaningful and timely collaboration between affected communities, primary healthcare, and regional and national public health authorities.

Vaccination invitations sent by warm and competent medical professionals disclosing risks and benefits increase trust and booking intention and reduce inequalities between ethnic groups.

OBJECTIVE: We aim to identify vaccination invitations that foster trust and improve vaccination uptake overall, especially among ethnic minority groups who are more at risk from coronavirus disease (COVID-19) and less likely to be vaccinated. METHOD: In a preregistered 4 × 4 mixed-design experiment, we manipulated how much risk-benefit information the message included within-subjects and the message source between-subjects (N = 4,038 U.K. and U.S. participants, 50% ethnic minority). Participants read four vaccine invitations that varied in vaccination risk-benefit information (randomized order): control (no information), benefits only, risk and benefit, and risk and benefit that mentions vulnerable groups. The messages were sent by one of four sources (random allocation): control (health institution), medical professional (unnamed), warm and competent medical professional (unnamed), and named warm and competent medical professional (Sanjay/Lamar). Participants assessed how much they trusted the message and how likely they would be to book their vaccination appointment. RESULTS: Information about vaccination benefits and risks increased trust, especially among ethnic minority groups-for whom the effect replicated within each group. Trust also increased when the message was sent by a warm and competent medical professional relative to a health institution, but the importance of the source mattered less when more information was shared. CONCLUSIONS: Our research demonstrates the positive impact of outlining the benefits and disclosing the risks of COVID vaccines in vaccination invitation messages. Having a warm and competent medical professional source can also increase trust, especially where the message is limited in scope. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Testing Psychological Inoculation to Reduce Reactance to Vaccine-Related Communication.

Research has found that vaccine-promoting messages can elicit state reactance (i.e., negative emotions in response to a perceived threat to behavioral freedom), especially among individuals with high trait reactance (i.e., proneness to experiencing reactance). This can result in a lower willingness to accept vaccines. We investigated whether inoculation against reactance - that is, forewarning individuals about potentially experiencing reactance - can reduce the effects of trait reactance on vaccination willingness. Participants (N = 710) recruited through Facebook were randomly allocated to be either inoculated or not. They were then shown a message promoting a fictitious vaccine, which included either a low, medium, or high threat to freedom. Contrary to research on other health topics, inoculation was ineffective at reducing state reactance toward the vaccination message. Inoculation also did not mitigate the effects of trait reactance on vaccination willingness, and was even counterproductive in some cases. High-reactant individuals were less willing to get vaccinated than low-reactant ones, especially at high freedom threat. Conversely, high freedom threat resulted in increased vaccination willingness among low-reactant individuals. Further research is needed to understand why inoculation against reactance produces different results with vaccination, and to develop communication strategies that mitigate reactance to vaccination campaigns without compromising the positive effects of vaccine recommendations for low-reactant individuals.

The empathetic refutational interview to tackle vaccine misconceptions: Four randomized experiments.

OBJECTIVE: We introduce and report early stage testing of a novel, multicomponent intervention that can be used by healthcare professionals (HCPs) to address false or misleading antivaccination arguments while maintaining empathy for and understanding of people's motivations to believe misinformation: the "Empathetic Refutational Interview" (ERI). METHOD: We conducted four experiments in 2022 with participants who were predominantly negative or on the fence about vaccination (total n = 2,545) to test four steps for tailoring an HCP's response to a vaccine-hesitant individual: (a) elicit their concerns, (b) affirm their values and beliefs to the extent possible, (c) refute the misinformed beliefs in their reasoning in a way that is tailored to their psychological motivations, and (d) provide factual information about vaccines. Each of the steps was tested against active control conditions, with participants randomized to conditions. RESULTS: Overall, compared to controls, we found that observing steps of the ERI produced small effects on increasing vaccine acceptance and lowering support for antivaccination arguments. Critically, an HCP who affirmed participants' concerns generated significantly more support for their refutations and subsequent information, with large effects compared to controls. In addition, participants found tailored refutations (compared to control responses) more compelling, and displayed more trust and openness toward the HCP giving them. CONCLUSIONS: The ERI can potentially be leveraged and tested further as a tailored communication tool for HCPs to refute antivaccination misconceptions while maintaining trust and rapport with patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trait reactance as psychological motivation to reject vaccination: Two longitudinal studies and one experimental study.

