To get vaccinated or not? An investigation of the relationship of linguistic assignment of agency and the intention to obtain the COVID-19 vaccine

Atlantic Journal of Communication ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/hajc20 To get vaccinated or not? An investigation of the relationship of linguistic assignment of agency and the intention to obtain the COVID-19 vaccine Kathryn E. Anthony, Braden Bagley, Elizabeth L. Petrun Sayers & Candace Forbes Bright To cite this article: Kathryn E. Anthony, Braden Bagley, Elizabeth L. Petrun Sayers & Candace Forbes Bright (2021): To get vaccinated or not? An investigation of the relationship of linguistic assignment of agency and the intention to obtain the COVID-19 vaccine, Atlantic Journal of Communication, DOI: 10.1080/15456870.2021.1981329 To link to this article: https://doi.org/10.1080/15456870.2021.1981329 Published online: 06 Oct 2021. Submit your article to this journal Article views: 162 View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=hajc20 ATLANTIC JOURNAL OF COMMUNICATION https://doi.org/10.1080/15456870.2021.1981329 To get vaccinated or not? An investigation of the relationship of linguistic assignment of agency and the intention to obtain the COVID-19 vaccine Kathryn E. Anthony a, Braden Bagleyb, Elizabeth L. Petrun Sayers and Candace Forbes Brightd c , a School of Communication, University of Southern Mississippi, Hattiesburg, Mississippi, USA; bSouthern Utah University, Cedar City, Utah, USA; cRAND Corporation, District of Columbia, USA; dEast Tennessee State University, Johnson City, Tennessee, USA ABSTRACT KEYWORDS Just nine months after the World Health Organization declared the outbreak of SARS-CoV-2 a global pandemic, the Food and Drug Administration granted emergency use authorization (EUA) for the Pfizer-BioNtech and Moderna vaccines in December 2020, followed by EUA for the Johnson & Johnson vaccine in February 2021. Although achieving herd immunity through vaccinations is the greatest hope for ending the pandemic, the COVID-19 vaccination effort has been plagued by misinformation and mistrust. Given the urgency to vaccinate the population, public health officials must construct messages that encourage individuals to obtain the COVID-19 vaccine. The current study examines the impact of linguistic assignment of agency on an individual’s desire to get vaccinated. Guided by the EPPM, participants (N= 296) were randomly assigned to receive either a virus agentic message or a human agentic message. The researchers discovered that the virus agentic message resulted in a greater intention to obtain the vaccine. Further, participants who received the virus agentic message reported a stronger sense of perceived self-efficacy and perceived susceptibility. Additionally, participants who perceived the societal reaction to the pandemic to be appropriate, as well as those who knew at least one person who had died from the virus, were more likely to express an intention to get vaccinated. COVID-19 vaccine; linguistic assignment of agency; message design On December 31, 2019, the Wuhan Municipal Health Commission identified a cluster of pneumonia cases in Wuhan City, Hubei Province of China, and on January 5, 2020, the World Health Organization (WHO, 2020a) published disease outbreak news about the “pneumonia of unknown etiology” (para. 1). Two days later, officials in Wuhan announced the outbreak was a new strain of a 2019 coronavirus or SARS-CoV-2 coronavirus. On January 22, WHO (2020b) authorities reported that the virus was likely spread via human-to-human transmission, and Chinese authorities moved to lockdown Wuhan. By March 7, 2020, when global cases exceeded 100,000 and 3,400 people had lost their lives to COVID-19, the WHO officially declared the outbreak a pandemic (Delgrossi, Morales, Smith, & Uzquiano, 2020). As the COVID-19 pandemic has unfolded, resulting in over 216 million reported cases and 4.5 million deaths worldwide to date (National Public Radio, 2021), the global crisis has demanded an unprecedented and collaborative response from governments and health-related organizations. CONTACT Kathryn E. Anthony anthony.kathryn@gmail.com College Drive, Box 5131, Hattiesburg 39406 © 2021 Atlantic Journal of Communication University of Southern Mississippi, Communication, 118 2 K. E. ANTHONY ET AL. Early in the pandemic, Dr. Anthony Fauci and Dr. Deborah Birx argued that the creation of a COVID-19 vaccine may be the only way for the global community to move beyond the crisis (Fottrell, 2020). In November 2020, several pharmaceutical companies including Pfizer, Inc. in partnership with BioNTech Manufacturing GmbH and Moderna, Inc. announced results indicating a 90% success rate in preventing the spread of COVID-19 (Zimmer, Corum, & Wee, 2020). The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) granted emergency use authorization (EUA) for Pfizer’s vaccine on December 11, 2020 (FDA, 2020a), for all persons 16 and older, followed soon by EUA for the Moderna vaccine on December 18, 2020 (FDA, 2020b). On February 27, 2021, the FDA granted EUA for the Johnson & Johnson vaccine (FDA, 2021a). On August 23, 2021, the Pfizer vaccine became the first vaccine to receive full FDA approval (FDA, 2021b). With the recent surge of cases of the highly contagious COVID-19 Delta variant, public health researchers continue to cite vaccines as the only path out of the global pandemic (Mandavilli, Zimmer, & Robbins, 2021). Unfortunately, vaccine hesitancy has emerged across several subpopulations in the United States. The pause in the dissemination of the Johnson & Johnson (J&J) vaccine damaged the vaccine’s reputation (Kaiser Family Foundation [KFF], 2021). Widespread misinformation related to the age of mRNA technology, vaccine efficacy, the speed of vaccine development and clinical trials, and notions that long-term vaccine side effects could be more detrimental than contracting COVID-19 have harmed vaccination efforts in the United States (CDC, 2021; Most, 2021). Health officials fear that even the full FDA approval of the Pfizer vaccine may not change perceptions among those who are vaccine averse (McCausland & Ortiz, 2021). Some external influences may weigh significantly on individuals’ willingness to get vaccinated. Avril (2020) claimed that knowing people who have become ill or who have died from COVID-19 influences one’s overall perception of the pandemic; these conditions may also affect a person’s desire to get vaccinated. Additionally, there have been vastly different perceptions on whether the COVID-19 crisis has been handled appropriately. For instance, Republicans have been far more skeptical of lockdowns and mask-wearing than have Democrats (Dean, Parker, & Gramlich, 2021). These perceptions may also influence individuals’ vaccination decision. Considering these challenges, strategic message design is especially needed to maximize the likelihood that individuals will accept a COVID19 vaccine (McMahon, 2020). This study aims to understand the ways public health and risk communication messages can encourage individuals to obtain a COVID-19 vaccine. Because getting vaccinated is a personal health choice, strategic message design is essential for increasing vaccination numbers among Americans. Guided by Extended Parallel Processing Model (EPPM), this study explores message characteristics that may motivate individuals to get vaccinated. While policies (e.g., travel restrictions, guidance for social distancing, etc.) and incentives (e.g., product discounts, sweepstakes entry, free merchandise, or cash offers) have motivated some to vaccinate, strategic message design remains foundational for meeting vaccination goals in the United States. Literature review Extended parallel process model When encouraging individuals to engage in healthy behaviors, including vaccination, fear appeals have been employed in behavior-change messages (Popova, 2012; Tannenbaum et al., 2015). According to the Extended Parallel Processing Model (EPPM), an individual’s determination to act when encountering a risk depends on the degree she feels personally threatened by the risk and the perception that she can enact recommendations to mitigate the risk (Cho & Witte, 2005; Witte, 1992). Witte (1992) maintains that for individuals who perceive high threat (and associated fear high) and high efficacy, fear appeals can stimulate adaptive behavior change. One’s appraisal of the perceived efficacy and perceived threat can result in either an acceptance or rejection of the message (Witte, ATLANTIC JOURNAL OF COMMUNICATION 3 Meyer, & Martell, 2001). Although danger control responses are based in perceptions of the recommended response and are distinct from fear control responses, when efficacy beliefs are high, perceptions of threat mediate the interaction of fear emotions and one’s behavior (Ort & Fahr, 2018; Witte, 1994). For example, if an individual experiences a high perception of threat (fear of developing breast cancer) and a high perception of response efficacy (belief that cancer screenings are effective), the EPPM posits she should engage in self-protective behavior (seek more information about mammograms); however, if perceptions of threat or efficacy are low, then the EPPM posits individuals are far less likely to engage in self-protective behavior. The EPPM has been frequently applied in vaccine-uptake studies, including studies on influenza (Cameron et al., 2009; Prati, Pietrantoni, & Zani, 2012), human papillomavirus (HPV) (Krieger & Sarge, 2013; Vorpahl & Yang, 2018), H1N1 (Zhang, Kong, & Chang, 2015), and Hepatitis B (Slonim et al., 2005). When employing the EPPM to study influenza vaccination perceptions among older adults, Cameron et al. (2009) revealed that health communication practitioners must provide patients who cite “a history of good health” with information about how healthy individuals are still at risk (Cameron et al., 2009, p. 324). Similarly, Prati et al. (2012) claimed that practitioners should invoke narratives of other patients because the use of narrative communication helps increase higher risk perceptions, higher perceptions of vaccine efficacy, and increases patient self-efficacy related to vaccination (Prati et al., 2012). Additionally, Krieger and Sarge (2013), argued that fear-appeal prevention messages about genital warts increased college students’ perceptions of self-efficacy, response efficacy, and increased their intention to talk to a doctor about the HPV vaccine (Krieger & Sarge, 2013). Vorpahl and Yang (2018), in researching the HPV vaccine, argued that for a fear appeal to be effective, it must foster perceived susceptibility and severity for a risk among young women. In the context of H1N1, Zhang et al. (2015) found that consuming H1N1 media coverage can provoke negative feelings (i.e., fear) in individuals and ultimately encourage preventive actions against H1N1 (Zhang et al., 2015). Finally, Slonim et al. (2005) advocated for educational efforts focused on fighting Hepatitis B to increase perceived susceptibility, severity, response-efficacy, and self-efficacy among at-risk individuals (Witte, 1992). In the context of vaccines, if individuals believe a disease poses a high threat to them, they will be more motivated to seek information and obtain the vaccine. The importance of message design concerning vaccine uptake cannot be understated (Krieger & Sarge, 2013). Linguistic assignment of agency As effective health messaging is central to public health communication, linguistic assignment of agency affects perceptions of, and response to, health messages (McGlone, Bell, Zaitchik, & McGlynn, 2013). The linguistic agency of assignment literature focuses on the impact of ascribing linguistic action to certain entity(ies) over others (Coppola, McGlone, Girandola, & Camus, 2020; McGlone & Harding, 1998; McGlone & Pfiester, 2009). Dragojevic, Bell, and McGlone (2014) claim that agency can be assigned linguistically to living beings or inanimate objects, concrete or abstract objects or ideas, or things that are natural or artificial. For example, in the message, “genital HPV infects six million Americans each year,” the agency of the message is assigned to HPV while simultaneously conveying passivity of those infected by HPV (Chen, McGlone, & Bell, 2015). Linguistic agency can also be used to indicate responsibility to a threat or to humans. For instance, saying “a virus could infect” gives linguistic agency to the virus, while saying “you could contract” ascribes agency to the message recipient (Bell, McGlone, & Dragojevic, 2014). Scholars using linguistic assignment have assessed the relative impact of human agency versus threat agency, particularly concerning vaccinations. For example, during the H1N1 pandemic prior to the release of the vaccine, Bell et al. (2014) compared the effects of human agency to that of virus agency and found that the “assignment of agency to the virus significantly increased perceptions of threat severity, susceptibility, response efficacy, and vaccination intentions relative to human agency assignment” (p. 3). Like Bell et al. (2014), McGlone et al. (2013) revealed that ascribing agency to the 4 K. E. ANTHONY ET AL. virus in influenza messaging increased perceptions of the severity of the flu and of one’s susceptibility to the flu, and in turn, increased intentions to obtain a flu vaccination. Similarly, McGlone, Stephens, Rodriguez, and