Limits of the social-benefit motive among high-risk patients: a field experiment on influenza vaccination behaviour

Abstract

Background Influenza vaccine uptake remains low worldwide, inflicting substantial costs to public health. Messages promoting social welfare have been shown to increase vaccination intentions, and it has been recommended that health professionals communicate the socially beneficial aspects of vaccination. We provide the first test whether this prosocial vaccination hypothesis applies to actual vaccination behaviour of high-risk patients. Methods In a field experiment at a tertiary care public hospital in Istanbul, Turkey, we compare the effects of two motivational messages for promoting vaccination. Using a between-subjects single-blind experimental design patients were randomly assigned to frames emphasizing the vaccine’s benefits to self (n = 125) or social benefits (n = 119). Free influenza vaccination was offered to each patient. Results Among 222 patients who were not vaccinated for the season prior to the study (72% medically assessed to be at high risk), 42% in the self-benefit frame chose to receive a vaccination compared with 34% in the social-benefits frame, but the difference was not statistically significant (aOR = 1.63, 95% CI 0.90 to 2.95, p = 0.108). Reasons for vaccination focused primarily on self-benefit (67%) rather than social-benefit (5%). Exploratory analysis showed that the effect of messages depended on patient perception of risk group membership (aORHigh / aORLow = 5.59, 95% CI 1.30 to 24.05, p = 0.021). In particular, emphasis on self-benefit was more influential among patients who perceived themselves to be in the risk group (aOR = 6.22, 95% CI 1.69 to 22.88, p = 0.006). Conclusions In contrast to the literature observing intentions of low-risk populations, we found no evidence that social-benefit motivates actual vaccination behaviour among a high-risk patient population. Instead, those who self-categorize as being in the high risk group are more motivated by the self-benefit message. Our results suggest that a stratified approach can improve coverage: even if an emphasis on social-benefit could be effective among low-risk groups, an emphasis on self-benefit holds more promise for increasing vaccination in medical organizational settings where high-risk groups are prevalent. Trial registration ClinicalTrials.gov NCT04230343 Retrospectively registered on the 13th January 2020.

Information nudges for influenza vaccination: Evidence from a large-scale cluster-randomized controlled trial

“…[24][25][26] There is also recent evidence suggesting that communicating the social-benefit motives of vaccinations to hospitalized high-risk patients does not enhance actual vaccination behavior. 27 Our null results related to the effects of communicating the social benefits of vaccination parallel the emerging conclusion from the literature that information materials tailored using behavioral science techniques do not affect real vaccination rates. In contrast, there is some evidence from the low-and high-income countries that modest in-kind incentives and direct monetary incentives may increase vaccine uptake.…”

Evaluations of Self-Focused Versus Other-Focused Arguments for Social Distancing: An Extension of Moral Matching Effects

“…We presume that public health as an issue (vs. many other issues) trends toward the higher end of the moral continuum on average, but careful testing of a communicator's target audience will be useful to identify their tendency to think of public health as a moral issue, which could help communicators tailor their message accordingly. In addition, there may be other factors that would make a self-focused message more persuasive, such as whether a person is at very high risk (e.g., Isler et al, 2020).…”

Don’t get it or don’t spread it: Comparing self-interested versus prosocial motivations for COVID-19 prevention behaviors

“…3Another stream of applied research has investigated self-interested versus prosocial motives in the context of health behavior (and especially vaccination decisions), and has provided clear evidence that both motives can encourage disease prevention [25][26][27][28][29] . A few studies have directly compared the relative effectiveness of personal versus public framing in vaccination appeals, with inconsistent results: some studies found that public framing was ineffective [30][31][32] , while others provided some mixed evidence for the effectiveness of public framing 33,34 ; and a set of field studies investigating handwashing among healthcare professionals found that it was more effective to emphasize patient safety than personal safety 35 . Thus, the literature surrounding disease spread prevention likewise does not make a clear prediction regarding the relative importance of self-interested versus prosocial motivations, and the relative efficacy of self-interested versus prosocial framing, for coronavirus prevention.To investigate, we measure the influence of three messaging treatments on intentions to engage in COVID-19 prevention behaviors: one that emphasizes personal benefits of prevention, one that emphasizes public benefits of prevention, and one that emphasizes both types of benefits.…”