Health pandemics are a regular occurrence in many nations around the world that often necessitate some form of behaviour change to save the lives of citizens leaving government and health bodies like the National Centre for Disease Control to spend billions to communicate behavioural change messages that can persuade recipients to adopt new healthy behaviours. This study studied the influence of behavioural change communication methods employed by the Federal Government and other bodies during the COVID-19 pandemic on vaccine hesitancy with a focus on undergraduates of the University of Lagos. The study employed questionnaire surveys with questions that sampled the perception of over 400 students of messages intended to persuade them to take the COVID-19 vaccine. The study discovered that respondents who got behavioural change communication messages were persuaded in favour of the vaccine. However, the need to pay attention to the BCC message design process that included choice of medium, the role of the influencing audience as well as relatedness of the message were discovered as inhibiting factors to the effectiveness of BCC messages.
TABLE OF CONTENTS
Title Page
Declaration
Certification
Dedication
Acknowledgments
Abstract
Table of Contents
List of Tables
CHAPTER 1: : INTRODUCTION
Background to the Study
Statement of the Problem
Objectives of the study
Research Questions
Significance of the Study
Scope of the Study
Delimitation of the Study
Operational Definition of Terms
References
CHAPTER 2: : LITERATURE REVIEW
Behavioural Change Communication
Behavioural Change Communication and Social Media Platforms
Use of Behavioural Change Communication during Nigerian Health Crises
Vaccination
Vaccine Hesitancy
COVID-
The Nigerian COVID-19 Situation
COVID-19 Vaccine Development, acceptance and hesitancy
Empirical Review
Theoretical Review
References
CHAPTER 3: EE: RESEARCH METHODOLOGY
Introduction
Research Design
Research Method
Population of the Study
Sample Size
Sample Technique
Data Collection Instrument
Validity of Data Collection Instrument
Procedure for Data Analysis
References
CHAPTER 4: R: DATA ANALYSIS, INTERPRETATION & PRESENTATION
Data Analysis and Interpretation
Discussion of Findings
References
CHAPTER 5: E: SUMMARY, CONCLUSIONS & RECOMMENDATIONS
Summary
Conclusion
Recommendations
Limitations of the Study
Suggestions for further studies
BIBLIOGRAPHY
APPENDIX
DEDICATION
This project is dedicated to God, the giver of wisdom and the one true communicator who is always speaking to us and also dedicated to my parents, Ogunleye Abiodun and Ogunleye Omolola for their many sacrifices of love.
ACKNOWLEDGEMENTS
Thanks be to the God and Father of our Lord Jesus Christ for his daily blessings of strength, wisdom and direction through the course of this research.
Immense gratitude goes to my Supervisor, Mr. Samuel Ejiwunmi for being a great source of support to this research work. Your interest in my topic from the start and many invaluable contributions have produced this research. I am indebted to you, sir.
I also especially appreciate Prof. Adepoju Tejumaiye, the Head of Department of Mass Communication first for your outstanding leadership so far. Your book on mass communication research was a great source of guidance in the course of this study.
I also thank all my lecturers in the course of my stay in school, Prof. Abigail Ogwezzy-Ndisika, Prof. Oloruntola Sunday, Prof. Ismail Ibraheem, Dr. Olasoji Alabi, Dr. Olunifesi Suraj, Dr. Ibitayo Popoola, Dr. Theresa Ifeoma Amobi, Dr. Ebony Oketunmbi, Mr. Teslim Lawal, Dr. Samuel Uwanna, Mrs. Joy-Rita Mogbogwu, Mrs Aweda Oluwakemi, Dr. Daramola, Dr Charles Onwunali, Dr. Yusuf Fassy Adetokunboh Olore, Mr. Okpaleke Declan, Dr. Shuaibu Husseini Hassan and Mr. Agboola Bola. Your continuous impartation of knowledge has formed this character of excellence. God bless you all.
Special thanks also go to my family on campus, the Anglican Students’ Fellowship, University of Lagos Branch for being a home away from home throughout my stay in school. I am also grateful to all my anonymous UNILAG undergraduates who served as my respondents. Thank you for providing valuable insights for this research.
I am also deeply indebted to the ‘one-of-a-kind’ Mrs. Tolulope Apinke-Ade Medebem, my boss at Aster Integrated Marketing Limited for all her support in this final phase. My project started and ended on my work laptop. I am also grateful to Favour Olusola and Paul Agada for being the elder brothers I never knew I needed through University. I also appreciate my coursemates and departmental mates, especially the Editors Geng, the Newsroom team, the TETAFOG family and The Oyomesi for being my family and support system in the department. Thanks to Feyisayo, Gypee and The Idahor Twins for being reference points throughout the project.
Lastly, I appreciate my awesome siblings for their welfare support during the research. Ife, Simi, Kemi, Juwon and Folarin, thank you all so much. I appreciate my parents, Mr Abiodun and Omolola Ogunleye for being more than teachers by profession but for being teachers even with their life. I am a proud student of yours for life. May you reap the fruit of your labour in good health and wealth. Amen.
Life is only a school and we are all students. If I have seen higher, it is because only I have been borne by giants. If there is anything I have learnt, it is that we can make fewer mistakes by looking through the experiences of others. Thank you all so much. God bless you!
ABSTRACT
Health pandemics are a regular occurrence in many nations around the world that often necessitate some form of behaviour change to save the lives of citizens leaving government and health bodies like the National Centre for Disease Control to spend billions to communicate behavioural change messages that can persuade recipients to adopt new healthy behaviours. This study studied the influence of behavioural change communication methods employed by the Federal Government and other bodies during the CO VID-19 pandemic on vaccine hesitancy with a focus on undergraduates of the University of Lagos. The study employed questionnaire surveys with questions that sampled the perception of over 400 students of messages intended to persuade them to take the CO VID-19 vaccine. The study discovered that respondents who got behavioural change communication messages were persuaded in favour of the vaccine. However, the need to pay attention to the BCC message design process that included choice of medium, the role of the influencing audience as well as relatedness of the message were discovered as inhibiting factors to the effetiveness of BCC messages.
LIST OF TABLES
Table 1- Sample Size of each Stratum
Table 2- Analysis of Performance of Research Instrument
Table 3- Total Respondents from each faculty
Table 4- Demographics of Participants
Table 5- Kinds of media messages respondents received
Table 6- Frequency of receipt of media messages
Table 7- Media format of the messages
Table 8- Reasons for the frequency with chosen medium
Table 9- Platforms on which respondents had seen messages about the
importance of the COVID-19 vaccine
Table 10- Respondents' rate of effectiveness of messages in addressing questions
about the COVID-19 vaccine
Table 11- Respondents' perception of the NCDC and NCPCHA messages about the
effectiveness of COVID-19 vaccines
Table 12- Contribution of messages in persuading respondents to take the vaccine
Table 13- Number of vaccinated respondents
Table 14- Respondents’ reasons for taking the vaccine
Table 15- Respondents’ reasons for taking the vaccine
Table 16- Primary source of information available to respondents about the
COVID-19 vaccine
Table 17- Concerns of respondents about the COVID-19 vaccine
Table 18- Respondents’ response to whether media messages can change their
Perception
Table 19- Factors capable of behaviour change towards the COVID-
Vaccine
Table 20- Respondents’ experience with vaccines
Table 21- Role of past vaccines in current hesitancy
Table 22- Respondents’ exposure to vaccine hesitancy communication messages
Table 23- Sources of negative information about COVID-19 vaccine
Table 24- Media messages most effective in addressing vaccine hesitancy
Table 25- Respondents’ rate of effectiveness of BCC interventions on vaccine hesitancy
Table 26- BCC interventions received in relation to vaccine hesitancy
Table 27 -Changes observed as a result of BCC interventions
Table 28- Respondent's perception to BCC interventions in addressing vaccine hesitancy
CHAPTER 1
BACKGROUND
From the start of time, communication has always been a major part of society. Societies around the world have depended on a mode and system of passing across messages and shared meanings from one member to the other.
Communication, defined as the process of sending and receiving messages from a sender to a receiver through a medium, has lasted through generations.
The very root word from which Communication is derived, “communis” means common which implies joint values and the creation of shared meaning. Lunenberg (2010) asserted that there must be a common understanding of the message between the source and the receiver concerning the message being communicated.
Communication can have various purposes, particularly in society. According to communication scholars Harold Lasswell and Wilbur Schramm (1949), it can serve purposes of surveillance, consensus, entertainment and socialization. The latter of which is the process by which an individual learns to conform to the norms of a social group according to W.F. Ogburn.
Fatimayin (2018) opined that communication is altogether an interaction within a social context involving people and communities. Communication, therefore, plays an important role in defining and attempting to instil societal norms and behaviours in individuals for the greater good. Communication serves an instrumental role that helps individuals acquire knowledge as well as fulfil ritualistic functions that reflect one as a member of a social community (WHO, 2009). This is where behavioural change and behavioural change communication come in.
Behavioural change communication (BCC) has been defined as an interactive process with communities to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours, promote and sustain individual, community and societal behaviour change. (FHI 2002). The Centers for Disease Control and Prevention ((2018) also defined Behavioural change communication as the strategic use of communication to promote positive health outcomes based on proven theories and models of behaviour change. According to Newson et al. (2013), Behaviour change is often positioned as a required individual adaptation for avoiding or reducing the risk of ill health.
The coming of COVID-19 necessitated a change in behaviour among global communities. Social distancing, cleanliness, wearing nose masks and using hand sanitisers were some of the safe practices introduced due to the wave of the pandemic. Although some of these practices were the norm in some places before the arrival of the pandemic, it became compulsory in many areas to curb and protect individuals from the pandemic. was responsible for a lot of economic downturns and stagnancy in the year 2020 with many
The pandemic did not only bring about changes in terms of health practices. The Organisation of Economic Cooperation and Development (2020) observed that the containment measures put in place to check the spread of the COVID-19 pandemic led to the temporary shutdown of many businesses, widespread financial market turmoil, an erosion of confidence, heightened business uncertainty as well as restrictions on travel and mobility resulting in a decline in the level of output of between twenty per cent to twenty-five per cent in many economies.
As soon as the virus commenced, scientific research commenced to find a cure and by early
December 2020, many countries around the world had started to approve the use of vaccines to immunise the body against the virus. With the gradual use of the vaccines, the spread has considerably reduced and activities are gradually back to normal. (Seyed et al. 2021)
Several behavioural change communication tactics such as advertisements and infomercials were put out by private and foreign bodies to encourage citizens to take the vaccines. Premium Times for example reported a mass vaccination campaign launched by the National Centre for Disease Control that aimed to reduce vaccine hesitancy and encourage vaccination. (Premium Times Newspapers, 2021)
There however remains a huge challenge as in Nigeria and many parts of the world, many are still hesitant to take the vaccine. This situation termed vaccine hesitancy refers to a delay in acceptance or refusal of vaccination despite the availability of vaccination services. (SAGE Working Group 2015)
This perception and behaviour have been a concern, and many governments recognising the importance of vaccines to flatten the curve, have employed various strategies to communicate the need for vaccination and build faith in the available COVID-19 vaccines. The various behavioural change communication efforts in the forms of public service announcements, print, broadcast and online adverts, movies and other forms of media platforms have been targeted at inducing a behaviour change thus far.
Students of the University of Lagos are not left out of the issue as the school is a foremost tertiary institution in the country that serves as a melting point located in the nation's centre of excellence. The school thus provides a significant measure to assess the general youth population in regards to behavioural change communication and vaccine hesitancy.
STATEMENT OF THE PROBLEM
While everyone agrees to the fact that COVID-19 has been a major drawback to global industries and activities and the majority wishes that the pandemic becomes a thing of the past, the problem is that many do not readily accept the available solution provided by health professionals i.e. the Vaccines.
COVID-19 vaccination began in Nigeria on the 5th of March, 2021 at various health centres and was organised by the National Primary Health Care Development Agency (NPHCDA) but this was met with initial scepticism for various reasons that will be discovered in the cause of this study. Over time, due to communication efforts by the government and other interested bodies, the scepticism began to dwindle and at the end of 2021, 14.8 million doses had been administered.
