Message Strategies Research Articles

Who is Willing to Learn About Inequality? Predictors of Choice Exposure to Messaging About Racial Disparities in Air Pollution Effects Among Black and White U.S. Residents

ABSTRACT Widespread public awareness is needed to address health disparities and push for effective and equitable solutions. However, in a high choice media environment, this can only be achieved to the extent that people opt to consume disparity messaging. Drawing on theories of selective exposure, the present research uses a pre-registered online study conducted with U.S. adult participants to examine identity-based predictors of choice exposure to a racial disparity message about the health consequences of air pollution. Findings indicate that racial identity and environmental justice awareness are key predictors of disparity message selection, likely motivated by information utility and a bias toward congenial information. Altogether, results underscore the difficulty of raising awareness of disparities beyond impacted or already well-informed groups and highlight the need to examine more creative messaging strategies in order to broaden public awareness.

Exploring Consumer Sentiment toward Affordable Housing

The goal of this research is threefold: provide a framework of the affordable housing ecosystem, understand non-recipients’ perceptions of affordable housing, and identify communication strategies to garner support for affordable housing. To do so, we reviewed the literature, identifying key participants in the affordable housing ecosystem. Next, we conducted focus groups which revealed six themes comprising consumers’ perceptions of affordable housing: (1) the right to housing, (2) negative connotations of affordable housing, (3) benefits of affordable housing, (4) nuances of affordable housing, (5) the link to education, and (6) challenges due to a lack of affordable housing. These themes suggest that, consistent with past research, negative connotations about affordable housing exist. Importantly, positive associations also arose as participants discussed housing as a right, expressed a desire for more affordable housing, and associated access to housing with facilitating educational attainment, diversity, and a stronger sense of community. Finally, participants noted the critical role of multiple stakeholders in the affordable housing ecosystem to not only create but also ensure the viability of maintaining affordable housing. Drawing on these themes, we then propose broad messaging recommendations as well as potential messaging strategies to garner consumer support for affordable housing.

Evolution of the “Hierarchy of Engagement” Model Over a Decade: Examining Social Media Use to Inform, Activate, and Create Community

ABSTRACTThe use and underuse of social media by organizations have garnered significant attention from scholars. The findings indicate that most public and nonprofit organizations primarily use one‐way messaging in their social media communication. In 2012, Lovejoy and Saxton presented a “Hierarchy of Engagement” framework to categorize nonprofits' social media communication into Information, Community, and Action (ICA) messages. Since its publication, more than 100 research articles, reports, etc. have referred to this framework. This study presents a systematic review of 48 published scholarly articles that applied and expanded the ICA typology over 10 years (2012–2021). We find that the messaging strategy has not changed much from how the authors initially framed it. The social media accounts reviewed by this literature average share 51% information, 24% community, and 26% action messages. This study offers practical implications for nonprofit professionals, marketers, digital media managers, and scholars.

Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign.

Health campaigns hold promise for promoting general awareness about OSA. In 2023, the American Academy of Sleep Medicine developed a series of messages as part of their "Count on Sleep" campaign. Three distinct messaging strategies were employed in posts disseminated on Facebook: (1) positive outcome (benefits of OSA treatment); (2) negative outcome (consequences of untreated OSA); and (3) partner-focused. We evaluated Facebook analytics to explore which, of the three strategies, was most impactful. The impressions were highest for the positive outcome message (n=120,062), followed by the negative outcome (n=12,286) and partner-focus (n=10,259) messages. Female users were more likely to engage with positive (39% v. 28%) and negative (34% v. 25%) message than males, but genders were quite balanced in engagement with the partner-focus message (36% v. 36%). There was more engagement from older adults (65 years and older) than younger adults across all message types.

Cartoon-based message strategies on vaccination in Romania and engagement behavior. A multimodal approach.

This study investigates the influence of Romanian cartoons related to COVID-19 vaccination on online engagement. Humor has been employed by (inter)national authorities in order to simplify complex issues and to encourage positive attitudes and behaviors toward certain health issues. Focusing our analysis on the cartoons employed by two Romanian authorities (CNCAV and European Commission’s Representation in Romania), the aims of this study are threefold: to determine how Health Belief Model constructs and humor types influenced the online users’ online engagement behavior towards the cartoons on vaccination in Romania; to identify how multimodal modes were employed in the cartoons on COVID-19 vaccination; to determine how knowledge resources help in the interpretation of humor in the overperforming multimodal cartoons. The findings showed that commenting was significantly triggered by cartoons embedding more cues to action than self-efficacy. Perceived barriers generated significantly more laughter than perceived benefits, more sad reactions and less angry reactions than cues to action. Despite the high frequency of irony and pun as humor types, aggressive humor (sarcasm or satire) triggered more Romanian users to interact with cartoons as a creative message strategy and the humorous representations of the anti-vaxxers and the undecided on both Facebook accounts scored higher in terms of engagement metrics.

