Vicarious experiences of long COVID: A protection motivation theory analysis for vaccination intentions.

Context: Long COVID can appear as a severe late consequence (sequela) of a COVID-19 infection, leading to the inability to work or participate in social life for an unknown amount of time. To see friends or family struggling with long COVID might influence people's risk perceptions, vaccine efficacy expectations, and self-efficacy perceptions to prevent COVID-19 and its consequences. Methods: In an online survey in August 2022, n = 989 German-speaking participants indicated whether they knew someone who suffered from long COVID illness. Four dimensions of protection motivation theory (PMT) were assessed afterwards, as well as vaccination intentions. Results: Multiple mediation analysis with participants who knew vs. didn't know someone with long COVID (n = 767) showed that knowing someone with long COVID was associated with higher perceived affective and cognitive risk of long COVID-19 as well as higher perceived vaccine efficacy. Self-efficacy, i.e., the ease to protect oneself against long COVID, was lower in participants who knew long-COVID patients. Indirect positive effects for response efficacy and affective risk suggest that vicarious experience with long COVID is associated with increased intentions to get a COVID-19 vaccine. Conclusion: The protection from long COVID through vaccination are relevant aspects for individual decisions and health communication.

The moderating role of trust in pandemic-relevant institutions on the relation between pandemic fatigue and vaccination intentions.

This research helps to clarify the relation between pandemic fatigue (PF) and vaccination intentions (VI). Theoretically, two patterns seem plausible. First, as with any other health protective measure, PF might reduce the motivation to get vaccinated. Second, PF might increase the motivation to get vaccinated because vaccination reduces the number of (other) health protective measure needed. We tested these two opposing predictions and further explored the moderating role of trust in pandemic-relevant institutions on the link between PF and VI in two large-scale survey studies from Denmark and Germany (collected between 2020 and 2021; total N > 22,000). Data was analyzed using multiple regression models. Analyses reveal a negative link between PF and VI that is less pronounced for people high in trust. Results remain stable when accounting for covariates and quadratic trends. Thus, trust might buffer the negative relation between PF and VI.

Historical narratives about the COVID-19 pandemic are motivationally biased.

How people recall the SARS-CoV-2 pandemic is likely to prove crucial in future societal debates on pandemic preparedness and appropriate political action. Beyond simple forgetting, previous research suggests that recall may be distorted by strong motivations and anchoring perceptions on the current situation1-6. Here, using 4 studies across 11 countries (total n = 10,776), we show that recall of perceived risk, trust in institutions and protective behaviours depended strongly on current evaluations. Although both vaccinated and unvaccinated individuals were affected by this bias, people who identified strongly with their vaccination status-whether vaccinated or unvaccinated-tended to exhibit greater and, notably, opposite distortions of recall. Biased recall was not reduced by providing information about common recall errors or small monetary incentives for accurate recall, but was partially reduced by high incentives. Thus, it seems that motivation and identity influence the direction in which the recall of the past is distorted. Biased recall was further related to the evaluation of past political action and future behavioural intent, including adhering to regulations during a future pandemic or punishing politicians and scientists. Together, the findings indicate that historical narratives about the COVID-19 pandemic are motivationally biased, sustain societal polarization and affect preparation for future pandemics. Consequently, future measures must look beyond immediate public-health implications to the longer-term consequences for societal cohesion and trust.

Heatwaves and their health risks: knowledge, risk perceptions and behaviours of the German population in summer 2022.

Heatwaves are becoming more common and impact health. We conducted a representative survey in June 2022 in Germany to determine people's knowledge and protective behaviours on heat days. In data from 953 respondents, we found that a large proportion informed themselves about upcoming heat days, but there are considerable gaps in knowledge. While knowledge was not related to taking up protecting behaviour, other predictors were (e.g. risk perception). Health campaigns should therefore not only aim to improve knowledge but also address risk perceptions, facilitate social learning, communicate social norms and remove barriers that prevent protective behaviours.

Toward future triage regulations: Investigating preferred allocation principles of the German public.

