{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:42:52Z","timestamp":1781188972076,"version":"3.54.1"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T00:00:00Z","timestamp":1729728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004429","name":"Inter-American Development Bank","doi-asserted-by":"publisher","award":["RG-E1814"],"award-info":[{"award-number":["RG-E1814"]}],"id":[{"id":"10.13039\/100004429","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004429","name":"Inter-American Development Bank","doi-asserted-by":"publisher","award":["RG-E1814"],"award-info":[{"award-number":["RG-E1814"]}],"id":[{"id":"10.13039\/100004429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Global Public Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Increasing vaccination coverage was key to curbing the COVID-19 pandemic globally. However, lack of trust in the vaccine and fear of side effects in regions like the Caribbean resulted in a low uptake despite enough vaccine supply.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted two correlational analyses and one experiment between five sequential behaviorally informed Facebook campaigns, social media performance outcomes, and district-level vaccination data. First, we ran multivariate linear regression models to estimate\u00a0the mean differences between the campaigns in (i) social media performance (\u201cClicks\u201d and \u201cEngagement\u201d) and (ii) COVID-19 vaccination uptake at the district level. \u201cClicks\u201d were measured by the number of people who clicked on the respective Facebook advert and visited the official vaccination site. \u201cEngagements\u201d were the number of people interacting with the advert through likes and emojis. Second, we took advantage of the experimental design during one of the campaigns to analyze the differential effect of messages conveying information about the number of people reporting vaccination side effects using words (\u201cFew\u201d\/ \u201cMajority) and numbers (\u201c3 out of 100 \u201c) on social media performance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The correlational analysis showed that the number of \u201cClicks\u201d and \u201cEngagement\u201d was similar among campaigns, except for the campaign focusing on vaccines\u2019 effectiveness, which had 14.65 less clicks and 19.52 less engagements per advert (including controls and district-fixed effects) compared to the base \u201cIt\u2019s safe\u201d campaign. Vaccination rates were highest at times coinciding with campaigns focusing on vaccination safety and effectiveness. Our experimental results showed that informational messages related to side effects that were framed using words (\u201cMajority did not report discomfort\u201d\/ \u201cFew persons reported discomfort\u201d) were better at generating \u201cClicks\u201d compared to those using numbers (\u201c3 out of 100 reported discomforts\u201d).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Facebook adverts highlighting vaccine safety had a similar level of social media performance as other campaigns, except for adverts focusing on vaccine efficacy, which performed worse. Communicating side-effect information with words instead of numbers can expand social media interest in low-uptake regions like the Caribbean. Our results serve as preliminary evidence for public health officials to encourage vaccine uptake in high-hesitancy contexts.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s44263-024-00079-w","type":"journal-article","created":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T12:02:23Z","timestamp":1729771343000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Behaviorally informed digital campaigns and their association with social media engagement and COVID-19 vaccine uptake in Belize"],"prefix":"10.1186","volume":"2","author":[{"given":"Giuliana","family":"Daga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lajos","family":"Kossuth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Boruchowicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florencia","family":"Lopez Boo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Largaespada Beer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,24]]},"reference":[{"key":"79_CR1","unstructured":"WHO. Strategy to achieve global COVID-19 vaccination by mid-2022. Geneva, Switzerland. 2021."},{"key":"79_CR2","volume-title":"Global COVID-19 vaccination strategy in a changing world: July 2022 update","author":"WHO","year":"2022","unstructured":"WHO. Global COVID-19 vaccination strategy in a changing world: July 2022 update. 2022."