Teresa Gavaruzzi

Background: The COVID-19 pandemic highlighted the need for practical digital health tools to support informed decision-making amid rapidly evolving evidence and widespread misinformation. Objective: We iteratively developed and refined VaxDA-C19, a bilingual (English and French) web-based patient decision aid designed to support informed decision-making in Canada about COVID-19 vaccination. VaxDA-C19 integrates interactive and personalized features aimed to enhance vaccine confidence, reduce cognitive overload, and respond to diverse informational needs. Methods: VaxDA-C19 was developed using an iterative, user-centered design approach. Throughout the development process, we involved a citizen panel, health care professionals, user experience designers, and scientific experts to guide refinements. We also conducted usability testing sessions with adults in Canada, using semistructured interviews, comparative testing, and think-aloud protocols with thematic analysis. We ultimately conducted 4 design cycles in total with adults in Canada (users) and expert reviewers (experts). Cycle 1 involved 9 people (9 users), cycle 2 involved 22 people (22 users), cycle 3 involved 9 people (3 users and 6 experts), and cycle 4 involved 9 people (9 experts). Results: In cycle 1, user feedback guided design decisions about how to present quantitative information and technical vaccine descriptions more simply. In cycle 2, while most users (9/11, 82%) favored in-depth explanations of vaccine development, a few raised concerns about content that could be perceived as politically charged. Cycle 3 identified usability improvements, including more explicit navigation controls, simplified medical terminology, and optimized interactive components (avatars and sliders). Expert reviews in cycle 4 refined linguistic consistency, mobile responsiveness, content transparency, and scientific accuracy, emphasizing explicit instructional guidance and bilingual accessibility. Conclusions: Our iterative process produced a personalized, bilingual digital decision aid to support evidence-informed, values-congruent decisions about COVID-19 vaccination. A randomized controlled trial will further evaluate VaxDA-C19’s impact on vaccination intentions, knowledge retention, emotional responses, decisional conflict, and decisional regret. If it proves effective, the patient decision aid may also be used as a platform to support other vaccine decisions, namely, influenza, measles, shingles, pertussis, and potentially other emerging infectious diseases.

BACKGROUND Vaccines protect not only individuals but entire communities through a phenomenon called community immunity (herd immunity). However, understanding this concept can be challenging. OBJECTIVE To evaluate the effects of a web-based, personalized avatar intervention conveying the concept of community immunity on risk perception (perceptions of the risk of infection spreading to self, family, community, vulnerable individuals) and cognitive and emotional responses across 4 vaccine-preventable disease contexts: measles, pertussis, influenza, and an unnamed “vaccine-preventable disease.” METHODS Through user-centered design process, we developed a web application, “herdimm,” showing how community immunity works. In herdimm, people personalize a virtual community by creating avatars (themselves, 2 vulnerable people in their community, and 6 others e.g., family members or co-workers.) Herdimm integrates these avatars in a 2-minute narrated animation showing how infections spread with and without the protection of community immunity. The present study was a 2x4 factorial randomized controlled trial to assess herdimm’s effects. We recruited 3883 adults via Qualtrics in Canada who could complete an online study in English or French. We pre-registered our study on Open Science Framework (https://osf.io/hkysb/). The trial ran from March 1 to July 1, 2021. We compared herdimm to no intervention (control) on primary outcome risk perception, divided into objective (accuracy) and subjective (sense of risk), and on secondary outcomes–emotions (worry, anticipated guilt), knowledge, and vaccination intentions–using analysis of variance for continuous outcomes and logistic regression for dichotomous outcomes. We conducted planned moderation analyses using participants’ scores on a validated scale of individualism and collectivism. RESULTS Overall, herdimm had desirable effects on all outcomes. People randomized to herdimm were more likely to score high on objective risk perception (58.0%, 95% confidence interval 56.0%-59.9%) compared to those assigned to the control condition (38.2%, 95% confidence interval 35.5%-40.9%). Subjective risk perception increased from a mean of 5.30 in the control group to 5.54 in the herdimm group (scale 1–7) The application also increased emotions (F(1,3875)=13.13, p<0.001), knowledge (F(1,3875)=36.37, p<0.001) and vaccination intentions (Chi-squared(1)=9.4136, p=0.002). Objective risk perception did not differ significantly by disease context, but subjective risk perception, emotions, knowledge, and vaccination intentions did. Moderation models showed that many findings were moderated by participants’ individualism and collectivism scores. Overall, whereas outcomes tended not to vary by individualism and collectivism among participants in the control condition, the positive effects of herdimm were larger among participants with more collectivist orientations and effects were sometimes negative among participants with more individualist orientations. CONCLUSIONS Prosocial messaging emphasizing collective vaccination benefits may enhance effectiveness among collectivist audiences but could backfire among individualistic individuals. CLINICALTRIAL ClinicalTrials.gov (NCT04787913) Open Science Framework (https://osf.io/hkysb/)

Background: This prospective observational multicenter cohort study aimed to establish the functional outcomes and quality of life (QoL) of patients with rectal cancer who showed a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy and underwent a rectum-sparing approach (watch and wait, WW, or local excision, LE). Materials and Methods: QoL and functional function were investigated using the EORTC QLQ-30, EORTC QLQ-CR29, the MSKCC bowel function instrument, and the FIQL index. Patients filled these questionnaires at the time of enrollment (T1), and 6 (T2) and 12 months (T3) thereafter. Variation over time for each group and comparisons between cCR patients who underwent WW or LE were performed. Results: Of 161 patients who were enrolled, 112 had a cCR (LE n = 50, WW n = 62) and 49 a mCR (all LE). LE patients showed changes after surgery, WW patients showed more gradual changes. LE patients showed reduced anxiety and depression and improved emotional functioning but also an increased fecal incontinence and reduced sexual function in men after surgery. WW patients showed a significant improvement over time in role functioning and anxiety, while their diarrhea and stool frequency progressively reduced. Among patients with a cCR, LE patients showed a significantly higher incontinence compared to WW patients. However, the two groups did not differ in terms of the impact of incontinence on QoL. Conclusion: Functional outcomes and QoL of patients who underwent WW or LE approach generally improve over time, but LE patients also showed some impact of surgery.

Background The COVID-19 pandemic highlighted the need for practical digital health tools to support informed decision-making amidst rapidly evolving evidence and widespread misinformation. Objective We iteratively developed and refined VaxDA-C19, a bilingual (English and French) web-based patient decision aid designed to support informed decision-making in Canada about COVID-19 vaccination. VaxDA-C19 integrates interactive and personalized features aimed to enhance vaccine confidence, reduce cognitive overload, and respond to diverse informational needs. Methods We developed VaxDA-C19 using an iterative, user-centered design approach. Throughout the development process, we involved a citizen panel, healthcare professionals, user experience designers, and scientific experts to guide refinements. We also conducted usability testing sessions with adults in Canada, using semi-structured interviews, comparative testing, and think-aloud protocols with thematic analysis. We ultimately conducted four design cycles in total: three with adults in Canada (cycle 1: n=9 users; cycle 2: n=22 users; cycle 3: n=3 users), one overlapping and one additional cycle with expert reviewers (cycle 3: n=5; cycle 4: n=9). Results In Cycle 1, user feedback guided design decisions about how to present quantitative information and technical vaccine descriptions more simply. In Cycle 2, while most users (82%) favored in-depth explanations of vaccine development, a few raised concerns about content that could be perceived as politically charged. Cycle 3 identified usability improvements, including more explicit navigation controls, simplified medical terminology, and optimized interactive components (avatars, sliders). Expert reviews in Cycle 4 refined linguistic consistency, mobile responsiveness, content transparency, and scientific accuracy, emphasizing explicit instructional guidance and bilingual accessibility. Conclusions Our iterative process produced a personalized, bilingual digital decision aid to support evidence-informed, values-congruent decisions about COVID-19 vaccination. A randomized controlled trial will further evaluate VaxDA-C19’s impact on vaccination intentions, knowledge retention, emotional responses, decisional conflict, and decisional regret. If it proves effective, the patient decision aid may also be used as a platform to support other vaccine decisions, namely, influenza, measles, shingles, pertussis, and potentially other emerging infectious diseases.

