Psychological impact of fear-based messages in context of COVID 19

Maternal worry of children contracting COVID-19 predicts vaccine uptake in young children in Vermont

Background

Young children, 6 months to 4 years of age, were the last population for whom the COVID-19 vaccines became available and remain the group with the lowest uptake. Scarce information exists on drivers of vaccine uptake in young children. The relationship between parental perceived risk of infection and child COVID-19 vaccination is unknown.

Objective

Examine the association between perceived risk of infection and early childhood vaccination.

Methods

In June 2020, perinatal women in Vermont were enrolled in a longitudinal survey study assessing life changes during the pandemic. Surveys included worry of infection, Parents Attitude about Childhood Vaccines (PACV), intention to vaccinate children with the COVID-19 vaccine, and masking behaviors. Once vaccines became available, surveys also included child vaccination status. A demographic-adjusted stepwise logistic regression was conducted to assess the relationship of worry of infection and vaccine hesitancy on child vaccination status.

Results

85 women completed baseline and follow up surveys. Participants were highly adherent to adult COVID vaccines with 93 % at least partially vaccinated and only 3 % demonstrated general childhood vaccine hesitancy on the PACV. However, in this highly adherent population, only 61 % of young children are vaccinated. In univariate [OR = 7.35 95 % CI (2.70 to 20.02)] and demographic adjusted [OR = 6.03 95 % CI (1.30 to 27.90)] models, current worry about child infection was associated with higher odds of child vaccination. Previously established predictors, vaccine hesitancy [OR = 0.91 95 % CI (0.84 to 0.99)] and younger maternal age [OR = 1.33 95 % CI (1.07 to 1.65)] were again associated lower odds of child vaccination.

Conclusion

Among vaccine adherent parents, worry of infection was a strong predictor of vaccine uptake. Continued efforts to articulate the potential morbidity of COVID in young children, along with established methods to address general vaccine hesitancy may aid in COVID vaccine uptake in this population.

How can we better frame COVID-19 public health messages?

This Perspective discusses the use of fear appeals in promoting health behaviour. The discussion establishes that fear appeal-based public health messages (i.e. public health messages that emphasise the consequences of failing to engage in a particular health behaviour) have two components (1) perceived threat and (2) perceived efficacy. A perceived threat has two subcomponents (a) perceived high susceptibility (e.g. ‘I can contract COVID-19’) and (b) perceived high severity (e.g. ‘COVID-19 can kill me’). In a parallel fashion, perceived efficacy has two subcomponents (a) high response efficacy (e.g. ‘Staying at home can reduce my risk for COVID-19’) and (b) high self-efficacy (e.g. ‘I can stay at home’). This discussion demonstrates that for fear appeals to have a desirable effect on health behaviour change, all of the four conditions (i.e. high perceived susceptibility, high perceived severity, high response efficacy, and high self-efficacy) are important and need to be fulfilled. However, empirical evidence shows that the four conditions are almost never fulfilled, calling into question the effectiveness of using fear appeals in promoting health behaviour change. In contrast, gain-framed public health messages (i.e. public health messages that highlight the benefits of engaging in a particular health behaviour), which do not require the fulfillment of these four conditions, have been shown to have positive effects on behaviour change outcomes. We argue that public health messages that highlight the benefits of engaging in COVID-19 preventive behaviour can have persuasive, desirable effects on health behaviour change, compared to public health messages that highlight the consequences of failing to engage in a particular COVID-19 preventive behaviour.