Improving Health Equity for COVID-19 Vaccination for At-risk Populations Using Online Social Networks

Not Applicable

Active, not recruiting

• Conditions: Covid19; Vaccination Refusal; Heart Diseases
• Interventions: Behavioral: Online Social Network and Collective Intelligence Intervention; Behavioral: Independent Control

• Registration Number: NCT04779827
• Lead Sponsor: University of Pennsylvania

Brief Summary

Social technologies for health have already become essential means for providing underserved populations greater social connectedness and increased access to novel health information. However, these technologies have also had negative unintended consequences. The resulting digital divide in social technology takes many forms - from explicit racism that excludes African American and Latinx populations from the resources enjoyed by White and Asian members of online communities, to self-segregation for the purposes of identity preservation and community-building that unintentionally results in limited informational diversity in underserved communities. The result is an often unnoticed, but highly consequential compounding of inequities.

This research seeks to use an online social network approach to address these challenges, in which the investigators demonstrate how reducing the online levels of network centralization and network homophily among African American community members directly increases their productive engagement with health-promoting information.

Detailed Description

To investigate the causal effects of network structure and composition on the acceptance of new or unfamiliar behavior-relevant health information, the investigators propose a randomized controlled experiment that compares several independent populations to identify and address participants' endorsement of biased information, and engagement with novel behavior relevant information (e.g., regarding COVID-19 vaccination). Each population will have its own network structure (i.e., level of centralization) and composition (i.e., level of homophily).

To run each experimental trial, the investigators will recruit 240 African American participants, aged 18 to 40, collectively to answer behavior-relevant questions over a period of no greater than 8 minutes. Participants can respond asynchronously - i.e., when the participants' time permits. As with previous studies, the technical infrastructure will manage participants' progress through the study to ensure that all participants have the relevant information about each other's responses.

To ensure causal identification, each network graph will constitute a single observation of how individual decisions change under conditions of interdependent social information. Thus, each trial of 240 people (6 networks x 40 participants per network) produces 6 observations of a community-level social learning process. Power calculations indicate that 8 independent trials are sufficient to produce results of p\<0.05 with 85% power, resulting in a desired population of 1920 participants for each health topic (e.g., COVID-19 vaccination is a single "health topic"), producing 48 independent observations of collective decision making per health topic.

The studies will target health topics for which there is substantial racial disparity in outcomes and behavior, such as acceptance of COVID-19 vaccination, and spreading of various categories of COVID-19 misinformation (e.g. beliefs related to assessment of personal risk, effectiveness of protective behaviors, methods of transmission, disease prevention, treatment, origins of the virus) and related health practices (e.g. choice of appropriate contraceptive methods, value of heart disease screenings, etc.).

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2021-02-21
• Study First Submitted QC: 2021-03-01
• Study First Posted: 2021-03-03
• Study Start: 2021-05-04
• Primary Completion: 2023-03-30
• Status Verified: 2024-01
• Last Update Submitted: 2024-01-31
• Last Update Posted: 2024-02-02
• Study Completion: 2025-01-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 4476

Inclusion Criteria

• Having internet access
• Aged 18 and above
• Living in the United States

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Exclusion Criteria

• Having no internet access
• Aged below 18
• Living outside of the United States

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Egalitarian Networks of Homogeneous Populations	Online Social Network and Collective Intelligence Intervention	Egalitarian networks are characterized by equal connectivity for all participants in an online network for information exchange. Each network is consisted of 40 individual participants. All network participants in this condition share similar baseline demographic characteristics, attitudes, or behavioral choices.
Centralized Networks of Homogeneous Populations	Online Social Network and Collective Intelligence Intervention	Centralized networks have a small number of influential individuals, called "hubs," with connections to most other people. Centralized networks characterize situations in which most or all individuals are connected to, and seek advice from, a few well-connected "influencers." Each network is consisted of 40 individual participants. All network participants in this condition share similar baseline demographic characteristics, attitudes, or behavioral choices.
Centralized Networks of Diverse Populations	Online Social Network and Collective Intelligence Intervention	Centralized networks have a small number of influential individuals, called "hubs," with connections to most other people. Centralized networks characterize situations in which most or all individuals are connected to, and seek advice from, a few well-connected "influencers." Each network is consisted of 40 individual participants. All network participants in this condition have very different baseline demographic characteristics, attitudes, or behavioral choices.
Egalitarian Networks of Diverse Populations	Online Social Network and Collective Intelligence Intervention	Egalitarian networks are characterized by equal connectivity for all participants in an online network for information exchange. Each network is consisted of 40 individual participants. All network participants in this condition have very different baseline demographic characteristics, attitudes, or behavioral choices.
Independent Control of Homogeneous Populations	Independent Control	Independent control condition does not have online networks. Participants in this condition are not put into online networks. Participants only respond to questions by themselves. All participants in this condition share similar baseline demographic characteristics, attitudes, or behavioral choices.
Independent Control of Diverse Populations	Independent Control	Independent control condition does not have online networks. Participants in this condition are not put into online networks. Participants only respond to questions by themselves. All participants in this condition have very different baseline demographic characteristics, attitudes, or behavioral choices.

Primary Outcome Measures

Name	Time	Method
COVID-19 vaccination attitude	Immediate after intervention	COVID-19 vaccination attitude scale, which is a self-reported scale measuring participants' attitudes toward COVID-19 vaccination. The scale is consisted of 5 questions (e.g., "How much confidence do you have that the COVID-19 vaccine in the U.S. is safe and effective?") with responses ranging from 1 (No confidence at all) to 5 (A great deal of confidence); a higher average score means a more positive attitude in favor of COVID-19 vaccination.
COVID-19 vaccination intention	Immediate after intervention	COVID-19 vaccination intention scale, which is a self-reported scale measuring participants' intention toward COVID-19 vaccination. The scale is consisted of 5 questions (e.g., "Would you get a COVID-19 vaccine when it is available to you?") with responses ranging from 1 (Definitely Not) to 5 (Definitely); a higher average score means a stronger intention to receive the COVID-19 vaccine.
COVID-19 vaccine safety perception	Immediate after intervention	One question asks participant's estimation of one potential side effect from the COVID-19 vaccine. The question asks "According to the most recent data, for every 10 million people in the US vaccinated for COVID-19, how many experienced a severe allergic reaction (anaphylaxis)? Answer must be between 0 and 10,000."

Secondary Outcome Measures

Name	Time	Method
COVID-19 vaccine belief	Immediate after intervention	COVID-19 vaccine belief scale, which is a self-reported scale measuring participants' knowledge and belief (including misbelief) about the COVID-19 vaccine safety and effectiveness. The scale is consisted of 12 items (e.g., "A COVID-19 vaccine will not alter my DNA") with responses ranging from 1 (completely disagree) to 5 (completely agree); a higher average score means more accurate knowledge and belief towards the COVID-19 vaccine.

Trial Locations

Locations (1)

Annenberg School for Communication; 🇺🇸 Philadelphia, Pennsylvania, United States