Conversational Agent Vaccine Promotion for COVID-19 and Influenza Vaccination

Overseen By Madison Blain, OTD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Northeastern University

Disqualifiers: Comprehension issues, Screener inability

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 12

600 Participants Needed

Trial Summary

What is the purpose of this trial?

The objective of this study is to assess the use of and satisfaction with the ECA intervention over a 12-month period, its ability to increase SARS-CoV-2 and influenza vaccination in the BMATP community, and the comparative effectiveness of proactive engagement strategies and cultural tailoring on these factors. The Investigators will assess app use and satisfaction among these participants, along with self-reported vaccination attitudes and behavior, at 6 months and 12 months. During this time the investigators will conduct a 2x2 factorial RCT (with the individual the unit of random assignment and measurement) to assess the impact of two app design features on engagement and outcomes: (1) the investigators will manipulate engagement mechanisms (ENGAGEMENT), including reminder notifications and trust-building dialogue by the ECA and, (2) independently manipulate cultural tailoring of vaccination promotion counseling language used by the agent (TAILORING) to either adaptive religiosity (tailored) or secular (non-tailored). The investigators' primary hypotheses are that participants with have significantly greater vaccination completion rates in the high engagement and tailored conditions at 6 months (H1) and 12 months (H2) compared to other conditions. The investigators' secondary hypotheses are that participants will use the app more, be more satisfied with the ECA, be more advanced in their stage of change, and have greater knowledge, self-efficacy, and decisional-balance from baseline to 6 and 12 months, in the high engagement and tailored conditions. In addition to the RCT participants, all members of the 12 participating BMATP churches will be invited to use the app (via snowball recruitment), to increase the utility of the social networking functions of the app by having as many users as possible.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Conversational Agent Vaccine Promotion for COVID-19 and Influenza Vaccination?

Research shows that personalized communication and dialogue-based interventions, like those used in the Conversational Agent Vaccine Promotion, can help increase vaccination rates by addressing specific concerns and barriers people have about vaccines. ^{1 2 3 4 5}

How is the ECA-ACE Vaccination Promotion Intervention treatment different from other treatments for COVID-19 and Influenza vaccination promotion?

The ECA-ACE Vaccination Promotion Intervention is unique because it uses a conversational agent (a chatbot) to engage people in dialogue, addressing their specific concerns and questions about COVID-19 and Influenza vaccines. This approach is designed to increase vaccination intentions and improve attitudes towards vaccination by providing personalized, empathetic support, which is different from traditional mass communication strategies. ^{4 6 7 8 9}

Eligibility Criteria

This trial is for adults over 18 who speak English, can see and hear well enough to use a smartphone app, and haven't met the Boston Public Health guidelines for COVID-19 or flu vaccination. They must own a recent iPhone or Android phone and be able to consent independently.

Inclusion Criteria

has adequate corrected vision to use the ECA system (based on a 1 minute ECA functional screener deployed over the web)

I own a recent iPhone or Android smartphone.

I am over 18 years old.

Exclusion Criteria

I understand the details and purpose of the research study.

they are unable to use the screener

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants use the ECA app with varying engagement mechanisms and cultural tailoring for 12 months

12 months

App usage at home, with assessments at 6 and 12 months

Follow-up

Participants are monitored for vaccination status, self-efficacy, decisional balance, and satisfaction

12 months

Videoconference calls at 6 and 12 months

Treatment Details

Interventions

• ECA-ACE Vaccination Promotion Intervention

Trial Overview The study tests an app called ECA designed to promote vaccinations. It looks at how different features like reminder notifications, trust-building dialogue, and cultural tailoring of messages affect user engagement and vaccination rates over a year.

Participant Groups

Group I: Low engagement mechanisms, tailed content Experimental Treatment 1 Intervention

manipulate low engagement mechanisms while provide adaptive religiosity (tailored) content

Group II: Low engagement mechanism, non-tailed content Experimental Treatment 1 Intervention

manipulate low engagement mechanisms and provide secular (non-tailored) content

Group III: High engagement mechanisms, tailed content Experimental Treatment 1 Intervention

During this time the investigators will conduct a 2x2 factorial RCT (with the individual the unit of random assignment and measurement) to assess the impact of two app design features on engagement and outcomes: (1) the investigators will manipulate engagement mechanisms (ENGAGEMENT), including reminder notifications and trust-building dialogue by the ECA and, (2) independently manipulate cultural tailoring of vaccination promotion counseling language used by the agent (TAILORING) to either adaptive religiosity (tailored) or secular (non-tailored). The investigators' primary hypotheses are that participants with have significantly greater vaccination completion rates in the high engagement and tailored conditions at 6 months (H1) and 12 months (H2) compared to other conditions.

Group IV: High engagement mechanism, non-tailed content Experimental Treatment 1 Intervention

manipulate high engagement mechanisms while provide secular (non-tailored) content

Who Is Running the Clinical Trial?

Northeastern University

Lead Sponsor

Trials

103

Recruited

72,600+

Georgia Institute of Technology

Collaborator

Trials

53

Recruited

5,600+

Boston University

Collaborator

Trials

494

Recruited

9,998,000+

Boston Medical Center

Collaborator

Trials

410

Recruited

890,000+

Findings from Research

Multimodal interventions that combine both patient-focused and clinician-focused strategies are most effective in increasing vaccination rates for influenza and pneumococcal diseases in patients with chronic obstructive pulmonary disease (COPD).

