Beyond Messages! How to Reach Vaccine Hesitant Parents with the Best Messengers

Editor’s Note: In the fall of 2023, GreenBook’s IIEX Health event took place in Philadelphia, bringing both useful and inspiration content to insights and analytics professionals spanning the healthcare, pharmaceutical, medical, and wellness industries. Attendees found the content so valuable that we wanted to make much of it available to all who could not attend this in-person event. Before even reading this post, know this: You can view all the sessions on-demand now!

If you aren’t in those industries … how might you apply the learning within your own? At GreenBook, we believe that IIEX is more than a conference series. It’s a mindset. These are the forums in which the most important insights innovations are revealed, demonstrated, debated, and championed. What starts at the events drive change in our world. It is in that spirit that we bring you, directly, some of the poignant content we heard during the event, starting with this session from the Founder and CEO of Strategic Health Policy International, Glenna Crooks.

Enjoy our On-Demand Video

The Covid-19 pandemic and vaccines have been, and are still, a point of concern for many people all over the country. When it comes to childhood vaccines, vaccine hesitancy among parents is on the rise, doubling over the last several years to reach approximately 18% for pediatric vaccines. Delivering the right message has never been more important. Click to view the video (courtesy of Civicom).

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View more 2023 IIEX Health content on-demand!

Whether you were able to attend, or you were not, join us online to see what was shared by some of the biggest brands, the newest startups, and expert-level researchers across healthcare, pharma, and consumer experience. Here’s just two of the amazing sessions you’ll find on-demand:

• Dr. Katelyn Jetelina speaks to the process she created for translating the complex science of epidemiology into plain English and communicating it in such a way that informed and empowered individuals across the globe.
• Greg Hewitt and James Bauler speak to the innovation process behind Fuse Oncology, a spin-out of Cone Health, after a critical examination of the lag between a patient’s diagnosis and start of treatment.

Online you’ll find other fantastic sessions by speakers from Pierre Fabre Group, Novartis, Hinge Health, and more! If you want to stay on top of the trends in the healthcare industry — one of the largest spends in market research — you won’t want to miss IIEX Health On-Demand!

Not familiar with the Insight Innovation Exchange (IIEX)?

Ten years ago, GreenBook embarked on a simple idea: Could we create opportunities for market research leaders to share ideas and collaborate to define the future of insights?

If there was something new to our industry — a company, methodology, or platform — that didn’t exist 10 years ago and is now considered a “best practice” … well, you probably saw it first at an IIEX event.

What starts here will change our world!

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Transcript

(Transcript courtesy of TranscriptWing)

Female 1: Without further ado, our first speaker has some really timely information for us, but to set it up, I don’t want to ask an embarrassing question, so I’ll just ask how many of you know someone who is vaccine hesitant, right? Okay. Yes, we all do. So, our first speaker in the afternoon is Glenna Crooks and if you’ve had a chance to look at her bio, she’s the Founder and CEO of Strategic Health Policy International. She talked earlier. She’s an academic. She was a presidential appointee responsible for US public health policy as well as Global VP of Merck’s Vaccine Business. So, she knows her stuff about what she’s about to talk about. I also did a little bit of digging and I’ve found out that she prepared herself for this career very early on, because at five years of age, she actually was the impresario of a neighborhood circus in her own backyard, and let’s face it, healthcare these days is a circus, so this was really good training. So, Glenna, please join us.

Glenna Crooks: I did that, by the way, without telling my mother. [Laughter] She didn’t know until everybody showed up and started to fill up the backyard. It is a credit to her patience that I am here to tell the tale. Well, I’ve been organizing chaos ever since, and since I work in healthcare, I am fully employed. First of all, I want to say that I was supposed to have been joined today by Bill Bloom. He is the developer of the research methodology that I’ll be talking about today. Unfortunately, Bill, [he’s on demand], but he is home in Austin, where he is still testing positive for COVID-19. So, this is going to be actually like something of a test. I imagine he might be white-knuckling at home right now to see if his client can explain to people who are his peers what this methodology is all about.

