A unique approach helped Arkansas Children’s take the lead with a statewide campaign to increase vaccination rates during a time of crisis and misinformation
As the Delta variant of the COVID-19 virus surges around the country, and the Omicron variant makes new headlines, health systems need guidance on how to approach wary, message-fatigued, sometimes apathetic and hesitant consumers to continue encouraging them to vaccinate themselves and their children against COVID-19. In July 2021, we completed a review of available research on vaccine hesitancy in order to consider the most effective strategies to move the needle with our clients. In this article, we’ll recap some of the highlights of that recent research, and how, in partnership with Arkansas Children’s, we applied it to an integrated internal and external communications campaign to encourage COVID-19 vaccination.
Defining the “Movable Middle” Audience
In early summer, the number of consumers “cautious” about the vaccine had declined quite significantly, according to McKinsey Consumer Health Insights; however, the number of consumers “unlikely” to vaccinate wasn’t budging. Similarly, Gallup found that 78% of those not planning to get vaccinated were unlikely to change their minds. Other recent research has since validated just how entrenched and difficult to convert the “unlikely” are. Those who are cautious yet potentially persuadable have been described by the U.S. Department of Health and Human Services as the “movable middle.”
Audience archetypes were further illuminated in an excellent study from the California Coronavirus Testing Task Force, Human-Centered Recommendations for Increasing Vaccine Uptake. This research identified seven consumer segments, ranging along a continuum from “Steadfast Opponents” to “Vaccine Advocates,” and offered different engagement strategies for each segment. The most likely (“movable middle”) prospective communication audiences are those who are willing storytellers (Vaccine Advocates), those who have some hesitation but are not firmly resistant (Reluctant Vaxxers, Cautious Supporters and Indifferent Individuals), and, to a lesser extent, those who are resistant with some openness to reconsidering (Healthy Independents and Concerned Skeptics).
Understanding the Barriers to Vaccination
Looking specifically at parents for our work with Arkansas Children’s, we learned that just over half of parents (55%) planned to vaccinate their children, according to McKinsey. Not surprisingly, the older the child, the higher the likelihood to vaccinate, ranging from 44% for a child four years old or younger to 64% for a child 16-17 years old. The research also quantified the significant influence of physicians, with one in four “cautious” parents (24%) citing their child’s pediatrician or another physician as a top source of advice and some “unlikely” parents (14%) also relying on a physician for advice. In total, 44% of all consumers surveyed said they would rely on physician advice, yet only 16% cited physicians as an actual information source. This strongly suggested that there was a need to jumpstart these conversations.
Planning the Strategic Approach
Based on the cited research and much more research previously reviewed, we arrived at a core set of recommended communication strategies for encouraging vaccination in the Summer of 2021 with Arkansas Children’s.
Build trust through reassurance, leveraging physicians as a trusted communication source
Clearly, there remains a need to provide reassurance, particularly from highly-trusted sources such as physicians. Therefore, a central aspect of our campaign with Arkansas Children’s is to equip physicians to “nudge” parents and offer access for parents to get their questions answered.
Present the vaccine as a reasonable choice, rather than a directive
For the vaccine hesitant, communicating freedom of choice may be more appealing than messages that overtly suggest “you should do this,” based on the Guide to COVID-19 Vaccine Communications published by the Center for Public Interest Communications at the University of Florida. This is especially true for certain sub-segments of consumers such as those with conservative values and those who may have lower trust in the healthcare system, such as Black communities. It stands to reason that this direction would reduce the polarizing effect of communications and foster more openness to hearing them.
Use positive emotion rather than fear or shame
People are bombarded with messaging about COVID-19 and vaccination on a daily basis — what the CDC wants them to do, what the health system wants them to do, what the school system wants them to do, what their friends want them to do, and on and on. There is a tremendous amount of fatigue at this stage, on top of confusion, concern and tense polarization. Trying to break through all of that using fear, appeals or shame is not likely to be a successful strategy, but to erect higher walls of resistance.
According to the Center for Public Interest Communications:
It can be tempting to activate emotions like fear or shame to get people to take a vaccine. But fear or shame is likely to achieve the opposite reaction … we must look to more positive emotions like love, hope and the desire to protect, to get people to act.
We always recommend starting from a place of empathy; this particularly sensitive messaging demands an especially large dose of empathy.
Inspire vaccine advocates to tell their stories
Reassuring people is not as simple as just sharing the facts; there is a deeper need to build a social normative perception that “many people like me are getting vaccinated.” This is thoroughly documented in the aforementioned Center for Public Interest Communications report.
Expressing the Strategy with Empathy: The Arkansas Children’s Campaign
In July 2021, the state of Arkansas had one of the lowest vaccination rates in the country, with just under 36% of residents having received both doses and 45% with one dose. With COVID-19 cases surging across the state by late summer, particularly with the Delta variant, Arkansas Children’s started to see child infection rates higher than they’d seen at any point during the pandemic. Driven to deliver “unprecedented child health,” Arkansas Children’s knew it was time to get loud about vaccination and actively engage their communities.
Knowing that many different vaccine concerns run deep for many different people, and that simply stating the facts incessantly does not address their unique needs, concerns and fears, we decided to start a conversation with people about vaccines.
We created a unifying call-to-action: Let’s Talk About It. Vaccines & You. This theme was crafted to work for both internal and external audiences, creating synergy between what is communicated to staff and what they will be seeing elsewhere, and to be extendable beyond COVID-19 vaccines. The approach is empathetic to the concerns of patients and the community and puts people in a position of greater “agency,” conveying that we know they have the freedom of choice and disarming them on a potentially heated topic.
A conversation with their physician or another trusted resource is simply the best way for people to feel seen, heard, comfortable and safe, lowering fear and resistance. Enabling people to ask their questions without judgement is the least threatening to their personal values, whatever they may be, and, as such, most likely to result in engagement and consideration.
Bringing the Campaign to Life
In partnership with Arkansas Children’s, we developed tools and resources for physicians and staff to facilitate starting conversations that address consumer questions about COVID-19 vaccines. Some of the tactics include t-shirts, signage throughout facilities, and internal communication pieces to encourage vaccine acceptance among staff. We also supported Arkansas Children’s in developing a comprehensive, consumer-friendly FAQ section for their website and other channels.
For external audiences, Core Health provided content strategy and key messaging to guide social media communications, as well as design and writing support for social content creation, in close collaboration with the Arkansas Children’s digital team. Currently, a multi-channel integrated paid media campaign is in development, to extend the impact of the “Let’s Talk About It” initiative statewide.
At the time of this writing, it’s early in Arkansas Children’s COVID-19 vaccination campaign. Visits to the website vaccine pages and increased social media engagement are resulting in a 300% increase in calls, as well as clicks to schedule vaccine appointments and find vaccine locations. Arkansas is up to 49% of its population fully vaccinated and 59% with at least one dose (11/15/21) — representing 13 to 14 point increases since late July. The increase is no doubt due in large part to growing fears about the Delta variant, as the illness hits close to home for more people. At the same time, the Arkansas Children’s campaign is providing an empathetic and inviting route for patients and other community members to face their vaccine fears, discuss them with a trusted resource, and ultimately decide to get vaccinated and/or vaccinate their children.