Fernandez (2017) revealed that virus agentic messages promoted individuals’ intention to obtain the HPV vaccine. The virus assignment of agency, particularly with vaccination research, has revealed to increase one’s perceived susceptibility to and perceived severity of the threat, ultimately assisting in one’s intentions to seek the recommended behavior (Bell et al., 2014; McGlone et al., 2013). Most recently, Ma and Miller (2020) revealed that COVID-19 virus agentic messages increased an individual’s sense of perceived threat more than human agentic messages; however, the scholars did not apply the linguistic assignment of agency in the context of obtaining the vaccine. Therefore, the current study seeks to extend the literature surrounding linguistic assignment of agency to messages concerning the COVID-19 vaccine. Rationale for current study In combatting the COVID-19 pandemic, public health messages about the vaccine must be designed with precision because the of general misinformation and public hesitancy concerning vaccines (Chou & Budenz, 2020). During a crisis, people typically encounter both trustworthy information and misinformation from various sources, and they must make sense of the often-disparate or contradictory information (Anthony & Sellnow, 2011, 2016; Anthony, Sellnow, & Millner, 2013; Herovic, Sellnow, & Anthony, 2014). Especially on social media forums, individuals “encounter disproportionate negative reporting and images, are more swayed by personal narratives about vaccination’s adverse effects than the science and tend to judge disparate ideas about vaccines as equally valid, regardless of expertise (Brunson et al., 2020, p. 77).” Not only have American adults reported being less willing to obtain the vaccine as compared to adults from other countries (Hsu, 2020), but the longstanding mistrust of the medical community from minority communities has also complicate the COVID-19 vaccine uptake (Smith, 2020). To combat the COVID-19 pandemic, vaccination messages must be designed strategically (Nazione, Perrault, & Pace, 2020). Based on the established body of EPPM literature and linguistic agency scholarship focused on the design of vaccination messages, the following hypotheses and research questions are offered: H1: The message constructs of the EPPM (perceived response-efficacy, self-efficacy, severity, and susceptibility) will significantly predict the desire to get vaccinated. H2: Participants who read the virus agency message will be more likely to indicate that they want to be vaccinated when compared to participants who read the human agency message. RQ1: How does linguistic agency assignment impact the main constructs of the EPPM (perceived responseefficacy, self-efficacy, severity, and susceptibility), and how does that in turn impact the desire to be vaccinated? RQ2a: How does an individual’s perception of the societal response to the COVID pandemic (appropriate/ inappropriate) impact their desire to be vaccinated? RQ2b: How does an individual’s perception of whether they live in an area with a large outbreak of COVID-19 impact their desire to be vaccinated? RQ2c: Does an individual’s experience of having somebody close to them die from COVID-19 impact their desire to be vaccinated? RQ2D: Does an individual’s experience of having somebody close to them test positive for COVID-19 impact their desire to be vaccinated? ATLANTIC JOURNAL OF COMMUNICATION 5 Methods Message design This study was a between-subjects post-study design. Participants were randomly assigned to one of two message conditions in the form of digital fliers or advertisements they might encounter online. Participants either received the virus agentic message or the human agentic message. In the virus agentic message, four statements linguistically attributed agency to the virus in the digital flier (Table 1), including, “Coronavirus will be powerless if a vaccine is found.” In the human agentic message, four statements linguistically attributed agency to the participant, including, “You can beat the Coronavirus if you get vaccinated.” The messages used in the study are included in the Appendix. After reading the message, participants completed a series of posttest measures (Table 2). Participants The scholars recruited participants with the crowdsourcing tool Amazon Mechanical Turk (MTurk). Participants received $1.00 for completing the survey. MTurk has been successful in helping scholars obtain high quality, demographically diverse data that are comparable to data collected with traditional methods (Buhrmester, Kwang, & Gosling, 2011; Sheehan, 2017). The inclusion criteria specified that Amazon MTurk clients had to be at least 18 years of age and reside in the United States. An a priori power analysis was conducted for a two-group, dichotomous experimental design with 90% power and an alpha of 0.01. The results suggested a minimum sample size of 160. After the data were screened (data screening process described below), the final data set consisted of 296 participants. Of the 296 participants, 32.4% were women and 67.6% were men. 72.6% of participants were white, 16.4% were Black or African American, 7.5% were Asian, and 2.7% were American Indian or Alaska Native. Finally, 55.7% were 34 years of age or younger, 32.8% were in between the ages of 35 and 54, and 11.5% were 55 or older. Procedure Prior to data collection, the researchers received IRB approval and collected informed consent from participants. From April 19, 2020, to April 20, 2020, the researchers recruited participants through Amazon M-Turk. Once they agreed to participate, participants accessed the survey through a Qualtrics link. Next, they read a message (either virus agentic or human agentic) intended to persuade them to seek the COVID-19 vaccine. After reading the message, participants completed the survey. The study team required participants to create an original code during the survey. Following survey completion, participants entered their original code into the MTurk assignment webpage. Ensuring the two codes matched in both Qualtrics and MTurk confirmed their participation incentive. The research team verified IP addresses to ensure each participant only took the survey once. Regardless, the researchers still removed several responses in post data collection cleaning. Table 1.. Linguistic assignment of agency manipulations. Agency assigned to COVID-19 “Coronavirus will be powerless if a vaccine is found.” “Coronavirus should be powerless against vaccinated populations because vaccines save an estimated 2–3 million lives per year.” “The Coronavirus will not spread in vaccinated populations” “The Coronavirus cannot overcome the immunity of vaccinated people.” Agency assigned to humans “You can beat the coronavirus if you get vaccinated.” “People who get immunized save an estimated 2–3 million lives per year.” “Vaccinated people will not spread the coronavirus.” “You can gain immunity against the Coronavirus if you get vaccinated.” 