Investigating the influence of message-frames, psychological flexibility, and distress on COVID-19 vaccine hesitancy: A systematic review and online survey experiment

This research was focused on understanding COVID-19 vaccine hesitancy. In March 2020 the respiratory infection COVID-19 led to the declaration of a global pandemic. A worldwide effort began to develop lifesaving vaccines; however, vaccine hesitancy threatened the success of the new vaccines and worldwide public health. The systematic review explored existing literature on message-framing interventions to increase COVID-19 vaccine take-up and decrease vaccine hesitancy. Message-framing interventions involve varying the information presented, how it is presented, or who presents it. Emphasis frames vary the content of messages, while equivalence frames present logically equivalent information in different ways, highlighting gains or losses (e.g., for a disease expected to kill 600 people and, an intervention will either ‘save 400 people’ or ‘mean that 200 people will die’). Source type manipulations vary who presents the message. Vaccine hesitancy has been assessed through participants’ intentions to receive COVID-19 vaccines and their attitudes. This is the first review examining the impact of message-framing on COVID 19 vaccine hesitancy. Five databases were systematically searched, and fifteen papers were reviewed. While message-frames were supported, methodological issues limited opportunities for meaningful comparisons between studies. None of the studies measured actual vaccine take-up so this aim could not be fulfilled. Many studies used different messages/sources and the overall quality varied. Some studies used equivalence framing, where logically equivalent information is presented as gains or losses. Gain-frames highlight the positive outcomes of a behaviour, such as being vaccinated reducing the risk of severe outcomes from COVID-19 infection. Loss-frames would highlight equivalent negative outcomes, which in this example would be not getting vaccinated increasing the chances of severe outcomes from COVID-19 infection. Higher quality studies found loss-frames had the most impact on vaccine attitudes/intentions. One study found loss-frames were more effective in younger adults and gain-frames were more effective in older adults. Lower quality studies supported gain-frames. Some studies found prior attitudes about the vaccines may influence message-framing effects. Future studies should consider the impact of prior attitudes. Messages emphasising the personal benefits of vaccination were supported. Cultural differences between individualistic/collectivist cultures may play a role, and future research could strengthen these findings. Negatively framed messages and messages highlighting economic benefits of vaccination were also supported. Expert sources were supported, although the sources varied. Future research is needed to determine whether certain frames are more effective, or if any information improves vaccine attitudes/intentions. Addressing the methodological limitations discussed will contribute to the quality of future research. The empirical paper was an online survey (n = 434) investigating the link between psychological flexibility (PF), psychological distress (PD), and COVID-19 vaccine attitudes and acceptance. PF is a person’s ability to do things that are important to them, experience both positive and negative emotions, and change their actions according to their thoughts and feelings. High PF supports effective coping strategies and protects from PD (Dawson & Golijani-Moghaddam, 2020). Psychological inflexibility (PIF) and PD have been linked to vaccine hesitancy (Wang & Zhang, 2021). Participants reported how many COVID-19 vaccines they had received, and their attitudes were measured using a scale assessing: confidence in the COVID-19 vaccines; complacency about the need to receive them; constraints preventing them from being vaccinated; how much calculation they had engaged in; and their feelings of collective responsibility to receive the vaccines. The results showed an association between PIF and PD, and these factors were also associated with participants reporting more constraints, and less personal and collective need for vaccination. The link between PF and coping may explain this, as individuals may be playing down the severity of COVID-19 and the need for vaccination to avoid distress associated with the pandemic. Distressed individuals also avoided information searching about the vaccine, which may reflect a strategy to manage their distress. Higher confidence in vaccines predicted vaccine take-up in participants with one and four plus doses of the vaccine, but none of the other factors predicted acceptance. The tool used to measure vaccine hesitancy has varied in its ability to predict vaccine take-up depending on the vaccine being assessed, so future research should be conducted with this measure to confirm its reliability. Unexpectedly, participants with one/two/three doses were less PF than unvaccinated participants. Only a small amount of vaccine take-up was explained by PIF so future research should consider other contributing variables, like conspiracy beliefs. The timing of the research and the pandemic context is also likely to have impacted the results, and the findings must be considered context specific. The results mean public health campaigns should aim to encourage confidence in vaccines, emphasise the personal and collective benefits of vaccination, and reduce the need for information searching. The results from the systematic review mean that message-framing might be an intervention that could support policy makers to design effective vaccine campaigns