Background: New strategies for respiratory syncytial virus (RSV) prevention are available and are in development, but their acceptance is crucial to their effectiveness. Objectives: This systematic review aims to summarize current quantitative and qualitative evidence regarding knowledge and attitudes relating to RSV prevention. Methods: Six databases (PubMed, Scopus, APA PsycArticles; APA PsycInfo; CINAHL Complete; Psychology and Behavioral Sciences Collection) and two preprint repositories (medRxiv and Preprints) were searched up until 23 December 2024 (PROSPERO: CRD42024602351). Results: Sixty-one articles were included, focusing on vaccination for the elderly and adults at risk (n = 10) or pregnant people (n = 24, of which 8 also examined preferences for maternal vs. infant immunization) and infant immunization (n = 27, of which 16 focused on palivizumab, with 6 focusing on adherence to its monthly administration). Eighteen articles assessed attitudes in healthcare professionals. Overall, findings showed limited knowledge and awareness of RSV but generally positive attitudes towards prevention strategies and moderate to high intentions and uptake rates. Protection against the disease and perceived severity promoted acceptance, whereas concerns about side effects hindered it. Maternal vaccination was more acceptable than infant immunization. Conclusions: Attitudes towards RSV prevention options were generally favorable. Should more options become available, preferences may depend on which options are available, their characteristics, and how they are framed and presented. These insights highlight the importance of education on RSV grounded in decision-making literature, while recognizing the likely favorable reception of preventive measures across target age-populations.

Background: To evaluate the effects of a web-based, personalized avatar intervention conveying the concept of community immunity (herd immunity) on risk perception (perceptions of the risk of infection spreading (to self, family, community, and vulnerable individuals)) and other cognitive and emotional responses across 4 vaccine-preventable disease contexts: measles, pertussis, influenza, and an unnamed “vaccine-preventable disease.” Methods: Through a robust user-centered design process, we developed a web application, “ herdimm ,” showing how community immunity works. In our application, people personalize a virtual community by creating avatars (themselves, 2 vulnerable people in their community, and 6 other people around them; e.g., family members or co-workers.) Herdimm integrates these avatars in a 2-minute narrated animation showing visually how infections spread with and without the protection of community immunity. The present study was a 2×4 factorial randomized controlled trial to assess herdimm ’s effects. We recruited 3883 adults via Qualtrics living in Canada who could complete an online study in English or French. We pre-registered our study, including depositing our questionnaire and pre-scripted statistical code on Open Science Framework ( https://osf.io/hkysb/ ). The trial ran from March 1 to July 1, 2021. We compared the web application to no intervention (i.e. control) on primary outcome risk perception, divided into objective risk perception (accuracy of risk perception) and subjective risk perception (subjective sense of risk), and on secondary outcomes–emotions (worry, anticipated guilt), knowledge, and vaccination intentions–using analysis of variance for continuous outcomes and logistic regression for dichotomous outcomes. We conducted planned moderation analyses using participants’ scores on a validated scale of individualism and collectivism as moderators. Results: Overall, herdimm had desirable effects on all outcomes. People randomized to herdimm were more likely to score high on objective risk perception (58.0%, 95% confidence interval 56.0%-59.9%) compared to those assigned to the control condition (38.2%, 95% confidence interval 35.5%-40.9%). Herdimm increased subjective risk perception from a mean of 5.30 on a scale from 1 to 7 among those assigned to the control to 5.54 among those assigned to herdimm . The application also increased emotions (worry, anticipated guilt) (F(1,3875)=13.13, pherdimm were larger among participants with more collectivist orientations and effects were sometimes negative among participants with more individualist orientations. Conclusions: Conveying the concept of community immunity through a web application using personalized avatars increases objective and subjective risk perception and positively influences intentions to receive vaccines, particularly among people who have more collectivist worldviews. Including prosocial messages about the collective benefits of vaccination in public health campaigns may increase positive effects among people who are more collectivist while possibly backfiring among those who are more individualistic.

The present study examined the role of the perception of risks and benefits for the mother and her babies in deciding about the COVID-19 vaccination. In this cross-sectional study, five hypotheses were tested using data from a convenience sample of Italian pregnant and/or breastfeeding women (N = 1104, July–September 2021). A logistic regression model estimated the influence of the predictors on the reported behavior, and a beta regression model was used to evaluate which factors influenced the willingness to become vaccinated among unvaccinated women. The COVID-19 vaccination overall risks/benefits tradeoff was highly predictive of both behavior and intention. Ceteris paribus, an increase in the perception of risks for the baby weighed more against vaccination than a similar increase in the perception of risks for the mother. Additionally, pregnant women resulted in being less likely (or willing) to be vaccinated in their status than breastfeeding women, but they were equally accepting of vaccination if they were not pregnant. COVID-19 risk perception predicted intention to become vaccinated, but not behavior. In conclusion, the overall risks/benefits tradeoff is key in predicting vaccination behavior and intention, but the concerns for the baby weigh more than those for the mother in the decision, shedding light on this previously neglected aspect.