Unfortunately, this is only a meagre 5% of the target population with 193, 486,056 (91.52%) yet to receive the vaccine for various reasons. Despite the numerous adverts and campaigns by the government, the World Health Organisation and other interested bodies, the majority of Nigerians are not vaccinated.
The adverts aimed at creating awareness on the importance of the vaccination were regularly broadcast on various media platforms ranging from newspapers, television commercials and programmes and even radio news bulletins. Media messages abounded on social media as well as traditional media sponsored by the National Primary HealthCare Development Agency and the National Centre for Disease Control to encourage vaccine acceptance and increase COVID-19 vaccination.
However, statistics have shown that the figures for vaccinated individuals are not increasing. As at March, 2023, the National Primary Health care Development Agency recorded that a total of 116,606,863 vaccine doses have been administered. That is about 7.6% of the entire population.
Herein lies the problem; the vaccine provides a safe way to end the pandemic, yet the majority of Nigerians are hesitant and despite the communication efforts of the government, there has been no attitude change.
This study hopes to assess the effectiveness of behavioural change-targeted communication in addressing vaccine hesitancy among students, particularly students from the University of Lagos.
RESEARCH OBJECTIVES
1. To find out the various forms of behavioural change communication employed towards the COVID-19 pandemic
2. To determine the level of awareness of UNILAG students about media messages addressing Vaccine hesitancy
3. To find out the various reasons for vaccine hesitancy among UNILAG undergraduates
4. To find out the influence of behavioural change communication in tackling vaccine hesitancy among UNILAG undergraduates
RESEARCH QUESTIONS
1. What are the various forms of behavioural change communication employed towards the COVID-19 pandemic?
2. What is the level of awareness of UNILAG students about media messages addressing
Vaccine hesitancy?
3. What are the various reasons for vaccine hesitancy among UNILAG undergraduates?
4. What is the role of behavioural change communication in tackling vaccine hesitancy among UNILAG undergraduates?
SIGNIFICANCE OF THE STUDY
In times of public health crises such as the COVID-19 pandemic, vaccines are considered the way out to restore society to normal. However, the availability of COVID-19 vaccines does not seem to solve any problem as Nigerians are largely hesitant. This has motivated the government and other health-related bodies to employ various communication strategies to change this behavioural pattern and get people to take the vaccines firstly for their well-being and then for the general good of society.
Unfortunately, these communication attempts do not seem to be working as the numbers of vaccinated folks are not improving at a geometrical rate. And while the COVID-19 cases have considerably dropped, there is a possibility that unvaccinated folks are at risk if a new wave of the pandemic breaks out. There is therefore a need to investigate the influence of behavioural change communication from interested bodies through various media channels and its ability to convert non-vaxxers into vaccinated individuals.
This study will examine the effectiveness of behavioural change targeted communication on addressing vaccine hesitancy in a bid to possibly suggest ways of enhancing better results and solving the existing pandemic situation.
This will in turn help media persons and communication managers for the government and other interested bodies in drafting better media messages that will have a better influence on the respective individuals.
SCOPE OF THE STUDY
The study is focused on determining the influence of behavioural change communication in terms of media messages in audio and video formats such as public service announcements on radio and televisions and social media content on tackling vaccine hesitancy among University of Lagos undergraduates. Print messages such as those in newspapers and magazines will not be considered as they are not a popular choice among the target population.
Also, the population considered for this study would be solely undergraduate students of the University of Lagos. The vaccines addressed would also specifically refer to the vaccines that immunise the body against COVID-19.
DELIMITATION
This study would be restricted solely to undergraduate students of the University of Lagos rather than the broader centralization of a general youth population such as in Lagos state or the country. This is due to limitations in time as the researcher is also a student at the time of research. Also, it would require some more finances to cover the costs of survey instruments and transportation facilities.
OPERATIONAL DEFINITION OF TERMS
Behavioural change communication:Any form of media message created and sent to correct an action, belief system or behaviour.
Media message:Any form of message performing functions of surveillance, socialisation, correlative, alternative and entertainment functions meant from a medium of mass communication.
Vaccines:A substance used to stimulate the production of antibodies and provide immunity against one or several diseases.
Vaccine Hesitancy:A delay in acceptance or refusal of vaccines despite the availability of vaccine services.
Undergraduate:A student undergoing studies in a tertiary institution in Nigeria yet to graduate.
REFERENCES
Lunenberg, Fred C (2010) Communication Schooling Volume 1, Number 1
Harold Lasswell and Wilbur Schramm (1949) The structure and functions of mass communication.SAGE Journals
Fatimayin Foluke (2018) What is Communication?National Open University of Nigeria
World Health Organisation (2009) Why Health Communication is Important in Public Health.
Vol 87, No 4.Available atwww.nhi.int.
FHI 2002. & USAID (2002). Behaviour Change Communication for HIV/AIDS a strategic framework:available atwww.hivpolicy.org.
Centers for Disease Control and Prevention (2018). Health Communication Strategies:Available atwww.npint.cdc.gov
Kerlinger F. (1973)Foundations of Behavioural Research 2nd edition Holt, Rinehart and Winston
Moghadas, S. M., Vilches, T N., Zhang, K., Wells, C. R., Shoukat, A., Singer, B. H., Meyers, L.
A., Neuzil, K. M., Langley, J. M., Fitzpatrick, M. C., & Galvani, A. P (2021).The impact of vaccination on CO VID-19 outbreaks in the United States. medRxiv : the preprint server for health sciences,2020.11.27.20240051.
Newson R. et al. (20130 Behaviour Change for better health: nutrition, hygiene and sustainability. BMC Public Health 12 (Supplement 1)
National Primary Health Care Development Agency (2022) COVID-19 Vaccination update, February 2022.www.nphcda.gov.ng
Organisation of Economic Cooperation and Development (2020). Evaluating the initial impact of
COVID-19 containment measures on economic activity. (online)available at www/organisation-of-economic-cooperation-and-development/coronavirus/policy-responses
Premium Times Nigeria; Covid-19 mass vaccination campaign; (online)available atwww.premiumtimesng.com/news/top-news/497985-covid-19-mass-vciccincition-campaign-nigerian-govt-lists-ogun-nasarawa-others-as-best-performing-states
SAGE Working Group on Vaccine Hesitancy (2015)
http://www.who.int.immmunization/sage_wg_vaccinejhesitancyapr12/en/
Stam H. (2007).Theoretical Psychology; The International handbook of psychology. Thousand Oaks
Wimmer D. and Dominick R. (2011)Mass Media Research: An Introduction; Ninth Edition:
Wadsworth Centage Learning
CHAPTER 2 LITERATURE REVIEW
This chapter covers the literature review as it pertains to the variables of the study. This will essentially relate to the review of previous related studies on behavioural change communication as well as vaccine hesitancy. Other related concepts such as the Coronavirus disease and vaccination would be reviewed. Related studies concerning the effects of behaviour change communication in addressing vaccine hesitancy would also be reviewed. This is together in line with the Agenda Setting and Cognitive Dissonance theories that form the theoretical framework for this study.
Conceptual Review
Behavioural Change Communication
The concept of Behavioural change communication (BCC) cannot be sufficiently addressed without looking at the very concepts that make up behaviour change- behaviour, behaviour change before behaviour change communication.
Hobbs et al (2011) define behaviour as anything that a person does in response to internal or external change. The online psychology dictionary also adds that behaviour is an action, activity or process that can be observed and measured. (N. Sam M.S. 2013). For behaviour to be observable and measurable also indicates that it can be changed. It is imperative to therefore also consider the concept of behaviour change.
Behaviour change (sometimes referred to as behaviour change interventions) can be defined as coordinated sets of activities designed to change specified behaviour patterns (Stralen & West, 2011). The intention and role of behaviour change is to change already set action patterns through carefully designed activities.
Behaviour change communication is defined by the National Library of Medicine as “an interactive process with communities (as integrated with an overall program) to develop tailored messages and approaches using a variety of communication channels to develop positive behaviours; promote and sustain individual, community and societal behaviour change; and maintain appropriate behaviours”.
Behaviour change communication is commonly used by health programmes to provide tailored messages and a supportive environment that persuades individuals and communities to make positive health behaviour changes. (Briscoe & Aboud, 2012) It is an interactive process of any intervention with individuals, communities and/or societies (as integrated with an overall program) to develop communication strategies to promote positive behaviours which are appropriate to their settings (Ngigi and Busolo, 2018).
Behavioural Change Communication is nowadays referred to as Social and Behavioural Change Communication (SBCC) is an approach that promotes and facilitates changes in knowledge, attitudes, norms, beliefs and behaviours. The “social” context was added to the approach to indicate for improved health outcomes, there is a broader need to reference changes in society.
It is a model that is commonly used in health and communication approaches to evaluate the processes of change in individuals. The Health Communication Capacity Collaborative defines Social and Behavioural Change Communication (SBCC) as the strategic use of communication approaches to promote changes in knowledge, attitudes, norms, beliefs and behaviours adding that both BCC and SBCC are terms that can be used interchangeably as they essentially refer to the coordination of messages and activities across a variety of channels to reach multiple levels of the society.
In most cases, Behavioural change communication approaches are usually adapted to address the health and social challenges of a community, especially in cases where such issues have become an emergency such as in the case of public health diseases, pandemics, environmental degradation and sanitation, etc.
A key finding is that BCC is most effective when targeted towards a specific audience usually from a proper understanding of their social, cultural and economic contexts rather than general messages. For example, a study by Rimal and Lapinksi (2015) discovered that tailored and specific messages with cultural relevance to the target audience were more effective in promoting behaviour change. Another study by Storey et al. (2002) showed that community based interventions changed behaviours more effectively than media campaigns.
Similarly, the use of multiple communication channels often results in more successful BCC interventions. Research suggests that combining mass media campaigns such as TV and radio spots, with interpersonal communication, such as community mobilisation can lead to greater behaviour change. (Betrand et al, 2006). In fact, the advent of new technologies such as mobile phones and social media have also shown great potential in reaching wider audiences and promoting behaviour change. (Free et al., 2013)
Dajarat et al (2002) therefore noted that BCC messages must be research centred to decide on the best strategic contexts for the intended audiences which often range from media mobilisation (MM) such as TV spots and radio campaigns, community mobilisation (CM) activities as well as interpersonal communication (IPC).
BCC is often used to change knowledge, attitudes, beliefs, and practices of specific target audiences and change social norms. BCC reaches and engages the target audience through interpersonal communication (one-on-one); interpersonal communication (small group); and mass media (such as social media (Facebook, Instagram, YouTube), digital media (mobile ads, Google ads, SMS), broadcast media (TV, radio), mass media print (newspaper, magazine), out-of-home (billboards, bus shelter ads, bus ads, sidewalk ads, etc.) (IHBP, 2013; USAID/GH/HIDN/CSHGP, 2014).
Figueroa et al, (2002) add that for these strategies to work, a few measures have to be considered given the evolving communication paradigms of communication for behavioural change. These include proper structuring to achieve carefully selected communication objectives, the integration of strategic communication elements into the programme areas to provide consistent, well-researched message elements to reflect the beneficiary population as well as ensure sustainability.
A study by McLean et al. (2016) highlighted the role of a BCC intervention aimed at promoting healthy behaviours among pregnant women in low-income settings led to improved maternal and child health outcomes. Another study that buttresses this conducted by Noar et.al (2016) found that a BCC intervention aimed at promoting HIV prevention behaviours resulted in major reductions in risky sexual behaviours among young adults.
Several theoretical frameworks also apply in BCC programmes such as the Health belief Model, the transtheoretical model, the social cognitive theory, the behaviour change model and the diffusion of innovation theory. These theories provide a framework that helps to understand behaviour change and factors that influence the same. One of the aforementioned models, the Behaviour change model will be briefly examined as it relates to the core of this study.
The Behaviour Change model was developed by the John Hopkins Centre for Communications Programmes in 1982 and has been used to measure audience responses to a wide range of communication programmes by using a set of traits known as the ‘Steps to the behaviour change model’. (Anieto et al, 2008) According to the model, the impact of communication programmes can be measured by how much the audience demonstrates the following traits;
A)Knowledge:The extent to which the audience recalls specific messages, understands what messages mean and can name products, methods or practices and/or source of services/supplies.