BACKGROUND: When intensive care capacity is limited, triage may be required. Given that the German government started working on new triage legislation in 2022, the present study investigated the German public's preferences for intensive care allocation in two situations: ex-ante triage (where multiple patients compete for available resources) and ex-post triage (where admitting a new patient to intensive care means withdrawing treatment from another because ICU resources are depleted). METHOD: In an online experiment, N=994 participants were presented with four fictitious patients who differed in age and pre- and post-treatment chance of survival. In a series of pairwise comparisons, participants were asked to select one patient for treatment or to opt for random selection. Ex-ante and ex-post triage situations were varied between participants and preferred allocation strategies were inferred from their decisions. RESULTS: On average, participants prioritized better post-treatment prognosis ahead of younger age or treatment benefit. Many participants rejected random allocation (on the flip of a coin) or prioritization by worse pre-treatment prognosis. Preferences were similar for ex-ante and ex-post situations. DISCUSSION: Although there may be good reasons for deviating from laypeople's preference for utilitarian allocation, the results can help to design future triage policies and accompanying communication strategies.

Explaining Boomerang Effects in Persuasive Health Communication: How Psychological Reactance to Healthy Eating Messages Elevates Attention to Unhealthy Food.

While psychological reactance is often invoked to explain the unintended boomerang effects of persuasive health messages, underlying processes that might explain how reactance affects behavior are rarely studied. We investigated whether messages that elicit reactance can bias attention by increasing the perception of information that potentially facilitates adverse behavior. Participants (N = 998) were assigned to one of three experimental conditions: reading an aggressive and emotional text asking them to stop eating meat (appeal condition); reading a neutral text about the nativeness and benefits of eating less meat (information condition); or completing an unrelated word count task (control condition). After assessing their reactance, participants were asked to identify as many words as possible in a word grid in which some words related to meat. Compared to the other conditions, the appeal condition elicited the greatest reactance. Furthermore, omnivore participants in this condition identified significantly more meat-related words when they reported higher levels of reactance. By showing that psychological reactance elicited by forceful health appeals increases attention to information that may facilitate the admonished behaviors, our findings contribute to an improved understanding of effective health communication.

Fear of COVID-19 disease and vaccination as predictors of vaccination status.

Vaccination rates are still insufficient to prevent the spread of COVID-19, so immunity must be increased among the population in order to reduce the virus' spread and the associated medical and psychosocial effects. Although previous work has identified various factors associated with a low willingness to get vaccinated, the role of emotions such as fear of vaccination (FVAC) or fear of COVID-19 (FCOV), vaccination as a subjective norm (SN), psychological factors like general control beliefs (CB) or psychological resilience, and their interaction have been investigated less intensively. We used data from three cross-sectional waves of the German Panel COSMO (November 2021, N = 1010; February 2022, N = 1026; March 2022, N = 1031) and multiple logistic regression analyses to test whether vaccination rates are moderated by those factors. After controlling for covariates (age, sex, confidence in own intuition, optimism, well-being), we found that CB was no significant predictor of vaccination status. Higher FCOV and higher ratings in SN, however, were associated with an increased likelihood of being vaccinated. In contrast, higher FVAC was associated with a decreased likelihood of being vaccinated. Psychological resilience did not consistently moderate the associations between fear and vaccination status.

Filter Questions in Symptom Assessment Affect the Prevalence of (A)Symptomatic COVID-19 Cases.

BACKGROUND: It has been reported that a substantial number of COVID-19 infections are asymptomatic, with both symptomatic and asymptomatic infections contributing to transmission dynamics. Yet, the share of asymptomatic cases varies greatly across studies. One reason for this could be the measurement of symptoms in medical studies and surveys. DESIGN: In 2 experimental survey studies (total N > 3,000) with participants from Germany and the United Kingdom, respectively, we varied the inclusion of a filter question on whether participants who tested positive for COVID-19 had experienced symptoms prior to presenting a checklist of symptoms. We measured the reporting of asymptomatic (versus symptomatic) COVID-19 infections. RESULTS: The inclusion of a filter question increased the reporting of asymptomatic (versus symptomatic) COVID-19 infections. Particularly mild symptoms were underreported when using a filter question. CONCLUSIONS AND IMPLICATIONS: Filter questions affect the reporting of (a)symptomatic COVID-19 cases. To account for such differences in the estimation of population infection rates, future studies should transparently report the applied question format. HIGHLIGHTS: Both symptomatic and asymptomatic infections are important for COVID-19 transmission dynamics.In previous research, symptoms have been assessed either with or without a filter question prior to presenting a symptom list.We show that filter questions reduce the reporting of asymptomatic infections.Particularly mild symptoms are underreported when using a filter question.