The review analyzed six unique interventional studies, highlighting the need for more high-quality research to better understand and improve vaccination rates among COPD patients, as many remain unvaccinated despite existing guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Interventions to Increase the Rate of Influenza and Pneumococcal Vaccination in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review. Trethewey, SP., Patel, N., Turner, AM.[2020]

Promotional communications for seasonal influenza vaccination can effectively increase vaccination uptake among healthcare workers and patients, with various methods and channels showing promise, especially mass communication strategies.

Personalized communications, when paired with improved service delivery, may particularly enhance vaccination rates among elderly adults, highlighting the need for more systematic and theory-based approaches in future interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promotional communications for influenza vaccination: a systematic review. Macdonald, L., Cairns, G., Angus, K., et al.[2022]

Influenza vaccination rates in the U.S. are significantly below the CDC's targets, with only about 60% of seniors vaccinated compared to a target of 90%, and much lower rates in younger populations and healthcare personnel.

To improve vaccination rates, it is crucial to extend access beyond the traditional fall season and implement multifaceted interventions, such as vaccination-only clinics and strong healthcare provider recommendations, tailored to specific practice needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Practice-proven interventions to increase vaccination rates and broaden the immunization season. Stinchfield, PK.[2018]

A quality improvement project involving tailored telephone conversations helped address barriers to COVID-19 vaccination among older adults, with 34% of unvaccinated patients expressing willingness to engage in discussions about vaccination.

After 30 days, 20% of those who participated in the tailored conversations had received the vaccine, indicating that personalized dialogue can be somewhat effective in promoting vaccination, especially in populations with lower vaccination rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Addressing Barriers to COVID-19 Vaccination Among Older U.S. Veterans. Desir, M., Cuadot, A., Tang, F.[2022]

New high-dose and adjuvanted influenza vaccines have been shown to enhance immune response and may lower the risk of complications from influenza in older adults, addressing a critical need for improved vaccination in this population.

The new recombinant zoster vaccine is significantly more effective than the previous live zoster vaccine in preventing zoster outbreaks and postherpetic neuralgia, highlighting advancements in vaccine efficacy for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vaccination of Adults in General Medical Practice. Hunter, P., Fryhofer, SA., Szilagyi, PG.[2020]

Expressing empathy and autonomy support in vaccination chatbots can negatively impact user perceptions when the chatbot struggles to understand questions, suggesting that conversation quality is crucial for effective communication.

The study found that higher rates of chatbot misunderstandings led to a decrease in perceived user autonomy and intention to follow chatbot recommendations, highlighting the importance of chatbot performance in vaccination promotion efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults. Trzebiński, W., Claessens, T., Buhmann, J., et al.[2023]

In a study of 1047 Chinese adults, 81.8% of those who intended to get vaccinated against COVID-19 actually received the vaccine, highlighting a strong correlation between vaccination intention and actual uptake.

Key factors influencing vaccine uptake included prior intention to vaccinate, belief in vaccine safety, and community recommendations, while vaccine supply shortages negatively impacted vaccination rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

From COVID-19 Vaccination Intention to Actual Vaccine Uptake: A Longitudinal Study Among Chinese Adults After Six Months of a National Vaccination Campaign. Wang, J., Zhu, H., Lai, X., et al.[2022]

A study involving 701 participants in France found that using a chatbot to answer questions about COVID-19 vaccines significantly increased people's intentions to get vaccinated and improved their attitudes towards vaccination.

The results suggest that a well-designed and regularly updated chatbot could be an effective tool in addressing vaccine hesitancy and promoting vaccination efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Information delivered by a chatbot has a positive impact on COVID-19 vaccines attitudes and intentions. Altay, S., Hacquin, AS., Chevallier, C., et al.[2023]

An AI chatbot was successfully implemented in various healthcare settings in the U.S. from April 2021 to March 2022, engaging 2479 users and facilitating 3994 conversations about COVID-19 vaccination.

The chatbot demonstrated a response accuracy rate between 54% and 91.1%, which improved as new information was added, highlighting its potential to provide timely and persuasive information to encourage vaccination.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An artificially intelligent, natural language processing chatbot designed to promote COVID-19 vaccination: A proof-of-concept pilot study. Zhou, S., Silvasstar, J., Clark, C., et al.[2023]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

Interventions to Increase the Rate of Influenza and Pneumococcal Vaccination in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Promotional communications for influenza vaccination: a systematic review. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Practice-proven interventions to increase vaccination rates and broaden the immunization season. [2018]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Addressing Barriers to COVID-19 Vaccination Among Older U.S. Veterans. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Vaccination of Adults in General Medical Practice. [2020]

6. Canada pubmed.ncbi.nlm.nih.gov

The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults. [2023]

7. England pubmed.ncbi.nlm.nih.gov

From COVID-19 Vaccination Intention to Actual Vaccine Uptake: A Longitudinal Study Among Chinese Adults After Six Months of a National Vaccination Campaign. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Information delivered by a chatbot has a positive impact on COVID-19 vaccines attitudes and intentions. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

An artificially intelligent, natural language processing chatbot designed to promote COVID-19 vaccination: A proof-of-concept pilot study. [2023]