Lifestyle Segmentation to Explain the Online Health Information-Seeking Behavior of Older Adults: Representative Telephone Survey

Influenza and pneumococcal vaccine hesitancy in the elderly population: results from two representative surveys in Germany

BACKGROUND

The reasons for low influenza and pneumococcal vaccine acceptance in the elderly population are largely unknown - despite the great need of vaccines in this risk group. While many studies examine the relationship between factors influencing vaccination, such as sociodemographic characteristics and influenza and pneumococcal vaccination intentions and behavior, psychological factors, such as vaccine-specific attitudes, are underutilized in research on vaccination behaviors and intervention strategies. This article assesses the psychological antecedents of influenza and pneumococcal vaccination in the elderly and assesses the predictive power of psychological vs. sociodemographic and other factors surrounding vaccination, on vaccination behavior.

METHODS

A cross-sectional telephone survey, representative of age, gender and rural/urban residence, was conducted with N = 701 German participants > 60 years of age, during the influenza season of 2016-17. Multiple logistic regressions were conducted to identify the relevant determinants of vaccination behavior.

RESULTS

Results show unique patterns in the psychological antecedents: while confidence, the belief in the effectiveness of vaccination and calculation, the need for information, complacency, the lack of risk perception and constraints, and perceived practical barriers to vaccination predicted influenza vaccination behavior, only complacency predicted pneumococcal vaccination behavior. The amount of explained variance in influenza vaccination behavior nearly doubles when psychological antecedents of vaccination are taken into account, beyond other factors surrounding vaccination. However, the effect was smaller for pneumococcal vaccination behavior. The results are compared to a subnational sample.

CONCLUSIONS

Understanding the psychological drivers of vaccination can help to plan interventions effectively.

TRIAL REGISTRATION

Deutsches Register Klinische Studien (German Clinical Trials Register) DRKS00012653. Registered 24.11.2017. Retrospectively registered.

Assessing Short-Video Dependence for e-Mental Health: Development and Validation Study of the Short-Video Dependence Scale

BACKGROUND

Short-video dependence (SVD) has become a significant mental health issue around the world. The lack of scientific tools to assess SVD hampers further advancement in this area.

OBJECTIVE

This study aims to develop and validate a scientific tool to measure SVD levels, ensuring a scientifically determined cutoff point.

METHODS

We initially interviewed 115 highly engaged short-video users aged 15 to 63 years. Based on the summary of the interview and references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for behavioral addictions, we proposed the first version of the short-video dependence scale (SVDS). We then screened the items through item analysis (second version) and extracted common factors using exploratory factor analysis (third version) and confirmatory factor analysis (final version). Convergent validity was tested with other scales (Chinese Internet Addiction Scale [CIAS] and DSM-5). Finally, we tested the validity of the final version in 16,038 subjects and set the diagnostic cutoff point through latent profile analysis and receiver operating characteristic curve analysis.

RESULTS

The final version of the SVDS contained 20 items and 4 dimensions, which showed strong structural validity (Kaiser-Meyer-Olkin value=0.94) and internal consistency (Cronbach α=.93), and good convergent validity (rCIAS=0.61 and rDSM-5=0.68), sensitivity (0.77, 0.83, 0.87, and 0.62 for each of the 4 dimensions), and specificity (0.75, 0.87, 0.80, and 0.79 for each of the 4 dimensions). Additionally, an SVDS score of 58 was determined as the best cutoff score, and latent profile analysis identified a 5-class model for SVD.

CONCLUSIONS

We developed a tool to measure SVD levels and established a threshold to differentiate dependent users from highly engaged nondependent users. The findings provide opportunities for further research on the impacts of short-video use.

A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study

Background

Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process.

Objective

This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia.

Methods

This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ≥65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method.

Results

The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved.

Conclusions

The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach.

Using Health Information Resources for People With Cognitive Impairment (digiDEM Bayern): Registry-Based Cohort Study

Background

Dementia is a growing global health challenge with significant economic and social implications. Underdiagnosis of dementia is prevalent due to a lack of knowledge and understanding among the general population. Enhancing dementia literacy through improved health information-seeking behavior is crucial for the self-determined management of the disease by those affected. Understanding the relationship between dementia literacy, health information-seeking behavior, and the use of various information sources among individuals with cognitive impairment is of high importance in this context.

