. 2020 Oct 30;22(10):e20113.

doi: 10.2196/20113.

A Web Application About Herd Immunity Using Personalized Avatars: Development Study

Hina Hakim¹, Julie A Bettinger², Christine T Chambers³, S Michelle Driedger⁴, Eve Dubé⁵, Teresa Gavaruzzi⁶, Anik M C Giguere¹, Éric Kavanagh⁷, Julie Leask⁸, Shannon E MacDonald⁹, Rita Orji¹⁰, Elizabeth Parent¹, Jean-Sébastien Paquette¹, Jacynthe Roberge⁷, Beate Sander¹¹, Aaron M Scherer¹², Martin Tremblay-Breault¹, Kumanan Wilson¹³, Daniel Reinharz¹⁴, Holly O Witteman¹

Affiliations

¹ Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada.
² Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
³ Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁴ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada.
⁵ Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada.
⁶ Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy.
⁷ École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada.
⁸ Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia.
⁹ Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
¹⁰ Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
¹¹ University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada.
¹² Department of Internal Medicine, University of Iowa, Iowa, IA, United States.
¹³ Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.

PMID: 33124994
PMCID: PMC7665952
DOI: 10.2196/20113

A Web Application About Herd Immunity Using Personalized Avatars: Development Study

Hina Hakim et al. J Med Internet Res. 2020.

. 2020 Oct 30;22(10):e20113.

doi: 10.2196/20113.

Authors

Affiliations

¹ Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada.
² Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada.
³ Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁴ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada.
⁵ Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada.
⁶ Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy.
⁷ École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada.
⁸ Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia.
⁹ Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
¹⁰ Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada.
¹¹ University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada.
¹² Department of Internal Medicine, University of Iowa, Iowa, IA, United States.
¹³ Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.

PMID: 33124994
PMCID: PMC7665952
DOI: 10.2196/20113

Abstract

Background: Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated.

Objective: This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses.

Methods: Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging.

Results: Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention.

Conclusions: Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.

Keywords: avatar; community immunity; herd immunity; vaccination; vaccine hesitancy; web application.

©Hina Hakim, Julie A Bettinger, Christine T Chambers, S Michelle Driedger, Eve Dubé, Teresa Gavaruzzi, Anik M C Giguere, Éric Kavanagh, Julie Leask, Shannon E MacDonald, Rita Orji, Elizabeth Parent, Jean-Sébastien Paquette, Jacynthe Roberge, Beate Sander, Aaron M Scherer, Martin Tremblay-Breault, Kumanan Wilson, Daniel Reinharz, Holly O Witteman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.10.2020.

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Conflict of interest statement

Conflicts of Interest: KW is the CEO and founder of CANImmunize, a digital immunization platform.

Figures

**Figure 1**
Conceptual frameworks used in this study and their relationship to the outcomes assessed.

**Figure 2**
Human-computer interaction laboratory apparatus.

See this image and copyright information in PMC

References

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A Web Application About Herd Immunity Using Personalized Avatars: Development Study

Affiliations

A Web Application About Herd Immunity Using Personalized Avatars: Development Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical