Health Knowledge, Attitudes, Practice, Vaccine Hesitancy, Vaccine Refusal
Conditions
Brief summary
Vaccines currently prevent several million deaths every year and more lives could be saved if vaccination take up increased. The World Health Organization identifies vaccine hesitancy as one of the ten most important threats to global health and emphasizes the importance of devising interventions to reduce vaccine hesitancy. The two most promising interventions rely on consensus messaging, which has robust but small effects, and interactive discussion, which has larger effects, but is difficult to scale up. School-based interventions aimed at adolescents have the potential to make the best of both types of interventions. Interventions that take place in schools can be conducted over longer periods of time (up to several hours) and are rolled out by a figure that is typically trusted and respected (the teacher). Moreover, intervening during adolescence is particularly timely since important vaccines are delivered at that age (most notably the human papillomavirus vaccine), and because attitudes towards vaccination during adolescence might have a long-lasting impact, as is the case for other health related attitudes. This study tests the effectiveness of two interventions, a pedagogical intervention based on consensus messaging, and a chatbot intervention designed to mimic interactive discussion, on 9th grade French pupils.
Interventions
BEHAVIORALActivité Vaccins et Vaccination - LAMAP
Two activities created by the La Main a la Pate foundation
BEHAVIORALKidivax Chatbot
A chatbot created by our team to answer the most common questions about vaccination, based on a literature review and on focus groups.
Sponsors
Université Paris-Dauphine
Fondation La main à la pâte
Direction de l Évaluation, de la Prospective et de la Performance
Centre National de la Recherche Scientifique, France
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
For ethical reasons, pupils' parents were informed that their children would take part in an experiment aiming to test pedagogical materials about vaccination. Thus, the pupils were aware that they were participating in an experiment, and of the broad purpose of this experiment. However, the investigators asked teachers not to tell pupils about the different experimental conditions, and to arrange for another colleague to administer the questionnaires to their pupils. This limits the risk that pupils bias their behavior to fit the hypotheses associated with their experimental group - whether because of their own reaction or because of their teachers' reaction. Furthermore, since vaccination is part of the French national curriculum, the investigators argue that it is difficult for pupils to know whether the materials they were presented with is the standard one or one of our interventions.
Intervention model description
Participants were randomized at the school level, to minimize contamination between experimental conditions. Using administrative data, schools were stratified by their Priority Education status and by geographical categories (urban with high density, urban with medium density, rural). Then, within each stratum, schools were matched by triplets using the closest-neighbors approach, minimizing the quadratic distance between schools' success rate at the national end-of-middle school exam and Covid vaccination rate at the EPCI3 level. This resulted in 149 triplets. Within each triplet, schools were randomly assigned to one of the three experimental groups. Randomization code is available at the experiment's OSF repository: https://osf.io/rf5w9/?view\_only=de759e4e36914c909adeac5fd541babf
Eligibility
Sex/Gender
ALL
Healthy volunteers
Yes
Inclusion criteria
* French 9th grade students (equivalent to troisième)' * One class per school
Exclusion criteria
* Do not understand French
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Attitude towards vaccination | Up to 8 months | Participants' attitude towards vaccination were measured as the average agreement with 4 questions measured on a 7-points Likert Scale created for this study, ranging from 1 - Completely disagree to 7 - Totally agree, where a higher score corresponds to more positive attitudes towards vaccination. The vaccines used in France are effective The vaccines used in France are safe Vaccines are useful because they protect us from dangerous diseases. It is important to get vaccinated to protect others. For the full questionnaire, see the experiment's OSF repository. All outcomes were assessed three times: before teachers received our interventions (November 15th - December 12th), in the middle of the school year (March 6th -June 8th), and after all teachers used our interventions (May 11th - June 23rd). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge about vaccination | Up to 8 months | Knowledge is measured as the average number of correct answers to 11 True or False questions: Vaccines are not necessary, since diseases can be treated by drugs (such as antibiotics) Without vaccines, smallpox would still exist The effectiveness of vaccines has been scientifically proven Children would be more resistant if they did not receive so many vaccines Vaccination can cause certain disorders, such as autism, multiple sclerosis or diabetes If a child receives too many vaccines at once, it can overload their immune system The chemicals included in vaccines are not dangerous Vaccination increases the risk of developing allergies Vaccines are injected too early, which prevents children from building their immune systems Vaccines cannot cause the disease they protect against Thanks to scientific advances, scientists can create vaccines with fewer side effects Like all other outcomes, knowledge was assessed three times during the year. |
| Intention to be vaccinated | Up to 8 months | Intention to be vaccinated is measured as the average agreement with 5 questions, measured on a 7-points Likert Scale created for this study, ranging from 1 - Completely disagree to 7 - Totally agree, where a higher score corresponds to a stronger intention to be vaccinated. If a vaccine for a new disease becomes available, I would get vaccinated If an AIDS vaccine became available, I would get vaccinated If a common cold vaccine became available, I would get vaccinated If a gastroenteritis vaccine became available, I would get vaccinated If a vaccine for certain cancers became available, I would get vaccinated For the full questionnaire, see the experiment's OSF repository All outcomes were assessed three times: before teachers received our interventions (November 15th - December 12th), in the middle of the school year (March 6th -June 8th), and after all teachers used our interventions (May 11th - June 23rd). |
Countries
France
Outcome results
None listed