Objective

The aim of this study was to analyze the relevance of different sources of health information from the perspective of people with cognitive impairment, while also evaluating differences based on age, gender, and disease progression.

Methods

This study is part of the ongoing project "Digital Dementia Registry Bavaria - digiDEM Bayern." The Digital Dementia Registry Bavaria is a multicenter, prospective, longitudinal register study in Bavaria, Germany. People with cognitive impairment rated several information sources by using Likert scales with the values unimportant (1) to very important (5). Data were analyzed descriptively, and multiple 2-sample, 2-tailed t tests were used to evaluate differences by cognitive status and gender and using multiple one-way ANOVA to evaluate differences by age group.

Results

Data of 924 people with cognitive impairment (531 with dementia, 393 with mild cognitive impairment) were evaluated. The most relevant health information sources were "Personal visit to a medical professional" (mean 3.9, SD 1.1) and "Family / Friends" (mean 3.9, SD 1.2). "Internet" was 1 of the 2 lowest-rated information sources by people with cognitive impairment (mean 1.6, SD 1.1), with nearly three-quarters (684/924, 74%) of the participants rating the source as unimportant. The age-specific analyses showed significant differences for the sources "Internet" (F2,921=61.23; P<.001), "Courses / Lectures" (F2,921=18.88; P<.001), and "Family / Friends" (F2,921=6.27; P=.002) for the 3 defined age groups. There were several significant differences between people with mild cognitive impairment and dementia whereby the first group evaluated most sources higher, such as "Internet" (mean difference=0.6; t640=7.52; P<.001). The only sources rated higher by the dementia group were "TV / Radio" and "Family / Friends," with none of them showing significant differences. Gender-specific analyses showed women with cognitive impairment valuing every evaluated source higher than men apart from "Internet" (mean difference=0.4; t685=4.97; P<.001).

Conclusions

To enhance health and dementia literacy, the best way to communicate health information to people with cognitive impairment is through interpersonal contact with medical professionals and their friends and family. Slight changes in valuation should be considered as the medical condition progresses, along with variations by age and gender. In particular, the evaluation and use of the internet are dependent on these factors. Further research is needed to capture potential changes in the valuation of the internet as a health information source.

Exploring pre-pandemic patterns of vaccine decision-making with the 5C model: results from representative surveys in 2016 and 2018

BACKGROUND

The 5C psychological antecedents of vaccination (Confidence, Complacency, Constraints, Calculation, and Collective Responsibility) facilitate understanding vaccination decisions in specific target groups as well as the general public's informational needs. This study aims to explain pre-pandemic vaccination behaviour (a) in general, (b) for specific vaccines such as influenza, and (c) for certain target groups (e.g. people over the age of 59 years, parents, healthcare workers), using the 5C model and sociodemographic variables. The intention to get an influenza vaccination was also analysed for target groups.

METHODS

The 5C, self-reported vaccination behaviour and the intention to vaccinate were collected in two representative telephone surveys in Germany - one in 2016 (n1 = 5,012) and another in 2018 (n2 = 5,054). Parents, people over the age of 59 years, chronically ill people, people with a migratory background, pregnant women and healthcare workers were target groups.

RESULTS

Overall, the 5C model had higher explanatory power than sociodemographic variables. The pattern of vaccine hesitancy slightly differed between vaccinations and target groups. Confidence in safety and effectiveness was always a significant predictor. Complacency (the underestimation of disease risks) and Constraints were significant predictors as well. Calculation (of risks and benefits) was important for influenza vaccination intentions.

CONCLUSIONS

This work builds an important benchmark for understanding potential changes in vaccine acceptance due to the pandemic. The benchmark can be used in research on potential effects of the pandemic on vaccination behaviours. Intervention designers can also use the results to understand specific audiences and their vaccination decisions.

Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study

BACKGROUND

The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI).

OBJECTIVE

This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions.

METHODS

A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions.

RESULTS

The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03).

CONCLUSIONS

To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life.

