Blog by Audrey Snyder, PhD, RN, FNP-BC, FAANP, FAEN, FAAN, President Rural Nurse Organization and Associate Dean of Experiential Learning and Innovation at the University of North Carolina Greensboro and Jessi (Seonglim) Hong, BSN, recent University of North Carolina Greensboro graduate.
As the FDA grants approval for Coronavirus vaccines for younger age groups, public health nurses must consider targeted messaging. We know that congregate settings show a higher risk of transmission of COVID-19. Some concerns expressed by college age students include missing classes if they had side effects and feeling they could not risk missing classes or an assignment.
Involve school systems. Schools could be involved and provide notes for students' instructors after getting vaccinated that would excuse the students from their school assignments, quizzes, or exams for a couple of days if they need it to recover but ONLY after getting vaccinated that day. This could be posted on the school's websites, their student health center's websites, their school's social media pages, signs displayed on their campus and dorms, and school emails / text messages. Sometimes, students would need that extra couple of days to complete assignments that they might be behind on or even take a break for their mental health.
Capitalize on peer pressure. Everyone has to wait for at least 15 minutes after being vaccinated. A small slip with a QR code to the registration webpage could be provided to each vaccinated person. While people are waiting in the post-vaccine area and/or making their second appointments (if Pfizer or Moderna), the person can message this site to their friends and friends to encourage them to get vaccinated. Since young people tend to have their own group of friends (high school and college) that influence them, it would be easier to reach those people through their own friends or families.
Survey young people to develop programing. Young people / adults are still in the stage of finding themselves, so their focus is generally more on themselves versus considering others. We need to survey and find out what they miss the most during this pandemic. Then use the data to build a foundation on what factors we need to focus on to plan how to target the population. Regardless of age, people hate feeling like they're being told what to do. People automatically draw back when they feel that they're being forced to do something. It's natural. On some campuses there have been lotteries for vaccinated students to win tuition, food, or housing vouchers. It might be successful if the school surveys students on what STUDENTS would like to win. The school will provide the options of the prizes that the young people would be interested in (of course, more data would need to be collected about the topic prior to posting surveys), and students will have their voices counted towards the prizes they picked. This is a great option to consider because people's participation and cooperation increase when they're active participants in the planning process. Then the school can decide which prizes will be given in which week for students who received vaccines for that week. And students who would like to receive those prizes will be more likely to show up during the week to receive their vaccines.
The surveys can be posted on the school's social media such as Facebook, Instagram, or by using school emails or even better by using all of them to reach the maximum number of students possible. Following the vaccine clinics, the school will send out the information to the winner(s) and the prize they won. The school can ask the student who won to share their story on their social media so that their other classmates or colleagues can see them too. Social media is the fastest way to disseminate information for young people.
Apply the Health Belief Model. Sundstrom and colleagues (2015) explored the Health Belief Model (HBM) with factors influencing college-age women’s decision to receive HPV vaccine. The HBM explains how an individual’s behavior might change if they perceive that they’re susceptible to a serious health disease. In other words, if pros outweigh cons, the individual’s behavior will change. Some of the factors include safety and concerns about the vaccine, cost, consent from parents, and perception of individual’s susceptibility to disease. Four factors that the researcher collected data on were perceived threat, benefits, barriers, and cues to action. Perceived threats were concerns about getting the disease and complications from it. Benefits included physician’s recommendation, support from parents, and individual’s desire to prevent disease or complications which affected the individual’s decision to receive the vaccine. Barriers were mainly concerns about the safety of the vaccine. Cues to action included TV, internet, magazine, paper, news, mass media campaigns, and so on. Students’ concern regarding the safety of getting vaccinated was the only factor that was a negative impact.
Some of the important information that needs to be considered are racial disparities and involvement of parents and students’ primary physicians. Based on the study results, race/ethnicity was the major predictor of college-age women receiving the HPV vaccine. First year black students were least likely to receive the vaccine compared to white students who were more likely to receive the vaccine compare to other students in different races. Parents and primary physicians were identified as the most trusted sources to obtain information about the vaccine and TV and internet were least likely sources to obtain the same information. The main reason that the participants avoided TV and internet was due to misleading or incomprehensive information. The researcher also pointed out that it’s crucial to provide multimodal information and target both internal and external cues to action. And the reason was that the information they obtain from their parents or primary physicians were more trustworthy than the information they’d obtain from TV and internet. For media, new media such as YouTube videos, Twitters, and text messages were identified as the most effective communication to promote successful message delivery. Another important factor was that college-age women were strongly influenced by their peer’s intention to vaccinate or vaccination. They were more likely to get vaccinated if their peers were, as well.
