Platform for Vaccine Dialogue

Through a mixed-methods study consisting of in-depth interviews, focus group discussions, and surveys, the international, interdisciplinary research team engaged HCWs in the design, testing, and evaluation of a digital platform featuring text-based and video-based (face-to-face) interactions. To maximise the potential for HCW engagement - given the polarisation concerning mandatory vaccination and the pressures of this period for them (see first paragraph of Key Points, below) - the researchers chose to use a digital (online) platform to allow HCWs to engage anonymously and asynchronously. At the time of the intervention, offering only a non-text or live platform would have made it extremely difficult to recruit and coordinate with HCWs, given the strain of the pandemic and also the variation in healthcare professions (e.g., their work demands or hours).

First, the team conducted 1-hour in-depth interviews (IDIs) and 2-hour focus group discussions (FDGs) with 74 HCWs from Flanders and Wallonia to understand 3 key topics: their COVID-19 vaccination perceptions and concerns, what they experienced as the atmosphere of vaccine discussions, and what they saw as essential features of a safe space for open dialogue among HCWs.

For rapid benchmarking, 5 prominent text-based social media and instant messaging platforms were selected, based on robustness of features for online dialogue and/or popularity: Facebook groups, Reddit, Discord, Slack, and WhatsApp. Although less widely used in Belgium, Discord offered integration of voice-based and text-based options, as well as the greatest level of anonymity; a feature of Discord that was also valued by the team was that Dutch and French were available as languages in the user's settings. The invitation letter linked to a short orientation video (in both Dutch and French) with basic guidance on how to orient oneself in the platform and where to engage in dialogue.

The Discord server Platform for Vaccine Dialogue was active from January 13 to February 21 2022. To recruit users, the team invited participants from the FGDs and IDIs that had already taken place, and they also issued an open invitation to other HCWs and healthcare institutions. Twelve HCWs anonymously joined the Discord server. To provide food for dialogue in the server, the team conducted social media analysis and posted the results weekly (e.g., sharing a word cloud with the most used hashtags from Belgian Twitter users' vaccination-related tweets that week, both in Dutch and French). As is common with online groups, a smaller subset (five users) actively posted and/or reacted to others. In the Discord server, the research team also announced opportunities for face-to-face dialogue sessions that were prescheduled group video calls, offered separately in Dutch and French. Ten HCWs joined the group video calls during that time, half in each language.

The researchers conducted short, Google form-based, pre- and post-intervention surveys to obtain feedback on how participants experienced different activities in this project. The pre-intervention survey was sent to all participants of the FGDs and IDIs that had already taken place and to all platform users when they joined; there were 53 respondents. After the platform closed, the post-intervention survey was sent to all participants the researchers had contact with throughout the project, not just to platform users; there were 29 respondents (including nine Discord users and five group video call participants). Roughly half of those respondents (15 out of 29) indicated they had participated in at least two project activities (i.e., FDGs, IDIs, text-based platform, group video calls). Among those who had not joined the platform, the most frequently cited reason for non-participation was lack of time.

Immunisation and Vaccines, COVID-19

At the time the project started, there were 1,380,343 confirmed cases of COVID-19 and 26,224 deaths in Belgium, significant for a population of 11.5 million. The national COVID-19 vaccination campaign kicked off on December 28 2020 with a prioritising scheme that began with the residents of nursing homes and HCWs. During the project, polarization (in Belgium and globally) was evident between supporters and opponents of the COVID-19 measures, including vaccination. The Belgian government's proclamation of mandatory vaccination for HCWs occurred just before the start of the study, and this was followed by the last Delta-wave, then the first Omicron-wave, which further burdened HCWs. Later, the deadline for mandatory vaccination was postponed until summer 2022 and then eliminated soon after the study concluded.

The seven members of the research team who were directly involved with participants regularly reflected (individually and collectively) on their experiences throughout the research and intervention design process.

Lessons that emerged included:

1. What dialogue means, entails, and requires can vary for a population and context. (Re)Determine how the population can be (re)engaged in dialogue in an evolving context. For instance, some participants had safety-related concerns that were not only about having anonymity but also about having protection from perceived untrustworthy information. For vaccine-confident participants, a safe space meant being able to block out misinformation or disinformation and knowing that there would be fact-checking of all posts. While vaccine-hesitant participants who leaned toward pro-vaccination valued a text-based platform they could consult for reliable information, the more hesitant participants placed greater value on synchronous dialogue via video-based interactions - in other words, a face-to-face digital platform.
2. The cultivation of open dialogue entails a tension between helping participants voice and overcome their concerns (e.g., about vaccination) and exposing participants to others' ideas that may exacerbate those concerns. This is the paradox of open dialogue that must be adaptively navigated. - Navigating the paradox on the text-based platform included: (i) sharing rules of conduct with users and (ii) closely monitoring the dialogue to address imbalance. For face-to-face dialogue sessions, navigating the paradox meant: (i) excluding the healthcare specialists who had previously "hijacked" the FDGs, which inhibited dialogue and (ii) selecting a professional facilitator who generated dialogue through structured debate.
3. Interactional exchanges (e.g., with peers or experts) that matter to participants may shape the dialogue in terms of its content and form. Uncover what is relevant to participants. - Due to the short duration of the platform, the research team ultimately chose not to engage scientific experts. They believed that doing so could have exacerbated asymmetries in expertise and power, which would have required more time for adaptation, as the notion of an "expert" can vary based on the participant and interaction context.

The team suggests that having a discovery orientation - that is, to work not only inductively and iteratively but also reflexively - is a necessary part of the development of dialogue-based interventions. This case also sheds light on the influences between: dialogue topic/content, socio-political landscape, population, intervention aim, dialogue form, ethics, researcher position, and types of interactional exchanges.