Online health information searching and health literacy among middle-aged and older adults: A cross-sectional study

Given the rapid increase in health information available, health literacy is now more important than ever when searching for health information online. Furthermore, health literacy and online health information searching are reported to be associated with support from others. In this study, we examined the associations of health literacy and social support with online health information searching among individuals in their 50s and 60s. Between March and May 2022, an anonymous self-administered questionnaire was administered among 750 middle-aged and older adults (age 50-69) living in northern Japan. The questionnaire items included personal characteristics, frequency of online health information searching, health literacy domains, and social support. A total of 237 respondents answered all the items (response rate: 31.6%). Multiple logistic regression analysis revealed that communicative health literacy was significantly associated with searching for information about illnesses and health promotion, while critical health literacy was significantly associated with searching for information about medical institutions. Controlling for personal characteristics, health literacy, was associated with online health information searching, suggesting that improving health literacy is important in a digital and information society.

Patient centeredness, independent health-related Internet use, and online communication with healthcare providers in later life: A cross-sectional study

OBJECTIVE

To test the links between patient centeredness, independent health-related Internet use, and online communication with healthcare provider in later life.

METHODS

These links were tested on a multivariable level through the prism of the socioemotional selectivity theory and the channel complementarity theory. The data were obtained from the Health Information National Trends Survey (Wave 5, Cycle 4) and analyzed using logistic regression models. The sample included older Internet users (N = 1165).

RESULTS

Low patient centeredness corresponded to a decreased likelihood of communicating with healthcare providers online. No particular patient centeredness component was associated with the studied phenomenon. Online health information seeking corresponded to an increased likelihood of communicating with healthcare providers online.

CONCLUSION

Patient centeredness plays a relatively modest role in explanation of the online communication with healthcare providers in later life. In addition, older adults' online health information seeking behavior and online patient-provider communication seem to complement each other.

PRACTICE IMPLICATIONS

The findings can serve public health officials for developing programs aimed at increasing the rates of the online communication with healthcare providers in older population. The findings can also serve healthcare providers in their efforts to improve the quality of (online) communication with their older patients.

Exploring how members of the public access and use health research and information: a scoping review

BACKGROUND

Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information.

PURPOSE

This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information.

METHODS

Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010-2022 on the public's access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews.

RESULTS

The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public's sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of 'health information' but a lack of reporting of the general public's access to and use of health research. It found that 'traditional' sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people's lived experiences, and the cultural knowledge required.

CONCLUSIONS

The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.

Refined Analysis of Older eHealth Users From an Agency Perspective: Quantitative Telephone Interview Study

BACKGROUND

Most studies on the eHealth divide among older people have compared users to nonusers and found that age, gender, and education were associated with eHealth misuse. They assumed that these characteristics were structural barriers to eHealth adoption. Furthermore, eHealth practices have been examined in a narrow and incomplete way, and the studies disagree about the association between health conditions and eHealth use. Using a more dynamic theoretical lens, we investigated the potential motivations driving older adults' agential adoption of eHealth practices despite their advanced age.

OBJECTIVE

This study aimed to obtain a complete and detailed description of eHealth uses among older adults; examine whether demographic characteristics such as age, gender, and education (previously related to eHealth misuse) are still associated with the various eHealth clusters; and determine whether contextual factors such as changes in the health condition of older eHealth users or their loved ones are associated with older adult eHealth use.

METHODS

We conducted a 30-minute telephone interview with a representative sample of 442 Israeli adults (aged ≥50 years) with a sampling error of 2.04%. The interviews were conducted in Hebrew, Arabic, and Russian. Using factor analysis with 21 eHealth use questions, we identified 4 eHealth clusters: instrumental and administrative information seeking, information sharing, seeking information from peers, and web-based self-tracking. In addition to age, gender, education, internet experience, frequency of internet use, perceived eHealth literacy, and self-rated health, we asked respondents to indicate how much they had used offline health services because of a health crisis in the past year.