If we consider the results of this vaccine study (Sundstrom et al., 2015), it’s crucial to collect data from parents, healthcare providers, people that are college-age, and people with different races/backgrounds regarding COVID-19 hesitancy. We need to collect data on parents’ and health care providers’ intentions of getting vaccinated (their family and friends) and their barriers, then come up with interventions that will target them. Since parents and physicians are the most influential in deciding to get vaccinated or not, we need to market to them the most. College students will most likely listen to their parents and physicians rather than TV and internet when they’re weighing the pros and cons of getting the COVID-19 vaccines. People, especially college students, will be less likely to trust information from TV and internet because it can be ambiguous and misleading.
We need comprehensive data from people in all age groups, but specifically from college students. We need to collect data on their opinions of media coverage on the vaccines, perceived accuracy of vaccine information, and preferred communication media. We need to identify what kind of messages each individual received from watching commercials or news on the vaccines to decide if they had negative impact on getting vaccinated. Their perceived accuracy of vaccine information is needed to evaluate if any additional information is needed to clarify misinformation. Finding out their preferred communication media is important because that’s how they will be in contact with vaccine information. Technology is developing fast, so we need to be more sensitive of which social media is on trend now. For example, current trending media for college students is Tik-Tok, Snapchat, and Instagram.
Lastly, collecting information on individual barriers is crucial. For many, safety concern is a major barrier. Each individual would like to know the accurate and comprehensive information on each COVID-19 vaccine brand that addresses safety concerns that they might have. Along with that, we need to target the same audience with consequences of COVID-19, such as multi-organ failure or huge hospital bills, so that they can weigh pros and cons of getting vaccinated. Having a vaccine question hotline staffed with a knowledgeable person and a designated person to answer concerns at vaccine sites before the person makes it to the vaccine station can help ensure people have accurate information to make decisions on vaccination.
A couple of interventions we can implement are involving peers and creating narrated videos. College students are most likely influenced by their peers. Instead of reaching out to each individual, contacting a group of students could be more successful. A group of students can be a sports team or a student organization whose members can easily catch the virus from each other. By reminding them of this fact, students might feel more motivated to get vaccinated to protect their friends or teammates from catching COVID. Narrated videos that have their colleagues, friends, or family plus a healthcare or CDC expert will more likely influence college students to get vaccinated than lengthy emails or the school’s public messages.
One last thing to think about is different cultures and languages. It could be difficult for students that are on international studies or are immigrants to understand the vaccine information fully. They might not feel safe enough to get vaccinated because they might not understand the severity or consequences of the disease either because of a language barrier or a lack of knowledge. Also, they might not be aware of the types of different COVID vaccines or their potential side effects. It’s essential to see the statistical data of different races and cultures of each college’s students and to determine how many different languages the informational videos should be narrated in.
What we should not forget is the fact that safety is the most importance concern against getting vaccinated, especially for COVID. Therefore, it is crucial to provide up-to-date research information on each COVID vaccine for each individual to decide which vaccine they would like to receive (if they have the option). Because of possible complications that happened with a few people who received the vaccines, some students and their parents will be worried and hesitant towards getting vaccinated. Mass media constantly showing news and raising fear in people has not helped, either. As nurses, it is our job to educate them on how rarely complications happen (provide accurate numbers), how they will be monitored post-vaccine for these potential complications, what signs or symptoms to watch out for, and when to see a doctor or seek emergency care. Personally, when we had people who were concerned about the potential side effects, we asked them to weigh the pros and cons of getting vaccinated, “Would you rather have small potential side effects from getting these vaccines or have multi-organ failure due to COVID complications?” I think that sometimes people need to be redirected. They do not realize that the fear or thoughts they have are not originally theirs. It is what their subconscious mind picked up from listening to all the news and people talking about the vaccines.
Identifying barriers and concerns can help tailor marketing of the CoVID-19 vaccine. Public health nurses can then target messaging to increase COVID-19 vaccine uptake in the younger population. Now is the time to act as high school students prepare to go to college and before the fall semester is back in session for college and high school students.
References
Sundstrom, B., Carr, L. A., DeMaria, A. L., Korte, J. E., Modesitt, S. C., & Pierce, J. Y. (2015). Protecting the next generation: elaborating the health belief model to increase HPV vaccination among college-age women. Social Marketing Quarterly, 21(3), 173–188.