6 K. E. ANTHONY ET AL. Table 2. EPPM constructs and desire to vaccinate. Predictor Response-Efficacy Wants Vaccination Does not Want Vaccination Self-Efficacy Wants Vaccination Does not Want Vaccination Severity Wants Vaccination Does not Want Vaccination Susceptibility Wants Vaccination Does not Want Vaccination M SD 5.44 4.53 1.01 1.24 5.14 4.70 1.14 1.30 5.39 4.82 1.23 1.57 4.92 4.55 1.40 1.33 t 5.824 df 294 p .000* 2.549 294 .011* 2.519 293 .014* 1.811 294 .071 This included 35 duplicate responses and 11 responses which suggested a clear lack of focus or effort based on the manipulation checks. Another 19 participant responses were removed from the dataset because they did not take enough time to complete the survey. This resulted in a participant pool of 296. Measures Perceived susceptibility Perceived susceptibility was measured with a modified version of the McGlone et al. (2013) threat susceptibility scale. The instrument consisted of four items on a six-point Likert-type scale ranging from “strongly disagree (1)” to “strongly agree (6).” The scale items included “It is possible that I could be a victim of COVID-19” and “I believe that I could be a victim of COVID-19.” Cronbach’s coefficient alpha for the scale was .860 (M = 19.46, SD = 5.417). Perceived severity Perceived severity was measured with a modified version of the McGlone et al. (2013) threat severity scale. The instrument consisted of four items on a six-point Likert-type scale ranging from “strongly disagree (1)” to “strongly agree (6).” The scale items included “COVID-19 is a serious risk to me” and “COVID-19 is a severe threat to me.” Cronbach’s coefficient alpha for the scale was .833 (M = 20.76, SD = 5.154). Perceived self-efficacy Perceived self-efficacy was measured with a modified version of the McGlone et al. (2013) self-efficacy scale. It consisted of four statements on a six-point Likert-type scale ranging from “strongly disagree (1)” to “strongly agree (6).” Items in the scale included, “When a COVID-19 vaccine is produced, it will be easily accessible to me” and “When a COVID-19 vaccine is produced, I can get vaccinated.” Cronbach’s coefficient alpha for the scale was .832 (M = 20.06, SD = 4.782). Perceived response-efficacy Perceived response-efficacy was measured with a modified version of the McGlone et al. (2013) response-efficacy scale. It consisted of four statements on a six-point Likert-type scale ranging from “strongly disagree (1)” to “strongly agree (6).” Items in the scale included, “I am less likely to die from COVID-19 if I am vaccinated” and “A COVID-19 vaccination will be effective in ending the threat of COVID-19 to me personally.” Cronbach’s coefficient alpha for the scale was .799 (M = 21.09, SD = 4.472) ATLANTIC JOURNAL OF COMMUNICATION 7 Behavioral intent to vaccinate Behavioral intent to vaccinate was measured by one item. “If you had the opportunity to be vaccinated against COVID-19, would you do so?” Participants were asked to respond with “yes (1)” or “no (0)” (M = .811, SD = .392). Perception of the reaction to COVID-19 In assessing individuals’ perception of the national reaction to the COVID-19 pandemic, participants were asked one item: “Do you think the reaction to COVID-19 has been an overreaction (1), underreaction (2), or appropriate reaction (3)?” Data were then divided into two groups including participants who thought the national reaction was appropriate (N = 103, 34.8%) and those who did not think the reaction was appropriate (N = 193, 65.2%) (M = .348, SD = .477). Reside in area with large COVID-19 outbreak numbers In assessing each participant’s area outbreak, they were asked “What best describes the place where you live? A very big outbreak of COVID-19 (1), a moderate outbreak of COVID-19 (2), or a small or no outbreak of COVID-19 (3).” The data were then split into two groups including big outbreak (N = 129, 43.6%) and moderate or small outbreak (N = 167, 56.4%) (M = .436, SD = .497). Relation to a person diagnosed with COVID-19 To determine whether participants knew someone who had been diagnosed with COVID-19, they were asked “Has someone close to you been diagnosed with COVID-19?” Participants were given the option to respond with yes (N = 93, 31.4%), no (N = 203, 68.6%), or I prefer not to disclose (N = 0) (M = .314, SD = .465). Relation to a person who died from COVID-19 To assess whether participants had experienced the death of someone close to them from COVID-19, they were asked, “Has someone close to you died as a result of COVID-19 complications?” Participants were asked to respond with yes (N = 88, 29.7%), no (N = 208, 70.3%), or I prefer not to disclose (N = 0) (M = .297, SD = .458). Results Hypothesis 1 Hypothesis 1 predicted that the message constructs of the EPPM (perceived response-efficacy, selfefficacy, severity, and susceptibility) would significantly predict an individual’s desire to get vaccinated. To address Hypothesis 1, the researchers compared the means of the outcome variable, the desire to vaccinate, with means of each predicting variable (severity, susceptibility, self-efficacy, and response-efficacy) through an independent samples t-test. This hypothesis was partially supported. Three of the four constructs (response-efficacy, self-efficacy, and severity) were revealed to be significant predictors while the fourth (susceptibility) was approaching significance (see Table 1). Hypothesis 2 Hypothesis 2 predicted that participants who read the virus agency message would be more likely to indicate that they wanted to be vaccinated when compared to participants who read the human agency message. To address Hypothesis 2, the means of the outcome variable, desire to vaccinate, were compared using the grouping variable, linguistic agency assignment (human agency and virus agency) using an independent samples t-test. Hypothesis two was supported (t = −2.227, p = .027). Specifically, the mean score for virus agency participants (M = 0.8621, SD = 0.356) was significantly higher than the mean score for human agency participants (M = 0.7616, SD = 0.428). 