So, we are going to talk about vaccine hesitancy, but we’re going to do it from different perspective. We’re not going to talk about messages, because a lot of people do that. We’re going to talk about the messengers instead. Now, even if we had not had an extraordinary epidemiologist joining us earlier today, you know what’s been going on and you mentioned that as you raised your hands. So many people are vaccine hesitant, not only for themselves, but for their children, and in fact, not only for COVID-19 vaccines, but among parents for all the pediatric vaccines. In fact, vaccine hesitancy among parents has doubled over the last several years and now stands at 18% for those pediatric vaccines.

Now, I was counting on the work of people like you in the insights profession who are exploring the messages that people would deliver, whether those were going to be delivered by government officials or by healthcare professionals, or even by social media influencers. I had pinned my hopes on good messages delivered by good messengers turning the tide. Well, that didn’t happen, as we know. So, there are too many gaps right now and one of the other things that I think about, based on my own training as an interdisciplinary social scientist, is how information itself does not change behavior. If it did, by the way, I would never have pancakes again, and I would never have that wonderful second cup of coffee, knowing what it will do to my jittery nerves for the rest of the day. It’s that gap that I’m interested in. What happens in that gap? That gap between when we get information and when we make a decision, and then take an action about it. Now, my interest in studying this using this methodology is not from a psychological perspective. I am more of a social scientist. So, I am interested in the social aspects. We live, work, and make decisions in a social ecosystem. So, how is that social ecosystem affecting us?

Now, to learn more about that and COVID-19 decision-making, we used the FastFocus methodology. This is a mobile first approach. What it does is give respondents a limited number of tokens and asks them, forces them to prioritize choices that they would make. There are four simple steps involved and it takes about four minutes. I’m going to describe the two studies that we have done using this methodology.

Now, in the first step, the respondent is presented with a call to action. In this case, we reminded people that they live and work with others, they turn to others for advice. When they are going to make decisions, they rely on others. After all, they’re busy. They’re working people. They’ve got families. They have a social life.

So, who are you going to go to when you’re going to make this decision? In the second step, we collect a lot of demographic information. This was probably the most time-consuming part of our work effort in deciding what we wanted to do in our analytics.

In the third step, we give respondents those limited number of tokens, in this case, they got 12, and we asked them to invest in one of these networks. We mentioned the network and we defined the types of people in them. In the fourth step, we invite people – we actually ask people to tell us why they made those choices. Those verbatims, which can be provided either by text or by video, allow us to do other sorts of analyses later on. Now, the scores that result from this, there are three. So, the first one is a passion score. The passion score captures the strength of the positive response. So, a higher number means more passion. This is a calculation that is a proprietary score and it has been demonstrated to be more predictive than net promoter scores.

That research, by the way, would be available to you from Bill if you would like to follow up with him on that. The idea score indicates likeability. So, a larger score means that it’s more likable and the controversiality score indicates polarization. So, the higher the score, the more polarizing. That means the respondent either likes it or hates it. There is no in-between. This is the hill they might be willing to die on. Okay.

Now, in our first study about which networks people turn to when they made this decision, the top choice overall was the health network. Now, you’ve heard a little bit about my background. I was delighted by that. This is exactly what I wanted. Healthcare professionals have the best information about vaccines. I was delighted people would go there to a health professional as they were making that decision. Unfortunately, our analytics showed that that wasn’t the case for everyone. What happened was there were such strong positive responses, such strong passionate responses on the part of white men that it overshadowed the preferences of everybody else. Without the subgroup analyses, the voices of every other group would have drowned out. So, what we’ve found then is that for everybody else, for black men, for Hispanic men, and for women, regardless of their ethnicity, it was the family network that was the one that they would go to as they were asking that question. Now, this is, in some ways, good news. We now have – now we know that there are two major networks that people will go to as they are actually making the decision, and we have a new one – we’ve got the family to think about as well. It shows us perhaps a new channel that we can turn to.

Now, what’s notable here though is the experience of one particular group, and that’s black women. Black women rated their family network first as the one they would turn to, their education network second that they would turn to, and their health network third. So, black women rated their health network lower than any other group, subgroup rated that network. That’s not surprising, given what we know of the experiences that black women have had with that network. Now, in addition to that, we’ve found some controversial networks.

