“Better safe than sorry”: Behaviorally informed digital campaigns and their association with COVID-19 vaccine interest and take-up in Belize

“Better safe than sorry”: Behaviorally informed digital campaigns and their association with COVID-19 vaccine interest and take-up in Belize | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Better safe than sorry”: Behaviorally informed digital campaigns and their association with COVID-19 vaccine interest and take-up in Belize Giuliana Daga, Lajos Kossuth, Cynthia Boruchowicz, Florencia Lopez Boo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3203862/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Increasing vaccine take-up has been key to curb the COVID-19 pandemic globally. However, vaccine acceptance and take-up has been a challenge in some regions such as the Caribbean countries. This paper analyzes the performance of different behaviorally informed social media campaigns on people’s engagement with information about the vaccination process and vaccine take-up in Belize, a country where despite of enough vaccine supply take-up was very low. Methods: Using Belize’s Facebook platform (>230,000 users) and national administrative vaccination data at the district level, we conduct three types of analyses. First, we run linear regression models to analyze which of five behaviorally informed and sequentially displayed Facebook campaigns were better at predicting i) social media engagement with COVID-19 vaccination; and ii) COVID-19 vaccination uptake. Then, within one of the campaigns (e.g. the side-effects one) we conduct a randomized experiment to measure the effect on social media engagement of exposure to either positively (“Majority did not report discomfort”) or negatively framed messages, using words (“Few persons reported discomfort”) or numerical proportions (“3 out of 100 reported discomfort”). Social media engagement is measured by the number of people that clicked on the respective Facebook ad and visited the official vaccination site (“Clicks”) and the number of people that interacted with the ad through likes and different emojis (“Engagements”). Results: Campaigns highlighting COVID-19 vaccine safety best predicted vaccination uptake (second and booster doses) and social media engagement. Emphasizing the vaccine´s effectiveness was associated with a higher uptake of first doses. These results match previous research showing that safety was one of the main concerns among Belizean citizens and that efficacy beliefs were important to increase the likelihood of uptake among the unvaccinated. Finally, informational messages related to side effects that were framed positively (“Majority did not report discomfort”) and using words (“Few persons reported discomfort”) were better at generating "Clicks” compared to those negatively framed and using numbers (“3 out of 100 reported discomforts”). Conclusions: Highlighting COVID-19 vaccines´ safety and framing side-effect information positively (i.e., focusing on those who will not get them) with words might increase vaccination uptake and interest in low-uptake regions like the Caribbean. COVID-19 Vaccines Behavioral economics Vaccine hesitancy AB Testing Latin America Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revision 15 Sep, 2023 Reviews received at journal 18 Aug, 2023 Reviewers agreed at journal 18 Aug, 2023 Reviewers agreed at journal 10 Aug, 2023 Reviewers invited by journal 02 Aug, 2023 Editor assigned by journal 26 Jul, 2023 Submission checks completed at journal 26 Jul, 2023 First submitted to journal 25 Jul, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3203862","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":221704659,"identity":"3dc6709e-9d1a-4b62-887e-31055ce39e3c","order_by":0,"name":"Giuliana Daga","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYDACZgbGAwkgxvHGBgbeBuK0MEC0nDlIrBYgOAAmbwA1EqVF3p3H4MCDmjvyfDcfN354u4NBzrx/AX4thoeBWhKOPTOceTuxWXLuGQZjmRsPCGhpBmlhO8y44XZigzRvG0PiDIkDxGj5d9h+w82Dzb+J0iLPDNSS2HY4ccMNxjaILfwN+LUYMLMVHEjsO5w880xim+XcMxLGEhL4dTDI9x/e+PDHt8O2fcePP77xdoeNnAQ/AYcZoMkDrZBIIGBLA4YQIVtGwSgYBaNgxAEAD8RO2XirlS8AAAAASUVORK5CYII=","orcid":"","institution":"Inter-American Development Bank","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Giuliana","middleName":"","lastName":"Daga","suffix":""},{"id":221704660,"identity":"a5163f4a-1d43-449e-9880-2bf6daad485c","order_by":1,"name":"Lajos Kossuth","email":"","orcid":"","institution":"Massachusetts Institute of Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lajos","middleName":"","lastName":"Kossuth","suffix":""},{"id":221704661,"identity":"fd4457d1-a6af-4dca-9e83-5530f7904685","order_by":2,"name":"Cynthia Boruchowicz","email":"","orcid":"","institution":"Inter-American Development Bank","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cynthia","middleName":"","lastName":"Boruchowicz","suffix":""},{"id":221704662,"identity":"b9aad966-a704-4388-863f-5b20317a3dd3","order_by":3,"name":"Florencia Lopez Boo","email":"","orcid":"","institution":"Inter-American Development Bank","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Florencia","middleName":"Lopez","lastName":"Boo","suffix":""}],"badges":[],"createdAt":"2023-07-25 17:29:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3203862/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3203862/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":40826710,"identity":"3e078894-8851-4b06-8298-7265c542b950","added_by":"auto","created_at":"2023-07-31 14:19:04","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":421923,"visible":true,"origin":"","legend":"","description":"","filename":"20230711Bettersafethansorry.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3203862/v1_covered_0a8f5a19-a58e-434b-bdee-a48695167c7f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“Better safe than sorry”: Behaviorally informed digital campaigns and their association with COVID-19 vaccine interest and take-up in Belize","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-global-and-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [BMC Global and Public Health](https://bmcglobalpublichealth.biomedcentral.com/)","snPcode":"44263","submissionUrl":"https://submission.springernature.com/new-submission/44263/3","title":"BMC Global and Public Health","twitterHandle":"@BMC_GPH","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Vaccines, Behavioral economics, Vaccine hesitancy, AB Testing, Latin America","lastPublishedDoi":"10.21203/rs.3.rs-3203862/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3203862/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIncreasing vaccine take-up has been key to curb the COVID-19 pandemic globally. However, vaccine acceptance and take-up has been a challenge in some regions such as the Caribbean countries. This paper analyzes the performance of different behaviorally informed social media campaigns on people’s engagement with information about the vaccination process and vaccine take-up in Belize, a country where despite of enough vaccine supply take-up was very low.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eUsing Belize’s Facebook platform (\u0026gt;230,000 users) and national administrative vaccination data at the district level, we conduct three types of analyses. First, we run linear regression models to analyze which of five behaviorally informed and sequentially displayed Facebook campaigns were better at predicting i) social media engagement with COVID-19 vaccination; and ii) COVID-19 vaccination uptake. 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