Framing the Future: How Vaccination Messages Shape Childhood Immunization Beliefs and Intentions Among Urban Low-Income Communities — a Randomized Field Experiment.
Background: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization...
| Published in: | International Journal of Behavioral Medicine p. 1 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Published: |
Springer Nature
Jun2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=186009547&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 186009547 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10705503 7M2 jtl: International Journal of Behavioral Medicine issn: 10705503 maglogo: N pubinfo: dt: Jun2025 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 186009547 10.1007/s12529-025-10376-9 186009547 ppf: 1 formats: fmt: @attributes: type: P tig: atl: Framing the Future: How Vaccination Messages Shape Childhood Immunization Beliefs and Intentions Among Urban Low-Income Communities — a Randomized Field Experiment. aug: au: Gichuki, Judy Ngoye, Ben Sierra, Vicenta Wafula, Francis affil: Institute of Healthcare Management, Strathmore University Business School sug: ab: Background: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization decisions for their children. Drawing on the Theory of Planned Behavior, this study examined the impact of messaging approaches on the interplay across four factors: attitudes, subjective norms, perceived behavioral control, and vaccination intentions.This was an experimental study that employed a between-participants, 2×2×2 design, taking into consideration message content (benefit or cost), message appeal (factual or emotional), and messenger type (layperson or expert). Data were collected from 366 caregivers of children under five residing in randomly selected urban informal settlements. The proposed model was assessed using a partial least squares structural equation model.The study found that caregivers’ attitudes toward vaccination (<italic>b</italic>=0.215, <italic>p</italic><0.001, <italic>f</italic>2=0.087), subjective norms (<italic>b</italic>=0.086, <italic>p</italic>=0.03, <italic>f</italic>2= 0.026), and perceived behavioral control (<italic>b</italic>=0.199, <italic>p</italic><0.001, <italic>f</italic>2= 0.087) were positively associated with their intentions to vaccinate their children. Structural equation modelling identified varying moderating effects of the messaging, with the inclusion of the moderators leading to an 8% increase in the <italic>R</italic>2. Exposure to benefit-based (<italic>b</italic>=0.097, <italic>p</italic>=0.016, <italic>f</italic>2=0.016) and fact-based messages (<italic>b</italic> = 0.162, <italic>p</italic><0.001, <italic>f</italic>2=0.031) intensified the influence of attitudes on vaccination intentions. In contrast, emotionally appealing messages strengthened the impact of perceived behavioral control on intentions (<italic>b</italic>= −0.149, <italic>p</italic><0.001, <italic>f</italic>2=0.033). The use of expert images did not have significant advantages over layperson images.Findings underscore the potential impact of messaging on the efficacy of vaccination promotion efforts. In developing communication strategies, policymakers should consider the interplay between messaging and its moderating influence on relationships between attitudes, subjective norms, and perceived behavioral control with vaccination intentions.Pan African Clinical Trials Registry. Trial no: PACTR202303735426128. Registered on 22/03/2023.Method: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization decisions for their children. Drawing on the Theory of Planned Behavior, this study examined the impact of messaging approaches on the interplay across four factors: attitudes, subjective norms, perceived behavioral control, and vaccination intentions.This was an experimental study that employed a between-participants, 2×2×2 design, taking into consideration message content (benefit or cost), message appeal (factual or emotional), and messenger type (layperson or expert). Data were collected from 366 caregivers of children under five residing in randomly selected urban informal settlements. The proposed model was assessed using a partial least squares structural equation model.The study found that caregivers’ attitudes toward vaccination (<italic>b</italic>=0.215, <italic>p</italic><0.001, <italic>f</italic>2=0.087), subjective norms (<italic>b</italic>=0.086, <italic>p</italic>=0.03, <italic>f</italic>2= 0.026), and perceived behavioral control (<italic>b</italic>=0.199, <italic>p</italic><0.001, <italic>f</italic>2= 0.087) were positively associated with their intentions to vaccinate their children. Structural equation modelling identified varying moderating effects of the messaging, with the inclusion of the moderators leading to an 8% increase in the <italic>R</italic>2. Exposure to benefit-based (<italic>b</italic>=0.097, <italic>p</italic>=0.016, <italic>f</italic>2=0.016) and fact-based messages (<italic>b</italic> = 0.162, <italic>p</italic><0.001, <italic>f</italic>2=0.031) intensified the influence of attitudes on vaccination intentions. In contrast, emotionally appealing messages strengthened the impact of perceived behavioral control on intentions (<italic>b</italic>= −0.149, <italic>p</italic><0.001, <italic>f</italic>2=0.033). The use of expert images did not have significant advantages over layperson images.Findings underscore the potential impact of messaging on the efficacy of vaccination promotion efforts. In developing communication strategies, policymakers should consider the interplay between messaging and its moderating influence on relationships between attitudes, subjective norms, and perceived behavioral control with vaccination intentions.Pan African Clinical Trials Registry. Trial no: PACTR202303735426128. Registered on 22/03/2023.Results: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization decisions for their children. Drawing on the Theory of Planned Behavior, this study examined the impact of messaging approaches on the interplay across four factors: attitudes, subjective norms, perceived behavioral control, and vaccination intentions.This was an experimental study that employed a between-participants, 2×2×2 design, taking into consideration message content (benefit or cost), message appeal (factual or emotional), and messenger type (layperson or expert). Data were collected from 366 caregivers of children under five residing in randomly selected urban informal settlements. The proposed model was assessed using a partial least squares structural equation model.The study found that