The Importance of Cultural Tailoring of Communicators and Media Outlets in an Influenza Vaccination Awareness Campaign: A Digital Randomized Trial

"These results suggest that cultural tailoring of media outlets may be critical to effectively reach out to ethnic minorities to help optimize vaccination rates and improve general health."

Health inequity within ethnic minority communities has been explained by factors such as the higher burden of underlying disease, limited access to health care, social deprivation, and health illiteracy. Ethnic minorities have consistently shown lower vaccination rates. A large survey demonstrated higher vaccine hesitancy in the population with a migration background in the Netherlands. However, with respect to the influenza vaccination, data on vaccine uptake are lacking, since migration background is not registered according to the annual Dutch flu vaccine campaigns in 2019 to 2021. Thus, this study investigated the effect of cultural tailoring of communicators and media outlets, respectively, on vaccine willingness in an influenza vaccination campaign in the Netherlands.

The data from this study were collected between November 1 and December 31 2021. The researchers randomised a video message (1:1) containing information highlighting the benefit of influenza vaccines, delivered by a communicator (study physician) with either an Indian or Dutch background. The vaccination awareness videos were distributed to 1,226 participants within 2 culturally non-tailored (generic) media outlets and one media outlet culturally tailored to the community of Indian ancestry (mostly migrated from Suriname) in the Netherlands. The culturally tailored media outlet consisted of a local radio station called Ujala, which presents news, views, and music tailored to and presented by people from Indian ancestry. The culturally non-tailored media outlets consisted of a Dutch newspaper called Algemeen Dagblad (AD) and Facebook (FB). The success of the intervention, improvement of vaccine willingness, was defined as the proportion of participants who changed from being against to pro-influenza vaccination. It was measured through an online survey.

At baseline (i.e., before introducing participants to the campaign video), 382 participants indicated they were vaccine hesitant (31.2%). The highest vaccine hesitancy was in those recruited through FB (37.3%), compared to the Indian radio station (22.2%) and the Dutch newspaper (16.9%). After showing the campaign video, vaccine hesitancy decreased across the formats but remained highest in participants from FB (36.5%), followed by the Indian radio station (17.8%) and the Dutch newspaper (13.2%). The overall improvement of vaccine willingness after showing the campaign video was 17.3%, i.e., 66 out of 382 participants.

Cultural tailoring compared to cultural non-tailoring of communicators showed no difference in improvement of vaccine willingness (13.9% vs. 20.7% increment, respectively, p = 0.083). Along those lines, for example, the predominantly migrant listeners to the Indian radio station tended to disagree with the importance of having a culturally tailored health care provider.

However, the media outlet tailored to the community with Indian ancestry resulted in a higher improvement of vaccine willingness compared to non-tailored media outlets (46.7% vs. 14.7% increment, respectively, p < 0.001, unadjusted odds ratio (OR) = 5.096). Although the video message was similar within all 3 media outlets, the success of the campaign within the Indian radio station may be explained by a messaging tactic emphasising the importance of vaccination to protect the community. The positive sentiments reported by the participants who were recruited from the Indian radio station reflect the fact that the campaign was well received, as seen by the improvement of vaccine willingness.

In contrast, the data also suggest that a generic approach in a culturally diverse population may even backfire and impede the effect of national vaccination campaigns, given the negative sentiments reported by the participants during the campaign and the lower improvement of vaccine willingness within the Dutch newspaper and FB groups.

The overall effect of the present vaccination campaign study may seem small, given the 17.3% change from being vaccine hesitant to vaccine willing. However, all participants, including those from the vaccine hesitant group, were exposed only once to the intervention video. The researchers suggest that repetitive exposure to an intervention in which information about vaccination is provided may help to increase the change from being hesitant to acceptance substantially.