RESULTS

We found differences in the number of older eHealth users in the various clusters. They used instrumental and administrative information (420/442, 95%) and obtained information from peers (348/442, 78.7%) the most; followed by web-based self-tracking related to health issues (305/442, 69%), and only a few (52/442, 11.3%) uploaded and shared health information on the web. When controlling for personal attributes, age, gender, and education were no longer predictors of eHealth use, nor was a chronic ailment. Instead, internet experience, frequency of internet use, and perceived eHealth literacy were associated with 3 eHealth clusters. Looking for health information for family and friends predicted all 4 eHealth clusters.

CONCLUSIONS

Many older adults can overcome structural barriers such as age, gender, and education. The change in their or their loved ones' circumstances encouraged them to make deliberate efforts to embrace the new practices expected from today's patients. Seeking health information for family and friends and dealing with unexpected health crises motivates them to use eHealth. We suggest that health professionals ignore their tendency to label older people as nonusers and encourage them to benefit from using eHealth and overcome stereotypical ways of perceiving these patients.

Relationships among patient activation, social support and online health information seeking of community-dwelling older adults living with coronary heart disease

AIMS

To explore the relationship between patient activation (subjective initiative of patients to participate in disease management in self-health care), social support, self-efficacy and online health information seeking among older patients with coronary heart disease.

DESIGN

A cross-sectional and survey-based design.

METHODS

A total of 451 older patients with coronary heart disease were recruited from July to November 2021 from four communities in Qingdao, China. We collected data using the Patient Activation Measure, Social Support Rating Scale, Self-Efficacy Scale and Online Health Information Seeking Scale. We performed structural equation modelling to analyse the data.

RESULTS

The final model showed good model fit. Patient activation influenced online health information seeking directly (β  = .39, p  < .05) and indirectly through self-efficacy (β  = .17, p  < .05). Social support influenced online health information seeking directly (β  = .23, p  < .05) and indirectly through self-efficacy (β  = .03, p  < .05). Self-efficacy directly influenced online health information seeking (β  = .26, p  < .05).

CONCLUSIONS

We identified the interrelationships of patient activation, social support and self-efficacy and their influence on the online health information seeking of older patients with coronary heart disease. Our findings provide a theoretical basis for developing and evaluating interventions to enhance online health information seeking for older patients with coronary heart disease.

IMPACT

These findings add a better understanding of the relationship between patient activation, social support, self-efficacy and online health information seeking in older patients with coronary heart disease, and help community health workers to intervene in the early stage of disease diagnosis.

Reaching Ambulatory Older Adults with Educational Tools: Comparative Efficacy and Cost of Varied Outreach Modalities in Primary Care

BACKGROUND

Providing patients with access to health information that can be obtained outside of an office visit is an important part of education, yet little is known about the effectiveness of outreach modalities to connect older adults to online educational tools. The objective was to identify the effectiveness and cost of outreach modalities providing online information about advance care planning (ACP) for older adults.

METHODS

Six different outreach modalities were utilized to connect patients to online educational tools (ACP video decision aids). Participants were 13,582 patients aged 65 and older of 185 primary care providers with appointments over a 30-month period within a large health system in the greater New York City area. Main outcome measures were number of online video views and costs per outreach for each modality.

KEY RESULTS

There were 1150 video views for 21,407 remote outreach events. Text messages, sent to the largest volume of patients (8869), had the highest outcome rate (9.6%) and were the most economical ($0.09). Characterization of phone calls demonstrated 21.7% engagement in the topic of ACP but resulted in minimal video views (<1%) and incurred the highest cost per outreach ($2.88). In-office handouts had negligible results (<1%).

CONCLUSIONS

Text was the most cost-effective modality to connect older adults to an online educational tool in this pragmatic trial, though overall efficacy of all modalities was low.

Understanding online health information seeking behavior of older adults: A social cognitive perspective

Introduction

Online health information seeking has been verified to play a crucial role in improving public health and has received close scholarly attention. However, the seeking behavior of older adults, especially the underlying mechanism through which they are motivated to seek health information online, remains unclear. This study addresses the issue by proposing a theoretical model leveraging social cognitive theory.

Methods

IT self-efficacy and IT innovativeness were identified as personal factors and professional support and social support were identified as environmental factors. We conducted a survey that included 347 older people in China and examined the research hypotheses with a structural equation model.