Anti-science attitudes can be resilient to scientific evidence if they are rooted in psychological motives. One such motive is trait reactance, which refers to the need to react with opposition when one's freedom of choice has been threatened. In three studies, we investigated trait reactance as a psychological motivation to reject vaccination. In the longitudinal studies (n = 199; 293), we examined if trait reactance measured before the COVID-19 pandemic was related to people's willingness to get vaccinated against COVID-19 up to 2 years later during the pandemic. In the experimental study (n = 398), we tested whether trait reactance makes anti-vaccination attitudes more resistant to information and whether this resistance can be mitigated by framing the information to minimize the risk of triggering state reactance. The longitudinal studies showed that higher trait reactance before the COVID-19 pandemic was related to lower willingness to get vaccinated against COVID-19. Our experimental study indicated that highly reactant individuals' willingness to vaccinate was unaffected by the amount and framing of the information provided. Trait reactance has a strong and durable impact on vaccination willingness. This highlights the importance of considering the role of trait reactance in people's vaccination-related decision-making.

Science Communication as a Collective Intelligence Endeavor: A Manifesto and Examples for Implementation.

Effective science communication is challenging when scientific messages are informed by a continually updating evidence base and must often compete against misinformation. We argue that we need a new program of science communication as collective intelligence-a collaborative approach, supported by technology. This would have four key advantages over the typical model where scientists communicate as individuals: scientific messages would be informed by (a) a wider base of aggregated knowledge, (b) contributions from a diverse scientific community, (c) participatory input from stakeholders, and (d) better responsiveness to ongoing changes in the state of knowledge.

Healthcare professionals' attitudes to mandatory COVID-19 vaccination: Cross-sectional survey data from four European countries.

Mandatory vaccinations are widely debated since they restrict individuals' autonomy in their health decisions. As healthcare professionals (HCPs) are a common target group of vaccine mandates, and also form a link between vaccination policies and the public, understanding their attitudes toward vaccine mandates is important. The present study investigated physicians' attitudes to COVID-19 vaccine mandates in four European countries: Finland, France, Germany, and Portugal. An electronic survey assessing attitudes to COVID-19 vaccine mandates and general vaccination attitudes (e.g. perceived vaccine safety, trust in health authorities, and openness to patients) was sent to physicians in the spring of 2022. A total of 2796 physicians responded. Across all countries, 78% of the physicians were in favor of COVID-19 vaccine mandates for HCPs, 49% favored COVID-19 vaccine mandates for the public, and 67% endorsed COVID-19 health passes. Notable differences were observed between countries, with attitudes to mandates found to be more positive in countries where the mandate, or similar mandates, were in effect. The associations between attitudes to mandates and general vaccination attitudes were mostly small to neglectable and differed between countries. Nevertheless, physicians with more positive mandate attitudes perceived vaccines as more beneficial (in Finland and France) and had greater trust in medical authorities (in France and Germany). The present study contributes to the body of research within social and behavioral sciences that support evidence-based vaccination policymaking.

How Should Doctors Frame the Risk of a Vaccine's Adverse Side Effects? It Depends on How Trustworthy They Are.

BACKGROUND: How health workers frame their communication about vaccines' probability of adverse side effects could play an important role in people's intentions to be vaccinated (e.g., positive frame: side effects are unlikely v. negative frame: there is a chance of side effects). Based on the pragmatic account of framing as implicit advice, we expected that participants would report greater vaccination intentions when a trustworthy physician framed the risks positively (v. negatively), but we expected this effect would be reduced or reversed when the physician was untrustworthy. DESIGN: In 4 online experiments (n = 191, snowball sampling and n = 453, 451, and 464 UK residents via Prolific; Mage≈ 34 y, 70% women, 84% White British), we manipulated the trustworthiness of a physician and how they framed the risk of adverse side effects in a scenario (i.e., a chance v. unlikely adverse side effects). Participants reported their vaccination intention, their level of distrust in health care systems, and COVID-19 conspiracy beliefs. RESULTS: Physicians who were trustworthy (v. untrustworthy) consistently led to an increase in vaccination intention, but the way they described adverse side effects mattered too. A positive framing of the risks given by a trustworthy physician consistently led to increased vaccination intention relative to a negative framing, but framing had no effect or the opposite effect when given by an untrustworthy physician. The exception to this trend occurred in unvaccinated individuals in experiment 3, following serious concerns about one of the COVID vaccines. In that study, unvaccinated participants responded more favorably to the negative framing of the trustworthy physician. CONCLUSIONS: Trusted sources should use positive framing to foster vaccination acceptance. However, in a situation of heightened fears, a negative framing-attracting more attention to the risks-might be more effective. HIGHLIGHTS: How health workers frame their communication about a vaccine's probability of adverse side effects plays an important role in people's intentions to be vaccinated.In 4 experiments, we manipulated the trustworthiness of a physician and how the physician framed the risk of adverse side effects of a COVID vaccine.Positive framing given by a trustworthy physician promoted vaccination intention but had null effect or did backfire when given by an untrustworthy physician.The effect occurred over and above participants' attitude toward the health care system, risk perceptions, and beliefs in COVID misinformation.