B)Approval:The extent to which audiences respond favourably to messages, discusses messages or issues with members of personal network, thinks their families, friends and communities approve of the message and when they finally approve practice of desired behaviour.
C)Intention:The extent to which the audience recognizes that specific health practices can meet a personal need, intends to consult a provider and intends to practise it at some time.
D)Practice:To measure how the audience goes to a provider of information, supplies or services, chooses a method of practice and begins to use and continues to use.
E)Advocacy: to measure how much the intended audience experiences and acknowledges the benefits of the practice, advocates the practice to others and supports programmes in the community
Ashiekpe (2012), concluded that while behavioural change communication helps to create demands on people to perform essential services and change required behaviours, such change may not occur without the physical possibilities required for such changes. It is therefore challenging to identify the most effective strategies coupled with the fact that BCC often requires long term investment and commitment. And even with all of this, some populations may resist change due to their inward seated beliefs and practices. It is on this premise that the context of this study is focused primarily on the influence of media mobilisation strategies employed towards the use of COVID-19 vaccines.
Behavioural Change Communication and Social Media platforms
Social media platforms came to be as a result of web 2.0 internet technologies that enable collective and expansive communication. According to Kaplan & Lee (2009), these innovative technologies were harnessed in a multi-way communication system based on consumer generated information sharing. Essentially, social media represents a group of internet based applications for creating and exchanging “user-generated contents''. These range from videos, photographics, texts, graphic files and so on. (Osborne-gowey, 2014)
A study conducted by Rimal et al. (2015) considering the effectiveness of social media as a tool for BCC interventions that sought to increase physical activity among college students found out that participants who received social media interventions fared higher compared to those who received traditional means.
Similarly, another study by Zhang et al. (2016) discovered the effectiveness of social media in promoting healthy eating habits among adults. This study showed that the effectiveness of social media for BCC is hinged on a couple of factors including the type of behaviour being promoted, the target audience and message contents. The study mentioned above recorded more effectiveness when messages were personalised and interactive. This is similar to a 2010 study by Webb et al. that resulted in the conclusion that social media was crucial in encouraging young adults to cease smoking.
Social media was discovered to be key in increasing physical activities that help become more physically active and improve people’s well-being. In a 2021 study by Petkovic et al that defined social media as computer-based technologies that help people share ideas, thoughts and information by building virtual networks and communities on the internet, they discovered that these interactive platforms significantly improved health behaviours among users.
Use of Behavioural Change Communication during Nigerian health crises
Behavioural change communication interventions are not new to the Nigerian health landscape as they have been used to address various health crises from HIV/AIDS, malaria and Ebola Virus. A 2019 study by Ogundeji and Adeniran investigating the impact of BCC on HIV/AIDS knowledge, attitude and practices among Nigerian adolescents. BCC was found relevant in improving the relevant attitudes.
A similar study by Obono (2011) recounted a few TV commercials used to facilitate behaviour change towards HIV/AIDS that resulted in massive societal behaviour change towards the virus in the South West. The study noted the effect of the Agenda Setting Theory which states that the media controls what the public thinks about.
Those implemented in Nasarawa state to address malaria occurrence and encourage residents to use the long-lasting insecticidal mosquito nets. Koenker et al (2015) recorded that a couple of BCC methods were employed including using print and broadcasting platforms, interpersonal communication and local advocacy. The messages revolved around educating influencing audiences on the need for the mosquito nets, ways to use the nets as well as reinforcing messages. The researchers discovered that the employed methods were effective in increasing net care and repair among targeted audiences.
Similarly, Apobo (2015) recalled the influence of the media in influencing behaviour change during the Ebola pandemic in the country. The paper noted that the media was able to rally community support through house-to-house information campaigns and messages on local radio stations and televisions, especially using local dialects to explain the risks and effective personal preventive measures which individuals could take.
Okpoko and Aniwada (2017) citing Ebong et al (2015) noted that in handling the malaria crisis in Enugu, seminars, community outreach events and radio talk shows were deployed as communication avenues that encourage communities to comply with malaria campaigns and induce behaviour changes that made citizens take protective measures.
Vaccination
The Centers for Disease Control (2021) defines a vaccine as a preparation that is used to stimulate the body’s immune response against diseases. Vaccines are usually administered through needle injections, but some can be administered by mouth or sprayed into the nose. The act of administering such preparations is commonly referred to as vaccination or immunisation in certain cases.
The World Health Organization (2021) defined vaccination as a simple, safe, and effective way of protecting the body against harmful diseases, before coming into contact with them. Vaccines use the body’s natural defences to build resistance to specific infections and makes the immune system stronger.
How vaccines work is that they train the immune system to create antibodies, just as it does when it’s exposed to a disease. However, because vaccines only kill or weaken forms of germs like viruses or bacteria, they do not cause the disease or put the body and the individuals at risk of its complications. (WHO, 2021)
Vaccination has had a long history in medical treatment of humankind beginning from the 15th century, even as early as 200 BCE, when people have attempted to prevent illnesses by exposing healthy people to smallpox in a practice known as variolation (after a name for smallpox, la variole). Plotkin (2005) records that the history of variolation is debated to be between China and India
This practice of variolation also referred to as “engrafting” was introduced into Europe in 1721 after Lady Mary Wortley Montagu after observing the practice in Turkey asked that her two daughters be inoculated against smallpox. In general, the treatment was effective but the results were erratic as most people contracted the disease from being inoculated.
In 1774, Benjamin Jesty, a cattle breeder made and tested an hypothesis that infection with cowpox, a virus which could be spread to humans, could protect a person from smallpox. This was based upon an observation that dairymaids who had first contacted cowpox while milking the cows seemed to be immune from the smallpox disease.
However, English physician, Edward Jenner is credited with the title of the first scientist attempt to control an infectious disease on a large scale by means other than by transmitting the disease itself. Jenner inoculates 8-year-old James Phipps with matter collected from a cowpox sore on the hand of a milkmaid and despite suffering a local reaction and feeling unwell for several days, the boy made a full recovery.
Two months later, in July 1796, Jenner inoculated Phipps with matter from a human smallpox sore to test Phipps’ resistance and the boy maintained perfect health thus becoming the first human to be vaccinated against smallpox. The term 'vaccine’ is later coined from the Latin word for cow, ‘vacca’.
This gave room to further studies on the science behind vaccines and today the World Health Organization reports that there are vaccines for more than 20 life-threatening diseases available in the world ranging from vaccines for polio, smallpox, tetanus, flu, influenza and so on. More often than not, these vaccines are usually administered from birth to prevent these conditions in newborns and continually supplied as the child grows.
The WHO however sadly notes that despite tremendous progress, vaccination coverage has plateaued and continued to drop in recent years. The COVID-19 pandemic and associated disruptions over the past two years have strained health systems, with 25 million children missing out on vaccination in 2021, 6 million more than in 2019 and the highest number since 2009. This gives rise to the concept of Vaccine hesitancy.
Vaccine Hesitancy
The WHO Strategic Advisory Group of Experts (SAGE) Working Group (2012) defines vaccine hesitancy as a delay in acceptance or refusal of safe vaccines despite the availability of vaccination services. The organisation regards it as a behaviour influenced by a number of factors including issues of confidence (lack of trust in the vaccine or provider), complacency (not perceiving a need for a vaccine, not valuing the vaccine) and convenience (the ease of access to vaccination).
Yaqub et al (2014) researched that while vaccines have been instrumental to the eradication of dangerous public health diseases, many individuals still doubt the benefits of vaccines and worry over their safety and question the need for vaccines. This attitude is what they termed vaccine hesitancy which they clarified is different from vaccine refusal as folks who are vaccinated may still harbour some hesitancy towards certain aspects.
The phenomenon was previously described as “vaccine opposition” or “vaccine resistance” by researchers but Vaccine hesitancy has emerged as a new term to replace the older expressions that describe the reluctance of people to be vaccinated. (Khumar et al, 2016).
Khumar et al (2016) identified some reasons for vaccine hesitancy such as complacency; which is a situation where the risk of vaccine preventable diseases are perceived to be low and therefore vaccination is not considered essential. Secondly, hesitancy is impacted by a lack of confidence in the vaccines safety and efficacy as well as lack of trust in the health care system. Convenience, the third reason advanced by Khumar et al (2016) speaks of the quality of service, physical and geographical accessibility and affordability associated with getting vaccinated.
In the Israel Journal of Health Research policy, they noted that vaccine hesitancy is a product of a triad of factors i.e. the complex interaction of environmental (external) factors such as patient health-professional relationship, immunisation requirements, social norms and collective values, vaccine policies and public health, media and communication. Also associated are agent factors that have to do with the vaccine such as vaccine efficacy, safety and disease susceptibility perception. The last are the host (individual) specific factors like race, education, income, individual decisions, knowledge and past experiences, etc .
Further findings in a study by Larson et al. (2018) suggest that one of the primary reasons for vaccine hesitancy is misinformation and mistrust. Similarly, cultural beliefs and religious values have contributed to hesitancy according to a study conducted among students in the United Kingdom by Drobniewski et al. (2022). Additionally, the fear of side effects was a significant predictor of vaccine hesitancy among parents in Canada in a study by MacDonald et al. (2015)
A study by the Centres for Diseases Control in Nigeria (2022) follows these lines closely as 56% of survey participants were unwilling to get vaccinated stating lack of confidence in the vaccine as the highest reason for not getting it. Some also indicated fear of possible side effects, mistrust of the government, disbelief in the existence of COVID-19 and lack of access to the vaccines as reasons for not getting vaccinated.
Studies have shown that vaccine hesitancy can have negative impacts for both individual and public health. It has become a growing public health concern and the WHO lists it as one of the top 10 global health issues of 2019 and still remains a major health concern for the current decade.
A study published in the Lancet in 2015 found out that vaccine hesitancy ultimately led to increased incidence and severity of diseases that could have been otherwise prevented. This invariably translates to increased healthcare costs and increased disease outbreaks.
The Journal of Health Communication (2017) also found out that vaccine hesitancy was associated with decreased trust in public healthcare service providers, government and
pharmaceutical companies. This is also linked to decreased vaccine acceptance and increased refusal.
COVID-19
COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus that emerged in Wuhan, China in December 2019 and rapidly spread globally, leading to a pandemic. Coronaviruses are called so because of the appearance of the CoV virions when observed under electron microscopy, in which spike projections from the virus membrane give the semblance of a crowncorona in Latin.
Velavan and Meyar (2020) define coronaviruses as enveloped, positive single-stranded RNA-viruses that are capable of infecting humans but are more consistent with animals.
Findings from Lotfi et al (2020) showed that the disease can be spread through direct means via droplets and human-to-human transmissions and by indirect contact through contaminated objects and airborne contagion. The human-to-human transmission has been described with incubation times between 1-14 days, facilitating spread through droplets and contaminated hands and surfaces. (Santas and Kente, 2020)
According to WHO (2020), the disease primarily affects the respiratory system with symptoms ranging from fever, cough and mild shortness of breath, to severe desaturation, causing respiratory failure. It can however lead to lung-damage as with most adult respiratory distress syndrome (ARDS) and kidney failure. (Anwar, 2020)
In December 2019, reports of patients with viral pneumonia in China surfaced. The origin was
related to the Huanan Seafood market. Researchers (cited in Cui et al, 2019) found that the disease likely originated from bats and mutated to infect humans and was transmitted by droplet routes among humans. Wuhan, an emerging business hub in China, experienced an outbreak of the novel virus that killed more than eighteen hundred and infected over seventy thousand individuals in the first fifty days of the epidemic. At first, it was named the Wuhan coronavirus or 2019 novel coronavirus (2019-NCoV) by Chinese researchers. Then, the International Committee on Taxonomy of viruses (ICTV) named the virus SARS-CoV-2 and the disease COVID-19.