8 K. E. ANTHONY ET AL. Research questions Binary logistic regression analysis was used to address RQ1 and RQ2a-d. In each case, desire to vaccinate was used as the outcome variable. For RQ1, the researchers conducted two binary logistic regression analyses for each of the predicting variables (severity, susceptibility, self-efficacy, and response-efficacy), including one test using the human-agency group and a second test using the virus agency group. The scholars used the same method for each of the extraneous variables to address RQ2a-d. Research question 1 RQ1 asked how linguistic agency assignment impacts the main constructs of the EPPM (perceived response-efficacy, self-efficacy, severity, and susceptibility) and one’s behavioral intent to be vaccinated. Essentially, if virus agentic language does impact the desire to be vaccinated, what are the perceptions that are being significantly heightened to cause a danger-control response. The binary logistic regression results revealed that perceived self-efficacy and perceived susceptibility were significant predictors for the virus-agency group but not the human-agency group. Specifically, selfefficacy was a significant predictor of desire to be vaccinated for virus-agency message readers (R2 = .107, β = .596, S.E. = .207, p = .004) but not for human-agency message readers (R2 = .010, β = .160, p = .322). Likewise, susceptibility was a significant predictor of desire to be vaccinated for virus-agency message readers (R2 = .087, β = .437, p = .008) but not for human-agency message readers (R2 = .001, β = .045, p = .760). The perceptions of response-efficacy and severity were significant predictors for both groups, but the perceptions of self-efficacy and perceived susceptibility were significant predictors for intent to vaccinate only in the virus agentic group. Research question 2a RQ2a asked how an individual’s perception of the societal response to the COVID pandemic (appropriate/inappropriate) would impact their desire to be vaccinated. Those who perceived the societal reaction to be appropriate reflected a statistically significant desire to be vaccinated (R2 = .031, β = .806, S.E. = .352, p = .022). Those who perceived the societal reaction to be inappropriate reflected a statistically significant desire not to be vaccinated (R2 = .031, β = −.806, S.E. = .352, p = .022). Therefore, individuals who perceived the societal reaction to the COVID pandemic to be appropriate were more likely to have a desire to be vaccinated. Research question 2b The second variable asked whether an individual’s perception of living in an area with a large outbreak of COVID-19 would impact their desire to be vaccinated. The results of the binary logistic regression did not indicate that the perception of living in an area with a large outbreak of COVID-19 was a significant predictor of desiring to be vaccinated (R2 = .010, β = −.408, S.E. = .298, p = .171). Research question 2C The authors wondered if the experience of “having someone close to you die from COVID-19 complications” resulted in an increased desire to get vaccinated by participants. The binary logistic regression results revealed that this variable was a significant predictor of desire to be vaccinated (R2 = .027, β = .125, S.E. = .375, p = .034). Therefore, individuals who had someone close to them die from COVID-19 complications had a significantly higher desire to be vaccinated. ATLANTIC JOURNAL OF COMMUNICATION 9 Research question 2D Finally, the authors wanted to investigate if the experience of “having someone close to you test positive for COVID-19” resulted in an increased desire to get vaccinated by participants. The binary logistic regression revealed that this variable was not a significant predictor of desire to be vaccinated (R2 = .001, β = .166, S.E. = .327, p = .610). Therefore, individuals who had someone close to them test positive for COVID-19 did not have a significantly higher desire to be vaccinated. Discussion The current study sought to determine the most impactful approach to message design when encouraging individuals to seek a vaccination to protect themselves from COVID-19. Guided by the EPPM, the current study offered two messages – a virus agentic and human agentic message – to better understand motivations for seeking vaccination. The first hypothesis predicted that perceived severity, susceptibility, self-efficacy, and response efficacy would predict one’s behavioral intent to seek a vaccination for COVID-19. Three of the four variables behaved according to the theoretical expectations. Participants revealed that the greater their perception of the threat of COVID-19, the more likely they would be to seek a vaccination. Additionally, participants revealed their belief that a vaccine could protect them (response efficacy) and the belief that they could gain access to the vaccine when it became widely available to the public (self-efficacy). Although perceived susceptibility was trending toward significance, this variable did not behave according to the theory. However, there may be some identifiable reasons for this. During data collection in April 2020, stay-at-home guidelines remained in place for most of the United States (excluding essential workers). Most individuals were encouraged to stay home to flatten the curve and slow the spread of the virus (Yeung, Renton, & Picheta, 2020). Although many participants reported that the threat from COVID-19 was real, it is possible because so many individuals stayed home (and thus did not interact with others) they might not have believed that they themselves were susceptible. Additionally, because early reporting and discussion of COVID-19 focused on vulnerable populations including older individuals and those with preexisting medical conditions (i.e., diabetes, hypertension, asthma), participants without such conditions might have felt less susceptible (Clark-Ginsberg & Petrun Sayers, 2020; Whyte & Zubak-Skees, 2020). If individuals stayed home consistently during the time of data collection and did not have health concerns that marked them as particularly “high-risk” for COVID-19, it would make sense that they did not necessarily believe they themselves were particularly susceptible. One of the most important findings of the current study focuses on the linguistic assignment of agency. Between the virus agentic message and the human agentic message, participants were more likely to be interested in seeking vaccination if they received the virus agentic message. This finding is particularly significant as it upholds the previous findings of McGlone et al. (2013) and Bell et al. (2014) in that the virus agentic messages are more effective in increasing an individual’s intention to get the COVID-19 vaccine. Individuals who received the virus agentic messages revealed greater perceptions of susceptibility and self-efficacy as compared to participants who received the human agentic message. Like previous studies assessing behavioral intention to obtain a vaccine, messages focused on the agency and potential harm of the virus increased the perceptions of susceptibility of the group receiving the virus agentic message. Perhaps the most unique aspect of this finding is the virus agentic message increased the perception of self-efficacy. Although several studies tested this relationship (Bell et al., 2014; Chen et al., 2015; Ma & Miller, 2020; McGlone et al., 2013), none to date have produced evidence that linguistic agency assignment has a significant impact on the perception of self-efficacy. However, in the current study, this relationship is present. One possible explanation for this finding could be the increased motivation to protect oneself after reading the message that induced the most fear. The selfefficacy scale focused solely on the respondent’s perception that they could get access to the vaccination once it was available. Participants who were motivated to do so would be less likely to let barriers prevent them from vaccinating. 10 K. E. ANTHONY ET AL. Regardless of the linguistic assignment of agency, perceived severity and perceived responseefficacy were both significant predictors of behavioral intent to be vaccinated. As a result, perceived response-efficacy was a significant predictor of one’s intentions to be vaccinated among both groups. However, the virus agentic message was more effective in increasing participants’ perceptions of their own susceptibility and their perceptions of their own self-efficacy for obtaining the vaccine. Therefore, messages intended to persuade individuals to get vaccinated should be virus agentic as these are the most impactful for encouraging individuals to seek a vaccine. Finally, the results revealed two other conditions which increased intentions to be vaccinated. First, participants reported their perception related to the appropriateness of the reaction to the COVID-19 pandemic. Not surprisingly, the belief that the societal reaction to the pandemic has been appropriate served as a significant predictor of intention to seek vaccination. This finding corresponds with Sandman’s (1993) Outrage Model, where Risk = Hazard + Outrage; the participants who perceived the societal outrage of the virus to be appropriate were more likely to seek vaccination concerning the risk. Alternatively, age and the perception that the individual lived in an area with high numbers of COVID-19 cases did not serve as a significant predictor of one’s intention to vaccinate. Knowing someone who was diagnosed with COVID-19 did not serve as a significant predictor of an intention to be vaccinated. However, if participants had lost someone close to them from COVID-19, this experience significantly predicted individuals’ intentions to get vaccinated. While Americans are constantly reminded of the uptick in deaths and cases related to COVID-19, the death of a someone close to participants resulted in a greater intention to seek the vaccine. It is also likely that the diagnosed acquaintances referenced by the participants had only minor symptoms. Therefore, it shouldn’t be surprising that knowing a diagnosed individual did not have the same impact as knowing an individual that died from COVID-19. Limitations and future directions There are some limitations in the current study. More message elements focused on ensuring that individuals feel appropriately susceptible to the virus would be helpful. The data for this study were collected early in the timeframe of our knowledge of the COVID-19. We now realize more fully the impact this disease can have on healthy persons and the ways in which the disease can affect those without preexisting conditions. The perception of self-efficacy was based solely on the ability of the individual to get vaccinated if they wished to do so. The construct could be measured in other ways (i.e., I can prevent a COVID-19 diagnosis with social distancing and mask wearing). Also, while the linguistic assignment of agency is impactful on perceptions of risk, there may be other message design elements that can enhance participants’ perceptions of the risk of COVID-19, including message framing (gain versus loss). More research is needed to develop messages encouraging individuals to get vaccinated. Additionally, the timing of this study likely impacted our results. Other social and political developments that occurred between the beginning of the pandemic and the availability of the vaccine are likely to have had a strong impact on the perceptions of the COVID-19 vaccination. For example, over time we learned more about barriers various subpopulations (e.g., age, race/ethnicity, gender, etc.) faced as vaccines became more readily available. Certain groups such as Hispanic adults fell behind White adults in vaccination uptake (Hamel et al., 2021). Republicans also emerged as a subpopulation that was most likely to say they would “definitely not” get the vaccine once it was available and free (Hamel et al., 2021). It is outside the scope of this study to conduct subpopulation analyses to understand the impact of how messages resonated with specific groups, however, many of these factors would be expected to impact the effectiveness of COVID-19 messaging. To examine differences between these groups in the future, we would need a larger and more diverse sample to do so. Unfortunately, our sample lacked sufficient representation from Hispanic respondents, and we did not capture participant ideology or political affiliation. However, we believe that the collected data are viable for the purposes of answering the proposed research questions and theory testing. ATLANTIC JOURNAL OF COMMUNICATION 11 Conclusion With the surge of the COVID-19 Delta variant in the United States during the spring and summer of 2021, the need to persuade Americans to vaccinate to stop the spread of COVID-19 has never been greater. Increasing current vaccination rates remains the greatest hope for ending the pandemic (CDC, 2020). Unfortunately, rampant COVID-19 vaccine misinformation and vaccine hesitancy (Chou & Budenz, 2020; Most, 2021) have provided significant complications for public health officials. However, strategically designed persuasive messages that are virus agentic rather than human agentic appear to create a greater perception of severity among the public. Implementing these types of messages into vaccination campaigns from the CDC and state health departments may be critical in moving the needle some for individuals on the fence about getting vaccinated. Disclosure statement No potential conflict of interest was reported by the author(s). ORCID Kathryn E. Anthony http://orcid.org/0000-0002-1375-0121 Elizabeth L. Petrun Sayers http://orcid.org/0000-0001-6796-6350 References Anthony, K. E., & Sellnow, T. L. (2011). Information