Planning engagement with web resources to improve diet quality and break up sedentary time for home-working employees: A mixed methods study.

As home working becomes more common, employers may struggle to provide health promotion interventions that can successfully bridge the gap between employees' intentions to engage in healthier behaviors and actual action. Based on past evidence that action planning can successfully encourage the adoption of healthier behaviors, this mixed-methods study of a web-based self-help intervention incorporated a randomized planning trial that included quantitative measures of engagement and follow-up qualitative interviews with a subsample of participants. Participants either (a) selected a movement plan for incorporating a series of 2-min exercise videos into their work week to break up sedentary time and a balanced meal plan with recipe cards for a week's lunches and dinners or (b) received access to these resources without a plan. Selecting a movement plan was more effective at increasing engagement with the web resources compared to the no-plan condition. In the follow-up interviews, participants indicated that the plan helped to remind participants to engage with the resources and made it simpler for them to follow the guidance for exercises and meals. Ease of use and being able to fit exercises and meals around work tasks were key factors that facilitated uptake of the resources, while lack of time and worries about how colleagues would perceive them taking breaks to use the resources were barriers to uptake. Participants' self-efficacy was associated with general resource use but not plan adherence. Overall, including plans with online self-help resources could enhance their uptake. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Endorsement of alternative medicine and vaccine hesitancy among physicians: A cross-sectional study in four European countries.

Vaccine hesitancy has become a threat to public health, especially as it is a phenomenon that has also been observed among healthcare professionals. In this study, we analyzed the relationship between endorsement of complementary and alternative medicine (CAM) and vaccination attitudes and behaviors among healthcare professionals, using a cross-sectional sample of physicians with vaccination responsibilities from four European countries: Germany, Finland, Portugal, and France (total N = 2,787). Our results suggest that, in all the participating countries, CAM endorsement is associated with lower frequency of vaccine recommendation, lower self-vaccination rates, and being more open to patients delaying vaccination, with these relationships being mediated by distrust in vaccines. A latent profile analysis revealed that a profile characterized by higher-than-average CAM endorsement and lower-than-average confidence and recommendation of vaccines occurs, to some degree, among 19% of the total sample, although these percentages varied from one country to another: 23.72% in Germany, 17.83% in France, 9.77% in Finland, and 5.86% in Portugal. These results constitute a call to consider health care professionals' attitudes toward CAM as a factor that could hinder the implementation of immunization campaigns.

Psychological profiles of anti-vaccination argument endorsement.

The proliferation of anti-vaccination arguments online can threaten immunisation programmes, including those targeting COVID-19. To effectively refute misinformed views about vaccination, communicators need to go beyond providing correct information and debunking of misconceptions, and must consider the underlying motivations of people who hold contrarian views. Drawing on a taxonomy of anti-vaccination arguments that identified 11 "attitude roots"-i.e., psychological attributes-that motivate an individual's vaccine-hesitant attitude, we assessed whether these attitude roots were identifiable in argument endorsements and responses to psychological construct measures corresponding to the presumed attitude roots. In two UK samples (total n = 1250), we found that participants exhibited monological belief patterns in their highly correlated endorsements of anti-vaccination arguments drawn from different attitude roots, and that psychological constructs representing the attitude roots significantly predicted argument endorsement strength and vaccine hesitancy. We identified four different latent anti-vaccination profiles amongst our participants' responses. We conclude that endorsement of anti-vaccination arguments meaningfully dovetails with attitude roots clustering around anti-scientific beliefs and partisan ideologies, but that the balance between those attitudes differs considerably between people. Communicators must be aware of those individual differences.

A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling.

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.

International adaptation and validation of the Pro-VC-Be: measuring the psychosocial determinants of vaccine confidence in healthcare professionals in European countries.

BACKGROUND: Healthcare professionals (HCPs) play an important role in vaccination; those with low confidence in vaccines are less likely to recommend them to their patients and to be vaccinated themselves. The study's purpose was to adapt and validate long- and short-form versions of the International Professionals' Vaccine Confidence and Behaviors (I-Pro-VC-Be) questionnaire to measure psychosocial determinants of HCPs' vaccine confidence and their associations with vaccination behaviors in European countries. RESEARCH DESIGN AND METHODS: After the original French-language Pro-VC-Be was culturally adapted and translated, HCPs involved in vaccination (mainly GPs and pediatricians) across Germany, Finland, France, and Portugal completed a cross-sectional online survey in 2022. A 10-factor multigroup confirmatory factor analysis (MG-CFA) of the long-form (10 factors comprising 34 items) tested for measurement invariance across countries. Modified multiple Poisson regressions tested the criterion validity of both versions. RESULTS: 2,748 HCPs participated. The 10-factor structure fit was acceptable to good everywhere. The final MG-CFA model confirmed strong factorial invariance and showed very good fit. The long- and short-form I-Pro-VC-Be had good criterion validity with vaccination behaviors. CONCLUSION: This study validates the I-Pro-VC-Be among HCPs in four European countries; including long- and short-form tools for use in research and public health.