The WHO eventually declared COVID-19 an international pandemic on 11th March, 2020 as the virus had by then shifted from China to Europe and North America (WHO, 2020). As at March, 2023 the WHO has recorded 761,071,826 confirmed cases and 6,879,677 confirmed deaths on a global scale (WHO, 2020).
The Nigerian COVID-19 Situation
The first African case was reported in Egypt on the 14th of February, 2020 while the first Nigerian case was on the 27th of February, by an Italian patient who flew to Nigeria from Italy on the 25th of February, 2020. (WHO, 2020).
In order to control the spread of the virus in Nigeria, the National Centre for Disease Control (NCDC) set up COVID-19 response teams across various states of the country with isolation centres to curb transmission. (Santas and Kente, 2020). People were coerced to stay at home as the country joined other nations of the world on a lockdown exempting healthcare facility workers, communication workers and essential commercial services. As at March 2023, th3e
WHO has recorded 266,641 confirmed COVID-19 cases as well as 3,155 deaths in Nigeria. Temperature screening was conducted at airports since the index case was discovered that way and individuals who were found with confirmed cases of the disease were asked to self-isolate. (Amzat et al, 2020) as contact tracking continued by the NCDC.
COVID-19 vaccine development, acceptance and hesitancy
Due to the rapid spread rate of the viral disease, vaccine development had to advance quicker than normal to meet the pandemic needs. Researchers confirm that although the process of vaccine development usually takes much longer, sometimes ten to fifteen years, in the case of the COVID-19 pandemic, the process was faster because it built on existing research. (Ndwandwe and Wiysonge, 2021).
Ideally, vaccine development begins with an exploratory stage to find potential antigens that can be suitable candidates followed by a preclinical study that takes between 18-30 months starting with cell-culture followed by animal studies to analyse the safety and immunising properties of the vaccine candidate. This is then followed by three phases of trials in small groups across differing demographics. If each phase is successful and clinical efficacy is determined, the vaccine is then reviewed for approval by regulatory bodies. Afterwards, manufacturing and post-marketing surveillance is done after the vaccine is marketed for public use and proven effective among the general population. Even at this stage, the adverse effects are recorded and the vaccine developer only advances developments if the data is promising, has a relatively low chance of failure as well as a suitable market. (Kashte et al, 2021).
Findings show that the fastest vaccine development process before was for the mumps disease. For the COVID-19 vaccine, the initial exploratory stage was avoided and the first clinical trials of the vaccines started in March 2020 with the United States accelerating the development of five vaccine candidates under the Operation Warp Speed to make them available by the end of 2020 for emergencies and billions of doses ready by 2021. (Krammer, 2020)
Manufacturers were also ready to produce doses and a few commenced commercial production without any results from the Phase III trials. The last review processes were bypassed by an Emergency Use Authorization (EUA) by the United Kingdom and the United States which other countries followed. Thus, the challenging task that should have taken about 10-15 years was achieved in a record time frame of 12- 16 months. (Kashte et al, 2021)
The UK became the first country to approve the COVID-19 vaccine, BNT162, developed by Pfizer and BioNTech on December 2nd, 2020 while the WHO also approved the same vaccine for emergency use on December 31st, 2020 to allow easier global manufacturing and distribution.
Others such as the Moderna’s mRNA-1273, India’s AZD1222 developed by AstraZeneca and the Oxford Vaccine Group, CoronaVac by ZinoVac and many others were gradually accepted and released globally to tackle the virus in quick succession.
The effectiveness of COVID-19 vaccines has been studied extensively. A study conducted by Bernal et al. (2021) found that two doses of the Pfizer-BioNTech vaccine were 88% effective at preventing symptomatic disease caused by the Delta variant. Similarly, a study by Earle et al. (2021) found that the AstraZeneca vaccine was 67% effective at preventing symptomatic disease caused by the Delta variant. Another study by Vitale et al. (2021) found that the Moderna vaccine was 93% effective at preventing symptomatic disease caused by the Delta variant.
As regards the safety of the vaccines, Shimabukuro et al. (2021) discovered that the incidence of serious adverse events following the Pfizer-BioNTech, Moderna or Janssen (Johnson & Johnson) vaccines were low and mostly non-serious. Some people however experienced side-effects. Findings from a LopezBernal et al. (2021) study revealed that the most common side effects following vaccination with the Pfizer-BioNTech and AstraZeneca vaccines were pain at the injection site, fatigue, headache and muscle aches. Baden et al. (2021) recorded similar effects for the Moderna vaccine.
COVID-19 vaccine hesitancy is however a serious problem with higher levels recorded among women (21%) versus men (15%), younger age groups (28% in 25-34 years versus 14% in 55-64 years) and in people with a lower education level (24% in secondary school graduates and 13% in university graduates). (Robertson et al, 2021). Similar variation was recorded amongst ethnic and religious groups as well.
A survey conducted in Nigeria in February 2021 found that 43% of respondents were unwilling to take the COVID-19 vaccine due to concerns about its safety and efficacy. (Nwankwo, 2021). Another survey by Uzochukwu et al. (2021) revealed that only 34.67% of respondents who had heard about the vaccine at the time of study were willing to receive the vaccine. 42.98% were unwilling while 22.06% were undecided, yielding a hesitancy rate of 65.04%. In this study, even though most of the respondents (78.51%) had been vaccinated against one disease or the other in the past and 85.30% never had any allergic reactions to any vaccine or injectable medication, the high hesitancy still exists.
Findings also revealed that there was a higher likelihood of vaccine hesitancy among respondents belonging to the Igbo ethnic group (AOR 1.88, 95% 1.10, 3.22) and the Christian faith (AOR 1.86, 95% 1.10, 3.14). Similarly, respondents without confidence in foreign manufactured vaccines compared with those who did were four times more likely to have vaccine hesitancy. (Ogunbosi et al., 2022)
Another survey among tertiary students in the South west of Nigeria showed that with just 17% of the students having a positive attitude about the vaccine, the major reasons for hesitancy were concerns about side effects (21.3%), lack of trust in the authorities (26.5%), vaccine efficacy (13.1%) and diverse mystical possibilities (39.1%). (Olawade et al, 2022).
Olawade et al (2022) concluded that the results indicated the existence of a significant communication gap between respondents and their local health authorities. They added that extensive and targeted health promotion campaigns were necessary to dismiss the concerns raised by the public and enhance acceptance of the vaccines.
Empirical Review
A 2017 study by Brewer et. al titled “Increasing Vaccination: Putting Psychological Science Into Action” aimed at discovering the effects between human psychology and vaccine acceptance and usage used a randomised controlled trial design to study 1, 759 parents. The study discovered that psychological knowledge included in BCC messages were effective in improving vaccine related knowledge, attitudes and intentions among them.
Sadaf et al (2013) also conducted a study in Pakistan titled “A systematic review of interventions for reducing vaccine refusal and vaccine hesitancy” . The study sought to evaluate existing literature around the effectiveness of a BCC intervention on getting parents to allow their children to be vaccinated. The researchers discovered that the intervention led to a significant increase in child vaccination.
Another study titled, “COVID-19 vaccine hesitancy among staff and students in a Nigerian tertiary educational institution” by Chinwe et al. (2021) commented on the Nigerian experience with vaccine hesitancy during the pandemic. The study used cross sectional surveys through a Google form to evaluate the population of the Nnamdi Azikiwe university community to learn their willingness to be vaccinated, their level of hesitancy and other associated factors.
A sample size of 349 people (both staff and students) were studied and results showed that factors such as the message content and track record of the communicator were relevant in convincing people to believe the communication about vaccine hesitancy. This was in line with other factors such as the channel choice where the researchers discovered that due to the involvement of the government in most messages, people were not convinced to trust the interventions. The study concluded that vaccine hesitancy was still high among staff and students in Nigerian tertiary institutions.
Oleribe et al. (2016) conducted a qualitative study titled, “Individual and socio-demographic factors associated with vaccine hesitancy in Nigeria: a multilevel model” to identify the factors associated with immunisation coverage in Nigeria using a quantitative dataset analysis of an existing 2013 Nigeria Demographic and Health survey. Univariate, bivariate and multivariate analyses were conducted on the survey which studied 27, 571 children aged 0 to 59 months. The study revealed that factors such as maternal age ,geographical location, education, religion, literacy,wealth index amongst other factors were responsible for vaccination coverage among these children.
Josiah & Kantaris (2021) in their study titled “Perception of COVID-19 and acceptance of vaccination in Delta State Nigeria'' looked at how the knowledge of the virus influenced vaccine acceptance among 401 participants from three local governments in Delta state. Results from the questionnaire survey showed that although the respondents had information about the vaccine, more than half were not willing to accept it due to issues of trust in the government intention to roll out the vaccines.
Generally, these studies show that Behavioural change communication is more often than not, effective in addressing vaccine hesitancy among different target groups. The effectiveness however depends on the content and strategies for communication methods such as wholesome information on the risks and benefits of vaccination and sufficient treatment of misconceptions and concerns.
This study will however go further to examine the influence of behavioural change communication, specifically media messages and advertisements on addressing vaccine hesitancy among University students. While the effectiveness cannot be doubted going by previous studies, this study will do a slightly different job of examining the contribution of media messages in changing negative perceptions about vaccinations.
Theoretical Review
A theory is defined as a set of interrelated constructs, definitions and propositions that present a systematic view of naturally occurring events by determining relationships between variables with the intent to explain and predict such phenomena. (Kerlinger, 1973). A philosopher of science, Karl Popper (1962) argued that a theory must be falsifiable which means that theories can be tested through observation and experimentation to potentially refute it. This means that theories are required to be supported by evidence as well as empirical data.
Thomas Kuhn, another scientist, argued that scientific theories are not simply objective descriptions of reality, but are rather shaped by the historical and cultural context in which they emerge. Stam (2007) defined a theory as the systematic organisation of knowledge, which can be applied for the purpose of problem solving. According to Severin and Tankard (1982), a theory is a set of ideas of systematic generalisations based on scientific observation (and) leading to further empirical observation. This means that with theories, we can predict the outcome of certain events.
A communication theory is a set of ideas which provide an explanation for communication phenomena. (Daramola, 2003). Theories are important to communication research as they are both related through the scientific methods. A well-researched subject forms a theory while a theory can also spring up from a hypothesis that begins a research. Theories provide the logical support while research provides the empirical support. Earl Barbie (1987) asserted that a scientific statement must have both logical and empirical support before it can be accepted. That is, it must be sensible and align with real world situations and observations.
The following theories will be examined in this study;
1. Agenda Setting theory
The Agenda setting theory is a media effects communication theory that examines the role of the media in influencing the public perception of issues and events. The theory states that the media’s selections and presentation of news items can shape the importance that the public places on such issues. Essentially, the media sets the agenda for what the public will think about.
The theory was first introduced by Maxwell McCombs and Donald Shaw in 1972 in their study, ‘The Agenda-Setting Function of Mass Media”, where the authors found that the media’s selection and emphasis of news stories had a significant impact on the public perception of the importance of those issues. This study laid the groundwork for the agenda setting theory. ‘
However, the idea of agenda setting is linked to Walter Lippman (1922) who proposed that the media was responsible for images in the heads of the public. Cohen (1963) has said that the media may perhaps not be successful in telling people what to think but it is strikingly triumphant in telling the audience what to think about. (Lopez-Escobar, Llamas, McCombs & Rey, 1998).
It is on this premise that the agenda setting theory is found. If the media has more content pointing to the need for investment over health measures, one would expect that the populace would perceive the former as more important. This theory therefore examines the relationship between the priorities of media houses and their audiences in the relative importance of media messages.
The theory has evolved in several ways with a significant change in the 1990s when researchers began to examine the role of the media in shaping public attitudes and beliefs in addition to their impact on issue salience. The concept of framing was also introduced which explored how media presentation of issues could influence public perception. (Scheufele & Tewksbury (2007) Some elements involved in agenda setting include the following:
i) The quality of reportage given to each issue
ii) The prominence given in terms of headlines display, pictures and layouts on various media platforms.
iii) The degree of conflict or controversy the report generates
iv) Cumulative media specific effects overtime
The agenda setting theory has been applied to a wide range of topics and in this study, it will be used to examine how the various media messages put out as forms of behavioural change communication interventions to discourage vaccine hesitancy especially among students of the University of Lagos.