Situational pathogen avoidance mediates the impact of social connectedness on preventive measures during the COVID-19 pandemic.

During the COVID-19 pandemic, physical distancing was one of the more important behaviours for reducing the spread of the virus. The present study investigated the influence on pathogen avoidance of familiarity with other people at private gatherings. Based on the social identity model of risk taking and the theory of the behavioural immune system, we assumed that greater familiarity with others would make people feel more connected with one another and decrease situational pathogen avoidance. This could result in lower perceptions of the risk of contracting COVID-19 and fewer protective behaviours. Two experiments (n1 = 1022, n2 = 994) showed that the negative influence of greater familiarity on the perceived risk of infection and protective behaviour is explained by an increased feeling of connectedness and less feeling of situational pathogen avoidance. In an additional survey, the participants (n = 23,023) rated the quality of their past social contacts. The correlational analyses showed that the familiarity of the other person was more important in explaining variance in protective behaviours than attitudes toward those behaviours or the pandemic situation itself. Understanding the process that result in an explosive increase in infection after social gatherings can improve infection control in the future.

From delta to omicron: The role of individual factors and social context in self-reported compliance with pandemic regulations and recommendations.

As SARS-CoV-2 spreads especially when larger groups gather (e.g., at the workplace), it is crucial to understand compliance with regulations and recommendations in such settings. Using data from adults in Germany (N = 29,355) assessed between October 2021 and February 2022, we investigated factors associated with self-reported compliance in both private and working life and how these relate to each other. The results indicate that private compliance was stronger among older individuals and females; among those who worried more about the pandemic situation and assumed that infection was more severe; among those who trusted the government more; and among those who did not perceive public health measures as exaggerated. Private compliance was also associated with personality traits; in particular, individuals who followed regulations and recommendations were likely to be more introverted, conscientious, open, and agreeable. Compliance at work related to both private compliance and colleagues' behaviors. Individuals whose private compliance was high also complied at work. However, when private compliance was low, compliance at work aligned with colleagues' behaviors; that is, compliance at work was high when colleagues complied and low when they did not. The observed effects were stable over time. In summary, they suggest that compliance with regulations and recommendations depends on individual risk perception, trust in government, perception of required or recommended measures, and social norms. To promote protective behaviors in contexts where larger groups gather (including workplaces), making positive social norms more salient (e.g., by supporting role models) may prove especially useful.

Different Interventions for COVID-19 Primary and Booster Vaccination? Effects of Psychological Factors and Health Policies on Vaccine Uptake.

BACKGROUND: Mitigation of the COVID-19 pandemic requires continued uptake of SARS-CoV-2 vaccines. To increase vaccination intention and uptake, key determinants of primary and booster vaccination need to be understood and potential effects of vaccination policies examined. DESIGN: Using experimental data collected in Germany in February 2022 (N = 2701), this study investigated 1) predictors of primary and booster vaccination and 2) potential effects of policies combining vaccination mandates and monetary incentives. RESULTS: Compared with unvaccinated participants, those with primary vaccination were less complacent, more often understood the collective protection afforded by vaccination, and less often endorsed conspiracy-based misinformation. Compared with participants with primary vaccination, boosted individuals were even less complacent, exhibited fewer conspiracy-based beliefs, perceived fewer constraints by prioritizing vaccination over other things, and more often favored compliance with official vaccination recommendations. Support for and reactance about vaccination mandates depended on vaccination status rather than policy characteristics, regardless of mandate type or incentives (up to 500 EUR). While unvaccinated individuals rejected policy provisions and declined vaccination, boosted individuals indicated mid-level support for mandates and showed high vaccination intention. Among vaccinated individuals, higher incentives of up to 2000 EUR had a considerable positive effect on the willingness to get boosted, especially in the absence of a mandate. CONCLUSIONS: While mandates may be needed to increase primary vaccination, our results indicate that financial incentives could be an alternative to promote booster uptake. However, combining both measures for the same target group seems inadvisable in most cases. HIGHLIGHTS: Unvaccinated individuals and people with primary and booster vaccinations differ on psychological dimensions, calling for tailored immunization campaigns.Vaccination intentions depend on vaccination status rather than on mandatory or incentivizing policies.Incentives are unlikely to persuade unvaccinated individuals but may increase booster uptake.Positive effects of incentives decrease when vaccination is mandatory, advising against combination.

