Infodemic Management Using Digital Information and Knowledge Cocreation to Address COVID-19 Vaccine Hesitancy: Case Study From Ghana

Exploring Implications of Risk Communication Strategies in Diminishing Adversities of Misinformation and Disinformation Against Hepatitis Vaccination in Global South

Background and Purpose

Concern over the low hepatitis immunization rates is growing. It is generally believed that misinformation and disinformation are the main barriers to the success of mass immunization campaigns. This study intends to investigate the matter of online misinformation and disinformation about hepatitis vaccination and its implications.

Material and Methods

The researchers employed a cross-sectional research design vis-à-vis a web-based survey method to collect data. Data were collected from a nationally representative sample of 1931 internet users across Pakistan. Participation in the study was voluntary. Data collection continued for four months, from Mar 1, 2024, to Jun 30, 2024.

Results

The "results" of structural equation modeling show that misinformation and disinformation substantially structure risk perception regarding hepatitis, which, in turn, impacts problem recognition, involvement recognition, and constraint recognition. Besides, the outcomes uncovered that the chain of problem identification impacts situational motivation, which drives risk communication behaviors. Also, these risk communication behaviors are closely linked to individuals' motivation to receive the hepatitis vaccine.

Conclusion

This research concludes that managing misinformation and disinformation via strategically designed, valid, and reliable digital interventions improves the public's active response regarding willingness to get vaccinated against hepatitis. This study contributes to increasing public acceptance of the hepatitis vaccine by utilizing reliable and valid digital interventions to achieve a more active public health response.

Debunking COVID-19 vaccine misinformation with an audio drama in Ghana, a randomized control trial

Misinformation about COVID-19 vaccines has hampered their uptake worldwide. In Ghana, a belief that COVID-19 vaccines affect fertility is prevalent and difficult to counter. UNICEF Ghana co-produced a context-driven, behavioral science-based audio drama ('A shot of love') that aimed to debunk this misinformation narrative. In a randomized controlled trial, 13,000 young adults who had previously interacted with UNICEF's Agoo platform were randomized to either control (audio about nutrition) or intervention (audio drama debunking the COVID-19 misinformation). We found that the intervention had a strong protective effect against belief in misinformation, both directly after listening to the audio drama (adjusted Odds Ratio (aOR) 0.45, 95% Confidence Interval (CI) 0.34-0.59) as well as at the one-month follow-up (aOR 0.66, 95% CI 0.49-0.91). Similarly, the intervention had a strong effect on perceived safety of the COVID-19 vaccines directly after listening to the audio drama (aOR 1.56, 95% CI 1.22-2.00) and at one-month follow-up (aOR 1.53, 95% CI 1.13-2.07). Overall, our behavioral science-based, context-driven audio drama was effective in reducing the strength of belief in COVID-19 vaccine misinformation and increasing the perceived safety of the vaccines in Ghana.

Co-designing and pilot testing a digital game to improve vaccine attitudes and misinformation resistance in Ghana

Misinformation related to vaccines has been shown to potentially negatively impact public perceptions and intentions to vaccinate in many contexts including COVID-19 vaccination in Ghana. Psychological inoculation - where recipients are warned about the misleading techniques used in misinformation - is a potential intervention which could preemptively boost public resistance against misinformation. Cranky Uncle Vaccine is an interactive, digital game that applies inoculation, offering a scalable tool building public resilience against vaccine misinformation and promoting positive health-related behaviors. In this study, we document the process of developing and testing a West African version of Cranky Uncle Vaccine, with co-design workshops and a pilot test conducted in urban and peri-urban areas of the Greater Accra region of Ghana with 829 young people who had access to mobile and computer devices. The average age was 21.8 and participants were highly educated (median education level "Some/all university") with slightly more females (51.2%) than males (48.4%). Pilot participants filled out surveys before and after playing the game, measuring vaccine attitudes (pre-game M = 3.4, post-game M = 3.6), intent to get vaccinated (pre-game M = 3.5, post-game M = 3.6), and discernment between vaccine facts and fallacies (pre-game AUC = 0.72, post-game AUC = 0.75). We observed a significant improvement in attitudes toward vaccines, with players demonstrating increased likelihood to get vaccinated after completing the game. Among players who indicated that they were unlikely to get vaccinated in the pre-game survey (N = 52, or 6.3% of participants), just over half of these participants (53%) switched to likely to get vaccinated after playing the game. Perceived reliability of vaccine facts remained the same, while perceived reliability of vaccine fallacies significantly decreased, indicating improved ability to spot misleading arguments about vaccines. These results demonstrate the effectiveness of a digital game in building public resilience against vaccine misinformation as well as improving vaccine attitudes and intent to get vaccinated.

