Table 2.
Regional adaptations of behavioural vaccination promotion
| Validation of strategy | Latin America and Caribbean (n=20) | Middle East and North Africa (n=5) | Europe and Central Asia (n=20) | Sub-Saharan Africa (n=7) | South Asia (n=8) | East Asia and Pacific (n=23) | North America (n=9) | |||||||
| Identity segments | 68.5% | Recommended segmentation by: the intersection of religious/spiritual belief and attitudes towards modern science. Segmenting by political party is highly variable; effective in some countries and to be avoided in others. | 100% | Recommended segmentation by: generational identity (age) and urban/rural lifestyle. Political identity should be avoided and religious identity should only be used with great care. | 94.7% | Recommended segmentation by: positive identities like sports, affiliations, and national pride. Political identity is not effective due to greater trust in government or distaste for disunity. Can segment based on risk-aversion. Religious segmentation may work in some countries. | 86.5% | Recommended segmentation by: followers of aspirational leaders or celebrities (entertainment/sports). Segmenting based on politics is largely ineffective because of low trust, consistency, and commitment across all parties. | 85.8% | Recommended segmentation by: the intersection of affluence and health/strength. Segmenting may also be based on the followers of aspirational leaders or celebrities(entertainment/sports). Do not segment on ‘anti-vax’ as the need for vaccines is largely accepted. | 76.2% | Recommended segmentation by: reasons for lack of speed in vaccination rather than ‘choice’ of vaccination; that is, why would people see less personal urgency for their own vaccination. Effective segmentation groups may include work/profession or education level. | 100% | Recommended segmentation by: the intersection of political or religious identity and attitudes about science/pharmaceuticals. Other segmentation identity may include personal strength/health or risk-aversion. |
| Common enemy | 84.2% | Common enemy: Economic distress. Avoid use of warfare language. | 100% | Reframe as common goal: Health/Welfare of Islamic Nation or citizens | 90% | Reframe as common goal: High variance across countries. Includes health, economic recovery, freedom of movement, cultural connections (cafes, sports) | 85.5% | Common enemy: Health apathy or fatalism. May also use common goal of provincial pride. | 85.7% | Common enemy: Health apathy or fatalism. If COVID-19 is the enemy, link to mythology antagonists. | 68.2% | Common enemy: COVID-19. Use positive language and focus on unity. | 83.4% | Common enemy: COVID-19 and economic distress. Can use warfare language, national pride and anthropomorphize the virus. |
| Analogy | 94.7% | High use. Especially analogies that are pictoral. | 100% | High use. Especially analogies with emotion or tied to local proverbs. | 100% | High-moderate use. Target analogies by age group to avoid perception of “dumbing down” information | 100% | High use. Especially analogies with emotion or tied to local proverbs. | 100% | High use. Especially analogies tied to positive emotion and local mythology or to past successes with disease. | 90.9% | High use. Especially with analogies tied to local mythology or to past successes with disease. | 71.4% | High use. Target analogies by region or identity segment. |
| Observability | 94.8% | Mix of community and individual. Individual can be digital (social media) or wearables (stickers). | 80% | Community only. | 70% | Mix of community and individual. Individual should be primarily digital and beware virtue-signalling. | 85.7% | Community only. | 100% | Mix of community and individual. Individual should be primarily digital. | 95.5% | Community only. | 85.7% | Individual only. Individual can be digital or wearables. |
| Leverage scarcity | 83.4% | Scarcity=precious/taking care. Beware inflation/poverty triggers. | 80% | Scarcity=precious/taking care. Beware status triggers. | 78.9% | Scarcity=precious/taking care. Beware inequity triggers. | 100% | Scarcity=precious/taking care. Beware inequity and poverty triggers. | 85.7% | Scarcity=precious/taking care. Beware inequity and poverty triggers. | 81.8% | Scarcity=precious/taking care. Beware status triggers. | 85.7% | Scarcity=precious/taking care. Beware inequity triggers. |
| Address Negative Attributions | 94.7% | Source credibility/trust: Use partnerships, build trust. Counter misinformation: Social media campaigning | 100% | Source credibility/trust: Use governments, regional medical agencies. Counter misinformation: Social media campaigning | 100% | Source credibility/trust: Use government and global agencies. Counter misinformation: Social media regulation; Transparency via fully shared data | 100% | Source credibility/trust: Use partnerships, build trust. Counter misinformation: Social media campaigning | 85.8% | Source credibility/trust: Use government, national and global agencies. Counter misinformation: Social media campaigning; Transparency via fully shared data. | 81.8% | Source credibility/trust: Use governments, national medical agencies. Counter misinformation: Social media campaigning; Transparency via fully shared data | 100% | Source credibility/trust: Use partnerships, government, and global agencies. Counter misinformation: Social media regulation; Transparency via fully shared data |
