Changing Entrenched Health Beliefs Is Not Impossible

4 min read

April 18, 2024 – Turns out it’s not a Sisyphean task – or at least not impossible, like trying to roll a large boulder up a steep hill over and over again. Some people with deep-rooted beliefs on a wide range of health topics – from COVID vaccination to mental health stigma to foods including genetically modified organisms – could be persuaded to rethink their positions. 

But how you deliver the message is as important as what you’re saying, new evidence suggests. 

A traditional public health message like "Get vaccinated. It’s good for your health and the health of others" typically does not persuade large numbers to change their minds right away. It could be one reason that the CDC reports that only 23% of Americans received the most recent COVID booster shot. 

In contrast, having someone who used to resist COVID vaccination explain why, in their own words – and explain what happened to make them change their minds – made some people rethink their attitudes in a study. 

These were not people “on the fence” about getting the vaccine. Years into the COVID pandemic, unvaccinated people “likely have some pretty entrenched views,” said lead researcher Jeff Conlin, PhD, an assistant professor of journalism and mass communications at the University of Kansas in Lawrence. “And we still saw success.”

These “two-sided conversion messages” help because people first relate to the person with the resistant attitude, Conlin said. Then they are more open to hearing why the person made the switch and got vaccinated. Authenticity also counts – it works best when people telling the story have lived experience. 

Conlin and colleagues compared 384 unvaccinated adults given either a conversion message or a one-sided story from someone who always intended to get vaccinated. The strongest reduction in hesitancy was among the most vaccine-resistant people given the conversion stories. The full study was published online in December 2023 in the journal Health Communication.

And it's not just about embracing of new kind of thinking, Conlin noted. These messages also help people “realize that their prior beliefs were maybe misinformed or misguided.”

Conversion messages also could influence other widely held health beliefs. “We're just starting to take a look at testing conversion messages with mental health stigma,” Conlin said. The goal is to test the strategy using a very specific story about someone who used to be against counseling, treatment, and support services for anxiety or depression, for example, and why they later changed their mind.

Another study looked at how conversion messages influence attitudes about another controversial topic – genetically modified crops. In contrast to the study by Conlin and colleagues, these researchers found it was the strength of the message that mattered the most. They concluded that stronger messages could lead to more durable changes in attitudes. The study was published in April 2019 in the Public Understanding of Science journal. 

Give People a Choice?

Just giving people a choice on the brand of COVID vaccine could also increase uptake, according to research findings from University of Oregon researchers published this month in the Journal of Applied Research in Memory and Cognition

“People get pleasure from choosing,” said Ellen Peters, PhD, study author and director of the Center for Science Communication Research at the University of Oregon School of Journalism and Communication in Eugene. “People feel empowered if they’re given a choice and, as a result, like the option they chose more than if they didn’t have the chance to make the decision themselves.”

In multiple studies, people were more willing to get vaccinated for COVID if they were allowed to choose between Pfizer and Moderna, for example, than when they were assigned to one of them, said Peters, who is also a professor of psychology at the university. 

“COVID presented an unusual situation for vaccines. For the first time, we had multiple vaccine brands that people could and did talk about," she said. “I also think the tactic may work anytime multiple options are available [such as] Tylenol versus Advil, different screening options for colorectal or other cancers, or choice of surgery versus medication." 

Conlin added, “What we want to do is [study] conversion messages in other diseases. That’s the goal.” 

Maybe Combine Strategies?

When asked for her take on Conlin’s study and two-sided messaging, Peters said, ”It’s a great idea to test with vaccines, and I’m glad they did it.”

“It would be interesting to pair their approach with ours,” Peters continued. The tactic she studied worked on people who had been vaccinated before and were considering a booster, as well as on unvaccinated people. 

“Might combining their approach and ours increase further the number of people intending to vaccinate, particularly among those who are vaccine-hesitant?” she asked.