Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Sep 22, 2024
Date Accepted: Jun 2, 2025
Effects of scalable, wordless, short, animated storytelling videos on flu vaccine hesitancy in China: a nationwide, single-blind, parallel-group, randomized controlled trial
ABSTRACT
Background:
Influenza vaccination rates in China remain low, posing a continuous and serious threat to public health. Influenza vaccinations have proven effective for preventing infection, but widespread vaccine hesitancy remains a significant barrier to uptake.
Objective:
The objective of this study was to investigate whether scalable, short, animated storytelling (SAS) videos could reduce influenza vaccine hesitancy among Chinese adults.
Methods:
In this single-blind, parallel-group, randomized controlled trial, we recruited adults in China through quota sampling. Participants were randomly assigned to one of three SAS video intervention groups, each using a different storytelling technique (humor, analogy, or emotion) or a control group in a 1:1:1:1 ratio. After watching the video or being assigned to the control group, participants completed the Influenza Vaccine Hesitancy Scale. Influenza vaccine hesitancy was compared between each intervention group and control group, respectively, as well as between different intervention groups, with p-values adjusted for multiple comparisons. The study is registered with the German Clinical Trials Register (DRKS #00023650).
Results:
A total of 12,000 participants met the inclusion criteria and were included in our analysis. Overall, participants in all SAS video intervention groups showed lower influenza vaccine hesitancy than the control group (mean difference -0.41, 95% CI: -0.60 to -0.23; p < 0.0001). Specifically, both intervention groups with humor (Video A) and analogy (Video B) storytelling techniques demonstrated significantly lower hesitancy compared to the control group. However, the intervention group with emotion vedio (Video C) did not show significant effects compared to the control group, nor were there significant differences compared with the other two intervention groups (Videos A and B). In subgroup analyses, Video A effectively reduced vaccine hesitancy among urban residents and participants from southern and southwestern China. Video B was effective within subgroups of participants aged 40-49, males, females, urban and rural residents, those with a college education or higher, households with an income of 90,000-180,000 CNY, and participants from the southwestern region and the western economic belt.
Conclusions:
Our study shows that SAS videos are effective in reducing influenza vaccine hesitancy among a large, diverse, adult population in China. This novel, low-contact, cost-effective, and highly scalable method holds significant promise for future public health initiatives. Clinical Trial: German Clinical Trials Register; DRKS00024505; https://drks.de/search/en/trial/DRKS00024505
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