Visual Policy Narrative Messaging Improves COVID-19 Vaccine Uptake

"The advent of social media and other forms of visual-based communication have only magnified the importance of storytelling through new and improved pathways for disseminating information..."

With the goal of diminishing COVID-19 vaccine hesitancy, the health community is calling for more effective risk communication approaches to raise awareness, align attitudes, and positively influence vaccine uptake. Entities such as the United States (US) Centers for Disease Control and Prevention have worked to improve vaccine communication - in part through the use of narrative structure. For example, "COVID-19 vaccination is the best way to protect children against severe COVID-19" is a narrative message that includes a victim (children) who could be harmed by a villain (COVID-19) but can be protected by a hero who provides them with a solution (the vaccine). This study explores a narrative-based risk communication approach whereby risk information is conveyed in story form as a lingua franca to influence risk reduction behaviour.

The study uses as its foundation the Narrative Policy Framework (NPF), which asserts that narratives have universal structural elements that can be systematically measured across different contexts and thus generalised to improve risk communication efforts. The NPF contends that a "policy narrative" must include at least one character (e.g. hero, villain, and victim) and a moral to the story that refers to a solution or call to action. These narrative elements, among others such as plot and setting, serve as narrative mechanisms to persuade the audience. This study tests the effects of a specific narrative mechanism - character selection - on outcome behaviour within the context of COVID-19 vaccinations. It also leverages visual or graphic messaging so as to test the effects of narratives embedded within and communicated through graphic stimuli.

The researchers conducted a panel survey experiment among a national sample of US citizens (n = 3,900) in 2021. Of 4 experimental conditions, 3 were treatment conditions (visual policy narrative messages), and 1 was a control (visual nonnarrative message). Each visual policy narrative message contains a different "victim" character, ranging from proximal to distal entities: "yourself", "your circle", or "your community". The "hero" character (the individual taking the survey who "protects" a victim) and the moral or solution (get the vaccine) are held constant across all conditions. The control condition features only the moral and contains no characters, making it nonnarrative. The outcome variable, COVID-19 vaccine behaviour, was collected 8 weeks later (n = 2,268).

The study found that each of the three visual policy narrative conditions leads to more positive affective responses, which in turn leads to higher motivation to get the COVID-19 vaccine, which in turn leads to more vaccination behaviour. In addition, character selection matters, as messages focusing on protecting others (i.e., your circle and your community) perform stronger than those of yourself. Political ideology moderated some of the effects, with conservative respondents in the nonnarrative control condition having a higher probability of vaccination in comparison to the protect yourself condition.

The paper concludes with 5 discoveries for practitioners and risk communication researchers to consider:

1. Relaying information in narrative form, which includes characters and a moral to the story (solution), is more powerful at influencing vaccine behaviour than nonnarrative, take-action–only, messages. Risk messages focusing on the hero protecting their in-group (i.e. "your circle") are an effective strategy to influence vaccination behaviour, suggesting the need for risk messaging aimed at motivating behaviour by emphasising the larger social or communal benefits of vaccination.
2. The pathway of influence from risk message to behaviour is not linear. Thus, to be effective at influencing behaviour, risk messages must first trigger the audience's attention, captured through a heightened affective response, which then activates an intention to act.
3. This study underscores the potential for positive effects across political ideologies of messages focusing on the communal benefit of vaccinations as opposed to strictly emphasising individual concerns.
4. The study partitions risk perception into its two dimensions - likelihood and severity - as separate variables and finds they operate differently. The perception of the severity of the impacts of COVID-19 influences greater affective responses, whereas the likelihood of getting COVID-19 impacts motivation to get the vaccine. Neither of the dimensions directly influences behaviour. Thus, the two dimensions of risk perception operate independently along different conditional pathways as opposed to in a harmonious fashion.
5. "[R]isk communication must join the age of visually based media as an efficient and effective avenue for information dissemination and sharing. This requires risk messages to be visual and substantive....There is a robust need for future work in discovering not just what message structures are impactful, but what venues of dissemination create the amplification desired..."

In conclusion, this study demonstrates that visual policy narrative messages can be a productive approach for risk communication across various venues, such as social media, for effective risk communication. Public health officials are encouraged to use narrative-based visual communication messages that emphasise communal benefits of vaccinations.