acquisition, perception, preference, and convergence by Gulf Coast residents in the aftermath of the Hurricane Katrina crisis. Argumentation & Advocacy, 48(2), 81–96. doi:10.1080/ 00028533.2011.11821756 Anthony, K. E., & Sellnow, T. L. (2016). The role of the message convergence framework in medical decision-making. Journal of Health Communication, 21(2), 249–256. doi:10.1080/10810730.2015.1064497 Anthony, K. E., Sellnow, T. L., & Millner, A. G. (2013). Message convergence as a message- centered approach to analyzing and improving risk communication. Journal of Applied Communication Research, 41(4), 346–364. doi:10.1080/00909882.2013.844346 Avril, T. (2020, October 12). Don’t know any COVID-19 patients who have died or been in the hospital? That may explain a lot. The Philadelphia Inquirer. Retrieved from https://www.inquirer.com/health/coronavirus/covid19-know -someone-died-empathy-risk-perception-trump-20201012.html Bell, R. A., McGlone, M. S., & Dragojevic, M. (2014). Bacteria as bullies: Effects of linguistic agency assignment in health message. Journal of Health Communication, 19(3), 340–358. doi:10.1080/10810730.2013.798383 Brunson, E. K., Chandler, H., Gronvall, G. K., Ravi, S., Sell, T. K., Shearer, M. P., & Schoch-Spana, M. (2020). The SPARS pandemic 2025–2028: A futuristic scenario to facilitate medical countermeasure communication. Journal of International Crisis and Risk Communication Research, 3(1), 71–102. doi:10.30658/jicrcr.3.1.4 Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk: A new source of inexpensive, yet highquality, data? Perspectives on Psychological Science, 6(1), 3–5. doi:10.1177/1745691610393980 Cameron, K. A., Rintamaki, L. S., Kamanda-Kosseh, M., Noskin, G. A., Baker, D. W., & Makoul, G. (2009). Using theoretical constructs to identify key issues for targeted message design: African American seniors‘ perceptions about influenza and influenza vaccination. Health Communication, 24(4), 316–326. doi:10.1080/ 10410230902889258 Center for Disease Control and Prevention. (2020, November 24). Benefits of getting a COVID-19 vaccine. Retrieved November 30, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html Center for Disease Control and Prevention. (2021, April 5). Answering patients’ questions about COVID-19 vaccine and vaccination. Retrieved from https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html Chen, M., McGlone, M. S., & Bell, R. A. (2015). Persuasive effects of linguistic agency assignments and point of view in narrative health messages about colon cancer. Journal of Health Communication, 20(8), 977–988. doi:10.1080/ 10810730.2015.1018625 Cho, H., & Witte, K. (2005). Managing fear in public health campaigns: A theory-based formative evaluation process. Health Promotion Practice, 6(4), 482–490. doi:10.1177/1524839904263912 Chou, W. Y. S., & Budenz, A. (2020). Considering emotion in COVID-19 vaccine communication: Addressing vaccine hesitancy and fostering vaccine confidence. Health Communication. doi:10.1080/10410236.2020.1838096 12 K. E. ANTHONY ET AL. Clark-Ginsberg, A., & Petrun Sayers, E. L. (2020). Communication missteps during COVID-19 hurt those already most at risk. Journal of Contingencies and Crisis Management, 28(4), 484. doi:10.1111/1468-5973.12304 Coppola, V., McGlone, M., Girandola, F., & Camus, O. (2020). Persuasive effects of linguistic agency assignment and linguistic markers of argumentation in health messages about an emerging sexually transmitted disease. Journal of Health Communication, 25(1), 33–42. doi:10.1080/10810730.2019.1697398 Dean, C., Parker, K., & Gramlich, J. (2021, March 5). A year of US public opinion on the coronavirus pandemic. Pew Research Center. Retrieved from https://www.pewresearch.org/2021/03/05/a-year-of-u-s-public-opinion-on-thecoronavirus-pandemic/ Delgrossi, S., Morales, C., Smith, J., & Uzquiano, K. (2020, May 12). Defining moments of a global pandemic. CNN. Retrieved from https://www.cnn.com/interactive/2020/health/covid19-pandemic-video-timeline/ Dragojevic, M., Bell, R. A., & McGlone, M. S. (2014). Giving radon gas life through language: Effects of linguistic agency assignment in health messages about inanimate threats. Journal of Language and Social Psychology, 33(1), 89–98. doi:10.1177/0261927X13495738 Fottrell, Q. (2020, April). Anthony Fauci says coronavirus ‘might keep coming back’ year after year – ‘the ultimate game changer in this will be a vaccine.’ Market Watch. Retrieved from https://www.marketwatch.com/story/anthony-faucisays-coronavirus-might-keep-coming-back-year-after-year-the-ultimate-game-changer-in-this-will-be-a-vaccine2020-04-02 Hamel, L., Kirzinger, A., Lopes, L., Sparks, G., Kearney, A., Stokes, M., & Brodie, M. (2021, May 28). KFF COVID-19 vaccine monitor: May 2021. The Kaiser Family Foundation COVID-19 Vaccine Monitor. Retrieved from https://www. kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-may-2021/ Herovic, E., Sellnow, T. L., & Anthony, K. E. (2014). Risk communication as interacting arguments: Viewing the L’Aquila earthquake disaster through the message convergence framework. Argumentation & Advocacy, 51(2), 73–86. doi:10.1080/00028533.2014.11821840 Hsu, T. (2020, November 23). Ad council’s challenge: Persuade skeptics to believe in a COVID vaccine. The New York Times. Retrieved from https://www.nytimes.com/2020/11/23/business/media/ad-council-covid-vaccine-skeptics. html Kaiser Family Foundation. (2021). Does the public want to get a COVID-19 Vaccine? When? The Kaiser Family Foundation COVID-19 Vaccine Monitor. Retrieved from https://www.kff.org/coronavirus-covid-19/dashboard/kffcovid-19-vaccine-monitor-dashboard/concerns/concerns/concerns/barriers Krieger, J. L., & Sarge, M. A. (2013). A serial mediation model of message framing on intentions to receive the human papillomavirus (HPV) vaccine: Revisiting the role of threat and efficacy perceptions. Health Communication, 28(1), 5–19. doi:10.1080/10410236.2012.734914 Ma, H., & Miller, C. H. (2020). The effects of agency assignment and reference point on responses to COVID-19 messages. Health Communication, 1–15. doi:10.1080/10410236.2020.1775439 Mandavilli, A., Zimmer, C., & Robbins, R. (2021, June 29). Three studies, one result: Vaccines point the way out of the pandemic. The New York Times. Retrieved from https://www.nytimes.com/2021/06/28/health/coronavirus-vaccineimmunity.html McCausland, P., & Ortiz, E. (2021, August 24). Vaccine hesitancy unlikely to disappear because of FDA approval. NBC News. Retrieved from https://www.nbcnews.com/health/health-news/vaccine-hesitancy-unlikely-disappear-becausefda-approval-n1277492 McGlone, M. S., Bell, R. A., Zaitchik, S. T., & McGlynn, J. (2013). Don’t let the flu catch you: Agency assignment in printed educational