Evaluating the Impact of a Linguistically and Culturally Tailored Social Media Ad Campaign on COVID-19 Vaccine Uptake among Indigenous Populations in Guatemala: A Pre/post Design Intervention Study
Affiliation
University of California, San Francisco - UCSF (Miguel, Sanders, Vosburg, Diamond-Smith); Wuqu' Kawoq, Maya Health Alliance (Lopez, Diaz); Stanford University School of Medicine (Skinner, Johnston)
Date
Summary
"[S]ocial media offers a unique opportunity to improve health communications targeted at hard-to-reach populations....In addition to providing educational information, these campaigns help counter the increasing amount of misinformation on these platforms."
Indigenous people represent more than 40% of Guatemala's population, but the municipalities where most of them live are the least vaccinated against COVID-19. Multiple system-level barriers to COVID-19 vaccination exist, all of which are exacerbated by these communities' marginalisation, resulting in structural racism, as well as their historical mistrust of the government, which evidence shows is a predictor of misinformation. In Guatemala, this situation was exacerbated by a lack of information in multiple indigenous languages. In response, this team used a community-engaged research approach to design a culturally tailored COVID-19 vaccine campaign in multiple languages. The aim of this study was to evaluate the impact on vaccine uptake of the social media campaign in Patzún, San Andrés Semetabaj, Solalá, and Tecpán, mainly Indigenous rural municipalities in the Guatemala Central Highlands.
The research team worked in close collaboration with Wuqu' Kawoq, which has been working since 2007 to provide culturally sensitive healthcare and health education to local indigenous communities in Guatemala. Participants (n=1,572) were recruited and preintervention surveys conducted during the first 2 weeks of March 2022. All the fieldwork (survey collection) was done by community health workers from the local communities. The intervention was designed using a qualitative human-centred design approach through in-person, in-depth key informant interviews and community focus groups to understand better vaccination barriers, including access, supply, trust, and fear. The interviews identified the main COVID-19 vaccines myths and sought to understand information sharing using social media networks in that region of Guatemala.
Findings from the qualitative phase informed the development of the social media campaign, including two animated video series with three 1- to 2-minute video clips each. The first video series focuses on the COVID-19 vaccine basic information, including how vaccines work and the side effects. The second series addresses the central myths and misinformation identified in the community, which are beliefs that the vaccine can kill, there is a microchip in the vaccine, and the vaccine causes infertility. All videos are identical, with translations and captions in Spanish, K'iche, and Kaqchikel. Community members also provided the script translation and voice-over for the videos, which were disseminated through Facebook, Instagram, and browser ads for 3 weeks. (See one example, below.)
Postintervention surveys were conducted by telephone among the same 1,572 participants in April 2022. Multiple dissemination strategies were used to ensure local stakeholders were aware of the findings, using the community and community partners as the primary messengers.
Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (n=1,402) of participants reported having at least one COVID-19 vaccine, compared with 97% (n=1,507) in the follow-up. Among the whole sample, those who reported watching the videos had 1.78 times the odds (95% confidence interval (CI) 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex, and language. When stratified by vaccination status at baseline, among those unvaccinated at baseline, those who reported watching the videos had 3.92 times the odds (95% CI 1.56 to 9.8) of getting their first COVID-19 vaccine compared with those who reported not watching it, adjusted by age, community, sex, and language spoken at home.
About one-fourth of those who were unvaccinated had tried to become vaccinated but faced access barriers such as vaccine or personnel shortages. The most common reasons unvaccinated people gave for not wanting a COVID-19 vaccine were fear of side effects (30%), fear of dying from the vaccine (19%), and lack of information about the vaccines (10%). Another misperception participants noted was the idea that having a comorbidity such as diabetes meant they were not eligible for vaccination or that vaccination was not safe for them.
Notably, although indigenous people are often considered "hard to reach", 86% of the predominantly indigenous participants in this study reported using a social media platform, which was their most common source of information about COVID-19 vaccines (more so than doctors and healthcare workers). "All too often social media or mHealth interventions are assumed not to be appropriate for non-urban, poor or non-educated populations - but this is clearly not the case and this assumption could lead to vast missed opportunities. Understanding social media use and how populations access information locally and nationally is critical for governments, policy makers and healthcare systems to optimise vaccine education and encourage vaccine uptake or any other health condition or behaviour. Additionally, ensuring people can access information in a language they understand, alongside visual depictions of their culture reflected in videos or graphics, may significantly impact their trust."
The researchers suggest that additional research is needed to understand the impact on other Mayan groups and languages not included in this project, who the most trusted groups or messengers are, and whether this intervention approach (social media) is appropriate for more rural populations who may have less regular and easy access to the internet and smart phones.
