Can a virtual nurse persuade people to get vaccinated? Scientists from SWPS University have proven that it is possible. Finding new forms of informing people about vaccinations is particularly important for public health while some question their validity.
While the consensus in the medical and scientific community is that preventive vaccinations are among civilization's greatest achievements, there are groups that resist this most effective method for preventing infectious diseases [1] . The recent COVID-19 pandemic has proven that mass vaccination is an effective method for achieving herd immunity and defeating a virus. Unfortunately, it has also led to an unprecedented level of misinformation and questioning of the scientific community's consensus, along with the intensification of the activity of anti-vaccination movements [2] . In the age of social media boom, false information spreads more easily than evidence-based positions of scientists.
Only a small percentage of society openly opposes vaccines. A significantly larger portion has some concerns and doubts related to this preventive measure. A marked decrease in the vaccination rate is particularly alarming in the context of the reappearance of diseases that were practically eliminated long ago (such as the highly infectious measles). Due to this, combating conspiracy theories and false information gains particular importance. It can positively influence attitudes toward science and directly affect our health and safety.
Let's have a (virtual) talk about vaccinations
A dialogue, understood as a social influence tool, may be an effective method of promoting vaccinations. However, if we take into account the permanently excessive workload that healthcare professionals have to deal with, a longer conversation with a doctor may be simply impossible. Researchers from SWPS University have proposed a solution: a simulation of a dialogue with the use of an avatar instead of a conversation between the patient and a real human. They described their conclusions in the paper " A virtual assistant can persuade you to get vaccinated against the flu. Online dialogue as a tool of social influence in promoting vaccinations ", published in Social Science & Medicine.
The FLORA application created by scientists leads a discussion about health with participants, specifically about influenza, a disease that poses a serious threat to public health, against which only a small percentage of the population is vaccinated. The vaccine not only minimizes the risk of the disease spreading, but also protects against serious complications, to which the elderly, pregnant women and people suffering from chronic diseases are particularly vulnerable. FLORA is a virtual nurse whose avatar is displayed to the application user.
The first experiment, in which 903 participants took part, assessed the impact of a virtual conversation on the willingness to get vaccinated, while the second one (870 participants) additionally included a direct request to get vaccinated. Each participant was randomly assigned to one of three groups. The first group talked to a virtual assistant. The dialogue concerned their health and physical condition. The program also assessed the individual risk of post-influenza complications, and encouraged some participants to get vaccinated. The second group of participants filled out a questionnaire enabling them to assess the risk of post-influenza complications. The third group was given a leaflet to read on their own (without the possibility of assessing the risk).
The application guided the conversation by asking specific questions to which users provided predefined responses. To make the simulation of social contact more credible, the boards were decorated with a virtual nurse - FLORA, who smiles, expresses interest or concern. The avatar does more than presenting dry facts - the dialogue resembles a real conversation, even seasoned with a dose of humour.
The virtual assistant is convincing, but is it empathetic?
We showed that people who talked to the avatar declared a significantly lower risk of post-influenza complications compared to participants from other groups (questionnaire, leaflet). This was particularly visible in the low-risk group, in which the dialogue clearly increased the willingness of participants to get vaccinated, says Professor Dariusz Doliński from the Faculty of Psychology in Wrocław of the SWPS University, head of the Department of Social Psychology in Wrocław SWPS University. The co-authors of the study are Agnieszka Kozłowska from the Faculty of Psychology in Wrocław of the SWPS University, and Professor Tomasz Grzyb, dean of the Faculty of Psychology in Wrocław SWPS University.
The second part of the study brought interesting results. It turned out that after supplementing the dialogue conducted by FLORA with a clearly formulated request to get vaccinated, the participants' willingness to get vaccinated was 33 times higher than in other conditions. This suggests that while the virtual dialogue itself does not necessarily change the users' attitudes, a direct request following the dialogue can have a significant impact on their approach (in this case, to vaccinations). However, the researchers acknowledge that additional factors could also play a role, such as individual predispositions or the credibility attributed to FLORA.
Among the practical applications of the study results, the authors point to support for healthcare providers. Numerous studies demonstrate that patients expect empathy from their doctors [3] , as well as well-developed communication skills [4] , credibility and trust [5] . All these attributes are connected with dialogue as a form of communication. Meanwhile, the time doctors can devote to their contact with patients has been decreasing. In this situation, solutions such as FLORA could relieve doctors to some extent.
[1] Hussain, A., Ali, S., Ahmed, M., & Hussain, S. (2018). The Anti-vaccination Movement: A Regression in Modern Medicine. Cureus. https://doi.org/10.7759/cureus.2919.
[2] Loomba, S., de Figueiredo, A., Piatek, S. J., de Graaf, K., & Larson, H. J. (2021). Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA. Nature Human Behaviour, 5(3), Article 3. https://doi.org/10.1038/s41562-021- 01056-1.
[3] Kim, S. S., Kaplowitz, S., & Johnston, M. (2004). The Effects of Physician Empathy on Patient Satisfaction and Compliance. Evaluation & the Health Professions, 27, 237– 251. https://doi.org/10.1177/0163278704267037.
[4] Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: A review. CMAJ: Canadian Medical Association Journal = Journal de l'Association Medicale Canadienne, 152(9), 1423–1433.
[5] Thom, D. H., Hall, M. A., & Pawlson, L. G. (2004). Measuring patients' trust in physicians when assessing quality of care. Health Affairs (Project Hope), 23(4), 124–132. https://doi.org/10.1377/hlthaff.23.4.124.