Some of these rated low. Personal affairs network, these are people like your accountant, your lawyer, your perhaps financial planner. They were not anyone that people would turn to, and the career network also ranked the lowest. It was also the most controversial. It’s really interesting to think about that from the perspective of how mandates through workplaces became requirements for vaccines. Had we known this, perhaps we would’ve soft pedaled that in the public policy decisions that we made. Also surprising to me, especially for some subgroups for blacks and for Hispanics is that the spiritual network also ranked very low.

Now, knowing then that the family network was such a source of decision-making influence for people, we dove deeper and we asked people to talk to us about the family network. What we asked them to do was to make some decisions based on the kinds of people in the family – your spouse or your life partner, your children, perhaps your parents, your siblings, and perhaps a close family friend.

Now, what we’ve found is that a person’s spouse or life partner was the top choice overall for each gender, if you segment it that way, for people over 35 and a few other subgroups. Children ranked second overall for whites and for women, and that was true regardless of whether children were, at that point, vaccinated, because we did ask that question. I had wondered about how much influence a child might have on the decision that parent might make about whether or not they would be vaccinated. Siblings ranked high, in fact, first for black men and second for men overall, and very close family friends ranked well, especially for women and especially for older adults. Now, there was some controversial members of families as well. In-laws, that wasn’t too much surprise, but I was surprised about the grandparents especially, because we have some other evidence to suggest that grandparents, in fact, especially grandmothers, are particularly helpful and effective in terms of the health of a child, but apparently, that grandmother hypothesis doesn’t hold up with COVID vaccines. Mothers are controversial among some people and white men are very polarized about whether or not the children ought to be involved in the decision.

Well, so what are some takeaways from this? What do we do with this data? Now, from a client perspective, I want to tell you that this sits very well with me, having been both in the public and the private sector. It meets the imperatives that we would have. For one thing, it’s easy for the respondent, just four minutes and mobile first. The next thing is it protects their privacy. We don’t need identifiable information at all here, and it protects their time, and we are all time starved today.

Now, particularly for those who may be doing public sector studies for the federal government, this is an interesting feature as well. You may know or not that the government not only has a budget with the money that it spends, but it has a budget for the number of hours it can spend asking Americans to answer questions. The Paperwork Reduction Act defines that and it also reduces the number year on year of those number of hours. So, any methodology that is efficient will have an easier time getting through all of the screens that the federal government layers require in order to make those calculations and to allocate those hours. During the time that I was in government, I actually controlled that budget. That’s actually my biggest experience with insights professionals is talking about their surveys and which questions should stay or go based on whether it was more or less important than some other agency’s question might be, and I’m not going to say more about that now, but if you are interested, I’ll be glad to talk about that later.

This is also really easy and efficient for the client. I designed the first study in about two hours, and the second study in about an hour. We fielded it the following day and I could look at results in real time as they came in. So, one of the things that I was able to do, as the client, was satisfy myself that we were getting the right sort of representation from each one of the subgroups that we were going to want to do the analytics on. We had some segments lagging and so our supplier was able to go back and do additional recruiting, so that we could fill those cells quite adequately, and by the end of the week, we had all the results available.

The second of the two studies, I think I designed in about 20 minutes. It is easily replicable and I think what’s well for me, in thinking about this in retrospect, it also helped me relax a bit. It wasn’t like there was so much effort going into it and we had to get everything right, and if we didn’t get it right, it was going to cost us a lot of money. This is not expensive, by the way. This is very affordable. So, all of that tension and anxiety left me. If it turned out that I wanted to pivot the next time in a different sort of question or different sort of options, it was really easy to do.

So, this lends itself to iterative studies and especially when the issue was fast moving, especially when the issue is controversial, and it’s not just confined to doing what we did in terms of looking at who are influential decision-makers, who influence my decision when it’s made, but it could be used for a variety of other things. I’ll make a CBD reference. One of the favorite studies that Bill did before I met him was one with a CBD product for dogs. He was testing the labels of various products and his client had a very pharma style efficacy-type label; and, oh, by the way, it was good tasting. They didn’t have much market share, because what respondents said was: “It’s a medicine. My dog won’t take it,” whereas the category leader led their message and their label with “This taste really good.” Oh, and by the way, it’s effective. So, what the client was able to do was start changing the label and tweaking the label, and they were able to see in really very short order and almost real time that their sales started to climb, because of the changes in packaging.

