JIU-JITSU WITH MISINFORMATION IN THE AGE OF COVID: USING REFUTATION-BASED LEARNING TO ENHANCE VACCINE UPTAKE AND KNOWLEDGE AMONG HEALTHCARE PROFESSIONALS AND THE PUBLIC

Project Information

JITSUVAX

Grant agreement ID: 964728

DOI

10.3030/964728

Project closed

EC signature date 21 January 2021

Start date 1 April 2021

End date 30 September 2025

Funded under

• SOCIETAL CHALLENGES - Health, demographic change and well-being

Total cost

€ 3 118 832,74

EU contribution

€ 3 118 832,74

Coordinated by

UNIVERSITY OF BRISTOL
United Kingdom

Periodic Reporting for period 2 - JITSUVAX (JIU-JITSU WITH MISINFORMATION IN THE AGE OF COVID: USING REFUTATION-BASED LEARNING TO ENHANCE VACCINE UPTAKE AND KNOWLEDGE AMONG HEALTHCARE PROFESSIONALS AND THE PUBLIC)

Reporting period: 2022-10-01 to 2024-03-31

Summary of the context and overall objectives of the project

Despite the unquestionable success of immunisation in reducing and eliminating infectious diseases and saving countless lives, scepticism about vaccine efficacy and safety remains a universal problem. The WHO has attributed this scepticism at least in part to misinformation, spread mainly on the internet. Misinformation comes from a variety of sources and may be disseminated for a variety of reasons: the common factor is that it is false or misleading and hence can be debunked. Debunking misinformation in a manner that is both effective and respectful of patients is, however, no trivial endeavour. By training health care professionals how to debunk misinformation effectively, and enabling them to communicate more constructively with patients, the JITSUVAX project aspires to contribute to an increase in public confidence in immunisation.

In line with a “Jiu Jitsu model of persuasion”, described by Hornsey and Fielding in 2017, the JITSUVAX project uses Jiu Jitsu as its explanatory analogy. Jiu Jitsu is known as the “gentle martial art” that teaches you not to challenge your opponent’s strength directly, but to understand it and leverage it to your advantage. JITSUVAX therefore explores ways of working with people’s motivations and attitudes in a relationship of trust and empathy, rather than fighting them in order to tackle misinformation about vaccination.

JITSUVAX is coordinated by the University of Bristol, UK, with teams based at the University of Cambridge in the UK, Turku University and Åbo Akademi in Finland, L'Observatoire Régional de la Santé in France, the University of Erfurt in Germany and the University of Coimbra in Portugal. We also have partnerships with Sherbrooke University in Canada, the Centre for Health Policies and Services in Romania and the Institute for Developmental and Strategic Analysis in Slovenia. The project started in April 2021 and is due to end in March 2025, with the last year focussing on dissemination of our outputs and ensuring that our work has long term impact.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

In our first Work Package our main goal was to understand vaccine hesitancy among health care professionals can have doubts about vaccines and their safety, and this can affect how they discuss and recommend these vaccines to their patients. To measure these doubts and underlying contributing factors we adapted and validated an international version of the Pro-VC-Be (Professionals-Vaccine Confidence-Behaviours) survey tool to ask professionals about their confidence in vaccines, perceptions of vaccine risks and the usefulness of vaccines. We also asked questions about their preparedness for vaccine discussions and their difficulties in refuting arguments against vaccination.

The first goal of our second work package was to identify the attitude roots (i.e. the underlying psychological attributes driving a person’s belief) of believing in vaccination misinformation. Although anti-vaccination arguments can take many surface forms, those arguments tend to reflect one or the other underlying root; for example distorted risk perceptions or a proclivity towards conspiracy theories.

Effectively rebutting misinformation therefore requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots that motivate a person’s opposition to or criticism of vaccines.

The JITSUVAX group developed a psychologically informed classification of arguments expressing opposition toward vaccines, which encompassed 11 attitude roots—well-established psychological attributes, such as fear and phobias, worldview and politics, and religious concerns. These attitude roots motivate the endorsement of many different thematic groups of anti-vaccination arguments.

The taxonomy has been validated through a systematic review of the scientific literature and the design of a computational linguistic model capable of predicting the attitude roots of a given anti-vaccination argument. Rebuttals that follow the Jiu Jitsu approach were designed for 62 thematic groups of anti-vaccination arguments and are available at an online learning resource: www.jitsuvax.info

The second goal of work package 2 was to develop and test interventions to address vaccine hesitancy.

HCPs are in an excellent position to speak with patients about their vaccination decisions. Training HCPs to refute misleading anti-vaccination arguments that patients may raise can help increase their confidence in having such conversations. We designed the Empathetic Refutational Interview (ERI) (see figure) which involves first affirming the patient’s underlying attitude root, in order to communicate empathy for the patient, and then refuting common misconceptions. This technique was successfully tested in a series of psychological experiments among vaccine-hesitant individuals, providing support for the ERI in controlled settings.

Members of JITSUVAX also designed Bad Vaxx, a 10-minute online game that seeks to improve people’s ability to recognise manipulation strategies commonly used in vaccine misinformation. This is available at www.badvaxx.com. Experimental tests of this game demonstrated that playing Bad Vaxx successfully inoculated people against anti-vaccine misinformation, and that perspective-taking makes a difference in the efficacy of the inoculation effect.

Our primary goal in the third work package was to field test theEmpathetic Refutational Interview in real healthcare contexts and evaluate how it can be successfully implemented in clinical settings. We carried out a series of field tests in different contexts in the UK, France, Romania, and Germany, providing training in the methodology to a wide range of HCPs. We found that the training increases health care professionals’ vaccine confidence and preparedness to rebut arguments.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

As we move in to our final, fourth work package, our primary goal is to develop readily accessible materials to disseminate the project outcomes. These will provide guidance on the theory and practice of the ERI. We found during the field tests that there is a high level of interest in the technique and we will continue to focus on ways in which we can continue to make training in the technique, as well as the guidance documents, widely available beyond the lifetime of the project.

The JITSUVAX team have been actively disseminating the work of the project through numerous channels throughout the project. So far we have published 18 articles in peer-reviewed journals such as Nature Human Behaviour and Expert Review of Vaccines. We are actively working to reach a wide range of audiences with our work, including frontline HCPs and HCP educators and leads, as well as policy makers and healthcare authorities. During the final work package in 2024 we will be demonstrating the training and methodology in different countries, languages and settings, including in Germany, Finland, France, Romania, Portugal and the UK.

We strive to make a difference through the development, evaluation, and dissemination of these evidence-based tools to counter vaccination misinformation and increase vaccine uptake. Our outputs, and in particular the ERI, will contribute towards increasing vaccine coverage in Europe and beyond by providing a practical and readily implementable technique to help HCPs effectively counter misinformation and communicate constructively with patients.

Summary of the steps of the Empathetic Refutational Interview