Emerging infodemic management strategies focus on technology: They can't forget trust

Public health authorities around the world are planning to manage infodemics as part of their next public health emergency. But the experience of managing communications for Ontario's COVID-19 Science Advisory Table suggests that emerging infodemic management (IM) strategies should include three key principles, which appear to be missing from much of the existing literature: (1) emerging IM strategies should incorporate leadership from epidemiologists who can align infodemic response with underlying disease; (2) they should embrace journalists who mediate trust in crises; and (3) they should acknowledge the unique opportunity for public health leaders to build public trust rapidly in the first days of a crisis-a foundation for all subsequent IM. Standardizing infodemic response may help accelerate interventions during a public health emergency, especially when paired with technology. But over-standardizing the human work of building trust risks losing the infodemic fight before it starts.

Lay beliefs of COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana: recommendations for improved vaccine uptake

BACKGROUND

The COVID-19 vaccine has faced increased hesitancy in Ghana and the Volta region in particular since its rollout. Acceptance of the vaccine among intercity commercial drivers is crucial, especially in the Volta region, as they transport people within and outside the country and could fuel the transmission of the virus if not vaccinated.

OBJECTIVE

We therefore established lay beliefs surrounding COVID-19 vaccine refusal among intercity commercial drivers in the Volta region of Ghana, as well as their recommendations for improved vaccine uptake.

METHODS

We purposively interviewed twenty-five (25) intercity commercial drivers who had not been vaccinated for COVID-19 in the Volta region of Ghana using a semi-structured interview guide and analysed their responses thematically using the ATLAS.ti software.

RESULTS

Various (ten) beliefs surrounding COVID-19 vaccine refusal were identified. These include the nonexistence of COVID-19, being immune to COVID-19, and the belief in the nonexistence of vaccines and vaccines being meant for the sick. Other beliefs identified were the belief that the COVID-19 vaccine is meant to reduce Africa's population, that the vaccine triggers other health complications leading to death, the belief that vaccination could cause financial loss, political mistrust, that the COVID-19 vaccine is not permitted by God, and the belief that prayer prevents COVID-19 infection. They also suggested that the adoption of persuasive communication techniques, the publication of information on those who died of COVID-19, providing evidence of tests conducted on the vaccine, testing people before vaccination, provision of care to those who may experience side effects from the vaccine, and being able to explain why varied vaccines are used for the same virus could help improve vaccine uptake.

CONCLUSION

Our findings show that there is a general lack of understanding and mistrust surrounding the COVID-19 vaccine among intercity commercial drivers in the Volta region. Hence, health promotion officers and communicators in the region need to be knowledgeable on the vaccine as well as on the conspiracy theories thwarting its uptake to provide comprehensive education to the public and intercity commercial drivers to improve its uptake.

Understanding COVID-19 vaccination behaviors and intentions in Ghana: A Behavioral Insights (BI) study

INTRODUCTION

Vaccine uptake is influenced by a variety of factors. Behavioral Insights (BI) can be used to address vaccine hesitancy to understand the factors that influence the decision to take or refuse a vaccine.

METHODOLOGY

This two-part study consisted of a survey designed to identify the influence of various drivers of people's COVID-19 vaccination status and their intention to take the vaccine in Ghana, as well as an experiment to test which of several behaviorally informed message frames had the greatest effect on vaccine acceptance. Data was collected from a total of 1494 participants; 1089 respondents (73%) reported already being vaccinated and 405 respondents (27%) reported not being vaccinated yet. The mobile phone-based surveys were conducted between December 2021 and January 2022 using Random Digit Dialing (RDD) to recruit study participants. Data analysis included regression models, relative weights analyses, and ANOVAs.