Rationally irrational: When people do not correct their reasoning errors even if they could.

Why is it that sometimes people do not correct their reasoning errors? The dominating dual-process theories of reasoning detail how people (fail to) detect their reasoning errors but underspecify how people decide to correct these errors once they are detected. We have unpacked the motivational aspects of the correction process here, leveraging the research on cognitive control. Specifically, we argue that when people detect an error, they decide whether or not to correct it based on the overall expected value associated with the correction-combining perceived efficacy and the reward associated with the correction while considering the cost of effort. Using a modified two-response paradigm, participants solved cognitive reflection problems twice while we manipulated the factors defining the expected value associated with correction at the second stage. In five experiments (N = 5,908), we found that answer feedback and reward increased the probability of correction while cost decreased it, relative to the control groups. These cognitive control critical factors affected the decisions to correct reasoning errors (Experiments 2 and 3) and the corrective reasoning itself (Experiments 1, 4 and 5) across a range of problems, feedbacks, types of errors (reflective or intuitive), and cost and reward manipulations pre-tested and checked in five separate studies (N = 951). Thus, some people did not correct their epistemically irrational reasoning errors because they followed the instrumentally rational principle of the expected value maximization: They were rationally irrational. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

When Science Becomes Embroiled in Conflict: Recognizing the Public's Need for Debate while Combating Conspiracies and Misinformation.

Most democracies seek input from scientists to inform policies. This can put scientists in a position of intense scrutiny. Here we focus on situations in which scientific evidence conflicts with people's worldviews, preferences, or vested interests. These conflicts frequently play out through systematic dissemination of disinformation or the spreading of conspiracy theories, which may undermine the public's trust in the work of scientists, muddy the waters of what constitutes truth, and may prevent policy from being informed by the best available evidence. However, there are also instances in which public opposition arises from legitimate value judgments and lived experiences. In this article, we analyze the differences between politically-motivated science denial on the one hand, and justifiable public opposition on the other. We conclude with a set of recommendations on tackling misinformation and understanding the public's lived experiences to preserve legitimate democratic debate of policy.

Public policy and conspiracies: The case of mandates.

Although conspiracy theories are only endorsed by a minority, conspiracy theories can nonetheless compromise public health measures to control the COVID-19 pandemic. Individuals who endorse conspiracy theories were less likely to wear masks, comply with social distancing, or get vaccinated. This poses a challenge to public health policy, in particular because vaccine uptake lags behind targets because of resistance from a relatively small, but highly vocal, number of people. One policy tool is to enact vaccine mandates, which, while controversial, have successfully increased vaccination uptake. In this article, we review the evidence about whether mandates can be successful, and whether they trigger increased opposition and conspiracy beliefs. We discuss the implications for using mandates in public health policy and argue that decisions about mandates need to be weighed against the consequences of alternative measures-which may also increase conspiracy beliefs albeit for different reasons.

Ambiguity and unintended inferences about risk messages for COVID-19.

The World Health Organization established that the risk of suffering severe symptoms from coronavirus disease (COVID-19) is higher for some groups, but this does not mean their chances of infection are higher. However, public health messages often highlight the "increased risk" for these groups such that the risk could be interpreted as being about contracting an infection rather than suffering severe symptoms from the illness (as intended). Stressing the risk for vulnerable groups may also prompt inferences that individuals not highlighted in the message have lower risk than previously believed. In five studies, we investigated how U.K. residents interpreted such risk messages about COVID-19 (n = 396, n = 399, n = 432, n = 474) and a hypothetical new virus (n = 454). Participants recognized that the risk was about experiencing severe symptoms, but over half also believed that the risk was about infection, and had a corresponding heightened perception that vulnerable people were more likely to be infected. Risk messages that clarified the risk event reduced misinterpretations for a hypothetical new virus, but existing misinterpretations of coronavirus risks were resistant to correction. We discuss the need for greater clarity in public health messaging by distinguishing between the two risk events. (PsycInfo Database Record (c) 2022 APA, all rights reserved).