The association between vaccination status identification and societal polarization.

Public discord between those vaccinated and those unvaccinated for COVID-19 has intensified globally. Theories of intergroup relations propose that identifying with one's social group plays a key role in the perceptions and behaviours that fuel intergroup conflict. We test whether identification with one's vaccination status is associated with current societal polarization. The study draws on panel data from samples of vaccinated (n = 3,267) and unvaccinated (n = 2,038) respondents in Germany and Austria that were collected in December 2021 and February, March and July 2022. The findings confirm that vaccination status identification (VSI) explains substantial variance in a range of polarizing attitudes and behaviours. VSI was also related to higher psychological reactance toward mandatory vaccination policies among the unvaccinated. Higher levels of VSI reduced the gap between intended and actual counterbehaviours over time by the unvaccinated. VSI appears to be an important measure for predicting behavioural responses to vaccination policies.

Crowdsourcing interventions to promote uptake of COVID-19 booster vaccines.

Background: COVID-19 booster vaccine uptake rates are behind the rate of primary vaccination in many countries. Governments and non-governmental institutions rely on a range of interventions aiming to increase booster uptake. Yet, little is known how experts and the general public evaluate these interventions. Methods: We applied a novel crowdsourcing approach to provide rapid insights on the most promising interventions to promote uptake of COVID-19 booster vaccines. In the first phase (December 2021), international experts (n = 78 from 17 countries) proposed 46 unique interventions. To reduce noise and potential bias, in the second phase (January 2022), experts (n = 307 from 34 countries) and representative general population samples from the UK (n = 299) and the US (n = 300) rated the proposed interventions on several evaluation criteria, including effectiveness and acceptability, on a 5-point Likert-type scale. Findings: Sanctions were evaluated as potentially most effective but least accepted. Evaluations by expert and general population samples were considerably aligned. Interventions that received the most positive evaluations regarding both effectiveness and acceptability across evaluation groups were: a day off work after getting vaccinated, financial incentives, tax benefits, promotional campaigns, and mobile vaccination teams. Interpretation: The results provide useful insights to help governmental and non-governmental institutions in their decisions about which interventions to implement. Additionally, the applied crowdsourcing method may be used in future studies to retrieve rapid insights on the comparative evaluation of (health) policies. Funding: This study received funding from the Austrian Science Fund (SFB F63) and the University of Vienna.

Understanding drivers of vaccine hesitancy among pregnant women in Nigeria: A longitudinal study.

Vaccine-preventable-diseases are major contributors to disease burden in Sub-Saharan Africa. There is dearth of knowledge on the drivers of childhood vaccine hesitancy in Nigeria and its impact on coverage. Although understudied, pregnant women are a particularly important vulnerable group and very relevant for childhood vaccination decisions. This study's aims are to adapt Confidence, Complacency, Constraints, Calculation, and Collective Responsibility, also known as the 5C psychological antecedence scale for the Nigerian context and to measure predictors of intention to vaccinate among pregnant women (prenatal) and subsequent vaccination behavior (postnatal). It is a longitudinal study that used multi-stage sampling procedure. One healthcare facility was selected from each district in five regional clusters, from which 255 pregnant women were randomly drawn. A standardized questionnaire was used to collect relevant data, including the 5C and some additional variables. Multiple linear regression using backward elimination analysis was performed to identify intention at prenatal and behavior at postnatal. Pregnant women's intention to vaccinate unborn children was lower if they were Muslims, had lower confidence in public health system, if husband approval was important, and if they believed in rumor. At postnatal, vaccination behavior was more likely to follow mothers' religious beliefs, when confidence in vaccine effectiveness was high and when mothers felt responsible for the collective. However, everyday stress (constraints) related to less vaccination behavior, and intention did not predict actual vaccination behavior. The 5C scale needs revision before being widely used in Nigeria. Yet, it is a better tool for measuring vaccination behavior than intention.

Payments and freedoms: Effects of monetary and legal incentives on COVID-19 vaccination intentions in Germany.

