Vaccination
Conditions
Keywords
health communication, digital health, trust
Brief summary
This study investigates how the design of web links in digital vaccination invitation emails affects recipient trust and their willingness to book an appointment. Researchers compare three different weblink formats: a control third-party link previously used by the NHS ("accurx"), and two experimental weblinks in which the original link is hidden: a shortened "bit.ly" link, and a text-embedded hyperlink. The study primarily tests whether the two experimental weblinks will be perceived as more trustworthy and increase booking intention compared to the control weblink. Furthermore, the study examines whether the experimental weblinks is perceived to be more fluent (easier to read) and improves participants' ability to correctly identify the organisation (e.g., the NHS or a US pharmacy) that sent the hypothetical email. To test these effects, investigators will gather data from 600 participants from the United Kingdom and 600 from the United States. They will be randomly assigned to view one of the three hypothetical email versions. UK participants will see emails appearing to be from the NHS, while US participants will see emails from a fictitious pharmacy (Pharma-US). This research aims to provide evidence on how to design more effective and trustworthy digital health communications.
Detailed description
This randomised experimental study investigates how weblink design influences the perceived trustworthiness of digital health communications. As digital invitations (e.g., emails and SMS) have become standard for public health initiatives such as vaccination programs, the use of third-party or disfluent (hard-to-read) web links may inadvertently undermine trust. Study Protocol and Intervention Participants will be randomly allocated to one of three experimental conditions. In all conditions, participants will read a hypothetical email invitation for a COVID-19 booster vaccine. The content of the emails remains identical except for the format of the booking weblink included in the email: Control Condition: Features the "accurx" web link (accurx.thirdparty.nhs.uk/r/aafwaczmd5) based on a third-party format used in official invitations from the UK's NHS. Experimental Condition 1: (Concealed in shortened URL) features a shortened version of the link using a bit.ly domain. Experimental Condition 2: (Concealed, text-embedded) shows the link presented as a descriptive hyperlink. To ensure relevance to the target populations, participants will see a version of the hypothetical email tailored to their country of residence: UK participants will see invitations sent from the NHS, while US participants will see invitations from a fictitious pharmacy (Pharma-US). Unlike the UK, COVID-19 vaccination in the US was predominantly organised by local pharmacies. Primary Hypotheses The study was designed to test six primary hypotheses: 1. The email containing the two experimental weblinks will be rated as significantly more trustworthy than the control "accurx" weblink. 2. Participants will report being more likely to use the link to book a vaccine appointment based on the experimental weblinks than the control "accurx" web link. 3. Participants will find the two experimental weblinks more fluent (easier to read) than the "accurx" control link. 4. Participants would be more likely to correctly identify the organisation that hosts the link based on the two experimental weblinks than based on the "accurx" control web link. 5. Trustworthiness, booking intention, host identification accuracy, and fluency would be positively correlated with each other. 6. The effect of the link will be mediated by the identification of the host organisation and the fluency of the link. Measurement Following the presentation of the hypothetical email, participants will rate the email on three 5-point Likert scales: trustworthiness (1: Very suspicious to 5: Very trustworthy), fluency (1: Very difficult to 5: Very easy), and booking intention (1: Very unlikely to 5: Very likely). Host identification will be assessed via a multiple-choice question with four options: the NHS, Pharma-US, Accurx, or 'Not sure'. The investigators will aim to gather data from 600 participants from the UK and 600 from the US. They will be invited to complete the study via an online platform. Participants who complete the study too fast or failed the attention check will be excluded. This study will be conducted as part of a larger research project exploring the broader relationship between the trustworthiness of digital messages and national vaccination rates. The study hypotheses, design, measures and analyses were preregistered before the start of data collection on a different platform (AsPredicted). This time stamped preregistration protocol is linked as a document in this registration.
Interventions
BEHAVIORALImproved trust and engagement
The intervention involved presenting a hypothetical invitation to a COVID-19 booster vaccination via email. Participants were randomly allocated to view one of three versions of the invitation to evaluate how the specific design of the embedded weblink influences recipient trust and booking behaviour. To ensure local relevance, the email stimulus was adapted based on the participant's country of residence: participants in the United Kingdom saw invitations that appeared to be from the NHS, while those in the United States saw invitations that appeared to be from a fictitious pharmacy, Pharma-US. Following the intervention, participants evaluated the email's trustworthiness, the link's fluency, and their own intention to book a vaccine appointment.
Sponsors
University of Essex
University of Southern California
Department of Health and Social Care, UK
Kingston University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
This is a double-blind study in which participants were unaware of the specific experimental condition to which they had been assigned. Participants were randomly allocated to view only one of three possible versions of a hypothetical vaccination invitation email-featuring either a control link, a shortened URL, or a text-embedded hyperlink-and were not informed of the existence or nature of the alternative stimuli. This masking ensures that their evaluations of trustworthiness, fluency, and booking intentions were not influenced by a direct comparison between the different link designs. As the study was conducted as an online survey via a fully automated platform, there was no direct interaction between the investigators and the participants during the intervention. As the study was conducted as an online survey via a fully automated platform, there is no direct interaction between the investigators and the participants during the intervention.
Intervention model description
This study follows a Parallel Assignment interventional model. Participants are randomly allocated to one of three independent groups to evaluate how weblink design in digital health communications influences recipient trust and engagement with vaccine apppointment booking invitations.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Residency: Must be a resident of either the United Kingdom or the United States
Exclusion criteria
* Attention Failure: Participants who failed the designated attention check included within the survey will be excluded from the analysis. * Speeding: Participants who completed the study "too fast"- indicating a lack of meaningful engagement with the experimental stimuli - were filtered out
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Perceived Trustworthiness | Immediately after the intervention | Participants rated the perceived trustworthiness of the vaccination invitation email on a 5-point Likert scale, where 1 represents "Very suspicious", and 5 represents "Very trustworthy". |
| Booking Intention | Immediately after the intervention | Participants rated their likelihood of booking a vaccine appointment based on the email invitation using a 5-point Likert scale ranging from 1 ("Very unlikely") to 5 ("Very likely"). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Ease of reading | Immediately after the intervention | Participants assessed the reading ease (or fluency) of the embedded weblink on a 5-point Likert scale, where 1 is "Very difficult", and 5 is "Very easy". |
| Host Identification | Immediately after the intervention | Participants were asked to identify the organisation that sent the communication by selecting one answer from a multiple-choice list of four options: the NHS, Pharma-US, Accurx, or Unclear/I don't know. |
Countries
United Kingdom
Outcome results
None listed