The quality of reportage given to the COVID-19 situation by Nigerian press same as the reportage of the vaccine development and history coupled with the prominence given to the vaccines, their effectiveness or other controversies are all supposed to have created a sort of agenda for Nigerians to focus on vaccination and perceive it as an important exercise. Ultimately, if the agenda setting theory is anything to go by, there ought to be a corresponding change in behaviour and attitudes towards vaccination. The theory will be relevant in determining the effects the media messages released towards addressing vaccine hesitancy.
2. The Cognitive Dissonance Theory:
Cognitive dissonance theory is a psychological theory that suggests that people often have an innate desire to remain consistent in their beliefs, attitudes and behaviours. Thus, when inconsistency or dissonance arises, individuals seek to resolve through various means part of which is behaviour change. It was first proposed by Leon Festinger in his 1957 book, “A theory of Cognitive Dissonance” where he posited that individuals experience dissonance when presented with information that conflicts their existing beliefs or attitudes.
Festinger (1957) proposed that there are three conditions necessary for dissonance to occur;
1. When there is an inconsistency between two cognitions (knowledge) or between a cognition a behaviour.
2. The dissonant cognitions are important to the individual
3. The individual perceives that they have control over the dissonant conditions.
Festinger and Carlsmith (1959) demonstrated their theory in an experiment involving participants in a boring task for an hour to lie to the next participants that the task was enjoyable. They were then paid either $1 or $20 to lie to the next participant. Findings from the research revealed that those paid $1 had more positive attitudes towards the task as they experienced dissonance and resolved it by changing their attitude to align with their behaviour. Those paid $20 did not and therefore saw no need to change their attitude.
The theory has been used in various spheres, health and behaviour change inclusive. With regards to health behaviour change, the theory has been used to develop interventions to promote healthy behaviour and cease unhealthy ones. The theory has also been used in persuasion to suggest that it is more effective to induce dissonance rather than present new information to change belief or behaviours. (Stone et al. 1994) In decision making, the cognitive dissonance theory suggests that people may rationalise their behaviours to reduce dissonance even if such decisions are irrational or harmful.
In this study, the theory of cognitive dissonance will aid the examination of the information shared by behavioural change communication messages that aim to address vaccine hesitancy in contrast to pre-existing values in University of Lagos undergraduate students.
Cognitive dissonance will consider how although University of Lagos undergraduate students are regularly flooded with information about the vaccine and its effectiveness, there is a cognitive dissonance that does not exactly believe the news about the vaccine thus promoting vaccine hesitancy. Media messages cannot therefore do anything to change behaviour in a case like this.
Moreso, since this theory has been previously used in health studies, it is expected to solve the question of whether received media messages actually have any influence in addressing vaccine hesitancy. This altogether will reveal the mindsets behind their specific behaviours as to whether some rationalise their hesitancy for various reasons even if it is a well known health hazard.
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Widman, L., Choukas-Bradley, S., Noar, S. M., Nesi, J., & Garrett, K. (2016). Parent-adolescent sexual communication and adolescent safer sex behavior: A meta-analysis.JAMA pediatrics,170(1), 52-61.
Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014). Attitudes to vaccination: A critical review.Social Science & Medicine,112, 1-11.
https://doi.org/10.1016/j.socscimed.2014.04.018
CHAPTER 3 RESEARCH METHODOLOGY
Introduction
This chapter intends to give a clear description of the methods and procedures that would be used in carrying out this study and ways by which the data necessary for the study would be gathered, analysed and interpreted to form data from proper analysis. The research methodology is explained under the following headings:
- Research Design
- Research Method
- Population of the study
- Sample size and sampling techniques
- Research instrument
- Reliability of the research instrument
- Method of data collection and analysis
Research Design
Tejumaiye (2017) defines communication research as the application of the scientific method to the study of the processes and effects of communication. Campbell (as cited in Tejumaiye, 2017) referred to research design as the framework or plan for a study that is used in collecting and analysing a set of data. Essentially, a research design is a plan that guides the researcher in the various stages of the research process. It helps the researcher keep a mental image of the process as he carries out his research.
Research Method
Research method is one of the important aspects of the research process. This is because it dictates parts like the research design, research instruction, data collection procedure, sampling population, size and others. For this study, the survey method of research will be used.
This method is the best for this kind of research according to Babbie (2007) who noted that the survey research method is the best for social scientists who are concerned with collecting original data for describing a population too large to observe directly.
A survey is a data collection technique that is used to collate information on individuals. It involves asking people to fill a self-administered or online questionnaire, which will form the research instrument for this research. Surveys do more than merely report data, they can be used to structure, analyse, interpret and integrate data to further point relations between variables.
Ajibade (2017) added that surveys also make it easier for respondents to complete questionnaires anonymously which can help the researcher gather honest opinions without fear on sensitive issues people may not want to discuss.
Surveys are also relatively easy to analyse and further cost-effective as they are cheaper compared to other research methods. (Ayedun et al, 2018) They can be administered from remote locations using mail, email or telephone. The flexibility in creation also makes it a good choice for any study. Most importantly, the survey method allows for standardisation of the data that will be collected (Osuala, 2001). Standardisation will ensure that the results can be generalised to the larger population.
According to Sobowale (as cited in Tejumaiye, 2017), the survey technique is the most commonly adopted research method amongst behavioural scientists. He said it involved drawing up a set of questions on various aspects of a subject to which selected members of a population are requested to react. Additionally, it guarantees uniformity of answers from respondents and facilitates data processing through easy coding. (Sobowale, 1981).
The survey method can be administered in various ways but the structured interview survey known as a questionnaire will be employed in this study. This means the participant will be required to fill out the survey instrument on their own.
It is not an uncommon method of research as many researchers commonly employ the same survey instrument. This is evident during election periods when polls are conducted among electorates to determine candidate positions. (Tejumaiye 2017). The survey technique is therefore the best method for this research to measure the influence of behavioural change communication messages in addressing vaccine hesitancy among UNILAG students.
Population of the Study
Population refers to the total number of people living in a geographical area at a particular time. In research, population means the total number of persons, behaviours or characteristics that are being studied. Kerlinger (1981) defines population as all members of any well-defined class of people, events or objects which can be living or non-living things. Calabrese (2009:118) adds that it represents the group towards whom the researcher draws conclusions and generalises his/her findings and results. The population for this study are students of the University of Lagos.
According to the 2019/2020 pocket statistics, the University has a student population of about sixty-two thousand, two hundred and fifteen (62,215) offering both full and part-time courses with a College of Medicine, twelve (12) faculties and a Distance Learning Institute. The school has an undergraduate population of 50,675 students (35,436 full-time and 15,329 part-time students) and 9,046 postgraduate students with 2,404 sub-degrees.
Sample size
The sample size is a subject of the population that is taken to be representative of the entire population. The University of Lagos has a full-time undergraduate population of about 50, 765 full-time and part-time undergraduates. The sample was taken from amidst solely full-time undergraduates of the University at a population of 35,436. For the purpose of this research, surveys were administered to a sample size of 401 respondents from eight out of twelve faculties in the population of the University of Lagos full-time undergraduate students.
Sampling Technique
Sampling technique is the process used in choosing the sample from the population for the purpose of the research. In order to ensure a systematic or scientific selection of the sample to be studied, the issue of sampling cannot be overemphasised. Sampling is, therefore, a process or technique of selecting a suitable sample of the population for the study. (Tejumaiye, 2017). It will not be viable to study at the University of Lagos. The reason for this technique is to give an equal chance to every unit of the population being represented. (Tejumaiye, 2017).
The sample size was calculated using the Yamane model given according to Taro Yamane (1967). The formula is suited for known population sizes such as the case of this study. The formula is given as; n = N/1 +N e[2].
Where n is the sample size while the first N is the population size and the second is always represented by 1,e2. which refers to the margin of error. The margin of error is presented at a confidence level of 95% (0.05) with the total sample size being 381.
The sampling technique employed here is theSimple Random Samplingmethod, hence the eight (8) faculties being sampled were randomly chosen. Given this, the faculties where respondents were chosen from are:
1. Faculty of Arts
2. Faculty of Education
3. Faculty of Engineering
4. Faculty of Environmental Science
5. Faculty of Law
6. Faculty of Management Science
7. Faculty of Science
8. Faculty of Social Sciences
In these faculties, the respondents will be drawn from any of the departments across 100-500 levels that make up the entire population. Ideally, 382 respondents divided equally, the number of respondents from each faculty should be 47.75 which was approximated to 48 persons per faculty as indicated below. However, due to the nature of the questionnaire, the number of respondents exceeded the targeted size with a total of 401 respondents. The table below indicates the sample size drawn from each faculty which is not proportionate to the size of the faculty.
Table 1: Sample Size of each Stratum
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This brings the total sample size to 401 respondents. This sample size is justified further because of the big nature of the population. Being a large population, the sample size is hereby bigger. Also, the heterogeneous nature of the population calls for a heterogeneous sample size that will truly reflect the nature of the larger population, hence a large sample size of 401 respondents. Thus, the sample size will be 401 undergraduate students.
Data Collection Instrument
These are the tools or methods that will be used in getting data from respondents. In this study, questionnaires would be the main research instruments that will be used for the study to gather necessary data from the sample respondents. Online questionnaires will be distributed to respondents for self-administration especially since the respondents are literate. The online nature of the forms will facilitate easier responses since the population is mostly found online. The questionnaire will contain both open-ended and closed-ended questions.
Validity of Data Collection Instrument
Validity refers to the degree to which measuring instruments can be relied upon to carry out what it is designed to measure. (Tejumaiye, 2007) Since the questionnaire is the measuring instrument of the study and is generally considered a viable tool for data collection. The research instrument will be pre-tested with a smaller sample population to confirm its workability before the main administration. Also, the research questions will be adequately revised after pre-testing to adequately capture the necessary data. The project supervisor will also scrutinise the entire instrument to ensure the questions reflect the raised issues.
Procedure for Data Analysis
Retrieved copies of the questionnaire filled satisfactorily will be analysed and presented in frequency distribution tables generated by the Google Forms package.
REFERENCES
Babbie, E (2007), The Practice of Social Research (11th ed), Belmont, CA: Thompson Wadsworth.
How to Calculate Sample Size Using Yamane Equation by G N Satish Kumar (2019): https://www.youtube.com/myeasystatistics
Tejumaiye J A (2017), Mass Communication Research: An introduction
Yamane, T (1967). Statistics: An introductory analysis, 2nd Ed., New York: Harper and Row.
CHAPTER 4 DATA ANALYSIS, INTERPRETATION AND PRESENTATION
This chapter analyses, interprets and presents the data gathered from the questionnaires sent out to measure the influence of various behavioural change communication methods on vaccine hesitancy among undergraduate students of the University of Lagos. Information gathered is presented in the form of tables to convey the research aims and objectives. Descriptive statistics were also computed using the data such as frequency counts and percentages.
This section represents the analysis in three parts. Section 1 presents demographic characteristics of the respondents; Section 2 presents responses to research questions and Section 3 is a discussion of the findings from the research.
Data Analysis and Presentation
Table 2: Analysis of Performance of Research Instrument
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Although the sample size required was 381 respondents, the online survey generated a total of 401 responses from undergraduates at the University of Lagos. The intention to have exactly 48 respondents from each faculty was not possible due to the unavailability of an equal number of willing respondents from each faculty. The link to the online survey was deactivated a few days after the number of respondents reached 381. The reason for this delay which increased the number of respondents to 401 was to ensure faculties that had not reached 48 respondents. Also, there were no invalid responses due to the fact that the form of survey used (online) only allowed completed responses to be recorded as respondents. Those who started to fill the questionnaire but did not fill it to the end were not recorded as respondents. The table below presents the eventual total number of respondents from each faculty:
Table 3: Total respondents from each faculty
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Table 4: Demographics of participants
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This research work is a study of undergraduate students of the University of Lagos as indicated above. Out of the 401 total respondents, it is evident that 219 (54.6%) were females while 182 (45.4%) were males. This, therefore, means that the majority of respondents were females rather than males.
