How to build trust in preventive vaccination and fight off medical fake news
“Med Fake” – a large and socially important project
In 2021, a consortium of four universities composed of the Medical Center for Postgraduate Education (project leader), the SWPS University of Humanities and Social Sciences, the Warsaw Medical University and Leon Koźmiński Academy launched a project called “Building trust in vaccination using the latest communication and social influence tools” – “Med Fake” (https://medfake.pl).
The aim was to strengthen confidence in vaccination in Poland by introducing tools designed to encourage patients and young people to reject false medical claims regarding the idea of vaccination (medical fake news). Researchers involved in the project investigated into the decision-making mechanisms within the target groups in order to respond to their needs and reduce the number of vaccine refusals.
The project was financed by the National Center for Research and Development (NCBR) under the “Gospostrateg II” program. The total amount of funding was PLN 14,452,346.25. The project officially ended on May 31, 2024.
More information: The finale of an important project implemented by the Medical University of Warsaw
The role of the Medical University of Warsaw in the project
As part of its tasks, the University’s team identified and characterized subgroups within the project’s target groups (task 2). Educational tools were then created for these groups to encourage them to reject medical fake news (task 10) and other tools were prepared to optimize the work of primary health care staff in terms of maximizing the effectiveness of mandatory vaccination (task 11).
The University’s team in the “Med Fake” project
The team was led by Dr. Filip Raciborski.
- Substantive supervision was provided by Prof. Mariusz Gujski.
- The managers of individual topics within the tasks were Dr. Aneta Tomaszewska and Dr. Paulina Mularczyk-Tomczewska.
- The team of analysts consisted of Dr. Piotr-Samel-Kowalik and Mr. Kamil Rakocy.
- The researchers were MS Artur Białoszewski, MD Paulina Nowicka, Dr. Anna Kłak and MS Karolina Sobeczek.
- Prof. Bolesław Samoliński and Dr. Barbara Bałan acted as expert consultants.
In addition, the project involved experts and external consultants from many areas such as epidemiology, immunology, family medicine, pediatrics, law, semiotics, vaccinology and public health.
The Medical University of Warsaw conducted a series of studies and analyses that allowed the creation of a report presenting detailed characteristics of the project’s target groups. Educational and communication activities were then to be addressed to these groups.
- Quantitative research conducted on a group of 1,560 people aged 15-39 of both sexes. A representative hybrid sample was used, combining elements of an address sample and a random route. Interviews were conducted with respondents face-to-face using the CAPI technique. The field study lasted from October 7 to November 10, 2021.
- BigData analysis using data obtained from:
- district sanitary and epidemiological stations (annual reports on preventive vaccination for the years 2010-2020);
- the National Institute of Public Health at the National Institute of Hygiene – the National Research Institute (a knowledge base on health inequalities);
- Central Statistical Office (a local data bank);
- Public Opinion Research Center (data regarding attitudes towards vaccination);
- Twitter API for Academic Research (a developer account was created for this purpose);
- Facebook – “Global COVID-19 Trends and Impact Survey” (it was necessary to sign a data sharing agreement between the Medical University of Warsaw and the University of Maryland). - Quantitative (CAWI) and qualitative research (60 individual interviews) in three groups:
a) medical staff;
b) medical students;
c) teachers and educators.
Relationships between opinions on vaccination and socio-demographic factors
Based on the research, relationships were found between opinions on vaccination, compliance with the obligation and socio-demographic factors such as age, sex, place of residence, level of education, etc.
Place of residence plays an important role in the perception of vaccines and, consequently, in making decisions about taking them. A geographical dividing line has been found between the north-east and south-west regions of the country, both in terms of mandatory vaccinations and that against COVID-19.
Importantly, people with extreme anti-vaccine attitudes represent a small percentage of the study population.
Most of the population have ambiguous attitudes. This group includes people who are partially convinced, as well as those who doubt, are indifferent or have conflicting attitudes. A significant part of the population express concerns about safety of vaccination in children, especially regarding its impact on development and adverse effects.
Another task for which the University’s team was responsible was the preparation of educational tools for various groups, which would encourage them to brush off medical fake news.
Comics for children and teenagers
As part of the project, a professional comic book scriptwriter and illustrator, working under the scientific editorship of the University’s expert team, created two comics:
- A comic book titled “Hansel and Gretel in a thicket of lies and nonsense” where the children traveling through the forest make choices about their health, hygiene, physical activity and healthy eating. It also introduces a good character: Doctor Lucy the Inoculator. The target group is children from grades 1-3. The printed version includes coloring books with cartoon characters. Two language versions have been prepared: Polish and English.
- A comic book titled “Vigor the Voluble vs. the Sowers of Nonsense” in the style of a story about the adventures of a superhero fighting villains. It discusses medical disinformation, the importance of the common good and social solidarity, and confronting one’s own fears. The target group is teenagers from grades 5-7. A page from the comic was used for the “Vaccinations Save Lives” poster. Two language versions have been prepared: Polish and English.
