Vaccination intention following receipt of vaccine information through interactive simulation vs text among COVID-19 vaccine-hesitant adults during the Omicron wave in Germany

ImportanceHesitancy toward COVID-19 vaccination is a major factor in stagnating uptake rates and in the risk of health care systems becoming overwhelmed.ObjectiveTo compare an interactive risk ratio simulation (intervention) with a conventional text-based risk information format (control) and analyze change in participants’ COVID-19 vaccination intention and benefit-to-harm assessment.Design, Setting, and ParticipantsCross-sectional study conducted online with 1255 COVID-19 vaccine–hesitant adult residents of Germany in April and May 2022, surveyed using a probability-based internet panel maintained by respondi, a research and analytics firm. Participants were randomized to 1 of 2 presentations on the benefits and adverse events associated with vaccination.ExposureParticipants were randomized to a text-based description vs an interactive simulation presenting age-adjusted absolute risks of infection, hospitalization, ICU admission, and death after exposure to coronavirus in vaccinated vs unvaccinated individuals relative to the possible adverse effects as well as additional (population-level) benefits of COVID-19 vaccination.Main Outcomes and MeasuresAbsolute change in respondents’ COVID-19 vaccination intention category and benefit-to-harm assessment category.ResultsParticipants were 1255 COVID-19 vaccine–hesitant residents of Germany (660 women [52.6%]; mean [SD] age, 43.6 [13.5] years). A total of 651 participants received a text-based description, and 604 participants received an interactive simulation. Relative to the text-based format, the simulation was associated with greater likelihood of positive change in vaccination intentions (19.5% vs 15.3%, respectively; absolute difference, 4.2%; adjusted odds ratio [aOR], 1.45; 95% CI, 1.07-1.96; P = .01) and benefit-to-harm assessments (32.6% vs 18.0%; absolute difference, 14.6%; aOR, 2.14; 95% CI, 1.64-2.80; P Conclusions and RelevanceIn this cross-sectional study, vaccine-hesitant adults presented with an interactive risk ratio simulation were more likely to show positive change in COVID-19 vaccination intention and benefit-to-harm assessment than those presented with a conventional text-based information format. These findings suggest that the interactive risk communication format can be an important tool in addressing vaccination hesitancy and fostering public trust.