Table 3 above also shows the age ranges of the respondents. Respondents in the age bracket of 21-25 were the highest with 265 (66.1%), followed closely by respondents within the ages of 16-20 with a total of 100 (24.9%). Respondents between the ages of 26-30 followed next with a total number of 32 (8%) and those above the age of 30 were 4 (1%). The majority of respondents
were then between the ages of 21 and 25, accounting for more than half of the sample size at 66.1%.
Also, the survey enquired into the religion of respondents with 337 Christian respondents {64%), 61 of the respondents were adherents of the Islamic faith (15.2%) while the remaining 3 respondents identified as Traditional, atheists and irreligious respectively at 0.2% each. The majority of respondents were either Christians or Muslims as the case may be.
Similarly, the survey required for the level of the undergraduates and received more responses from 400 level students with 120 respondents (29.9%), followed by 91 responses from students in 200 level (22.7%), 78 responses from 100 level students (19.5%), 72 responses from 300 level students (18%) and 40 responses from 500 level students (10%). The majority of responses, therefore, came from 400-level students across various faculties in the University of Lagos.
Table 3 also shows the respondents from the faculties considered for the study. 45 students from the faculty of Arts (11.2%), 50 respondents from Education (12.5%), 50 from Engineering (12.5%), 40 from environmental science (10%), 54 from the faculty of Law (13.5%), 46 from the faculty of management sciences (46%), 59 from the faculty of social sciences (59%) and 57 from the faculty of social sciences (14.2%). This shows that although the initial number of 48 from each faculty was not realised, the least number of respondents from each faculty still falls within an average of 40 and is still suitable for the course of study.
SECTION B
Research Question 1: What are the various forms of BCC employed towards the COVID-19 pandemic?
Out of the 401 responses, 395 (98.5%) confirmed that they received messages during the COVID-19 pandemic while a meagre 6 (1.5%) respondents said that they had not. However, they had come in contact with the messages in some way or the other.
Table 5: Kinds of media messages respondents received
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The different kinds of media messages received varied from one respondent to the other. 47 (11.7%) respondents received messages about the nature of the virus while 57 (14.2%) received about the mode of transmission while 90 (22.4%) respondents received messages about how to protect themselves from the virus. A majority however of 324 (80.8%) respondents admitted to having received all three categories of messages highlighted above.
Table 6: Frequency of receipt of media messages
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As presented in Table 5 above, 141 (35.2%) respondents received COVID-19 messages daily while 95 (23.7%) respondents received every week and 165 (41.1%) received them occasionally. This shows that the respondents all received the messages frequently enough to be a part of the study.
Table 7: Media format of the messages
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The respondents that received COVID-19 messages from broadcast media, either radio or television were 137 (34.2%) while 47 (11.2%) respondents saw it in print media (newspapers and magazines), 180 (44.9%) got them through their social media platforms while 137 (34.2%) received the messages through text messages and emails. Another 41 (10.2%) saw messages through outdoor advertising on either billboards or fliers while 173 (43.1%) respondents received their messages through all the media formats provided.
Table 8: Reasons for the frequency with chosen medium
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218 (54.4%) respondents when asked about their reasons for the chosen medium from which they received messages about COVID-19 chose the medium because of the nature of the medium. 88 (21.9%) chose that medium because of the content of the message while 82 (20.4%) chose it because of the simplicity of the message and 13 (3.2%) chose it for other reasons.
RQ 2: What is the level of awareness of UNILAG students about media messages addressing vaccine hesitancy?
Respondents were asked if they received messages about the importance of the COVID-19 vaccine and on which platform they had seen it the most and their responses are presented below.
Table 9: Platforms on which respondents had seen messages about the importance of the COVID-19 vaccine
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201 (50.4%) respondents saw these messages more on social media platforms followed by 133 (33.2%) who saw it on broadcast platforms, 46 (11.5%) saw it through text messages and emails, 11 (2.7%) received it through print media while 11 (2.7%) received their messages about the importance of the vaccine through outdoor advertising such as billboards and fliers.
Table 10: Respondents' rate of effectiveness of messages in addressing questions about the COVID-19 vaccine
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According to Table 9, 66 (16.5%) of respondents found the messages very effective in answering their questions about the vaccine. 81 (20.2) respondents found the messages effective while 155 (28.7) found them moderately effective. 70 (17.5%) found the messages ineffective while 29 (7.2%) found the messages highly ineffective in addressing their questions.
Out of the 401 respondents, 369 (92%) received messages from the National Centre for Disease Control ( NCDC) or the National Primary HealthCare Development Agency (NPHCDA) about the need to be vaccinated against COVID-19 while 32 (8%) did not.
Table 11: Respondents' perception of the NCDC and NCPCHA messages about the effectiveness of COVID-19 vaccines
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Table 10 presents the perception of the respondents to the messages about the effectiveness of the vaccine. 58 (14.5%) found it to be believable while 21 (5.2%) found it suspicious. 276 (*68.8%) found the message informative while 19 (4.7%) perceived the messages as disturbing and another 27 (6.7%) perceived them as unnecessary.
Table 12: Contribution of messages in persuading respondents to take the vaccine
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195 (48.6%) respondents were encouraged to take the vaccine due to these messages while
206(51.4%) were not encouraged to take the vaccine by the messages.
RQ 3: What are the various reasons for vaccine hesitancy among UNILAG undergraduates?
Table 13: Number of vaccinated respondents
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171 (42.6%) respondents have taken the COVID-19 vaccine while a majority 230 (57.4%) responded that they had not taken the vaccine. To better understand this behaviour, a question was asked to find out their reasons for taking the vaccine from which findings are presented in the table below;
Table 14: Respondents’ reasons for taking the vaccine
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The above table shows that 74 (18.5%) respondents took the vaccine because they believed it can protect them from the virus while 41 (10.2%) were convinced by their family and friends. 46 (11.5%) took it because they were convinced because of the information from media messages and 5 (1.2%) took it because of the government messages. 10 (2.5%) respondents took the vaccine even though they were still unsure about the vaccine. A study was made into the reasons why those who did not take the vaccine did not as well with the findings presented below;
Table 15: Respondents' reasons for not taking the vaccine
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27 (6.7%) respondents did not believe that they could contract the virus while 105 (26.2%) did not take the vaccine because they did not believe it. 8 (2%) respondents did not believe in the existence of COVID-19, while it was against the beliefs of 4(1%) respondents to vaccinate. 98 (24.4%) respondents were still unvaccinated because of the lack of time to go to the vaccination centre. Out of these unvaccinated respondents, 39 (9.7%) were willing to be vaccinated while 83 (20.7%) were still unsure and a larger 124 (30.9%) were still resolute to stay unvaccinated.
The survey also evaluated the sources of information from which respondents got informed about the COVID-19 vaccine presented in the table below:
Table 16: Primary source of information available to respondents about the COVID-19 vaccine
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Majority of respondents, 227 (56.6%) got their information primarily through social media while 124 (30.9%) were informed through news, 38 (9.5%) respondents got their information through their families and friends, 3 (0.7%) from their opinion leaders and 9 (2.2%) from other sources.
Table 17: Concerns of respondents about the COVID-19 vaccine
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The study continued to discover the possible concerns limiting respondents from taking the vaccine. According to Table 16 above, 28 (7%) respondents have concerns about the scientific process of developing the vaccine, 44 (11%) respondents were concerned about the source of the vaccine, 36 (9%) were bothered with the involvement of governmental agencies in distribution while the largest expressed concerns about the side effects of the vaccine. 55 (13.7%) had no concerns about the vaccine.
Table 18: Respondents’ response to whether media messages can change their perception
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According to Table 17 above, 162 (40.4%) respondents think that well-structured media messages can change their perception of the virus. 139 (34.7%) were undecided as to whether their perception could be changed while 100 (24.9%) were certain that media messages could change their perception.
Table 19: Factors capable of behaviour change towards the COVID-19 vaccine
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215 (53.6%) of respondents said that approval from trusted friends and family members was capable of changing their behaviour towards the vaccine. 62 (15.5%) opted for government messages addressing vaccine hesitancy while 58 (14.4%) picked locally developed and patented vaccines and 66 (16.5%) respondents picked community-level behaviour-oriented campaigns.
Questions were also asked regarding respondents’ experience with vaccines and the responses are presented below;
Table 20: Respondents’ experience with vaccines
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152 (37.9%) respondents felt that past vaccines were effective while 71 (17.7%) admitted to taking them under compulsion. 5 (1.2%) respondents felt that the vaccines were ineffective while 173 (43.1%) respondents were indifferent about them. Further, respondents reacted as to whether their past with vaccines was a contributing factor to the current hesitancy.
Table 21: Role of past vaccines in current vaccine hesitancy
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87 921.7%) respondents admitted that their past experiences with vaccines played a contributing factor to their current hesitancy while 237 (59.1%) responded in the negative and 77 (19.2%) respondents were unsure.
RQ 4: What is the role of Behavioural Change Communication in tackling Vaccine hesitancy among UNILAG students?
Table 22: Respondent's exposure to vaccine hesitancy communication messages
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According to Table 19 above, 191 (-47.6%) respondents have seen media messages that addressed vaccine hesitancy while 161 (40.1%) have not seen any. 49 (12.2%) respondents were unsure whether they had seen such messages.
Concerning the role of communication in addressing vaccine hesitancy, 267 (66.6%) respondents admitted that communication had a role to play while 69 (17.25) believed otherwise and 65 (16.2%) were unsure if communication could change their perception of the vaccine.
Furthermore, 168 (41.9%) respondents have been influenced to develop a negative perception of the vaccines due to the information they had gotten. 173 (43.1%) respondents denied the same while 60 (15%) were unsure if the information they had gotten contributed to their wrong perception of the COVID-19 vaccines. They also confirmed the various sources of information about the vaccine that encouraged the negative perception as presented below:
Table 23: Sources of negative information about COVID-19 vaccine
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According to Table 23, 71 (17.7%) respondents developed a negative perception due to information gotten from news while 47 (11.7%) respondents developed a negative perception from television adverts and radio jingles, 230 (57.4%) got the negative information from social media and 193 (48.1%) respondents developed a negative perception through their friends and families. An additional 95 (23.7%) respondents developed a negative perception through wrong information from their opinion leaders.
Table 24: Media messages most effective in addressing vaccine hesitancy
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110 (27.4%) respondents found news content as most effective in improving their knowledge while 43 (10.7%) preferred television commercials and radio jingles, 67 (16.7%) respondents found government-sponsored public service announcements effective followed by 164 (40.9%) respondents who found social media content effective and 17 (4.2%) respondents who found emails and phone texts more effective.
A last section narrowed in on the effectiveness of behavioural change communication on vaccine hesitancy with a question on how effective did respondents think they were. Responses are presented below:
Table 25: Respondents’ rate of effectiveness of BCC interventions on vaccine hesitancy
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This study revealed that 200 respondents (49.9%) were in between as to the effectiveness of behavioural change communication on vaccine hesitancy with 100 (24.9%) respondents sure of the effectiveness of behavioural change communication. 101 (25.2%) respondents expressed lesser confidence in the same. Observed, more respondents seemed hopeful that behavioural change interventions could address vaccine hesitancy.
Table 26: BCC interventions received in relation to vaccine hesitancy
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Furthermore, in response to the question above, 184 (45.9%) respondents received social media based campaigns while another 156 (38.9%) respondents received through public service based announcements. 28 (7%) received one-on-one counselling sessions, 31 (7.7%) were part of group sessions or community campaigns and 41 (10.2%) received other forms of behavioural change interventions addressing vaccine hesitancy. From the data gathered, the respondents were more familiar with social media campaigns and public service announcements.
Table 27: Changes observed as a result of BCC interventions
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Respondents were asked whether they observed any changes in vaccine hesitancy in their community due to the received behavioural change communication interventions. 51 (13.25) respondents agreed that they had seen a significant decrease in vaccine hesitancy while 115 (29.7%) respondents observed a somewhat decrease in vaccine hesitancy. 116 (42.9%) observed no changes in vaccine hesitancy due to behavioural change interventions but 43 (11.1%) observed a slight increase in vaccine hesitancy and 12 (3.1%) observed a significant increase.
