“At the interpersonal level, people can help to normalize vaccination as the standard among their friends and family–not by lecturing or hectoring, simply by openly sharing that they themselves are vaccinated. Health care providers also have a role to play in de-sensationalizing the issue and making discussions about COVID vaccination a more routine part of their standard practice.

Even as the U.S. looks forward to a summer of possibility, the true end of COVID is still a long way off. The virus will continue to evolve, perhaps in unpredictable ways.

Science has done the heavy lifting to create an extraordinarily effective vaccine; it will take individuals adapting to social norms to keep those defenses working.”

Stefanie Demetriades is a communications researcher.

She shares her story and discusses her KevinMD article, “Done with COVID? Not so fast.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at kevinmd.com/rate. Subscribe at kevinmd.com/follow. Today on the show, Stefanie Demetriades. She is a communications researcher, and she wrote the KevinMD article “Done with COVID? Not so fast.” Stefanie, welcome to the show.

Stefanie Demetriades: Thank you so much. It’s a pleasure to be here.

Kevin Pho: So we’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Stefanie Demetriades: Yeah, so as you said, I’m a communication researcher at Northwestern University, and there I’m part of the COVID Vaccine Communication and Evaluation Network, what we call CoVAXCEN, which is this really fascinating group of scientists, immunologists, epidemiologists, health industry people, and also communication people who are studying how best to advocate for COVID vaccination. And I think, like so many people, we came to COVID sort of half prepared, with all kinds of insights and ideas from our research. And then suddenly it was all put to the test under very high-pressure and high-stakes circumstances with COVID. So it’s been an exhausting and exciting time to be a health communication researcher, for sure.

Kevin Pho: So health communication has been at the forefront, and there are so many aspects of this, but I’m interested in hearing from your lens. What would you say are some of the biggest issues when it comes to health care communication during the pandemic era?

Stefanie Demetriades: Yeah, I think, again, there have been so many incredible advances in terms of the science and the vaccines, specifically with COVID. And what we see is that at the end of the day, whether or not it succeeds or fails really comes down to how people behave, the social behavior within our communities. And so much of that is dependent on communication, and that’s communication writ large: how we talk with each other, how we talk with experts, and how we make sense of what’s going on in the world.

And when I was thinking about this article, what really triggered it was that I wrote it at a time when mask mandates were starting to be lifted. So suddenly we no longer had the clear requirements to wear masks in public places. But what you saw, and I think what so many of us, including myself, experienced, was that we would walk into a coffee shop or a grocery store, and there’s this moment where you look around and sort of see, “Well, how many other people are wearing masks? What’s the vibe here? What’s normal in this context?” And then if it seems like most people are wearing masks, then you pull out your mask and you put it on. And if it seems like most people are not, then people are less likely to wear masks.

And as a communication researcher, that was such a clear, tangible illustration of what we call normative influence, which is that at the end of the day, even when our health is at stake, and even when in some cases it’s life or death, so many of our decisions come down to this really basic question of “What’s everybody else doing?” So again, we talk about normative influence in these two key pieces: What do we think other people like us are doing? And also, what do we think that people we admire and respect would want us to do? Often that becomes more salient and more powerful than the facts of the vaccine, and that’s what I was trying to get at in this piece.

Kevin Pho: And that piece is titled “Done with COVID? Not so fast.” So talk more about your research about normative influence. That almost sounds like peer pressure to me.

Stefanie Demetriades: Peer pressure is, I guess, the negative side of the coin, and one way to think of it. The truth is, it’s one of these cognitive tricks that we have to make sense of the huge amount of information that we’re encountering. And in contexts like COVID, when there’s just so much uncertainty and so much information that’s constantly changing, we look for these mental shortcuts to figure out what’s appropriate, what’s useful, and what’s helpful behavior. And that’s true of all sorts of things, all kinds of behaviors, health and otherwise.

But when it comes to a context like COVID, it means that a lot of the decisions that we’re making are based, as I said, not on the objective facts and these lists of recommendations from the CDC, but on “What’s my neighbor doing? What are my friends doing? What are my coworkers doing?” These kinds of heuristic shortcuts really are very powerful in shaping what we think is best for us to do, because otherwise it’s just too much information to process.

Kevin Pho: So knowing the influence of normative influence, is there anything that health care policy experts and health care communicators can do better to help communicate the message?

Stefanie Demetriades: Yeah, absolutely. I think one of the things that’s really important to remember about social norms and normative influence is that they’re created socially, right? They’re social norms. We construct those through the way we talk about things like vaccines and our behaviors. So what we can do, in terms of ordinary people and also clinicians, is just reestablish vaccination as the norm. And that doesn’t mean getting into fights with anti-vaxxers. It can really make a difference simply to talk about vaccination as the standard, rather than as a more controversial, opt-in, opt-out kind of topic that emphasizes the political frame that we so often hear. If we instead focus on the fact that the vast majority of people are already vaccinated, and talk about the fact that so many people have been vaccinated, so many people are protected, and so many people have had these good outcomes, then that becomes more simply the way things are done, rather than a point of controversy or hesitation. So clinicians can definitely help in terms of talking to their patients, again, just emphasizing that vaccines are the norm and the standard.

And then the other piece is that if there’s a single consistent message from decades and decades of health communication research, it’s that facts alone aren’t enough. So clinicians building trust with their patients and helping them figure out their own reasons for getting vaccinated is really important. For some people, that might be keeping elderly relatives safe. For other people, it might be going to a concert or getting back out in the world, whatever it is. Clinicians can really help to make the argument that getting vaccinated is the best way to achieve those aims.