Monetary and legal incentives have been proposed to promote COVID-19 vaccination uptake. To evaluate the suitability of incentives, an experiment with German participants examined the effects of payments (varied within subjects: 0 to 10,000 EUR) and freedoms (varied between subjects: vaccination leading vs. not leading to the same benefits as a negative test result) on the vaccination intentions of previously unvaccinated individuals (n = 782) in April 2021. While no effect could be found for freedoms, the share of participants willing to be vaccinated increased with the payment amount. However, a significant change required large rewards of 3,250 EUR or more. While monetary incentives could increase vaccination uptake by a few percentage points, the high costs of implementation challenge the efficiency of the measure and call for alternatives. As the data suggest that considering vaccination as safe, necessary, and prosocial increases an individual's likelihood of wanting to get vaccinated without payment, interventions should focus on these features when promoting vaccination against COVID-19.

Attitude toward a mandatory COVID-19 vaccination policy and its determinants: Evidence from serial cross-sectional surveys conducted throughout the pandemic in Germany.

BACKGROUND: Mandating vaccination against COVID-19 is often discussed as a means to counter low vaccine uptake. Beyond the potential legal, ethical, and psychological concerns, a successful implementation also needs to consider citizens' support for such a policy. Public attitudes toward vaccination mandates and their determinants might differ over time and, hence, should be monitored. METHODS: Between April 2020 and April 2021, we investigated public support for mandatory vaccination policies in Germany and examined individual correlates, such as vaccination intentions, confidence in vaccine safety, and perceived collective responsibility, using a series of cross-sectional, quota-representative surveys (overall N = 27,509). RESULTS: Support for a vaccination mandate declined before the approval of the first vaccine against COVID-19 in December 2020 and increased afterwards. However, at the end of April 2021, only half of respondents were in favor of mandatory regulations. In general, mandates were endorsed by those who considered the vaccines to be safe, anticipated practical barriers, and felt responsible for the collective. On the contrary, perceiving vaccination as unnecessary and weighing the benefits and risks of vaccination was related to lower support. Older individuals and males more often endorsed vaccination mandates than did younger participants and females. Interestingly, there was a gap between vaccination intentions and support for mandates, showing that the attitude toward mandatory vaccination was not only determined by vaccination-related factors such as vaccine safety or prosocial considerations. CONCLUSIONS: Because of low public support, mandatory vaccination against COVID-19 should be considered a measure of last resort in Germany. However, if removing barriers to vaccination and educational campaigns about vaccine safety and the societal benefits of high vaccination uptake are not sufficient for increasing vaccination uptake to the required levels, mandates could be introduced. In this case, measures to ensure and increase acceptance and adherence should be taken.

Ok Google: Using virtual assistants for data collection in psychological and behavioral research.

Because of the increasing popularity of voice-controlled virtual assistants, such as Amazon's Alexa and Google Assistant, they should be considered a new medium for psychological and behavioral research. We developed Survey Mate, an extension of Google Assistant, and conducted two studies to analyze the reliability and validity of data collected through this medium. In the first study, we assessed validated procrastination and shyness scales as well as social desirability indicators for both the virtual assistant and an online questionnaire. The results revealed comparable internal consistency and construct and criterion validity. In the second study, five social psychological experiments, which have been successfully replicated by the Many Labs projects, were successfully reproduced using a virtual assistant for data collection. Comparable effects were observed for users of both smartphones and smart speakers. Our findings point to the applicability of virtual assistants in data collection independent of the device used. While we identify some limitations, including data privacy concerns and a tendency toward more socially desirable responses, we found that virtual assistants could allow the recruitment of participants who are hard to reach with established data collection techniques, such as people with visual impairment, dyslexia, or lower education. This new medium could also be suitable for recruiting samples from non-Western countries because of its wide availability and easily adaptable language settings. It could also support an increase in the generalizability of theories in the future.

Vaccination policy reactance: Predictors, consequences, and countermeasures.

Ending the COVID-19 pandemic will require rapid large-scale uptake of vaccines against the disease. Mandating vaccination is discussed as a suitable strategy to increase uptake. In a series of cross-sectional quota-representative surveys and two preregistered experiments conducted in Germany and the US (total N = 4629), we investigated (i) correlates of individual preferences for mandatory (vs voluntary) COVID-19 vaccination policies; (ii) potential detrimental effects of mandatory policies; and (iii) interventions potentially counteracting them. Results indicate that reactance elicited by mandates can cause detrimental effects, such as decreasing the intention to vaccinate against influenza and adhere to COVID-19 related protective measures.