RESULTS

The findings indicated that vaccine uptake in Ghana is influenced more by social factors (what others think) than by practical factors such as ease of vaccination. Respondents' perceptions of their family's and religious leaders' attitudes towards the vaccine were among the most influential drivers. Unexpectedly, healthcare providers' positive attitudes about the COVID-19 vaccine had a significant negative relationship with respondents' vaccination behavior. Vaccine intention was positively predicted by risk perception, ease of vaccination, and the degree to which respondents considered the vaccine effective. Perceptions of religious leaders' attitudes also significantly and positively predicted respondents' intention to get vaccinated. Although perceptions of religious leaders' views about the vaccine are an important driver of vaccine acceptance, results asking respondents to rank-order who influences them suggest that people may not be consciously aware-or do not want to admit-the degree to which they are affected by what religious leaders think. Message frames that included fear, altruism, social norms were all followed by positive responses toward the vaccine, as were messages with three distinct messengers: Ghana Health Services, a doctor, and religious leaders.

CONCLUSIONS

What drives COVID-19 vaccine intentions does not necessarily drive behaviors. The results of this study can be used to develop appropriate COVID-19 vaccine uptake strategies targeting the most important drivers of COVID-19 vaccine acceptance, using effective message frames.

Informing social media analysis for public health: a cross-sectional survey of professionals

BACKGROUND

During the COVID-19 pandemic, the field of infodemic management has grown in response to urgent global need. Social listening is the first step in managing the infodemic, and many organizations and health systems have implemented processes. Social media analysis tools have traditionally been developed for commercial purposes, rather than public health, and little is known of the experiences and needs of those professionals using them for infodemic management.

METHODS

We developed a cross sectional survey and distributed through global infodemic management networks between December 2022 and February 2023. Questions were structured over four sections related to work-practice and user needs and did not collect any personal details from participants. Descriptive analysis was conducted on the study results. Qualitative analysis was used to categorise and understand answers to open-text questions.

RESULTS

There were 417 participants, 162/417 who completed all survey questions, and 255/417 who completed some, all responses are included in analysis. Respondents came from all global regions and a variety of workplaces. Participants had an average of 4.4 years' experience in the analysis of social media for public health. COVID-19 was the most common health issue people had conducted social media analysis for. Results reveal a range of training, technical capacity, and support needs.

CONCLUSIONS

This paper is the first we are aware of to seek and describe the needs of those using social media analysis platforms for public health purposes since the start of the COVID-19 pandemic. There are key areas for future work and research, including addressing the training, capacity building and leadership needs of those working in this space, and the need to facilitate easier access to better platforms for performing social media analysis.

The role of digital surveillance during outbreaks: the Ghana experience from COVID-19 response

Over the years, Ghana has made notable strides in adopting digital approaches to address societal challenges and meet demands. While the health sector, particularly the disease surveillance structure, has embraced digitization to enhance case detection, reporting, analysis, and information dissemination, critical aspects remain to be addressed. Although the Integrated Disease Surveillance and Response (IDSR) structure has experienced remarkable growth in digitization, certain areas require further attention as was observed during the COVID-19 pandemic. Ghana during the COVID-19 pandemic, recognized the importance of leveraging digital technologies to bolster the public health response. To this end, Ghana implemented various digital surveillance tools to combat the pandemic. These included the 'Surveillance Outbreak Response Management and Analysis System (SORMAS)', the digitalized health declaration form, ArcGIS Survey123, Talkwalker, 'Lightwave Health information Management System' (LHIMS), and the 'District Health Information Management System (DHIMS)'. These digital systems significantly contributed to the country's success in responding to the COVID-19 pandemic. One key area where digital systems have proved invaluable is in the timely production of daily COVID-19 situational updates. This task would have been arduous and delayed if reliant solely on paper-based forms, which hinder efficient reporting to other levels within the health system. By adopting these digital systems, Ghana has been able to overcome such challenges and provide up-to-date information for making informed public health decisions. This paper attempts to provide an extensive description of the digital systems currently employed to enhance Ghana's paper-based disease surveillance system in the context of its response to COVID-19. The article explores the strengths and challenges or limitations associated with these digital systems for responding to outbreaks, offering valuable lessons that can be learned from their implementation.

Health risk communication and infodemic management in Iran: development and validation of a conceptual framework

OBJECTIVE

The COVID-19 pandemic exposed significant gaps in Iran's and other health systems' risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health recommendations among the Iranian population. This study aimed to develop a conceptual framework for health risk communication and infodemic management (RCIM) during epidemics and health emergencies in Iran that could have potential applications in other contexts.