materials about the H1N1 influenza virus. Journal of Health Communication, 18(6), 740–756. doi:10.1080/10810730.2012.727950 McGlone, M. S., & Harding, J. L. (1998). Back (or forward?) to the future: The role of perspective in temporal language comprehension. Journal of Experimental Psychology: Learning Memory and Cognition, 24(5), 1211–1223. doi:10.1037/ 0278-7393.24.5.1211 McGlone, M. S., & Pfiester, R. A. (2009). Does time fly when you’re having fun or do you? Affect, agency, and embodiment in temporal communication. Journal of Language and Social Psychology, 28(1), 3–31. doi:10.1177/ 0261927X08325744 McGlone, M. S., Stephens, K. K., Rodriguez, S. A., & Fernandez, M. E. (2017). Persuasive texts for prompting action: Agency assignment in HPV vaccination reminders. Vaccine, 35(34), 4295–4297. doi:10.1016/j.vaccine.2017.06.080 McMahon, M. (2020, November 23). Coronavirus: Is vaccine skepticism the next hurdle to overcome in the fight against COVID-19? Euro news. Retrieved from https://www.euronews.com/2020/11/23/coronavirus-is-vaccine-scepticismthe-next-hurdle-to-overcome-in-the-fight-against-covid-1 Most, D. (2021, August 13). Myths vs facts: Making sense of the COVID-19 vaccine misinformation. Boston University: The Brink. Retrieved from https://www.bu.edu/articles/2021/myths-vs-facts-covid-19-vaccine/ National Public Radio. (2021). Coronavirus world map: We’ve now passed the 200 million mark for infections. Retrieved from https://www.npr.org/sections/goatsandsoda/2020/03/30/822491838/coronavirus-world-map-tracking-thespread-of-the-outbreak ATLANTIC JOURNAL OF COMMUNICATION 13 Nazione, S., Perrault, E., & Pace, K. (2020). Impact of information exposure on perceived risk, efficacy, and preventative behaviors at the beginning of the COVID-19 pandemic in the United States. Health Communication. doi:10.1080/ 10410236.2020.1847446 Ort, A., & Fahr, A. (2018). Using efficacy cues in persuasive health communication is more effective than employing threats–An experimental study of a vaccination intervention against Ebola. British Journal of Health Psychology, 23 (3), 665–684. doi:10.1111/bjhp.12310 Popova, L. (2012). The extended parallel process model: Illuminating the gaps in research. Health Education & Behavior, 39(4), 455–473. doi:10.1177/1090198111418108 Prati, G., Pietrantoni, L., & Zani, B. (2012). Influenza vaccination: The persuasiveness of messages among people aged 65 years and older. Health Communication, 27(5), 413–420. doi:10.1080/10410236.2011.606523 Sandman, P. M. (1993). Responding to community outrage: Strategies for effective risk communication. American Industrial Hygiene Association: Fairfax, VA. Sheehan, K. (2017). Crowdsourcing research: Data collection with Amazon’s Mechanical Turk. Communication Monographs, 85(1), 140–156. doi:10.1080/03637751.2017.1342043 Slonim, A. B., Roberto, A. J., Downing, C. R., Adams, I. F., Fasano, N. J., Davis-Satterla, L., & Miller, M. A. (2005). Adolescents’ knowledge, beliefs, and behaviors regarding hepatitis B: Insights and implications for programs targeting vaccine-preventable diseases. Journal of Adolescent Health, 36(3), 178–186. doi:10.1016/j. jadohealth.2004.08.002 Smith, E. D. (2020, November 29). ‘Why won’t black folks trust us’ on COVID-19? These doctors and nurses have answers. Los Angeles Times. Retrieved from https://www.latimes.com/california/story/2020-11-29/coronavirusvaccine-covid-black-doctors-nurses-racism-healthcare Tannenbaum, M. B., Hepler, J., Zimmerman, R. S., Saul, L., Jacobs, S., Wilson, K., & Albarracín, D. (2015). Appealing to fear: A meta-analysis of fear appeal effectiveness and theories. Psychological Bulletin, 141(6), 1178. doi:10.1037/ a0039729 U.S. Food and Drug Administration. (2020a, December 11). FDA takes key action in fight against COVID-19 by issuing emergency use authorization for first COVID-19 vaccine. FDA News Release. Retrieved from https://www.fda.gov/ news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-useauthorization-first-covid-19 U.S. Food and Drug Administration. (2020b, December 18). FDA takes additional action in the fight against COVID-19 by issuing emergency use authorization for second COVID-19 vaccine. FDA News Release. Retrieved from https:// www.fda.gov/news-events/press-announcements/fda-takes-additional-action-fight-against-covid-19-issuingemergency-use-authorization-second-covid U.S. Food and Drug Administration. (2021a, February 27). FDA issues emergency use authorization for third COVID-19 vaccine. FDA News Release. Retrieved from https://www.fda.gov/news-events/press-announcements/fdaissues-emergency-use-authorization-third-covid-19-vaccine U.S. Food and Drug Administration. (2021b, August 23). FDA approves first COVID-19 vaccine. FDA News Release. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine Vorpahl, M. M., & Yang, J. Z. (2018). Who is to blame? Framing HPV to influence vaccination intentions among college students. Health Communication, 33(5), 620–627. doi:10.1080/10410236.2017.1289436 Whyte, L., & Zubak-Skees, C. (2020, April 1). These charts show who’s most vulnerable to the coronavirus. Center for Public Integrity. Retrieved from https://publicintegrity.org/health/coronavirus-and-inequality/pre-existing-inequality -could-make-coronavirus-hit-some-harder/ Witte, K. (1992). Putting the fear back into fear appeals: The extended parallel process model. Communications Monographs, 59(4), 329–349. doi:10.1080/03637759209376276 Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model (EPPM). Communications Monographs, 61(2), 113–134. doi:10.1080/03637759209376276 Witte, K., Meyer, G., & Martell, D. (2001). Effective health risk messages: A step-by step guide. Thousand Oaks, CA: Sage. World Health Organization. (2020a, January 5). Pneumonia of unknown cause - China. Disease Outbreak News. Retrieved from https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/ World Health Organization. (2020b, April 27). WHO Timeline – COVID-19. World Health Organization Newsroom. Retrieved from https://www.who.int/news-room/detail/27-04-2020-who-timeline—covid-19 Yeung, J., Renton, A., & Picheta, R. (2020, April 24). April 24 coronavirus news. CNN. Retrieved from https://www.cnn. com/world/live-news/coronavirus-pandemic-04-24-20- intl/index.html Zhang, L., Kong, Y., & Chang, H. (2015). Media use and health behavior in H1N1 flu crisis: The mediating role of perceived knowledge and fear. Atlantic Journal of Communication, 23(2), 67–80. doi:10.1080/15456870.2015.1013101 Zimmer, C., Corum, J., & Wee, S. (2020, December 2). Coronavirus vaccine tracker. The New York Times. Retrieved from https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html 14 K. E. ANTHONY ET AL. Appendix Virus agentic Message Human agentic Message