In conclusion, the researchers write: "This project was done using a community-engaged approach, which we believe should be the standard for any public health research, especially in marginalised communities....Our findings showed that a culturally and linguistically concordant, community-informed campaign using social media could be used to increase vaccine confidence and address misinformation...Providing information in local languages may be essential for vaccine uptake in hard-to-reach, historically marginalised populations."
Indigenous people represent more than 40% of Guatemala's population, but the municipalities where most of them live are the least vaccinated against COVID-19. Multiple system-level barriers to COVID-19 vaccination exist, all of which are exacerbated by these communities' marginalisation, resulting in structural racism, as well as their historical mistrust of the government, which evidence shows is a predictor of misinformation. In Guatemala, this situation was exacerbated by a lack of information in multiple indigenous languages. In response, this team used a community-engaged research approach to design a culturally tailored COVID-19 vaccine campaign in multiple languages. The aim of this study was to evaluate the impact on vaccine uptake of the social media campaign in Patzún, San Andrés Semetabaj, Solalá, and Tecpán, mainly Indigenous rural municipalities in the Guatemala Central Highlands.
The research team worked in close collaboration with Wuqu' Kawoq, which has been working since 2007 to provide culturally sensitive healthcare and health education to local indigenous communities in Guatemala. Participants (n=1,572) were recruited and preintervention surveys conducted during the first 2 weeks of March 2022. All the fieldwork (survey collection) was done by community health workers from the local communities. The intervention was designed using a qualitative human-centred design approach through in-person, in-depth key informant interviews and community focus groups to understand better vaccination barriers, including access, supply, trust, and fear. The interviews identified the main COVID-19 vaccines myths and sought to understand information sharing using social media networks in that region of Guatemala.
Findings from the qualitative phase informed the development of the social media campaign, including two animated video series with three 1- to 2-minute video clips each. The first video series focuses on the COVID-19 vaccine basic information, including how vaccines work and the side effects. The second series addresses the central myths and misinformation identified in the community, which are beliefs that the vaccine can kill, there is a microchip in the vaccine, and the vaccine causes infertility. All videos are identical, with translations and captions in Spanish, K'iche, and Kaqchikel. Community members also provided the script translation and voice-over for the videos, which were disseminated through Facebook, Instagram, and browser ads for 3 weeks. (See one example, below.)
Postintervention surveys were conducted by telephone among the same 1,572 participants in April 2022. Multiple dissemination strategies were used to ensure local stakeholders were aware of the findings, using the community and community partners as the primary messengers.
Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (n=1,402) of participants reported having at least one COVID-19 vaccine, compared with 97% (n=1,507) in the follow-up. Among the whole sample, those who reported watching the videos had 1.78 times the odds (95% confidence interval (CI) 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex, and language. When stratified by vaccination status at baseline, among those unvaccinated at baseline, those who reported watching the videos had 3.92 times the odds (95% CI 1.56 to 9.8) of getting their first COVID-19 vaccine compared with those who reported not watching it, adjusted by age, community, sex, and language spoken at home.
About one-fourth of those who were unvaccinated had tried to become vaccinated but faced access barriers such as vaccine or personnel shortages. The most common reasons unvaccinated people gave for not wanting a COVID-19 vaccine were fear of side effects (30%), fear of dying from the vaccine (19%), and lack of information about the vaccines (10%). Another misperception participants noted was the idea that having a comorbidity such as diabetes meant they were not eligible for vaccination or that vaccination was not safe for them.
Notably, although indigenous people are often considered "hard to reach", 86% of the predominantly indigenous participants in this study reported using a social media platform, which was their most common source of information about COVID-19 vaccines (more so than doctors and healthcare workers). "All too often social media or mHealth interventions are assumed not to be appropriate for non-urban, poor or non-educated populations - but this is clearly not the case and this assumption could lead to vast missed opportunities. Understanding social media use and how populations access information locally and nationally is critical for governments, policy makers and healthcare systems to optimise vaccine education and encourage vaccine uptake or any other health condition or behaviour. Additionally, ensuring people can access information in a language they understand, alongside visual depictions of their culture reflected in videos or graphics, may significantly impact their trust."
The researchers suggest that additional research is needed to understand the impact on other Mayan groups and languages not included in this project, who the most trusted groups or messengers are, and whether this intervention approach (social media) is appropriate for more rural populations who may have less regular and easy access to the internet and smart phones.
In conclusion, the researchers write: "This project was done using a community-engaged approach, which we believe should be the standard for any public health research, especially in marginalised communities....Our findings showed that a culturally and linguistically concordant, community-informed campaign using social media could be used to increase vaccine confidence and address misinformation...Providing information in local languages may be essential for vaccine uptake in hard-to-reach, historically marginalised populations."
Source
BMJ Open 2022;12:e066365. doi:10.1136/bmjopen-2022-066365; and Digital Medic at Stanford University website, July 14 2023. Image credit: Stanford University
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