Kevin Pho: So one thing that you mentioned earlier was how everything was politicized, and of course, I’m no stranger to that. I see that every day in my clinic, everywhere from people debating the severity of COVID to the vaccines to masking, and I’m sure you encounter this all the time too. Depending on where you live in the country, and depending on one’s political affiliation, people may have different norms compared to someone who lives somewhere else in the country. So how do you convince someone who sees this politically and is perhaps consuming media that supports their worldview? How do you reach across that aisle and try to convince them of, say, vaccines and masking, for instance?

Stefanie Demetriades: Yeah, as we’ve seen again and again, I think that has been one of the biggest challenges of this pandemic in the vaccination effort. And you’re right, of course: Social norms are different in different contexts, and in certain areas of the country, in certain political circles, the norm seems to be to be unvaccinated. Now, there are a couple of things that we can do in a case like that.

First, I think, again, it’s important to emphasize how common vaccination actually is. One of the things that’s interesting about people who aren’t vaccinated is that they tend to overestimate the percentage of the population that is also unvaccinated. So we can help to correct the baseline by saying, “No, actually, more than 70 percent of the U.S. population is now vaccinated.” That can really help to shift, again, the broader norms in terms of what they think is standard. If they only talk to the 15 people in their immediate circle and none of those people are vaccinated, that can skew their perception of the broader picture. So we can help to reset the broader baseline by talking about the larger trends in the country, in the state, in the world, even.

Now, the other key piece: You may remember that I said normative influence comes down to “What are other people doing?” but also “What do people I respect, and whose opinions I care about, want me to do?” So when it comes, again, to people who are in contexts where vaccination is not as prevalent, pulling out a couple of key examples of role models or people with influence who have been vaccinated and have credibility and clout within that community can make a big difference. We see spikes when people like Dolly Parton, who is universally loved across partisan divides, get vaccinated. So if we can get these kinds of public figures and public leaders to more explicitly and positively emphasize vaccines, that will make a big difference as well. So again, it’s these two pieces: the bigger picture, and then finding the individual people and the individual reasons that will sway a particular person’s decision.

Kevin Pho: Now, we always focus on what people do wrong when it comes to health care communication, but I want to flip that. Can you share a case study where health care communication was done successfully to sway people’s minds?

Stefanie Demetriades: Yeah, there have been plenty of examples, in the real world and also in health communication research, of how creating space for people to make their own health decisions can really be effective. What we’ve found, for instance, is in talking to pregnant women about their concerns with vaccination. If you approach that conversation as “That’s ridiculous. This is all misinformation. You just need to get vaccinated,” that can create a whole lot of defensiveness and resistance. If, however, clinicians and health communication researchers approach that same question from a place of perspective-taking and empathy, and you come instead from “It makes absolute sense that you’re concerned about your health and the health of your baby. Fortunately, we have an answer in the vaccine,” and approach it from that positive perspective, then we see much more productive results and conversations.

Kevin Pho: Stefanie, I want to switch gears and talk about the impact of social media, because I’ve been involved with the health care social media space for a little bit now, but I’m interested in hearing from your perspective. What is the impact of social media on health care communications?

Stefanie Demetriades: Yeah, social media. I mean, we’re dealing with this very tangled, very thorny complication in all sorts of contexts. The challenge with health, as you and I’m sure your listeners well know, is that there’s so much information related to health on social media, and because it doesn’t get filtered, and because the guy next door has the same kind of platform as a CDC health expert, these cues that we typically use for who’s credible and who’s not get lost. And that’s a real double-edged sword.

And I think it fits very well with the idea of normative influence, because social media can really skew our perceptions of what’s normal, especially because misinformation and negative stories get so amplified on social media. Those are the stories that tend to get shared more. Those are the stories that get more likes and clicks and that we see more. That can really skew the perception of what’s normal and what’s standard. So you see many more of the horror stories of vaccine side effects, rather than the millions and millions of uneventful stories that just aren’t as much fun to read.

So one of the things that we’re really grappling with as a society, and certainly in health communication research, is how we use that double-edged sword of social media to our advantage. Because the same mechanisms of feeling like you can have a direct connection with someone and talking to peers who you can trust, those same affordances of social media, can be really helpful. So one of the things that we’re working on now, actually, with some colleagues at Northwestern, is putting together social media-specific campaigns that are tailored to specific populations on social media, so that you’re reaching people where they are and where they’re most likely to encounter misinformation in the first place.

Kevin Pho: We’re talking to Stefanie Demetriades. She is a communications researcher, and she wrote the KevinMD article “Done with COVID? Not so fast.” Stefanie, from your perspective as a health care communications researcher, what do you think are some of the lasting lessons from the pandemic?

Stefanie Demetriades: I think what’s been so remarkable, for better or for worse, is how resilient people are. I mean, this has been a very long and very devastating slog, and it’s incredible to see how people are able to build that resilience and continue on with their lives. That is what’s going to save us at the end of the day, but it’s also a real challenge in terms of keeping people attentive and keeping levels of complacency down, because we are so ready to get back to normal. It can be a challenge to continually remind people that we are in a dangerous and fraught context. And that, again, is where simply making things the norm, by talking about vaccination and masking and preventive behaviors as standard behavior rather than a temporary fix, is really going to help us down the line as we work through the longer-term evolution of this pandemic.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Stefanie Demetriades: The science has done a lot to protect us from COVID-19. The vaccines are an incredible bit of medical magic. What needs to happen now is that people need to step up in their own communities and in their families, in terms of taking that across the finish line and making that science work in terms of their social interactions and their health behaviors. So talk about vaccines. Share the fact that you’re vaccinated. You don’t need to fight about it. Just continually share the fact that vaccines are safe, effective, available, and our best protection against COVID-19.

Kevin Pho: Stefanie, thank you so much for sharing your time and insight. Thanks again for being on the show.

Stefanie Demetriades: My pleasure. Thank you.