Now, a couple of other things about this. It is reassuring to me that we know that white men, at least, will be influenced when they make a decision by a healthcare provider. I’d love to know who in the healthcare provider world that would be. Is it their physician? Is it their pharmacist? Might it be a nurse? I’m hoping that if we did the study again, we would find out it was a pharmacist, because that would open all kinds of possibilities for us to improve immunization rates that we’ve really not thought about so far.

I’m also interested in what’s happening to all of those lower ranking networks. Why was it that the career network was so controversial? Why was it that that failed? Was it the fact of a mandate at all or was it because of the person who communicated it, the boss perhaps or HR perhaps? Would it have made a difference if it had been a group of peers within a company who came to that decision as well or as an alternative? Then, of course, there were segments that we didn’t study. We did not study non-English speaking people. This methodology lends itself to that. We didn’t study groups that have very particular challenges, like single parent families. That’s not – and that’s another group that I would be concerned about from the vulnerability perspective.

Now, we’ve made our slides available, so you’ll be able to see these later. If you have questions, Bill would be delighted to address the technical aspects of what we’ve done as well as to provide you with the papers about how this compares to NPS.

On a final note, this was self-funded in pilots that Bill and I did. We did not set out to do this. We were introduced by someone in the insights profession who knew about Bill’s methodology and knew that I was a subject matter expert and put the two of us together to see if this might be productive. We could not have done that without help, and particularly from Matt Walmsley at Survey Healthcare Global. Matt is supposed to be here, and he and I have only met e-wise. So, I’m hoping that I’ll have a chance to actually meet him in person today. Then finally, our data has just been sent to Relative Insights, and they are going to be doing those qualitative analytics, and we would intend to wrap up that into a paper that we will edit as we get more information. Otherwise, a basic paper on everything that I’ve described today will be available on Monday, and we’ll be glad to share it.

This is my first time at GreenBook. I am green in that regard. I want to thank everyone here for being so welcoming, the staff and everyone. It’s been a pleasure to be with you.

Female 1: Let’s give Glenna a round of applause. Truly amazing. We have room for like one
more question – one question.

Denene Rodney: Oh, yes. I just have a couple of questions. When you talked about – oh, great. Thank you, and I’ll [wrap it] u . So, this is Denene Rodney from Zebra Strategies. When you talked about spiritual influence, we’re talking about faith-based leaders and is that how we define them?

Glenna Crooks: Please say that again.

Denene Rodney: When you talked about spiritual influencers, are you talking about faith-based
leaders?

Glenna Crooks: What I’m talking about is a spiritual network, which in this framework would include clergy, church staff or mosque staff, or those people who staff the operations of a synagogue and so on. Those people who are leaders in that community, that’s what I mean by a spiritual network.

Denene Rodney: The other thing I’m curious about, when you talked about some of the influencers, and from a cultural nuanced standpoint, do we touch base with anything like peer educators or like in this Hispanic community, we have promotors, those people that are specifically influencers. Is that laid in there at all?

Glenna Crooks: Some of the people, like the promotors that you’ve just mentioned, I would put in
the health network.

Denene Rodney: Yes, sure.

Glenna Crooks: We did not specifically test for that, but it could be in a methodology such as this.

Denene Rodney: I wonder if when we talk about the physician influence, if we think about racial concordance and adding that in there and asking racial concordance as it relates to the black, Hispanic, and maybe even South Asian, Southeast Asian participants.

Glenna Crooks: I understand the issue that you’re raising and we did not test for that. What we were looking at is at a very topline level. First of all, which networks? The next peel of the onion then are people within the networks. What you’ve just described, for example, would be a good follow-on study with some communities to take a look at the different types, including some of the non-traditional types like a promotors, yes.

Denene Rodney: Right. [Unintelligible] reports might [Unintelligible].

Glenna Crooks: Concordance may well be an issue and that could be tested with this methodology
as well.

Denene Rodney: Thank you.

Glenna Crooks: Okay.

Female 1: Thank you, Glenna.

A special thank you to: