JMIR Publications

ABSTRACT

Background:

Despite the availability of effective vaccines, flu and COVID-19 uptake remains suboptimal, particularly among Indigenous communities who face unique barriers to accessing public health information. While previous research has evaluated health communication message content and design, fewer studies have systematically compared different dissemination strategies for the same intervention, leaving gaps in understanding optimal approaches for reaching marginalized populations.

Objective:

This protocol describes a three-arm dissemination study designed to compare the effectiveness of different strategies for distributing COVID-19 and flu vaccine promotion videos targeting Indigenous Peoples residing in California, including American Indian, Alaska Native, Native American, and migrant Indigenous communities from Latin America.

Methods:

Following extensive formative work including cross-sectional surveys, social network analyses, discrete choice experiments, and focus groups conducted with guidance from an Indigenous Community Advisory Board, we developed two 30-second vaccine promotion videos available in English, Spanish, and four Indigenous languages (Purépecha, Mam, Zapoteco, and Mixteco). We will test three dissemination strategies over one month: (1) paid social media advertisements on Facebook and Instagram targeting high Indigenous population areas, (2) distribution through community-based organizations using their established communication channels, and (3) peer-to-peer sharing through Indigenous community members ("seeds") recruited from previous research. Data collection will utilize Bitly link tracking, YouTube analytics, embedded video polls, and follow-up surveys to measure reach, engagement, and message impact across dissemination strategies.

Results:

The intervention will launch in October 2025, timed for the COVID/flu vaccine season. Primary outcomes include dissemination effectiveness measured through reach (clicks, views), engagement (watch time, survey completion), and message impact (trust, vaccination intent).

Conclusions:

This study addresses a critical gap in health communication research by providing a systematic methodology for comparing digital dissemination strategies within Indigenous communities. The combination of community-informed recruitment, multilingual accessibility, and comprehensive digital tracking tools offers a replicable model for evaluating how public health messages spread through different channels, particularly for populations historically excluded from traditional outreach efforts. Clinical Trial: This trial has been registered (NCT07096245) and approved by IRB [UCSF 23-38709]