The last question aimed to find out if respondents believe that behavioural change interventions are important in addressing vaccine hesitancy.
Table 28: Respondent's perception to BCC interventions in addressing vaccine hesitancy
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According to Table 27, 223 (57.2%) respondents believe that behavioural change communication interventions are important in addressing vaccine hesitancy while 49 (12.6%) did not. 118 (30.6%) others were unsure as well.
SECTION C
DISCUSSION OF FINDINGS
This research aimed to contribute to the existing body of work on the influence of behavioural change communication on vaccine hesitancy with a closer focus on the University of Lagos undergraduates. The research objectives set out to find the various forms of behavioural change communication employed towards the COVID-19 pandemic, and determine the level of awareness they had about media messages addressing vaccine hesitancy and the various reasons for hesitancy. Another objective was to discover the influence of behavioural change communication in tackling vaccine hesitancy among students.
From the study conducted, according to the first research objective, 395 (98.5%) respondents received messages during the COVID-19 pandemic while only 6(1.5%) did not receive messages during the pandemic. They however admitted to having come in contact with COVID-19 messages during the pandemic in some way or the other such as through friends and families. Similarly, the majority of the respondents 324 (80.8%) received all three categories of media messages ranging from messages about the nature of the virus, the mode of transmission as well as how to protect themselves from the virus. 165 (41.1%) respondents also admitted to receiving these messages at least occasionally which implied that they received them frequently enough to recognise the messages and take note of them.
This, therefore, means that the respondents were familiar with and aware of various behaviour change communication forms deployed during the pandemic. The most common media platform for receipt of messages was social media with 180 (44.4%) respondents followed by equal responses from broadcast media (radio and television) as well as through text messages and emails, which 137 (34.2%) respondents admitted to. This provided an idea of the various media platforms through which COVID-19-related communication was transmitted to the respondents. This, therefore, agrees with the 2015 study conducted by Rimal et al that found that social media was key to effective BCC interventions.
Similarly, the study also found that the respondents preferred the chosen mediums more because of the nature of the medium. 218 (54.4%) respondents gave this as their reason for being frequent on such mediums. This was followed by other reasons such as the message content (21.9%) and the simplicity of the message (20.4%). This ties in with the fact that Behaviour change communication takes into cognizance among other factors the nature of the medium as well as its relatedness with the target audience.
Further on, 201 (50.4%) respondents saw these messages on social media closely followed by 133 (33.2%) who saw them on broadcast media. These altogether confirm Zhang et al’s 2016 study that showed that the effectiveness of social media for BCC was hinged on certain factors with media that were more personalised and interactive having more effectiveness compared to other platforms. Social media meets this criterion of personalisation, individually targeted messages as well as options for interaction and responsiveness followed by broadcast media and the responses show the same.
In response to research question two about the respondents' level of awareness of messages addressing vaccine hesitancy, respondents were asked how effective the messages they received were and a higher percentage of them responded in the affirmative. 155 (28.7%) respondents chose moderate effectiveness while 81 (20.2%) and 66(16.5%) chose effective and high effectiveness with a total of 302 respondents admitting that the messages were effective in addressing their questions. Similarly, 369 (92%) admitted to receiving messages from the National Centre for Disease Control (NCDC) or the National Primary HealthCare Development Agency (NPHCDA) informing them to be vaccinated while 32 (8%) did not. This is in line with previous studies such as Koenker et al (2015) and Apobo (2015)about the use of Behavioural change communication during Nigerian health crises.
Also, the survey showed that more respondents, 276 (68.8%) found the government sponsored messages through the NCDC and the NPHCDA to be informative while another 58 (14.5%) believed the message. There were other reactions to the messages such as suspicion, disturbance and unnecessary from 67 respondents. This further buttresses their previous responses that the messages were effective.
There is however a slight difference in the contributing of the messages in persuading them to take the vaccine. 195 (48.6%) respondents were encouraged while 206 (51.4%) were not. Findings revealed that just 171 (42.6%) respondents were vaccinated at the time of response while a larger 230 (57.4%0 were not.
Going further, not all the vaccinated respondents were fully convinced about the effectiveness of the vaccine. 120 respondents were fully convinced with 74 (18.5%) who expressed belief in the protection the virus offers and 51 (12.7%) because of the information from media messages and government pleas. The remaining were not fully convinced even though they were vaccinated. This reinforces the results of Yaqub et al (2014) who posited that vaccine hesitancy is different from vaccine refusal simply because vaccinated people might still harbour certain hesitancy. Even though some did not totally accept the vaccine, 41 (10.2%) took it to identify with their friends and family and 10 (2.5%) were still unsure about the vaccine.
Several reasons were given for the hesitancy such as lack of belief in the existence of a virus (2%) or the possibility of contracting it(6.7%), lack of trust in the vaccine (26.2%), personal beliefs (1%), and lack of time (24.4%). These confirm the studies of Larson et al (2018) and Drobniewski et al (2022) that suggest that misinformation, mistrust, and a mix of cultural and religious values contribute to vaccine hesitancy.
Misinformation is developed from a couple of sources and respondents indicated that the highest sources of information were social media (56.6%), news (30.9%), family and friends (9.5%) and opinion leaders (0.7%) in that order. More reasons given for hesitancy are the concerns respondents have about the vaccine. These ranged from the scientific process of development (7%), the source of the vaccine (11%), and concerns about the side effects of the vaccine (59.4%). These factors and concerns are situated within what the Israel Journal of Health Research Policy described as the triad of factors for vaccine hesitancy. The reasons for not taking the vaccine such as lack of time, and the involvement of governmental agencies in distribution are environmental factors, agent factors such as the process of development, side effects of the vaccine and individual factors such as the personal beliefs. Side effects, by the way, were of more concern to more vaccine-hesitant respondents.
Furthermore, to evaluate the influence of media messages on the hesitancy, more respondents believed that there was a possibility as 162 (40.4%) respondents picked ‘yes’ and 139 (34.7%) picked ‘no’. This meant that the respondents agreed to the chance that media messages influence their perception of vaccination which made them hesitant.
The study also discovers the factors that can further aid this behaviour change towards the vaccine. Results showed that approval of family and friends ranks first (53.6%) for many undergrads to change their perception and behaviour. This was followed by community-level behaviour oriented campaigns as suggested by 66 (16.5%) respondents. Government messages addressing vaccine hesitancy ranked third with 62 (15.5%) respondents and then locally developed and patented vaccines with 58 (14.5%) respondents. On the contrary, while many expressed fear about the source of the vaccines earlier (11%) the results showed that campaigns built around trust and approval were capable of changing behaviour beyond the vaccine continent itself. 237 (59.1%) respondents also confirmed that their experience with previous vaccines did not contribute so much to the current behaviour. This also tallies with previous research about the use of vaccine hesitancy in previous Nigerian health crises.
The last research objective was to measure the role of BCC in tackling vaccine hesitancy among UNILAG students. Majority of the respondents, 240 (59.8%) admitted to seeing media messages that addressed vaccine hesitancy. Majority of them, 267 (66.6%) also agree that communication admits that communication had a role to play in changing their perception of the vaccine as well. 168 (41.9%) respondents have been influenced to develop a negative perception of the vaccines due to the information they had gotten. This confirms that messages actually influence perception and ultimately behaviour. Sources of these negative perceptions according to the survey were also primarily social media (57.4%), followed by friends and family (48.1%), opinion leaders (23.7%), news (17.7%) and then Broadcast adverts (11.7%). This underscores the fact that social media has a key role to play in behaviour change particularly among undergraduates. This is further reflected in the next set of responses about the kinds of media messages that were effective in improving their knowledge and attitude to vaccination. 164 (40.9%) respondents had their knowledge improved due to social media content. Next to this was news content (27.4%) followed by government sponsored public service announcements (16.7%).
This aligns with the principles of John Hopkins Centre for behaviour change model according to Anieto et al (2008) that states that knowledge, approval, intention were key components for behaviour change.
In response to a scalar question on how effective respondents think vaccines were in addressing hesitancy, 200 (49.9%) were in between while 100 (24.9%) thought they were effective. Apparently, more respondents felt hopeful that BCC interventions could stop vaccine hesitancy. Further proving the effectiveness of the social ledai as a tool for behaviour change particularly in the area of vaccine hesitancy, more respondents received social media based campaigns (45.9%) followed by public service announcements from various platforms (38.9%). These proved to be effective on majority of them as seen in following replies and they also gave both social media campaigns and public service announcements high recommendation for behavioural change campaigns according to their replies in following questions. More of them (42.9%) attested to positive changes and decreases in vaccine hesitancy than those who observed increase in hesitancy. There however still lies a challenge as an equal percentage (42.9%) also observed no changes and due to information gathered so far, it would likely have to do with the methods and format involved in the message design and delivery for behaviour change particularly those that address the personal reasons for vaccine hesitancy.
To directly answer the research questions, various forms of behavioural change communication deployed towards the COVID-19 pandemic included social media content, community campaigns, government sponsored public service announcements, phone texts and emails, broadcast messages through radio and television. Similarly, the majority of UNILAG students were very well aware of media messages addressing vaccination and vaccine hesitancy.
The various reasons for vaccine hesitancy were also discovered such as concerns about the source of the vaccine, involvement of governmental agencies in distribution, lack of belief in the existence of a pandemic, personal and religious deep seated belief, family and friends sponsored misinformation, etc. The influence of the behavioural change communication employed is therefore varied. Majority were convinced because of the methods employed to discourage hesitancy such as social media messages, working through family and friends, one-on-one counselling and community campaigns. However, due to the fact that more of the intensive behavioural change communication methods through government and media agencies such as messages, community campaigns and one-on-one advocacy counselling which could have reached families (who hold the fort as the influencing audience), there were still students who could not be influenced against hesitancy.
The findings of the study are in agreement with the Agenda Setting Theory as it revealed that the media (social media and broadcast platforms, in this case) set the agenda for discussion amongst their various audiences. The messages sent out by the various media platforms regarding the virus as well as the vaccine, determined what firstly, the recipients knew about the both as well as their perception of the vaccine. Wrong information spread through the same media platforms and with support from family and friends, opinion leaders who were obviously spurred to discussion because of what they had seen, either discouraged or encouraged hesitancy.
The twist is however in the fact that while the media messages painted several images, it couldn't directly dictate their opinion. Just as Cohen (1963) said that the media may not be successful in telling people what to think but is triumphant in telling them what to think about. It is without dispute that the vaccine was a matter of discussion in many groups due to the emphasis the media placed on it.
This also aligns with the theory of Cognitive dissonance which suggests that people have an inborn desire to remain consistent in their beliefs, attitude and behaviours. This explains why despite the information and messages, certain respondents did not take the vaccine because they felt the pandemic was a hoax, or the vaccine was ineffective or their personal beliefs against vaccination.
REFERENCES
Drobniewski, F., Kusuma, D., Broda, A., Castro-Sanchez, E., & Ahmad, R. (2022). COVID-19 vaccine hesitancy in diverse groups in the UK—is the driver economic or cultural in student populations.Vaccines,10(4), 501.
Koenker, H., Kilian, A., Hunter, G.etal.(2015) Impact of a behaviour change intervention on long-lasting insecticidal net care and repair behaviour and net condition in Nasarawa State, Nigeria.Malar J14, 18 (2015). https://doi.org/10.1186/s12936-014-0538-6
Larson, H. J., Jarrett, C., Eckersberger, E., Smith, D. M., & Paterson, P (2014). Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012.Vaccine,32(19), 2150-2159.
Rimal, R. N., & Lapinski, M. K. (2015). A re-explication of social norms, ten years later.Communicati
S G Anieto, O S Onabanjo & JB Osifeso (2008), Models and Theories of Communication
Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford University Press.