| Anticipated regret | 79% | Regret about others, not self; Use cautiously to avoid guilt | 75% | Regret about others, not self; Use cautiously to avoid fear and guilt | 85% | Regret about others and self; Use cautiously to avoid reactance | 85.7% | Regret about others, not self; Use cautiously to avoid fear and guilt | 85.7% | Regret about others, not self; Use cautiously to avoid fear and reactance | 95.5% | Regret about others, not self; Use cautiously to avoid fear and guilt | 71.4% | Regret about others and self; Use cautiously to avoid reactance |
| Piecemeal info | 73.7% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 75% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 89.4% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 85.8% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 100% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 81.8% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ | 84.7% | Frame changes in advice from trusted sources as continual improvement not ‘corrections’ |
| Compromise effect | 57.9% | Choice of vaccination is common. However, use with extreme caution as compromise options can be seen as weak or ambivalent | 75% | Choice of vaccination is mixed. Use compromise options in peripheral decisions (eg, timing) | 75% | Choice of vaccination is common. | 85.7% | Choice of vaccination is common. | 85.7% | Choice of vaccination is common. | 82.6% | Choice of vaccination is less common. Use compromise options in peripheral decisions (eg, timing) | 85.8% | Choice of vaccination is common. |
| FOMO motivations | 90% | Incentives effective; offer utilitarian family-oriented goods (school supplies, bus tickets, food coupons); don't trigger fear of loss | 100% | Incentives effective; offer utilitarian family-oriented goods (school supplies, bus tickets, food coupons); don't trigger fear of loss | 75% | Incentives less effective; offer safety/travel options (event attendance; ‘fast lane’ for flight check-in; skip temperature checks); don't trigger ‘bought behaviour’ | 71.5 | Incentives effective; offer utilitarian family-oriented goods (school supplies, transportation compensation, food coupons); don't trigger fear of loss | 85.7% | Incentives effective; offer utilitarian family-oriented goods (school supplies, transportation compensation, food coupons); don't trigger fear of loss | 90.9% | Incentives less effective; offer safety/travel options (event attendance; ‘fast lane’ for flight check-in; skip temperature checks); don't trigger ‘bought behaviour’ | 87.5% | Incentives effective; offer monetary incentives and safety/travel options (event attendance; ‘fast lane’ for flight check-in; skip temperature checks) |
| Uniqueness neglect | 77.8% | Less common: Special information or accomodation may be by affluence or religion | 50% | Less common: Special information or accomodation may be by affluence or religion | 84.2% | More common: Special information or accomodation may be by medical condition or religion | 85.7% | Less common: Special information or accomodation unlikely | 71.4% | Less common: Special information or accomodation may be by religion | 63.6% | Less common: Special information or accomodation may be by medical condition | 71.4% | More common: Special information or accomodation may be by medical condition or religion |
| Base-rate fallacy | 95% | High use. Use stories specific to region, dialect. Use only positive ‘happy ending’ stories. | 100% | High use. Use stories specific to region, dialect. Use mainly positive ‘happy ending’ stories. Always follow stories with stats. | 100% | High use. Use stories specific to region, dialect. Use both positive and negative stories. Always follow stories with stats. | 100% | High use. Use stories specific to region, dialect. Use only positive ‘happy ending’ stories. | 100% | High use. Use stories specific to region, dialect. Use mainly positive ‘happy ending’ stories. Always follow stories with stats. | 90.9% | High use. Use stories specific to region, dialect. Use only positive ‘happy ending’ stories. | 100% | High use. Use stories specific to region, dialect. Use both positive and negative stories. Always follow stories with stats. |
Proportions reflect validation by region (the proportion of each region’s panel members who responded Yes or Maybe to question of ‘whether the strategy would be helpful in your region’). Mechanism is categorisation based on the underlying psychological mechanism of the strategy, and color-coding is based on mechanism. Recommended adaptations are shown by region and reflect consensus opinions in panel members’ open-ended responses.
FOMO, fear of missing out.