DESIGN

This study was designed in two phases. Phase 1 involved semistructured qualitative interviews with key informants to explore effective RCIM strategies across public health settings in Iran and to develop a conceptual framework. Phase 2 involved revising the framework based on feedback from an online expert panel regarding its comprehensiveness and validity.

SETTING

Provincial/national public health settings in Iran.

PARTICIPANTS

Twenty key informants from provincial and national public health authorities who contributed to COVID-19 response programmes participated in interviews. Nine experts from diverse academic disciplines, provincial and national settings, and geographical locations participated in an online expert panel.

RESULTS

The conceptual model was created based on qualitative interviews and expert panel discussions and was structured according to six pillars of the WHO health system framework: leadership and governance, information, health workforce and financial resources, along with media and community. Leadership and governance, including trustworthy leaders, were recommended as the foundation for developing RCIM in Iran. Developing an official strategy with information infrastructures, including high-quality surveillance systems, identified personnel and training for specialists among the health workforce, financial resources, communication channels and community engagement were recognised as other dimensions for developing health risk communication in Iran.

CONCLUSION

The proposed framework represents a step toward establishing a national RCIM strategy in Iran. Further validation of the conceptual framework and experiments on how it could potentially influence policy and practice is recommended. This model has the potential to be applied in other contexts in its current form or as the foundation for customised local versions.

"This is most likely not the correct vaccine": Analyzing COVID-19's viral spread and vaccine anxieties in Ghana, Cameroon, and Malawi

Following the successful development of vaccines for COVID-19, attention turned to the problem of vaccine access. However, in contexts where vaccines are available, hesitancy remains a major problem. Informed theoretically by the scholarship on vaccine anxiety, this paper uses a qualitative research approach that included 144 semi-structured interviews to investigate how social and political dynamics shaped people's perspectives in particular environments in Ghana, Cameroon, and Malawi about COVID-19's viral spread and COVID-19 vaccines. Vaccines and the viral spread of COVID-19 are related to political tensions and class-related fractures in particular contexts, and how the public interprets COVID-19's viral spread and engages with vaccination is based on people's social and political environment and their experience. Subjectivities are also rooted in coloniality. Vaccine confidence goes beyond clinical and regulatory authority approvals, and encompasses forces that are economic, social, and political in nature. Thus, an exclusive focus on technical prescriptions for enhancing vaccine uptake will not achieve significant positive results.

Identifying factors influencing COVID-19 vaccine uptake in Finland - a qualitative study using social media data

Introduction

Vaccine demand creation requires understanding what is driving the uptake of the vaccine. 24 Qualitative research methods are paramount to gaining a localized understanding of behavioral 25 drivers and barriers to vaccine uptake, but they are often underutilized.

Methods

This is a qualitative study that 26 used public comments on the Facebook and Twitter posts of the Finnish Institute for Health and 27 Welfare (THL) as data sources to identify behavioral drivers for COVID-19 vaccine uptake in 28 Finland. The participatory data analysis utilized thematic analysis and the Theoretical Domains 29 Framework (TDF). NVIVO was used to assist in the coding process.

Results

The greatest number of FB and 30 Twitter comments were linked with six TDF domains: knowledge, environmental context and 31 resources, beliefs in consequences, beliefs in capabilities, social and professional role, and social 32 influences. The domains included 15 themes that were interlinked. The knowledge domain 33 overlapped with all other domains.

Discussion

By using public discourse on Facebook and Twitter, and rapid 34 qualitative data analysis methods within a behavioral insight framework, this study adds to the 35 emerging knowledge about behavioral drivers of COVID-19 vaccines that can be used by public 36 health experts to enhance the uptake of vaccines during future pandemics and epidemics.

Can Risk Communication Surveillance Prompt COVID-19 Vaccine Acceptance among Internet users? Applying the Situational Theory of Problem Solving: A Cross-Sectional Study

BACKGROUND

The World Health Organization has recently raised concerns about the low number of fully vaccinated people against COVID-19 among developing countries. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine-related infodemics as the significant risk perception factor that hinders mass vaccination campaigns.

OBJECTIVE

Given the ambiguous digital communication environment which has fostered infodemics, developing nations struggle to boost public willingness to get people fully vaccinated. Authorities have launched some risk communication-laden digital interventions in response to infodemics. However, the value of these risk communication strategies employed to tackle infodemics needs to be evaluated. The current research using the tenets of the situational theory of problem-solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception about COVID-19 vaccine safety and risk communication actions to intensify willingness to get fully vaccinated was examined.

METHODS

This research used a cross-sectional research design vis-à-vis nationally representative online survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after filling consent form and reading the ethical permissions. Responses were received over three months, from May 2022 to July 2022.

RESULTS

The results delineated that infodemics positively affect risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and search for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (e.g., digital interventions) using the situational context could predict robust willingness to get fully vaccinated against COVID-19.

CONCLUSIONS

The pioneering results offer strategic considerations for health authorities to effectively man-age the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using the situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underpinning problem (i.e., selection of appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response.

Strengthening polio vaccine demand in Ghana: Understanding the factors influencing uptake of the vaccine and the effectiveness of different message frames

BACKGROUND

Ghana has experienced recent polio outbreaks. Behavioral insights can be used to understand behavior and create demand for the polio vaccine.

METHODS

This cross-sectional study is based on an interactive mobile phone survey that explored factors influencing the uptake of the polio vaccine among Ghanaian mothers with children younger than five years old. The survey also explores the mothers' intention to vaccinate their children in the future as well as an experiment with short polio vaccine voice message nudges to identify the most effective message frames in encouraging vaccination. The study sample was drawn from volunteers from a mobile service platform. Linear probability model regressions with Ordinary Least Squares (OLS) estimates were used to analyze the data.

RESULTS

In total, data from 708 caregivers was assessed. Out of the sample, 35% (n = 250) had not vaccinated their children against polio, around 8% (n = 53) of respondents stated they did not plan to do so, while 28% expressed intent to do so during the next polio vaccination campaign. Higher vaccination of children against polio, i.e. better uptake of the polio vaccine, appeared to be associated with children's caregivers knowing that polio causes paralysis (with a coefficient of 0.13 (95% CI: 0.02, 0.24), i.e. 13% more likely than not to have their child vaccinated). Higher vaccine uptake also appeared to be associated with the perception that the polio vaccine is safe (with a coefficient of 0.11 (95% CI: 0.01, 0.22), i.e. 11% more likely than not to have their child vaccinated). Another factor in increasing vaccine uptake is whether caregivers receive support from healthcare workers with a coefficient of 0.11 (95% CI: 0.02, 0.20), i.e. 11% more likely than not to have their child vaccinated. Crucially, difficulty accessing the polio vaccine appeared to be associate with a negative change in vaccine uptake (with a coefficient of -0.16 (95% CI: -0.23, -0.08), i.e. 16% less likely to have their child vaccinated). Satisfaction with the information provided by vaccinators was also associated with better vaccine uptake (with a coefficient of 0.12 (95% CI: 0.05, 0.20) i.e. 12% more likely than not to have their child vaccinated); and having seen or heard something negative about the polio vaccine with a coefficient of 0.10 (95% CI: 0.03, 0.17), i.e. 10% more likely than not to have their child vaccinated. The social norms message frame was statistically significant with a coefficient of 0.06 (95% CI: -0.004, 012).

CONCLUSION

The findings from this study suggest that most women with children under the age of 5 appear to have vaccinated their children against polio. Many more caregivers express an intention to vaccinate their children, never having done so before. The behavior and the intention to vaccinate are both driven by a number of factors that must be addressed to create demand for the polio vaccine. Targeted message frames appeared to be statistically significant drivers of vaccine uptake. However, more research is required to understand how they impact vaccine behavior and future intention for vaccination.

The Future of Infodemic Surveillance as Public Health Surveillance

Public health systems need to be able to detect and respond to infodemics (outbreaks of misinformation, disinformation, information overload, or information voids). Drawing from our experience at the US Centers for Disease Control and Prevention, the COVID-19 State of Vaccine Confidence Insight Reporting System has been created as one of the first public health infodemic surveillance systems. Key functions of infodemic surveillance systems include monitoring the information environment by person, place, and time; identifying infodemic events with digital analytics; conducting offline community-based assessments; and generating timely routine reports. Although specific considerations of several system attributes of infodemic surveillance system must be considered, infodemic surveillance systems share several similarities with traditional public health surveillance systems. Because both information and pathogens are spread more readily in an increasingly hyperconnected world, sustainable and routine systems must be created to ensure that timely interventions can be deployed for both epidemic and infodemic response.