key: cord-0740506-2dageoa9 authors: Kobayashi, T.; Nishina, Y.; Tomoi, H.; Harada, K.; Tanaka, K.; Matsumoto, E.; Horimukai, K.; Ishihara, J.; Sasaki, S.; Inaba, K.; Seguchi, K.; Takahashi, H.; Salinas, J.; Yamada, Y. title: Corowa-kun: Impact of a COVID-19 vaccine information chatbot on vaccine hesitancy, Japan 2021 date: 2021-05-30 journal: nan DOI: 10.1101/2021.05.26.21257854 sha: 04573f80989afef30ba5daf88639d5038b34fe74 doc_id: 740506 cord_uid: 2dageoa9 Background: Few studies have assessed how mobile messenger apps affect COVID-19 vaccine hesitancy. We created a COVID-19 vaccine information chatbot in a popular messenger app in Japan to answer commonly asked questions. Methods: LINE is the most popular messenger app in Japan. Corowa-kun, a free chatbot, was created in LINE on February 6, 2021. Corowa-kun provides instant, automated answers to frequently asked COVID-19 vaccine questions. In addition, a cross-sectional survey assessing COVID-19 vaccine hesitancy was conducted via Corowa-kun during April 5 to 12, 2021. Results: A total of 59,676 persons used Corowa-kun during February to April 2021. Of them, 10,192 users (17%) participated in the survey. Median age was 55 years (range 16 to 97), and most were female (74%). Intention to receive a COVID-19 vaccine increased from 59% to 80% after using Corowa-kun (p < 0.01). Overall, 20% remained hesitant: 16% (1,675) were unsure, and 4% (364) did not intend to be vaccinated. Factors associated with vaccine hesitancy were: age 16 to 34 (odds ratio [OR] = 3.7, 95% confidential interval [CI]: 3.0-4.6, compared to age [≥] 65), female sex (OR = 2.4, Cl: 2.1-2.8), and history of another vaccine side-effect (OR = 2.5, Cl: 2.2-2.9). Being a physician (OR = 0.2, Cl: 0.1-0.4) and having received a flu vaccine the prior season (OR = 0.4, Cl: 0.3-0.4) were protective. Conclusions: Corowa-kun reduced vaccine hesitancy by providing COVID-19 vaccine information in a messenger app. Mobile messenger apps could be leveraged to increase COVID-19 vaccine acceptance. We tracked the total number of users who accessed and used Corowa-kun from February 6 to April 12, 09 2021. We analyzed how frequently each FAQ was accessed from April 5 to 12, 2021. We did not examine 10 frequency of FAQ access before April 5 because new FAQ messages were added prior to then, and the total 11 number of FAQs changed from the initial content in February. 13 . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2021. ; https://doi.org/10.1101/2021.05.26.21257854 doi: medRxiv preprint Cross-sectional survey accessed Corowa-kun by April 12, 2021 were invited within Corowa-kun to participate in the survey. We did questions: (1) "Are you 16 years old or older?"; (2) "Have you received a COVID-19 vaccine?"; and, (3) "Do 18 you agree to participate?". We included persons ages 16 years old and older who had not received a COVID-19 19 vaccine. Those who agreed to participate received a link to a Google form. Each LINE account could only 20 answer the survey once. The survey was written in Japanese and consisted of 21 questions. To examine attitudes and beliefs 23 regarding COVID-19 vaccines, we included survey items used in similar studies and added our own questions 24 (supplemental document 1). [4] We asked for age, sex, geographic location, educational attainment, 25 employment status, occupation, marriage status, pregnancy status, household members <16 or >64 years old, 26 household size, annual household income, presence of chronic diseases identified as risk factors for severe 27 COVID-19 [21] , smoking status, history of influenza vaccine in the previous season, self-rated overall health 28 (scale from 1 to 9 with 9 being best), history of COVID-19, whether they would like to get COVID-19 29 vaccination once available ("I would like to get the vaccine" = Yes, "I am not sure" = Unsure, and "I do not want 30 to get the vaccine" = No). Geographic locations were combined using the following categories: Hokkaido, Tohoku, Kanto (e.g., Tokyo), Chubu, Kansai (e.g., Osaka), Kinki, Chugoku, Shikoku, Kyushu regions, and 32 outside Japan. [23] We asked why they did or did not want to get COVID-19 vaccines using pre-defined 33 answers with a free-text comment (supplemental document 1, respondents could choose multiple answers). Since we aimed to investigate the impact of Corowa-kun on COVID-19 vaccine hesitancy, we also asked 35 whether there was any change in intent to be vaccinated before and after using Corowa-kun. intended to be vaccinated increased after using Corowa-kun (p < 0.01). Overall, after use of Corowa-kun, 67 80.0% of participants intended to be vaccinated (an increase from 59% before use), 16.4% were not sure, and 68 3.6% did not intend to be vaccinated. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. We created a chatbot to answer COVID-19 vaccine FAQs using the most popular messenger app in Japan. that 66% of participant were willing to be vaccinated against COVID-19 once a vaccine become available. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2021. 25 [32] , we found lower vaccine acceptance among younger people, those with lower income and education 26 attainment, active smokers, those with a history of a vaccine side-effect, and those with poor self-reported 27 health. We also found that healthcare workers other than physicians were not as protective as physicians 28 were; healthcare workers other than physicians had similar hesitancy levels as non-healthcare workers. Shekhar et al. revealed that only 8% of healthcare workers did not plan to get a vaccine. [35] However, 80% of 30 their responders were providers (e.g., physicians, nurse practitioners), which might have influenced the high 31 acceptance in their study. Healthcare workers other than physicians may have a greater COVID-19 risk than 32 physicians do: nurses and respiratory therapists often have more direct and prolonged patient contact. Special 33 attention to non-physician healthcare workers may be needed, and efforts to understand and address their 34 concerns are critical. Furthermore, people unemployed due to COVID-19 had low vaccine acceptance. Though not common, 12% of vaccine hesitant respondents mentioned distrust of the government or municipal 36 authorities. Japan has a lower level of public trust in the national government compared to other countries: 37 only 4% reported that they had "a lot" of trust in the government. CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted May 30, 2021. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted May 30, 2021. ; https://doi.org/10.1101/2021.05.26.21257854 doi: medRxiv preprint A future vaccination campaign against COVID-19 at risk of vaccine hesitancy and 20 COVID-19 Vaccination Intent, Perceptions, and Reasons We thank Chaorong Wu and Patrick Ten Eyck for useful discussions around study design.