Chen Wenjin, Jiao Lirui, Chen Qiushi, Zheng Zhoutao, Geldsetzer Pascal, Greuel Merlin, Gates Jennifer, Zhao Jinghan, Bärnighausen Till, Adam Maya, Chen Simiao, Wang Chen
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany.
J Med Internet Res. 2025 Aug 27;27:e66758. doi: 10.2196/66758.
Low influenza vaccination rates in China pose a serious public health threat. The vaccination prevents infection, but widespread vaccine hesitancy remains a significant barrier. Short, animated storytelling videos may help by conveying health messages in an engaging, culturally neutral format that transcends literacy barriers.
We aim to investigate whether scalable, short, animated storytelling videos, using different storytelling techniques-humor, analogy, and emotion-could reduce influenza vaccine hesitancy among Chinese adults.
In this single-blind, parallel-group, randomized controlled trial, we recruited adults in China through quota sampling. Participants were randomly assigned to 1 of 3 short, animated storytelling video intervention groups, each using a different storytelling technique (humor, analogy, or emotion) or a control group in a 1:1:1:1 ratio. After watching the video or being assigned to the control group, participants completed the questionnaire. Influenza vaccine hesitancy was compared between each intervention group and the control group, respectively, as well as between different intervention groups, with P values adjusted for multiple comparisons.
A total of 12,000 participants met the inclusion criteria. Participants in any scalable animated storytelling video group showed lower hesitancy than controls (mean difference -0.41, 95% CI -0.60 to -0.23; P<.001). Specifically, both intervention groups with humor (video A) and analogy (video B) storytelling techniques resulted in significantly lower hesitancy compared to the control group, with mean differences of -0.44 (99.17% CI -0.75 to -0.13; P<.001) for video A and -0.55 (99.17% CI -0.86 to -0.24; P<.001) for video B. However, the intervention group with emotion video (video C) did not show significant effects compared to the control group, nor were there significant differences compared with the other 2 intervention groups. In subgroup analyses, video A effectively reduced vaccine hesitancy among urban residents and participants from southern and southwestern China. Video B was effective within participants aged 40-49 years, both sexes, both urban and rural residents, those with a college education or higher, households with an income of CN ¥90,000-180,000 (the 2021 official exchange rate of CN ¥1=US $0.155 was used for reference, based on World Bank data), and participants from the southwestern region and the western economic belt.
Our study showed that storytelling videos, especially with humor and analogy, reduced hesitancy among Chinese adults. Our results highlight the importance of selecting appropriate narrative strategies for health communication, particularly for vaccine hesitancy across various demographic and regional contexts. Given the scalability, low cost, and high accessibility of short, animated storytelling videos, integrating them into national health campaigns could enhance vaccine uptake and mitigate hesitancy in underserved populations. Future research should explore the long-term impacts of these interventions on vaccine uptake and their adaptability to other preventive health measures.
中国流感疫苗接种率较低，对公众健康构成严重威胁。接种疫苗可预防感染，但广泛存在的疫苗犹豫情绪仍是一个重大障碍。简短的动画故事视频或许有助于解决这一问题，它能够以一种引人入胜、文化中立且超越文化水平障碍的形式传递健康信息。
我们旨在研究采用不同叙事技巧（幽默、类比和情感）制作的可扩展、简短的动画故事视频，是否能够降低中国成年人的流感疫苗犹豫情绪。
在这项单盲、平行组、随机对照试验中，我们通过配额抽样在中国招募成年人。参与者按1:1:1:1的比例随机分配到3个简短动画故事视频干预组中的一组，每个干预组使用不同的叙事技巧（幽默、类比或情感），或分配到对照组。观看视频或被分配到对照组后，参与者完成问卷。分别比较每个干预组与对照组之间以及不同干预组之间的流感疫苗犹豫情况，并对P值进行多重比较调整。
共有12000名参与者符合纳入标准。任何可扩展动画故事视频组的参与者的犹豫程度均低于对照组（平均差值为-0.41，95%置信区间为-0.60至-0.23；P<0.001）。具体而言，采用幽默叙事技巧（视频A）和类比叙事技巧（视频B）的两个干预组与对照组相比，犹豫程度显著降低，视频A的平均差值为-0.44（99.17%置信区间为-0.75至-0.13；P<0.001），视频B的平均差值为-0.55（99.17%置信区间为-0.86至-0.24；P<0.00l）。然而，情感视频干预组（视频C）与对照组相比未显示出显著效果，与其他两个干预组相比也无显著差异。在亚组分析中，视频A有效降低了城市居民以及中国南部和西南部参与者的疫苗犹豫情绪。视频B在40至49岁的参与者、男女参与者、城乡居民、具有大学及以上学历者、家庭收入为9万至18万元人民币（根据世界银行数据，以2021年官方汇率1元人民币=0.155美元为参考）的人群以及来自西南地区和西部经济带的参与者中均有效。
我们的研究表明，故事视频，尤其是采用幽默和类比手法的视频，降低了中国成年人的犹豫情绪。我们的研究结果凸显了为健康传播选择合适叙事策略的重要性，尤其是针对不同人口统计学和地区背景下的疫苗犹豫问题。鉴于简短动画故事视频具有可扩展性、低成本和高可及性，将其纳入国家健康宣传活动可提高疫苗接种率并缓解服务不足人群的犹豫情绪。未来的研究应探索这些干预措施对疫苗接种率的长期影响及其对其他预防性健康措施的适应性。
