The Vaccine Training Barometer: Assessing healthcare providers' confidence to answer vaccine-related questions and their training needs.

Healthcare providers (HCP) are seen by the public as the most trustworthy source of information about vaccination. While HCPs could be a valuable partner to increase vaccine confidence in general, it is not clear whether they feel confident themselves to address questions concerning vaccination. In the context of the EU Joint Action on Vaccination (EU-JAV), the Vaccine Training Barometer, an online survey tool, was developed to assess how frequently HCPs receive questions about vaccination, how confident they feel to answer these questions, and to what extent they are willing to follow extra training. After a pilot test in Flanders, Belgium, the Barometer was launched and completed by 833 HCPs in Flanders and 291 HCPs in the Spanish regions of Catalonia, Navarre and Valencian Community from November 2020 until January 2021, during the COVID-19 pandemic, just before and during the start of the first COVID-19 vaccination campaigns. In both countries, HCPs frequently received questions about vaccination (mostly on a daily or weekly basis), and about two thirds of them indicated that the frequency of questions had increased during the three months prior to completing the survey. Most questions were about the side effects and safety of vaccines. In both countries, a considerable proportion of HCPs did not feel confident to answer vaccine-related questions (31.5% felt confident in Flanders, 21.6% in Spain). A large proportion of HCPs received questions in the last three months before the survey that they could not answer (52.4% of respondents in Flemish sample, 41.5% in Spanish sample). Only 11.4% (Flanders) and 11.3% (Spain) of the respondents felt they gained sufficient knowledge through their standard education to be able to answer questions about vaccination. Almost all respondents were willing to follow extra training on vaccination (Flanders: 95.4%, Spain: 96.6%). The Vaccine Training Barometer is thus a useful tool to monitor HCPs' confidence to answer questions about vaccination and to capture their training needs.

The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults.

BACKGROUND: Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context. OBJECTIVE: This study aims to investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy support using COVID-19 vaccination chatbots. METHODS: This experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used a 2 (empathy/autonomy support expression: present vs absent) × 2 (chatbot expertise cues: expert endorser vs layperson endorser) between-subject design. Chatbot conversation quality was assessed through actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from -5 to 5 (VIS). RESULTS: There was a negative interaction effect of chatbot empathy/autonomy support expression and conversation fallback (CF; the percentage of chatbot answers "I do not understand" in a conversation) on PUA (PROCESS macro, model 1, B=-3.358, SE 1.235, t186=2.718, P=.007). Specifically, empathy/autonomy support expression had a more negative effect on PUA when the CF was higher (conditional effect of empathy/autonomy support expression at the CF level of +1SD: B=-.405, SE 0.158, t186=2.564, P=.011; conditional effects nonsignificant for the mean level: B=-0.103, SE 0.113, t186=0.914, P=.36; conditional effects nonsignificant for the -1SD level: B=0.031, SE=0.123, t186=0.252, P=.80). Moreover, an indirect effect of empathy/autonomy support expression on CPI via PUA was more negative when CF was higher (PROCESS macro, model 7, 5000 bootstrap samples, moderated mediation index=-3.676, BootSE 1.614, 95% CI -6.697 to -0.102; conditional indirect effect at the CF level of +1SD: B=-0.443, BootSE 0.202, 95% CI -0.809 to -0.005; conditional indirect effects nonsignificant for the mean level: B=-0.113, BootSE 0.124, 95% CI -0.346 to 0.137; conditional indirect effects nonsignificant for the -1SD level: B=0.034, BootSE 0.132, 95% CI -0.224 to 0.305). Indirect effects of empathy/autonomy support expression on VIS via PUA were marginally more negative when CF was higher. No effects of chatbot expertise cues were found. CONCLUSIONS: The findings suggest that expressing empathy/autonomy support using a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users' questions. The paper adds to the literature on vaccination chatbots by exploring the conditional effects of chatbot empathy/autonomy support expression. The results will guide policy makers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy.

From Message to Messenger: Should Politicians Lead-by-Example to Increase Compliance with Public Health Directives?

This study proposes that in order to increase compliance with government directives during health crises, we should consider the message as well as the messenger. Prior research shows that highly instructional crisis communication increases compliance during acute crisis situations. Crisis communication literature provides no clear answers on how to address prolonged crises like the COVID-19 pandemic, however. We examined the impact of crisis communication on compliance with health directives in March - April 2021, during the third wave of the pandemic in Belgium. Two field experiments were conducted at two different points in time. Participants received an informational message from Belgian authorities, that was either highly instructional or not. Next, they watched a set of messages from traditional and social media, depicting Belgian politicians setting a good or a bad example in terms of adhering to public health directives. Instructional messages only proved to be effective in the first study. Leading-by-example had a stronger impact, especially in study two. During the third wave of COVID-19, Belgian people seemed more inclined to follow public health directives when politicians set the right example, due to an increase in trust in the government. Bad examples, however, decreased compliance.