School lesson scripts
Primary school teachers and curriculum authors developed four lesson plans with support from the University’s expert team:
- A lesson plan for early school education (grades 1-3) entitled “Be Healthy” – focused on promoting a healthy lifestyle including disease prevention. The classes were divided into 6 subjects: the essentials of health, healthy eating, physical activity, disease prevention, hygiene and mental health. The modular nature allows for implementation tailored to the capabilities and needs of students. Worksheets and additional materials have been prepared for each module.
- A lesson plan for early school education (grades 1-3) based on the comic “Hansel and Gretel in a thicket of lies and nonsense” – using a paper or electronic book as an introduction (a PDF version displayed on the multimedia board in the classroom, read together), the main goal of which is to consolidate health-promoting behaviors related to the prevention of infectious diseases and developing an attitude of responsibility for one’s own health and that of other people. The material is focused on developing critical thinking skills (students identify false information about health) and uses elements of competition (the last step in the script is the making of a board game).
- A biology lesson plan titled “Rewrite it, wrap up and pass on! What do viruses want from us and why do we need vaccines?” – for students of grades 5-7, the main goal of which is to introduce students to the subject of vaccination in parallel to the standard teaching. The material is based on two pillars: sticky notes, as a metaphor for quick transfer of information, and a leaflet about the spike protein of the SARS-CoV-2 virus, specific scientific content that connects all tasks.
- A history lesson plan titled “The ‘pigeon cure’, exploding frogs, or the rationality of treatment methods during the Black Death (in the 14th and 17th centuries)” – for students of grades 5-7, the main goal of which is to introduce students to the topic of plague epidemics and treatment methods in the Middle Ages and the modern era. In addition, the material is conductive to the development of critical thinking skills by identifying rational and irrational methods of treatment. The scenario is modular, which enables the choosing of most relevant exercises and tasks.
Guide for parents
As a result of the work of the interdisciplinary team of experts in the field of epidemiology, public health, immunology and semiotics, a guide for parents was written: “A world without vaccines? Diseases forgotten thanks to vaccination.” The leitmotif was the world without vaccines, as it was before the emergence of the field of vaccinology. Parents of children in all ages were selected as the target group.
The material is intended to be a comprehensive but short study on the most important diseases that people have been vaccinating against for decades.
The study consists of two main parts. The first one presents the early days of immunization and the sanitation revolution. The second part is devoted to selected infectious diseases and the timeline of introduction of population-wide vaccination. Two language versions have been prepared: Polish and English.
Video guide for medical staff
A video guide for doctors on communication with patients was filmed. The video tutorial format was used, which proved to be an interactive and engaging way to transfer knowledge among medics. The guide covers such topics as the importance of communication between medical staff and patients and includes a case study about communication and building relations, practical examples and conversation strategies. The problem of using reliable sources of information was also taken into account.
Validation of educational materials
The educational materials developed for children and adolescents have been validated. Approximately 630 students and 20 teachers from 7 schools, including 4 urban and 3 rural ones, took part in the pilots. Opinions of teachers and older students were collected using questionnaires (on paper and online).
The guide was piloted in 10 primary health care facilities located in Poland, in regions with high and low vaccination rates. Parents were contacted and handed the guides printed for them during their children’s vaccination visits, emergency admissions, health check-ups and “patronage” visits. 636 copies were distributed. The guide was given to both parents who vaccinate their children and those who avoid vaccination. 195 parents and guardians decided to share their opinions about the guide in an online questionnaire.
The video guide for medical staff was also piloted online with support from the Supreme Medical Chamber and the District Medical Chamber in Warsaw. 112 doctors took part in the pilot.
Conclusions and recommendations from all the validations are presented in pre-implementation reports.
Good practices in vaccination – recommendations for primary health care
As part of the study, specialists from the Medical University of Warsaw also prepared recommendations for primary health care facilities regarding the organization of the vaccination process, a draft regulation for the Minister of Health regarding the algorithm for financing preventive vaccination and guidelines for local governments on building confidence in vaccines.
The University’s team conducted a number of study visits, working meetings and expert workshops in primary health care facilities throughout Poland, paying attention to their vaccination results. A dialogue was undertaken with various professional groups involved in the delivery of preventive vaccinations. Areas requiring intervention were diagnosed based on it. Actions were recommended for each area with an intent to an increase the vaccination rates achieved by primary health care facilities.
Recommendations for local governments
In parallel, a number of study visits were carried out with the participation of representatives of local governments in order to determine their role in building confidence in vaccination and, consequently, improving vaccination rates. Their results were discussed during expert workshops and then guidelines were prepared for local governments in the field of education and promotion.
A draft regulation for the Minister of Health
A draft regulation for the Minister of Health was prepared regarding the algorithm for financing preventive vaccination in primary health care. A model was used based on bonuses for such facilities, depending on their vaccination rates.
Conclusion
The results achieved as part of the project show how important problem in public health is the abandonment of the obligation to take preventive vaccination. Confidence in vaccination should be built using modern educational tools and precise and comprehensive communication strategies tailored to individual target groups. Taking into account the enormous influence of the Internet as a source of knowledge about health, as well as the ongoing spread of disinformation, particular attention should be paid to the dissemination of health-related information in public space.
The team of the Medical University of Warsaw responsible for the implementation of this project express their sincere thanks to all those who agreed to share their knowledge and experience from everyday work related to the organization and operation of preventive vaccination schemes.