},{"key":"79_CR3","unstructured":"PAHO, \u201cLow vaccination rates in the Caribbean must be urgently addressed to stop the spread of COVID-19 says PAHO Director,\u201d 22 February 2022. [Online]. Available: https:\/\/www.paho.org\/en\/news\/23-2-2022-low-vaccination-rates-caribbean-must-be-urgently-addressed-stop-spread-COVID-19-says. Accessed 23 May 2024."},{"key":"79_CR4","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1038\/s41562-021-01122-8","volume":"5","author":"E Mathieu","year":"2021","unstructured":"Mathieu E, Ritchie H, Ortiz-Ospina E, Roser M, Hassel J, Appel C, Giattino C, Rold\u00e9s-Guirao L. A global database of COVID-19 vaccinations. Nat Hum Behav. 2021;5:947\u201353. https:\/\/doi.org\/10.1038\/s41562-021-01122-8.","journal-title":"Nat Hum Behav."},{"key":"79_CR5","doi-asserted-by":"publisher","first-page":"n1138","DOI":"10.1136\/bmj.n1138","volume":"373","author":"M. S Razai","year":"2021","unstructured":"Razai M. S, Doerholt K, Majeed A. COVID-19 vaccination hesitancy. BMJ. 2021;373:n1138.","journal-title":"BMJ"},{"key":"79_CR6","doi-asserted-by":"publisher","unstructured":"Zertuche Rios D, Daga G, Iorillo F, Aguilar A. M, Diaz-Musa M, Largaespada Beer N, Lopez Boo F\u00a0 and Sabido J, \u201cFactors associated with COVID-19 vaccination in Belize,\u201d Vaccine: X, 2023,\u00a0https:\/\/doi.org\/10.1016\/j.jvacx.2023.100380.","DOI":"10.1016\/j.jvacx.2023.100380"},{"issue":"2","key":"79_CR7","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1111\/j.1468-2885.2003.tb00287.x","volume":"12","author":"M Fishbein","year":"2003","unstructured":"Fishbein M, Yzer M. Using theory to design effective health behavior interventions. Commun Theory. 2003;12(2):164\u201383.","journal-title":"Commun Theory"},{"issue":"3","key":"79_CR8","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1177\/1529100618760521","volume":"18","author":"N Brewer","year":"2018","unstructured":"Brewer N, Chapman G, Rothman A, Leask J, Kempe A. Increasing vaccination: putting psychological science into action. Psychol Sci Public Interest. 2018;18(3):149\u2013207.","journal-title":"Psychol Sci Public Interest"},{"key":"79_CR9","doi-asserted-by":"publisher","unstructured":"Milkman K, Beshears J,\u00a0 Choi J, Laibson D.\u00a0 and Madrian B, \u201cUsing implementation intentions prompts to enhance influenza vaccination rates,\u201d Proc Natl Acad Sci U S A.\u00a0 108(26):10415\u201320. https:\/\/doi.org\/10.1073\/pnas.1103170108. Epub 2011 Jun 13. PMID: 21670283; PMCID: PMC3127912., 2011.","DOI":"10.1073\/pnas.1103170108"},{"key":"79_CR10","doi-asserted-by":"crossref","unstructured":"Gallegos S, Roseth B, Cuesta A, Sanchez M. Increasing the take-up of public health services: an at-scale experiment on digital government. J Public Econom. 2023;227:104975.","DOI":"10.1016\/j.jpubeco.2023.104975"},{"key":"79_CR11","doi-asserted-by":"publisher","unstructured":"Wouter O, Shadlen K, Salcher-Konrad M, Pollard A, Larson H, Teerawattananon Y and Jit M, \u201cChallenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment,\u201d Lancet. 2021;1023\u20131024.\u00a0https:\/\/doi.org\/10.1016\/S0140-6736(21)00306-8.","DOI":"10.1016\/S0140-6736(21)00306-8"},{"key":"79_CR12","doi-asserted-by":"publisher","unstructured":"Wang J, Zhu H, Zhang H, Huang Y, Feng H, Lyu Y, Jing R, Guo J\u00a0 and Fang H, \u201cFrom COVID-19 vaccination intention to actual vaccine uptake: a longitudinal study among Chinese adults after six months of a national vaccination campaign,\u201d Expert Review of Vaccines. 2022;21:3, 385\u2013395.\u00a0\u00a0https:\/\/doi.org\/10.1080\/14760584.2022.2021076.","DOI":"10.1080\/14760584.2022.2021076"},{"issue":"32","key":"79_CR13","doi-asserted-by":"publisher","first-page":"e2108225118","DOI":"10.1073\/pnas.2108225118","volume":"118","author":"M Ashworth","year":"2021","unstructured":"Ashworth M, Thunstr\u00f6m L, Cherry T, Newbold S, Finnoff D. Emphasize personal health benefits to boost COVID-19 vaccination rates. Proc Natl Acad Sci. 2021;118(32):e2108225118.","journal-title":"Proc Natl Acad Sci"},{"key":"79_CR14","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1111\/aphw.12285","volume":"13","author":"P Sprengholz","year":"2021","unstructured":"Sprengholz P, Betsch C, B\u00f6hm R. Reactance revisited: consequences of mandatory and scarce vaccination in the case of COVID-19. Appl Psychol Health Well-Being. 2021;13:986\u201395.","journal-title":"Appl Psychol Health Well-Being."},{"issue":"7876","key":"79_CR15","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1038\/s41586-021-03843-2","volume":"597","author":"H. Dai","year":"2021","unstructured":"Dai H., Saccardo S., Han M. A., Roh L., Raja N., Vangala S., Modi H., Pandya S., Sloyan M., Croymans D. M. Behavioural nudges increase COVID-19 vaccinations. Nature. 