Enabling Family Physicians to Reduce Vaccine Hesitancy and Increase COVID-19 Vaccine Uptake: a Cluster-randomized Trial

Background. The approval and distribution of COVID-19 vaccines is a key milestone in the fight against the pandemic. As many countries around have rapidly implemented complex vaccination programs, there are still people who remain hesitant to get vaccinated. In Canada, 83% of Canadian adults have received at least one dose of a COVID-19 vaccine, but nearly 20% of adults remain concerned about receiving vaccines. Canadian primary care providers have not had a large role to date in the administration of COVID-19 vaccines, despite their traditional role in vaccinating infants and seniors. Nonetheless, primary care providers can play a key role in decreasing vaccine hesitancy, as they are one of the most trusted emissaries of people who are vaccine-hesitant. The Canadian Practice Information Network (CPIN), a primary care practice tool, can be used by primary care providers to send messages to patients across small independent primary care practices to improve uptake of COVID-19 vaccines in Canada. Because of their trusted relationship, messages sent by the patient's primary care provider are read and 60% of CPIN surveys completed,9 making this an efficient tool for patient engagement.

An experimental study will be conducted using CPIN as a tool for primary care providers across Canada to communicate and engage with their patients regarding COVID-19 vaccines to identify and address vaccination hesitancy in their own patient populations. A survey will be conducted to explore the reasons for vaccine hesitancy among the unvaccinated population of each participating provider as well as their unmet information needs about COVID-19 vaccination. This will then enable family physicians to implement a targeted and tailored COVID-19 vaccine digital health communication strategy reaching patients by e-mail or text to address vaccination hesitancy and improve COVID-19 vaccination uptake. The effectiveness of this communication strategy in persuading patients to get vaccinated against COVID-19 will be evaluated.

Trial design. A two-arm, pragmatic cluster randomized trial design will be used.

Setting and sample. The study will be conducted in primary care practices across Canada. The study will occur in a convenience sample of any model of comprehensive primary care practices. All primary care providers who provide comprehensive care for a defined patient panel that represents at least 75% of their patient population and who have been with the practice for > 2 years are eligible to participate including those who work part-time. Providers are considered to be in the same practice if they share at least four of the following: patient electronic medical record, waiting room, receptionist, coverage after hours, telephone number, and address.

Through CPIN, 300 providers across 100 Canadian practices will be used for connecting patients and physicians. It is assumed that each provider will care for on average 800 adult patients and that 20% are not yet vaccinated. CPIN will be used to send a questionnaire to at least 180,000 adult patients with email or cell number on record, to recruit participants. The questionnaire will ask patients about COVID-19 vaccination status and intention and, if not vaccinated, their reasons for vaccine hesitancy based on the Health Belief Model, or barriers to access. The survey responses will be aggregated across practices and use machine learning to classify the unvaccinated patients into distinct segments reflecting age, language, education level, rurality, sex, gender, ethnicity, reasons for vaccine hesitancy, and barriers to access.