Visual narratives emphasizing communal benefits boost COVID-19 vaccination rates

In a recent study published in the journal PNAS Nexus, researchers performed a three-wave online panel survey across 50 states in the United States of America (USA) and Washington D.C. in 2021 to test the influence of visual narrative-based policy communication messages on people's attitudes and behavior towards coronavirus disease 2019 (COVID-19) and benefits of COVID-19 vaccination.

They aimed to advance the science of narrative risk communication about COVID-19 vaccination by developing an understanding of the influence of the message structure via a visual platform of risk messaging.

In addition, they assessed the effects of specific narrative mechanisms (character selection), moderation effects of political ideology, and mediation effects of affective response & motivation to vaccinate on COVID-19 vaccine uptake behavior. More importantly, they evaluated how covariates, such as risk perception, COVID-19 & vaccination history, and demographics, affected mediator, moderator, and outcome variables.

Study: Visual policy narrative messaging improves COVID-19 vaccine uptake. Image Credit: CDC


In times of crisis, such as the COVID-19 pandemic, how messages influencing risk reduction behavior (e.g., getting vaccinated) were conveyed was crucial. In fact, there is always this need to identify the specific narrative mechanisms that lead to greater persuasion.

About the study

In the present study, researchers distributed a panel survey experiment to 3,900 US citizens in 2021, recruited from several sources, e.g., gaming sites, social media, and targeted email lists, to name a few.

The team randomly assigned survey respondents to one of the four experimental conditions in T1 launched between January 11 and February 3, 2021. Two months later, at T2, they measured vaccine behavior (Y1) as the outcome variable.

Four experimental conditions comprised three visual policy narrative messages (or treatment conditions) – protect yourself, your circle, and your community, and a non-narrative message (control condition), viz., get the vaccine. They tested the narrative mechanism of character selection in the treatment conditions. Likewise, they measured all covariates in T1 before exposure to experimental conditions.

The team conducted two analyses.

In analysis 1, they assessed the overall effect of narrative risk messages (Xi) on vaccination (Y1), moderated by political ideology (W), controlling for all covariates. Importantly, risk perception was not used as a mediating variable in the model, as the risk perception surrounded the impacts of getting the coronavirus, not the COVID-19 vaccine.

The second analysis was a moderated serial mediation analysis with conditional effects. It tested the mediation effects of message conditions (Xi) through affective response (M1) and motivation to vaccinate (M2) on vaccine behavior at T2 (Y1), both as individual mediators and as serial mediators controlling for all covariates.

The team measured M1 and M2 immediately after respondents were exposed to the message conditions during T1 using a seven-point scale from "extremely negative" to "extremely positive" and another seven-point scale from "not at all" to "a great deal," respectively.

They also measured political ideology, a potential moderator (W), on a seven-point scale, where lower numbers indicated stronger conservative beliefs and higher numbers hinted at firmer liberal beliefs. The researchers used a regression-based moderated mediation model called Hayes PROCESS macro to analyze visual policy narratives' total, mediation, and moderation effects on COVID-19 vaccination behavior.


First and foremost, the current study confirmed that narrative-based risk messages are more powerful than non-narrative ones regarding influencing the COVID-19 vaccine uptake. In addition, all three narrative conditions tested in this study had substantial conditional effects on vaccine uptake behavior than the control condition.

Importantly, the narrative structure also strongly influenced people's decision-making. Thus, risk communication practitioners and researchers should craft narrative-based risk messages with characters rather than a moral or directive. Furthermore, risk messaging motivating behavior with communal benefits, i.e., protect your circle, was far more effective in increasing vaccine uptake.

Another significant discovery of this study was that the pathway of influence of risk message to risk mitigation behavior was non-linear, highlighting the need for more accurate models explaining the direct effects of risk communication on behavior.

A risk message that generated a positive affective response resulted in higher motivation to vaccinate, which subsequently led to higher COVID-19 vaccination behavior eight weeks later. Thus, an effective risk communication message had to first trigger the audience's attention via augmenting affective response, which later activated an intention to act. Given the progressive politicization of COVID-19 vaccines in the U.S., the researchers tested whether the moderation of political beliefs influenced COVID-19 vaccine behavior.

The researchers noted that political beliefs did not have a widespread moderating effect potentially because at the time of the study, i.e., between February and April 2021, individual perceptions and intentions about the COVID-19 vaccine uptake were in their formative stage.

It is also noteworthy that conservative participants considered themselves less susceptible to the risk of COVID-19 than liberals, thus, entirely neglected the message to get the vaccine. More importantly, conservatives accepted COVID-19 vaccination with messages fixated on "protecting the circle" than "protecting yourself" messaging.

Since conservatives are considered more individualistic, it was a surprising revelation. However, it highlighted the need for messages focused on the communal benefits of COVID-19 vaccinations than messages strictly raising individual concerns.

In this study, the researchers positioned risk perception as a covariate and partitioned it into two distinct dimensions, likelihood and severity. They operated independently along different conditional pathways but not in a harmonious fashion. The perception of severity triggered higher affective responses, whereas the perception of the likelihood of contracting COVID-19 motivated people to get the vaccine; however, none directly affected risk reduction behavior.

Finally, in the context of graphic communication, risk messaging must use efficient visual avenues for spreading and sharing information and adequately influence risk reduction behavior, as desired.


To conclude, stories elevate the human experience and shape how we perceive the world and our history, and, eventually, make decisions that affect us and the community. Moreover, the emergence of social media and graphic communication has highly augmented the importance of storytelling through novel and complex pathways for spreading information.

The current study showed that visual narrative risk communication was highly effective at encouraging COVID-19 risk mitigation behavior. As different narratives differentially impacted their audiences, thus, using narrative mechanisms that enhanced narrative power could elevate public health communication and, subsequently, people's behavior regarding COVID-19 vaccine uptake.

Journal reference:
  • Visual policy narrative messaging improves COVID-19 vaccine uptake, Elizabeth A Shanahan, Rob A DeLeo, Elizabeth A Albright, Meng Li, Elizabeth A Koebele, Kristin Taylor, Deserai Anderson Crow, Katherine L Dickinson, Honey Minkowitz, Thomas A Birkland, Manli Zhang, PNAS Nexus 2023, DOI:,

Posted in: Child Health News | Men's Health News | Medical Research News | Women's Health News | Disease/Infection News

Tags: Coronavirus, Coronavirus Disease COVID-19, Pandemic, Public Health, Vaccine

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Written by

Neha Mathur

Neha is a digital marketing professional based in Gurugram, India. She has a Master’s degree from the University of Rajasthan with a specialization in Biotechnology in 2008. She has experience in pre-clinical research as part of her research project in The Department of Toxicology at the prestigious Central Drug Research Institute (CDRI), Lucknow, India. She also holds a certification in C++ programming.

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