Yaqub, O., Castle-Clarke, S., Sevdalis, N., & Chataway, J. (2014). Attitudes to vaccination: A critical review.Social Science & Medicine,112, 1-11.
https://doi.org/10.1016/bsocscimed.2014.04.018
Zhang, Y, et al. (2018). Using social media for weight loss: A systematic review of recent
evidence. Journal of Medical Internet Research, 20(5), e11600
CHAPTER 5 SUMMARY, CONCLUSION AND RECOMMENDATIONS
SUMMARY
This study titled “Influence of behavioural change communication on Vaccine hesitancy: a study of University of Lagos undergraduates” is divided into five chapters all having unique discussions and information as gathered in relation to the study.
Chapter One provided the background to the study, the statement of the problem which the research aims to solve, the research objectives and questions, significance of the study, scope of the study and operational definition of terms.
Chapter Two contains a critical review of related literature. It comprised a conceptual review of key concerts such as behavioural change communication, behavioural change communication and social media platforms, use of behavioural change communication during Nigerian health crises, vaccination, vaccine hesitancy, COVID-19, the Nigerian COVID-19 situation and COVID-19 vaccine development, acceptance and hesitancy. It also included empirical studies and review of selected theories.
The third chapter was where the study employed the survey research method, defined the research method, population of study, sample size, sample frame, sampling technique, data collection instrument, validity and reliability of research instrument, method of data administration, unit of analysis and data analysis method.
Chapter four presented the findings in a tabular format followed with a discussion of findings obtained during the research while this chapter, chapter five holds the summary, conclusion of the study as well as recommendation for further studies.
CONCLUSION
The COVID-19 pandemic, like many health situations before, needed to influence individuals to change their attitudes, beliefs, perception and behaviour first for their own good and then for greater societal reasons. Behavioural change communication has been shown to have relative influence on communicating these reasons for change. In the case of vaccine hesitancy, thi study has discovered the influence of vaccine hesitancy on the effectiveness of behavioural change communication among undergraduates students of the University of Lagos. Findings from this research suggest that the students were aware of the pandemic as well as the various alternatives available for prevention, vaccines inclusive. It also suggests that the students were aware of the various forms of behavioural change communication messages intended to change their hesitancy. Findings further suggest that while these messages were somewhat effective among a slightly larger percentage, there are still unconvinced students who still remain hesitant to being vaccinated majorly for personal beliefs.
After a thorough review of literature, textbooks, journals and audience attitude (through the questionnaires) revealed the following findings above. It therefore suggests that there needs to be a proper look into the behavioural change communication message design processes. This is because, if the messages are designed with factors such as taking the influencing audience into mind, using their familiar media platforms (mostly social media) which the students who showed significant changes in hesitancy due to messages, would make more effective influences instead.
RECOMMENDATIONS
Based on the findings and conclusions from this study, the following recommendations are given:
1. Government, being a key source of messages during pandemics and health situations like the COVID-19 pandemic should involve communication experts in the design and development of their media messages.
2. Further studies should be made into the message design aspect of most Nigerian targeted behavioural change communication programmes and campaigns. This is because findings showed that BCC messages and campaigns that were relatable with the target audience, came on a platform they were familiar with and through the people ( family and friends) they were familiar with were more believable and prompted behaviour change. If these are considered in more behaviour change communication campaigns, greater effectiveness will be recorded.
3. The sample size could be further broken down into more specific sizes especially with a research conducted based on the interplay of social media and other new media interventions with behavioural change communication. A study of the uniqueness of each platform compared to others, its various strengths and weaknesses and type of audience can be closely studied subsequently.
LIMITATIONS OF THE STUDY
The study was conducted on four hundred and one undergraduate respondents from the University of Lagos. Therefore, it may not be an actual representative of the general student or youth population of Nigeria. Similarly, it is not focused on any specific behavioural change communication intervention proposed by the Federal Government or deployed by agencies during the COVID-19 pandemic. The study also researched the mainly young population of the University of Lagos, it therefore unlikely that the same results would argue with a study conducted on another segment of the society say adults or parents for example.
SUGGESTIONS FOR FURTHER STUDIES
For further studies, the researcher suggests the study of the influence of behavioural change communication among adults or older generations in their natural home setting. Also, further research could be conducted into weighing the difference between the effectiveness of behaviour change communication that are received mainly through various social media platforms. This will help to ascertain the influence and separate roles and strategies available to different audiences across various social media platforms.
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APPENDIX
QUESTIONNAIRE
Dear Respondent,
My name is Ogunleye lyanuoluwa Abiola, a final year student of the Department of Mass Communication, University of Lagos. I am conducting a research titled “INFLUENCE OF BEHAVIOURAL CHANGE COMMUNICATION ON VACCINE HESITANCY: A STUDY OF UNILAG STUDENTS” in partial fulfilment of the requirements for a B.Sc degree in Mass Communication.
In this regard, your honest opinions are helpful in completing this questionnaire. You are assured that the information you provide will be treated with confidentiality and not used for any other purposes than academic.
Thank you.
SECTION A:Demographic Information
Gender:Male ( ) Female ( )
Age:( ) 16-20 ( )21-25 ( ) 26-30 Above 30 ( )
Religion:( ) Christianity ( ) Islam
Level:( ) 100 Level ( ) 200 Level ( ) 300 Level (
Level
Faculty:( ) Arts ( ) Law ( ) Sciences
Sciences ( ) Engineering ( ) Education (
Environmental Sciences ( ) Management Sciences (
Department:
SECTION B:
Research Question 1: What are the various forms of behavioural change communication employed towards the COVID-19 pandemic?
1. Did you receive or see any media messages or information about the COVID-19 pandemic?
Yes ( ) No ( )
2. Which of the following kinds of media messages did you receive? Messages about the nature of the virus
Messages about the mode of transmission
Messages on how to protect yourself All of the above
Others
3. How frequently did you receive any of these messages? Daily ( )
Weekly ( )
Occasionally ( )
4. In what forms of media did you receive these messages? Broadcast Media (Radio & TV)
Print Media (Newspapers and Magazines)
Social Media platforms
Text Messages & Emails
Outdoor Advertising (Billboards & Fliers) Others
5. Which of these forms was most effective in capturing your attention and influencing your behaviour?
Broadcast Media (Radio & TV)
Print Media (Newspapers and Magazines)
Social Media platforms
Text Messages & Emails
Outdoor Advertising (Billboards & Fliers) Others
6. Which of the following reasons influenced the medium to capture your attention? The nature of the medium
The content of the message
The simplicity of the message Others
Research Question 2: What is the level of awareness of UNILAG students about media messages addressing Vaccine hesitancy?
7. Did you receive any media message about the importance of vaccines during the pandemic?
Yes ( ) No ( )
8. On what platform did you see these messages more frequently?
Broadcast Media (Radio & TV)
Print Media (Newspapers and Magazines)
Social Media platforms
Text Messages & Emails
Outdoor Advertising (Billboards & Fliers)
Others
9. On a scale of 1-5, How effective do you think those messages were in addressing your questions about the vaccine?
1 Very Effective
2 Effective
3 Neutral
4 Ineffective
5 Very Ineffective
10. Did you receive any messages from the National Centre for Disease Control (NCDC) or the National Primary Health Care Development Agency (NPHCDA) about the need to get vaccinated against COVID-19?
Yes ( ) No ( )
11. If yes, what was your perception of that message?
Believable
Suspicious
Informative
Disturbing
Unnecessary
12. Did the message(s) encourage you to take the COVID-19 Vaccine?
Yes ( ) No ( )
Research Question 3: What are the various reasons for vaccine hesitancy among UNILAG undergraduates?
13. Have you taken the COVID-19 vaccine?
Yes ( ) No ( )
14. If “Yes”, why did you take the vaccine?
I believe it can protect me against the vaccine
I took it because my friends and family were taking it
I was convinced because of the information from media messages
I took it because of the government pleas
I am still unsure about the vaccine
15. If “No’, why haven’t you taken the vaccine?
I don’t believe I can contract the virus
I don’t trust the vaccine
I don’t believe COVID-19 is real
Vaccination is against my beliefs
I did not have time to go to the vaccination centre
16. If “No”, are you willing to be vaccinated for COVID-19?
Yes ( ) No ( )
17. What are your primary sources of information about the COVID-19 Vaccine?
News
Social media
Family and Friends
Opinion leaders
Others
18. What concerns or fears do you have about the vaccine?
The scientific process of development
The source of the vaccines
The involvement of governmental agencies in distribution
The side effects of the vaccine
None
Others
19. Do you think well-structured media messages can change your perception of the COVID-19 vaccines?
Yes ( ) No ( ) Maybe ( )
20. Which of the following factors can change your behaviour towards the COVID-19 vaccine?
Approval from trusted ones (family and friends)
Government messages addressing hesitancy
Locally developed and patented vaccines
Community-level behaviour change-oriented campaigns
21. Have you received vaccines in the past?
Yes ( ) No ( ) Maybe ( )
22. How did you feel about the vaccines you took in the past?
They were effective
I took them under compulsion
They were ineffective
Indifferent
Others
23. Do you think your past experience with vaccination has influenced your current attitude towards the COVID-19 vaccine?
Yes ( ) No ( ) Maybe ( )
Research Question 4: What is the role of behavioural change communication in tackling vaccine hesitancy among UNILAG students
24. Have you seen any media message or communication form that addresses vaccine hesitancy?
Yes ( ) No ( ) Maybe ( )
25. Do you think communication plays any role in changing your perception of the COVID-19 vaccines?
Yes ( ) No ( ) Maybe ( )
26. Have you been influenced to develop a negative perception in any way by the information you have gotten about the COVID vaccines?
Yes ( ) No ( ) Maybe ( )
27. Which of the following are sources of the information that give a negative perception about the COVID-19 vaccines?
News
TV Adverts and Radio jingles
Social Media
Friends and Family
Opinion leaders
28. Which of the following media messages were most effective in improving your knowledge or attitude to vaccination?
News
TV commercials and Radio Jingles
Government sponsored Public Service Announcements
Social media content
Emails and phone texts
Assessing effectiveness of BCC on vaccine hesitancy
29. Have you received any BCC interventions on vaccines?
Yes ( ) No ( ) Maybe ( )
30. On a scale of 1-5, 5, how effective do you think BCC interventions are in addressing vaccine hesitancy?
1 (Not effective at all)
2 (Somewhat ineffective)
3 (Neutral)
4 (Somewhat effective)
5 (Very effective)
31. What specific BCC interventions did you receive in relation to the vaccination?
Social media campaigns
Public service announcements (Broadcast & TV)
One-on-one counselling sessions
Group Sessions or community campaigns
Others (please specify)
32. How did the BCC interventions you received affect your perception of the COVID-19 vaccine?
Significantly decreased vaccine hesitancy
Somewhat decreased vaccine hesitancy
Somewhat decreased vaccine hesitancy
Somewhat increased vaccine hesitancy
Significantly increased vaccine hesitancy
33. Have you recommended or encouraged someone else to get vaccinated after receiving BCC interventions?
Yes ( ) No ( ) Maybe ( )
34. On a scale of 1-5, how likely are you to recommend vaccination to someone else after receiving BCC interventions?
1 (Not likely at all)
2 (Somewhat unlikely)
3 (Neutral)
4 (Somewhat likely)
5 (Very likely)
35. In your opinion, what additional BCC interventions could be effective in addressing vaccine hesitancy?
a. Social media campaigns
b. Public service announcements
c. One-on-one counselling sessions
d. Group sessions or community meetings
e. Others (please specify)
36. Have you observed any changes in vaccine hesitancy in your community as a result of BCC interventions?
a. Yes, a significant decrease in vaccine hesitancy
b. Yes, a somewhat decrease in vaccine hesitancy
c. No, no change in vaccine hesitancy
d. Yes, a somewhat increase in vaccine hesitancy
e. Yes, a significant increase in vaccine hesitancy
37. Do you believe that BCC interventions are important in addressing vaccine hesitancy?
a. Yes
b. No
- Quote paper
- Iyanuoluwa Ogunleye (Author), 2023, Influence of Behavioural Change Communication on Vaccine Hesitancy, Munich, GRIN Verlag, https://www.grin.com/document/1495670
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