2021;597(7876):404\u20139.","journal-title":"Nature"},{"key":"79_CR16","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1257\/pandp.20231112","volume":"113","author":"L Ho","year":"2023","unstructured":"Ho L, Breza E, Alsan M, Banerjee A, Chandrasekhar G, Stanford F, Fior R. G.-P. P. The impact of large-scale social media advertising campaigns on COVID-19 vaccination: evidence from two randomized controlled trials. AEA Pap Proc. 2023;113:653\u20138.","journal-title":"AEA Pap Proc"},{"key":"79_CR17","unstructured":"Our World Data, \u201cCoronavirus (COVID-19) vaccinations,\u201d 2022. Available: https:\/\/ourworldindata.org\/covid-vaccinations. Accessed 30 June 2022."},{"key":"79_CR18","doi-asserted-by":"crossref","unstructured":"Li K, \u201cGain or loss? The effect of ad framing on the intention to control sugar intake.,\u201d Sugar Intake-Risks and Benefits and the Global Diabetes Epidemic.\u00a02021.","DOI":"10.5772\/intechopen.95779"},{"key":"79_CR19","doi-asserted-by":"crossref","unstructured":"Fetter D. S,\u00a0 Dharmar, M.\u00a0 Lawry-Hall S, Pressman J, Chapman J\u00a0 and  Scherr R. E, \u201cThe influence of gain-framed and loss-framed health messages on nutrition and physical activity knowledge.,\u201d Global Pediatric Health. 2019;6: 2333794X19857405.","DOI":"10.1177\/2333794X19857405"},{"key":"79_CR20","doi-asserted-by":"crossref","unstructured":"Tang Y\u00a0 and Chooi W, \u201cA systematic review of the effects of positive versus negative framing on cancer treatment decision making,\u201d Psychol Health. 2021;PMID: 34856837.","DOI":"10.1080\/08870446.2021.2006197"},{"key":"79_CR21","doi-asserted-by":"crossref","unstructured":"Gantiva C, Jim\u00e9nez-Leal W, Urriago-Rayo J. Framing messages to deal with the COVID-19 crisis: the role of loss\/gain frames and content.\u00a0Front\u00a0Psychol. 2021;12:568212.","DOI":"10.3389\/fpsyg.2021.568212"},{"issue":"3","key":"79_CR22","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s42761-022-00128-3","volume":"3","author":"CA Dorison","year":"2022","unstructured":"Dorison CA, Lerner JS, Heller BH, Rothman AJ, Kawachi I. I, Wang Kand Pantazi M, \u201cIn COVID-19 health messaging, loss framing increases anxiety with little-to-no concomitant benefits: experimental evidence from 84 countries.\u201d Affective Sci. 2022;3(3):577\u2013602.","journal-title":"Affective Sci"},{"key":"79_CR23","doi-asserted-by":"publisher","unstructured":"Barnes K, Faasse K\u00a0 and  Colagiuri B, \u201cThe impact of side effect framing on COVID-19 booster vaccine intentions in an Australian sample,\u201d Vaccine. 2023 https:\/\/doi.org\/10.1101\/2022.05.09.22274840.","DOI":"10.1101\/2022.05.09.22274840"},{"key":"79_CR24","doi-asserted-by":"publisher","unstructured":"Kerr J,\u00a0 Freeman A, Marteau T. and van der Linden S., \u201cEffect of information about COVID-19 vaccine effectiveness and side effects on behavioural intentions: two online experiments,\u201d Vaccines, 2021;9(4), 379.\u00a0https:\/\/doi.org\/10.3390\/vaccines9040379.","DOI":"10.3390\/vaccines9040379"},{"key":"79_CR25","doi-asserted-by":"crossref","unstructured":"Giese H, Neth H, Wegwarth O, Gaissmaier W and Stok M, How to convince the vaccine-hesitant? An ease-of-access nudge, but not risk-related information increased Covid vaccination-related behaviors in the unvaccinated, Applied Psychology: Health and Well-Being, 2023.","DOI":"10.1111\/aphw.12479"},{"key":"79_CR26","doi-asserted-by":"crossref","unstructured":"Beyth-Marom R, \u201cHow probable is probable? A numerical translation of verbal probability expressions,\u201d J Forecast. 1982;257\u2013269.","DOI":"10.1002\/for.3980010305"},{"key":"79_CR27","doi-asserted-by":"publisher","first-page":"3820","DOI":"10.1007\/s11606-021-07050-7","volume":"36","author":"K Andreadis","year":"2021","unstructured":"Andreadis K, Chan E, Park M, Benda N, Sharma M, Demetres M, Delgado D, Sigworth E, Chen Q, Liu A, Grossman L, Sharko M, Zikmud-Fisher B, Ancker J. Imprecision and preferences in interpretation of verbal probabilities in health: a systematic review. J Gen Intern Med. 2021;36:3820\u20139.","journal-title":"J Gen Intern Med"},{"key":"79_CR28","doi-asserted-by":"crossref","unstructured":"B\u00fcchter R. B, Fechtelpeter D, Knelangen M. M\u00a0 and Waltering A, \u201cWords or numbers? Communicating risk of adverse effects in written consumer health information: a systematic review and meta-analysis,\u201d BMC Medical Informatics and Decision Making, 2014.","DOI":"10.1186\/1472-6947-14-76"},{"key":"79_CR29","doi-asserted-by":"publisher","unstructured":"Rabb N, Bowers J, Glick D, Wilson K\u00a0 and Yokum D, \u201cThe influence of social norms varies with \u201cothers\u201d groups: evidence from COVID-19 vaccination intentions,\u201d Psychological and Cognitive Sciences.