Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 17, 2025
Open Peer Review Period: Jun 18, 2025 - Aug 13, 2025
Date Accepted: Aug 20, 2025
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Testing Theory-Enhanced Messaging to Promote COVID-19 Vaccination: Results from a Randomized Controlled Trial
ABSTRACT
Background:
Uptake of the COVID-19 vaccine has been low in the US (about 22% among adults in 2023-241) despite ongoing public health recommendations. This has been linked to many factors including pandemic fatigue, reduced risk perception, dis/misinformation, and more recently, to symptoms of depression and anxiety. Novel communication and messaging strategies are one potential approach to promote vaccine uptake.
Objective:
Randomized control trial testing two communication-based approaches compared to standard public health messaging on vaccine uptake in a cohort of adult US residents.
Methods:
We completed a 3-arm, parallel-group, assessor-blinded stratified-randomized trial between April-15-2024 and May-2-2024. Eligible individuals were ≥18 years old who: 1) had received at least one dose of the COVID-19 vaccine, but, 2) had not received COVID-19 vaccine doses since September-11-2023, and 3) had not been infected with SARS-CoV-2 in the past three months. We purposively sampled eligible individuals with and without symptoms of anxiety and depression. Participants were randomly allocated to: 1) attitudinal inoculation intervention; 2) CBT-kernels intervention; or 3) standard public health messaging intervention.
Results:
At four-week follow up, these groups showed no meaningful differences in uptake (CBT- kernels:1.6% [95%CI:0.4-2.8]; Inoculation:0.9% [95%CI:0.0-1.8]; and Standard:1.3% [95%CI:0.3-2.4]) or level of vaccine willingness.
Conclusions:
Successful efforts to increase uptake of the COVID-19 vaccine via theory-enhanced messaging remain elusive. Clinical Trial: Protocol NCT06119854
Citation
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Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.