caregivers’ attitudes toward vaccination (<italic>b</italic>=0.215, <italic>p</italic><0.001, <italic>f</italic>2=0.087), subjective norms (<italic>b</italic>=0.086, <italic>p</italic>=0.03, <italic>f</italic>2= 0.026), and perceived behavioral control (<italic>b</italic>=0.199, <italic>p</italic><0.001, <italic>f</italic>2= 0.087) were positively associated with their intentions to vaccinate their children. Structural equation modelling identified varying moderating effects of the messaging, with the inclusion of the moderators leading to an 8% increase in the <italic>R</italic>2. Exposure to benefit-based (<italic>b</italic>=0.097, <italic>p</italic>=0.016, <italic>f</italic>2=0.016) and fact-based messages (<italic>b</italic> = 0.162, <italic>p</italic><0.001, <italic>f</italic>2=0.031) intensified the influence of attitudes on vaccination intentions. In contrast, emotionally appealing messages strengthened the impact of perceived behavioral control on intentions (<italic>b</italic>= −0.149, <italic>p</italic><0.001, <italic>f</italic>2=0.033). The use of expert images did not have significant advantages over layperson images.Findings underscore the potential impact of messaging on the efficacy of vaccination promotion efforts. In developing communication strategies, policymakers should consider the interplay between messaging and its moderating influence on relationships between attitudes, subjective norms, and perceived behavioral control with vaccination intentions.Pan African Clinical Trials Registry. Trial no: PACTR202303735426128. Registered on 22/03/2023.Conclusion: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization decisions for their children. Drawing on the Theory of Planned Behavior, this study examined the impact of messaging approaches on the interplay across four factors: attitudes, subjective norms, perceived behavioral control, and vaccination intentions.This was an experimental study that employed a between-participants, 2×2×2 design, taking into consideration message content (benefit or cost), message appeal (factual or emotional), and messenger type (layperson or expert). Data were collected from 366 caregivers of children under five residing in randomly selected urban informal settlements. The proposed model was assessed using a partial least squares structural equation model.The study found that caregivers’ attitudes toward vaccination (<italic>b</italic>=0.215, <italic>p</italic><0.001, <italic>f</italic>2=0.087), subjective norms (<italic>b</italic>=0.086, <italic>p</italic>=0.03, <italic>f</italic>2= 0.026), and perceived behavioral control (<italic>b</italic>=0.199, <italic>p</italic><0.001, <italic>f</italic>2= 0.087) were positively associated with their intentions to vaccinate their children. Structural equation modelling identified varying moderating effects of the messaging, with the inclusion of the moderators leading to an 8% increase in the <italic>R</italic>2. Exposure to benefit-based (<italic>b</italic>=0.097, <italic>p</italic>=0.016, <italic>f</italic>2=0.016) and fact-based messages (<italic>b</italic> = 0.162, <italic>p</italic><0.001, <italic>f</italic>2=0.031) intensified the influence of attitudes on vaccination intentions. In contrast, emotionally appealing messages strengthened the impact of perceived behavioral control on intentions (<italic>b</italic>= −0.149, <italic>p</italic><0.001, <italic>f</italic>2=0.033). The use of expert images did not have significant advantages over layperson images.Findings underscore the potential impact of messaging on the efficacy of vaccination promotion efforts. In developing communication strategies, policymakers should consider the interplay between messaging and its moderating influence on relationships between attitudes, subjective norms, and perceived behavioral control with vaccination intentions.Pan African Clinical Trials Registry. Trial no: PACTR202303735426128. Registered on 22/03/2023.Trial Registration: Unvaccinated and partially vaccinated children are often found in complex environments, including urban poor settlements. Beyond typical factors affecting vaccination among low-income urban populations, such as affordability, trust remains a critical determinant of caregiver immunization decisions for their children. Drawing on the Theory of Planned Behavior, this study examined the impact of messaging approaches on the interplay across four factors: attitudes, subjective norms, perceived behavioral control, and vaccination intentions.This was an experimental study that employed a between-participants, 2×2×2 design, taking into consideration message content (benefit or cost), message appeal (factual or emotional), and messenger type (layperson or expert). Data were collected from 366 caregivers of children under five residing in randomly selected urban informal settlements. The proposed model was assessed using a partial least squares structural equation model.The study found that caregivers’ attitudes toward vaccination (<italic>b</italic>=0.215, <italic>p</italic><0.001, <italic>f</italic>2=0.087), subjective norms (<italic>b</italic>=0.086, <italic>p</italic>=0.03, <italic>f</italic>2= 0.026), and perceived behavioral control (<italic>b</italic>=0.199, <italic>p</italic><0.001, <italic>f</italic>2= 0.087) were positively associated with their intentions to vaccinate their children. Structural equation modelling identified varying moderating effects of the messaging, with the inclusion of the moderators leading to an 8% increase in the <italic>R</italic>2. Exposure to benefit-based (<italic>b</italic>=0.097, <italic>p</italic>=0.016, <italic>f</italic>2=0.016) and fact-based messages (<italic>b</italic> = 0.162, <italic>p</italic><0.001, <italic>f</italic>2=0.031) intensified the influence of attitudes on vaccination intentions. In contrast, emotionally appealing messages strengthened the impact of perceived behavioral control on intentions (<italic>b</italic>= −0.149, <italic>p</italic><0.001, <italic>f</italic>2=0.033). The use of expert images did not have significant advantages over layperson images.Findings underscore the potential impact of messaging on the efficacy of vaccination promotion efforts. In developing communication strategies, policymakers should consider the interplay between messaging and its moderating influence on relationships between attitudes, subjective norms, and perceived behavioral control with vaccination intentions.Pan African Clinical Trials Registry. Trial no: PACTR202303735426128. Registered on 22/03/2023. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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