Results

IT self-efficacy and IT innovativeness facilitate older adults to seek health information online by increasing their perceived benefit of using the internet. Additionally, professional support and social support enhanced older adults' online seeking behavior by promoting their health awareness. We also found that perceived benefit displayed a stronger impact than health awareness on older adults' behavior related to searching for health information online.

Conclusion

This study reveals that IT self-efficacy, IT innovativeness, professional support, and social support will promote older adults to seek health information online by enhancing their health awareness and perceived benefit. The findings of this study provide significant theoretical and practical implications.

Evaluating a theory-based intervention for improving eHealth literacy in older adults: a single group, pretest-posttest design

BACKGROUND

The Internet is considered an important channel for providing health information to older adults. We developed an intervention to improve eHealth literacy in older adults according to the information-motivation-behavioral skills (IMB) theory and Intervention Mapping. This study aimed to analyze the effect of a developed intervention on information, motivation, behavioral skills, and behaviors related to eHealth information in older adults.

METHODS

Forty-six older adults over the age of 65 were recruited from two senior welfare centers in a city in South Korea. We divided the participants into four groups and conducted one intervention per group from March to December 2019. One intervention consisted of 5 sessions and was performed once a week (2 h/1 time) for 5 weeks, culminating in a total lecture time of 10 h. One lecture instructor and two assistant instructors supported the participants in the computer practices.

RESULTS

Participants' computer/web knowledge, perceived ease of use, perceived enjoyment, and attitude toward eHealth information showed statistically significant increases. The eHealth literacy efficacy score, searching performance score, and understanding score were also significantly increased. However, there was no significant difference in perceived usefulness.

CONCLUSION

The application of the current theory-based methodology can improve the quality of research in eHealth literacy. Additionally, various interventions should be developed and continuously applied to improve eHealth literacy among older adults.

The Relationship between Internet Use and Self-Rated Health among Older Adults in China: The Mediating Role of Social Support

The development of Internet technology has significantly impacted how people live their daily lives. How this disparity in Internet use affects the self-rated health of older adults needs to be further explored. This paper studies the impact of Internet use on self-rated health, aiming to examine the effect of Internet use and social support on the self-rated health of older adults in China. This study used data from the 2017 China General Social Survey (CGSS) to verify the effect of Internet use on older adults' self-rated health. The results showed that Chinese elderly who used the Internet had a higher self-rated health, and social support from relatives and friends significantly improved the elderly's self-rated health. This social support played a critical, partially mediating role between Internet use and self-rated health. In China, the effect of Internet use on older adults' self-rated health was heterogeneous. Among them, the impact of Internet use was more significant for the male elderly, younger elderly, and rural elderly. The results suggest that the government should formulate targeted policies to improve the utilization of the Internet and maintain a good Internet environment to enhance the well-being of older adults according to the trend of population aging and the popularity of the Internet.

Radio public service announcements to promote vaccinations for older adults: Effects of framing and distraction

This article investigates the effects of message framing and distraction on older adults' responses to a radio public service announcement (PSA) to promote influenza and pneumococci vaccinations. In detail, it addresses the message impact on recognition, attitudes toward the ad, and information-seeking intentions. The 2 × 2 online experiment was conducted in August 2019 in Germany. 378 participants aged 60 years and above received a radio PSA with either gain- or loss-framed messages (factor 1). Additionally, half of the participants completed a distraction task while listening (factor 2). Gain frames (η²_p =.02) and a non-distracted reception situation (η²_p =.04) positively influenced older adults' recognition accuracy. Recognition, in turn, was found to mediate the effect of framing and distraction on the intention to seek further information on the campaign (framing: b = -0.03, distraction: b = 0.05). We conclude that gain-framed radio PSAs are an appropriate tool to raise awareness for a vaccination campaign and its contents, especially when recipients are concentrated while listening to it. We suggest to implement them at the early stages of a health intervention to sensitize people about vaccination, followed by more in-depth information material (e.g., brochures) to create behavior change.

Determinants of adoption and rejection of protective measures during the SARS-CoV-2 pandemic: A longitudinal study in Germany’s second wave