Hao Tan, Jiayan Liu, Yingli Zhang
Abstract
As a major concern shared by parents globally, COVID-19 vaccine safety is typically being messaged to the public in a negative frame in many countries. However, whether the COVID-19 vaccine safety framing have an effect on parents when vaccinating their children is unclear. Here we implement an online survey with a convenience sample of 3,861 parents living in mainland China, all over 18 years old and with at least one child under 18. The parents were randomly assigned to receive information about COVID-19 vaccine safety in either a negative frame (incidence of side effects) or a positive frame (the inverse incidence of side effects), to compare parental reactions to a range of questions about communication, risk perception, trust, involvement and behavioral intention. We found that parents were more likely to regard vaccine safety as relevant to policy support and as a higher priority for government when receiving positively framed information (p = 0.002). For some specific subgroups, parents in positive framing group showed lower risk perception and higher trust (p<0.05). This suggests that positive framing of COVID-19 vaccine safety messages show more effective performance than negative framing in terms of involvement, as well as trust and risk perception in specific subgroups, which may lead to a reflection on whether to adjust the current widespread use of negative framing.
Introduction
Despite the benefits and worldwide approval use of COVID-19 vaccination for children [1–7], parents still remain a high level of vaccine hesitancy due to concerns about vaccine safety [8–15]. Growing evidence showing that behavioral nudges, which are usually shifts in how a message is framed, are desperately needed to boost COVID-19 vaccination [16–20]. However, public-health specialists and healthcare workers face a particular dilemma in communicating vaccine safety information to parents [21], because they are not provided with guidelines for presenting or framing the information. Public health agencies in many countries such as China, the UK and the US are using a negative frame (incidence of side effects) when explaining COVID-19 vaccine safety [22–26], but our understanding of the framing effect is limited. Understanding how the framing of COVID-19 vaccine safety information affects parental reactions helps examine the appropriateness of the frame currently used in most countries, and may help to address the challenge of risk communication regarding COVID-19 vaccination in the future when China rolls out COVID-19 vaccine for younger children.
Methods
Ethics statement
This study was approved by the Research Ethics Committee of Hunan University (2019002). Written consent was obtained from respondents when they registered and completed the questionnaire on the online survey platform, and they were assured that all results would be disseminated in aggregate form to guarantee anonymity and confidentiality.
Results
Our data were derived from a large online survey (N = 3861) conducted across China in 2022, during the period when children were receiving the COVID-19 vaccine. We first performed a series of two-sided independent samples t-tests to identify differences in framing effects between the negative frame sample and positive frame sample for the full sample. The 7 dependent variables were not normally distributed; however, the t-test has been found to be robust when data are non-normally distributed, particularly with a large sample size. We also performed the Mann-Whitney test and found no significant difference between two tests.
Discussion
Similar to some previous studies showing that subtle changes in framing had an impact on people’s reactions [45, 77, 78], our study revealed a significant framing effect for parents’ involvements. Specifically, parents exposed to positively framed COVID-19 vaccine safety messages were more likely to regard vaccine safety as relevant to policy support and as a higher priority for government than parents exposed to the same messages in the negative frame. In addition, more framing effects on trust and risk perception were observed among female participants, parents with children aged 11 years or older, parents with a junior college degree, and those on low incomes. The results suggest that the negative framing of COVID-19 vaccine safety information, which is widely used worldwide, should be used with particular caution, and that health professionals and policy makers need to carefully consider how to present information well.
Acknowledgments
We express our sincere thanks to all the participants of this study, whose involvement and dedication enabled us to explore and draw meaningful conclusions. We also thank Sojump for their invaluable support and the use of their online survey platform, which greatly facilitated our research.
Citation: Tan H, Liu J, Zhang Y (2024) Effects of COVID-19 vaccine safety framing on parental reactions. PLoS ONE 19(4): e0302233. https://doi.org/10.1371/journal.pone.0302233
Editor: Omar Enzo Santangelo, Regional Health Care and Social Agency of Lodi, ITALY
Received: August 1, 2023; Accepted: March 29, 2024; Published: April 16, 2024
Copyright: © 2024 Tan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: This research was supported by the Natural Science Foundation of Hunan Province (2023JJ30149) and Research Foundation of Lushan Lab, which were got by Hao Tan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0302233#ack
