Human-centred design bolsters vaccine confidence in the Philippines: results of a randomised controlled trial

• Published in: BMJ global health Vol. 8; no. 10; p. e012613
• Main Authors: Reñosa, Mark Donald C, Wachinger, Jonas, Guevarra, Jerric Rhazel, Landicho-Guevarra, Jhoys, Aligato, Mila F, Endoma, Vivienne, Landicho, Jeniffer, Bravo, Thea Andrea, Malacad, Carol, Demonteverde, Maria Paz, Silvestre, Catherine, Bärnighausen, Kate, Bärnighausen, Till, Chase, Rachel P, McMahon, Shannon A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.10.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Caregivers; Child; child health; Childrens health; Community health care; Community Health Workers; COVID-19 vaccines; Data collection; Dengue fever; Families & family life; Humans; Immunization; Intervention; intervention study; Maternal & child health; Measles; Medical personnel; Original Research; Parents & parenting; Philippines; public health; Rural areas; Socioeconomic factors; Vaccination; Vaccines; Philippines; South Africa; Burkina Faso; India; child health; vaccines; public health; intervention study
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-012613

BackgroundThe public’s confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. ‘Salubong’, a Filipino term, refers to welcoming someone back into one’s life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes.MethodsUsing human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure.ResultsAlthough the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher’s exact, p<0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen’s d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p<0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher’s exact, p<0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen’s d=0.35 with 95% CI −0.01 to 0.70, two-sided t-test, p=0.06).ConclusionsOur results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations.