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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how a conversational app can boost COVID-19 and flu vaccination rates. Researchers are testing various app features, such as reminders and personalized messages, to determine which most effectively encourage vaccination. They are particularly interested in how culturally and religiously tailored messages might influence vaccination decisions. This trial suits English-speaking adults in the BMATP community who own a smartphone and have not yet received all recommended COVID-19 or flu vaccines. As an unphased trial, it offers participants the chance to contribute to innovative research that could enhance public health strategies.

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 prior data suggests that this conversational agent intervention is safe for promoting vaccination?

Research shows that the ECA-ACE Vaccination Promotion Intervention aims to increase COVID-19 and flu vaccination rates. This intervention uses a conversational agent, similar to a smart app, to interact with users and encourage vaccination.

The trial is labeled as "Not Applicable" in terms of phase, indicating no direct safety concerns with the app itself. This is because the intervention involves a digital tool rather than a medication or injection. Generally, these tools are considered safe as they provide information and reminders instead of administering drugs or treatments that might cause physical side effects.

The main goal of this intervention is to determine if the app can effectively encourage more people to get vaccinated. No reports of negative effects have been linked to using the app to promote vaccinations. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Conversational Agent Vaccine Promotion intervention because it leverages engaging digital tools to boost vaccination rates for COVID-19 and influenza. Unlike traditional methods like flyers or clinic reminders, this approach uses a virtual agent to provide personalized encouragement and build trust through reminders and culturally adapted language. By tailoring messages to individuals' religious or secular preferences, the intervention aims to increase vaccination completion rates more effectively than standard one-size-fits-all communication strategies.

What evidence suggests that this trial's treatments could be effective for increasing COVID-19 and influenza vaccination rates?

Research has shown that chatbots, such as the ECA-ACE, can help increase vaccination rates. In this trial, participants will experience different versions of the ECA-ACE intervention. Some will receive high engagement mechanisms, including frequent reminders and trust-building dialogue, while others will experience low engagement mechanisms. The trial will also test the impact of tailoring the chatbot's messages to match cultural and personal beliefs, with some participants receiving tailored content and others receiving non-tailored, secular content. Studies have found that these digital tools can connect with people by sending reminders and having personalized conversations, which helps build trust. Adjusting messages to match cultural and personal beliefs increases satisfaction and willingness to get vaccinated. Features like frequent notifications are linked to better vaccination results. Overall, the aim is to make getting vaccinated feel more personal and supportive, leading to higher vaccination rates. ^{1 2 3 4 6}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

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]

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]

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]

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]

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Conversational Agent Vaccine Promotion RCT

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 ...

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Project Details - NIH RePORTER

In this project, we propose to create an effective and sustainable smartphone-based ECA intervention designed to deliver personalized and tailored education ...

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Project Details - NIH RePORTER

In this project, we propose to create an effective and sustainable smartphone-based ECA intervention designed to deliver personalized and tailored education ...