\u00a02021;119: No. 29 e2118770119.\u00a0https:\/\/doi.org\/10.1073\/pnas.2118770119.","DOI":"10.1073\/pnas.2118770119"},{"key":"79_CR30","doi-asserted-by":"publisher","first-page":"1385","DOI":"10.1038\/s41591-021-01454-y","volume":"27","author":"J Solis Arce","year":"2021","unstructured":"Solis Arce J, Warren S, Meriggi N, Scacco A, McMurry N, Voors M, Syunyaev G, Malik A, Aboutajdine S, Adeojo O, Anigo D, Armand A, Asad S, Atyera M, Augsburg B A. M, et al. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nature Med. 2021;27:1385\u201394.","journal-title":"Nature Med"},{"key":"79_CR31","doi-asserted-by":"crossref","unstructured":"Lazarus J. V, Wyka K, W. T. M, Piccchio C. A, Rabin K, Ratzan S. C,  Leigh J. P. Hu J\u00a0 and El-Mohandesv A, \u201cRevisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021,\u201d Nature communications, 2022.","DOI":"10.1038\/s41467-022-31441-x"},{"key":"79_CR32","unstructured":"Idealab Studios Ltd, \u201cBelize internet users,\u201d 2017. Accessed 23 May 2023."},{"issue":"2","key":"79_CR33","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1287\/mksc.2018.1135","volume":"38","author":"B. R Gordon","year":"2019","unstructured":"Gordon B. R, Zettelmeyer F, Bhargava N, Chapsky D. A comparison of approaches to advertising measurement: evidence from big field experiments at Facebook. Market Sci. 2019;38(2):193\u2013225.","journal-title":"Market Sci"},{"key":"79_CR34","doi-asserted-by":"crossref","unstructured":"Edwards D. Ensuring effective public health communication: insights and modeling efforts from theories of behavioral economics, heuristics, and behavioral analysis for decision making under risk. Frontiers in Psycho, . 2021;12:715159.","DOI":"10.3389\/fpsyg.2021.715159"},{"key":"79_CR35","doi-asserted-by":"crossref","unstructured":"Fishbein  M, Yzer M. Using theory to design effective health behavior interventions. Commun Theor.\u00a02003;13(2):164\u201383.","DOI":"10.1111\/j.1468-2885.2003.tb00287.x"},{"key":"79_CR36","doi-asserted-by":"crossref","unstructured":"Giese H and Wolfgang Gaissmaier H. N, \u201cDeterminants of information diffusion in online communication on vaccination: the benefits of visual displays,\u201d Vaccine.\u00a02021;6407\u20136413.","DOI":"10.1016\/j.vaccine.2021.09.016"},{"key":"79_CR37","unstructured":"WHO, \u201cRisk communication and community engagement (RCCE),\u201d 2018.. Available: https:\/\/www.who.int\/emergencies\/risk-communications. Accessed 23 May 2024."},{"key":"79_CR38","doi-asserted-by":"publisher","unstructured":"Lathan H, Kwan A, Takats C, Tanner J, Wormer R., Romero D, Jones H. Ethical considerations and methodological uses of Facebook data in public health research: a systematic review. Soc Sci Med. 2023;322:155807. https:\/\/doi.org\/10.1016\/j.socscimed.2023.115807.","DOI":"10.1016\/j.socscimed.2023.115807"}],"container-title":["BMC Global and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44263-024-00079-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44263-024-00079-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44263-024-00079-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,24]],"date-time":"2024-10-24T12:02:42Z","timestamp":1729771362000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcglobalpublichealth.biomedcentral.com\/articles\/10.1186\/s44263-024-00079-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,24]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["79"],"URL":"https:\/\/doi.org\/10.1186\/s44263-024-00079-w","relation":{},"ISSN":["2731-913X"],"issn-type":[{"value":"2731-913X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,24]]},"assertion":[{"value":"25 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"IRB approval was not deemed necessary for social media data because it was accessed through Meta Ads Manager and did not contain any personal identifiers. It is important to note that standards for ethical considerations and the need for an IRB for social media use in public health research have yet to be established [].Vaccination record data was obtained from the MOHW. The MOHW determined that its use was exempt from Institutional Review Board (IRB) approval because it was shared at the district level and did not include any personal identifiers.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"71"}}