Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings.

BACKGROUND: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. OBJECTIVE: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. METHODS: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents' vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. RESULTS: About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents' perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. CONCLUSIONS: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians' fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies.

Injectable hydrogel electrodes as conduction highways to restore native pacing.

There is an urgent clinical need for a treatment regimen that addresses the underlying pathophysiology of ventricular arrhythmias, the leading cause of sudden cardiac death. The current report describes the design of an injectable hydrogel electrode and successful deployment in a pig model with access far more refined than any current pacing modalities allow. In addition to successful cardiac capture and pacing, analysis of surface ECG tracings and three-dimensional electroanatomic mapping revealed a QRS morphology comparable to native sinus rhythm, strongly suggesting the hydrogel electrode captures the deep septal bundle branches and Purkinje fibers. In an ablation model, electroanatomic mapping data demonstrated that the activation wavefront from the hydrogel reaches the mid-myocardium and endocardium much earlier than current single-point pacing modalities. Such uniform activation of broad swaths of tissue enables an opportunity to minimize the delayed myocardial conduction of heterogeneous tissue that underpins re-entry. Collectively, these studies demonstrate the feasibility of a new pacing modality that most closely resembles native conduction with the potential to eliminate lethal re-entrant arrhythmias and provide painless defibrillation.

Determinants of Human Papillomavirus Vaccine Acceptance among Caregivers in Nigeria: A Fogg Behavior Model-Based Approach.

Human papillomavirus (HPV) vaccine uptake among adolescent girls is critical to reducing the burden of HPV-related cancers in Nigeria. This study assesses the factors influencing caregivers' acceptance of HPV vaccination for their charges, using the Fogg Behavior Model (FBM) as a theoretical framework. We analyzed cross-sectional data from 1429 caregivers of girls aged 9-17 in six Nigerian states, using a survey instrument based on the FBM. Participants were recruited via Facebook and Instagram advertisements and interviewed through Facebook Messenger in August and September 2023. The study received ethical clearance from Nigeria's National Health Research Ethics Committee. We applied bivariate and multivariate analyses to assess the relationships between the caregiver's perception of how likely their adolescent girl was to get vaccinated in the next 12 months and motivation, ability, social factors (such as discussions with family and friends), injunctive norms, previous COVID-19 vaccination, and respondents' sociodemographic characteristics. Adjusted odds ratios derived from logistic regression analyses revealed that caregivers' motivation and ability, as well as social factors, were significantly associated with their perception that the adolescent girl in their care would get vaccinated within the next 12 months. Our findings suggest that behavioral interventions tailored to enhance motivation, ability, and social support among caregivers could significantly increase HPV vaccine uptake among adolescent girls in Nigeria.

How do psychobehavioural variables shed light on heterogeneity in COVID-19 vaccine acceptance? Evidence from United States general population surveys on a probability panel and social media.

OBJECTIVES: To (1) understand what behaviours, beliefs, demographics and structural factors predict US adults' intention to get a COVID-19 vaccination, (2) identify segments of the population ('personas') who share similar factors predicting vaccination intention, (3) create a 'typing tool' to predict which persona people belong to and (4) track changes in the distribution of personas over time and across the USA. DESIGN: Three surveys: two on a probability-based household panel (NORC's AmeriSpeak) and one on Facebook. SETTING: The first two surveys were conducted in January 2021 and March 2021 when the COVID-19 vaccine had just been made available in the USA. The Facebook survey ran from May 2021 to February 2022. PARTICIPANTS: All participants were aged 18+ and living in the USA. OUTCOME MEASURES: In our predictive model, the outcome variable was self-reported vaccination intention (0-10 scale). In our typing tool model, the outcome variable was the five personas identified by our clustering algorithm. RESULTS: Only 1% of variation in vaccination intention was explained by demographics, with about 70% explained by psychobehavioural factors. We identified five personas with distinct psychobehavioural profiles: COVID Sceptics (believe at least two COVID-19 conspiracy theories), System Distrusters (believe people of their race/ethnicity do not receive fair healthcare treatment), Cost Anxious (concerns about time and finances), Watchful (prefer to wait and see) and Enthusiasts (want to get vaccinated as soon as possible). The distribution of personas varies at the state level. Over time, we saw an increase in the proportion of personas who are less willing to get vaccinated. CONCLUSIONS: Psychobehavioural segmentation allows us to identify why people are unvaccinated, not just who is unvaccinated. It can help practitioners tailor the right intervention to the right person at the right time to optimally influence behaviour.

Addressing anemia among women in India-an informed intervention using Facebook Ad Manager.

BACKGROUND: Women in India continue to have high rates of anemia, especially in critical periods of adolescence and pregnancy. Anemia persists despite decades of government programs aimed at combatting anemia, including through the provision of iron folic acid tablets (IFA). With growing access to mobile phones and social media, even among women, mobile interventions hold potential for influencing knowledge and behaviors. Social media consumption, including on Facebook, is high in India. However, little research has explored if women can be reached with health messages using social media, if data can be collected through this mechanism, and if interventions using social media impact knowledge and behaviors surrounding important health issues such as anemia. The aims of this study were to test an advertising campaign on Facebook about anemia and IFA to women, collect data through social media, and measure its impact. METHODS: A baseline survey and two follow-up surveys were sent to women via Facebook in 2019 in two states of India: Madhya Pradesh and Uttar Pradesh. Between each round of data collection, a set of advertisements based on gaps in knowledge and practices identified in the baseline on anemia and IFA were delivered to more than 3 million women on Facebook. Using this data, we analyze current knowledge and behaviors around anemia and IFA and look at differences by socio-demographics including age, marital status, and pregnancy. Using logistic regression models, we then look for evidence of a significant change in knowledge and behaviors between rounds of data collection. RESULTS: We find that while general knowledge about anemia was high, especially related to its importance in pregnancy, misperceptions persist, such as that it makes babies large and delivery difficult. Only about 15% of the population was currently taking IFA, although nearly 50% noted that they had at some point. Younger women had lower levels of knowledge and practices. Findings about the impact of the Ad campaigns were mixed, with some indicators changing in positive and some in negative directions and no clear trend between surveys. Two indicators that were of high focus in the Ad campaigns changed in the desired direction after both ad campaigns (iron can make labor/delivery difficult and iron supplements are only for women who have anemia). CONCLUSIONS: Overall, this study shows that a social media campaign about anemia has the potential to reach a large number of women in India, including young women, who are hard to reach if they are not in school or currently pregnant and seeing a physician. This study shows that it is possible to collect data from women through social media and measure the impact of an intervention. More research is needed to know if social media is an effective approach to actually change attitudes and behaviors related to anemia, or other important health concerns.

Facebook Powered Measurement and Evaluation for Iron Folic Acid Health Intervention in India.

As the media landscape changes and billions of people around the world turn to Facebook, Instagram, WhatsApp, and other social media platforms for information and social interactions, the need to develop effective methods of leveraging social media for social behavior change communication (SBCC) becomes increasingly important. Yet, in order for the public health sector to embrace social media for SBCC, we must have methods for measuring the impact of social media-based SBCC. In this letter, we share a new approach for measurement and evaluation of social media-based SBCC campaigns. The approach was developed as part of an iron-folic acid health intervention targeting young women in two states in northern India; Uttar Pradesh and Maydar Pradesh.