Content Feature of Medical Crowdfunding Information in Social Media—A Content and Effectiveness Analysis of Medical Crowdfunding Posts on Sina Weibo in China

Attracting donations is challenging but imperative for fundraisers to secure donations. Solicitation narratives serve as a key strategy for attracting both acquaintances and strangers, thereby influencing donation behavior. To optimize medical crowdfunding messaging on social media, this study explores prevalent content features of medical crowdfunding messages on Sina Weibo and determines whether these features impact message effectiveness. A retrospective content analysis was conducted on medical crowdfunding posts on Sina Weibo in China throughout 2023. The posts were systematically coded for the author’s gender, author type, target audience, key themes, human imagery, message sentiments, and message strategies, with their effectiveness analyzed using SPSS. Out of the 394 posts analyzed, private authors emerged as the dominant voices, directing their appeals predominantly toward the general public and often expressing neutral to negative sentiments. The overarching theme across these posts centered on the dire need for medical assistance. Including human imagery and informative message strategies was pivotal in determining post-effectiveness, eliciting heightened audience engagement in terms of likes and shares. Negative sentiment posts influenced comment effectiveness. These findings underscore the potential of social media campaigns in promoting altruistic health behaviors while emphasizing the critical role of strategic message design through the use of human imagery, informative message strategies, and negative sentiment to improve audience engagement.

Cannabis Users' and Non-Users' Differential Responses to Two Anti-Cannabis Campaigns.

Even though multiple states have approved legal recreational use of cannabis, the expansion of recreational cannabis legalization has led to public health concerns in the United States. Young adults (18-25 years old) have the highest percentage of cannabis use disorder compared to all other age groups. The purpose of this study is to compare cognitive and emotional responses of young adults who use cannabis and non-users to two anti-cannabis media campaigns that employed different message strategies. In total, 50 people (25 people who use cannabis and 25 non-users) participated in the study-a 2 (cannabis use status: people who currently use cannabis/non-users) × 2 (Public Service Advertising [PSA] campaign: Don't be a Lab Rat-Informational/Stoner Sloth-Narrative) × 3 (message replication) experiment. Participants viewed six messages based on the combinations of each of the three message replications within two campaigns. Participants' facial emotional responses were recorded during message exposure. Self-report questions were asked after viewing each message. Self-report indices showed no differences between the two campaigns for participants who use cannabis and non-users. However, after controlling for individual differences, participants who use cannabis displayed more negative emotional responses to the Don't be a Lab Rat messages than to the Stoner Sloth messages. Conversely, cannabis users experienced more positive emotional responses to the Stoner Sloth messages than to the Don't be a Lab Rat messages. The study provides insights for message design in public health campaigns addressing cannabis use, suggesting that psychophysiological measures can be helpful in providing insights into responses not detected by traditional self-report measures.

Quitting on TikTok: Effects of Message Themes, Frames, and Sources on Engagement with Vaping Cessation Videos

This study examined how message themes, frames, and sources in vaping cessation videos on TikTok influenced positive (i.e. likes, shares, positive comments regarding quitting vaping) and negative video engagement (i.e. negative comments regarding quitting vaping). TikTok videos (N = 412) with the hashtags #quitvaping and #quittingvaping were analyzed. Aspect-based sentiment analysis was conducted to evaluate the sentiment of quitting vaping in comments. Negative binomial regression models predicted video engagement from six message themes, ratios of gain and loss frames, and message sources. Themes related to nicotine addiction and physical health effectively drove positive engagement, such as likes and shares. The theme of harmful chemicals elicited mixed responses, generating both positive and negative comments regarding quitting vaping. Videos with a higher ratio of gain frames led to more positive engagement, including likes, shares, and positive comments regarding quitting vaping. Sources with informal expertise (e.g. those who have successfully quit vaping) and current e-cigarette users were more effective in engaging the TikTok audience than non-expert and non-user sources. These findings provide insights into messaging strategies that can effectively engage TikTok audiences and encourage vaping cessation.

Perspectives of Sexual and Gender Minority Youth on Anti-Vaping Messages in Social Media.

Sexual and gender minority (SGM) youth have higher rates of nicotine vaping than other youth in the United States. While social media can be effective in reaching youth and discouraging vaping, informed cultural tailoring is necessary to ensure effective messaging to SGM youth. This study aimed to understand SGM youth perspectives on anti-vaping social media messages and tailoring approaches. In-depth, qualitative videoconference interviews were conducted from February to July 2022 with 34 SGM youth recruited in the United States via social media ads. The interview guide addressed participants' beliefs about vaping, the context of vaping, perspectives on tailoring messages, and responses to examples of social media anti-vaping messages. Coding and thematic analysis followed a team-based approach. SGM youth perspectives fell into four categories - representation and diversity, facts and evidence, empowering messages, and source credibility. Participants stressed the importance of accurate, genuine representation of SGM youth in messages, but also noted that more overt representation may be seen as tokenizing. Participants recommended partnering with known LGBTQ+ influencers who can promote or share anti-vaping messages on social media platforms. They also recommended using culturally tailored language, including statistics specific to SGM youth, and invoking themes of empowerment to improve the relevance, reach, and effectiveness of anti-vaping campaigns. Findings can inform future efforts to develop anti-vaping messages for SGM youth with effective reach through social media. Nuanced perspectives on SGM representation in messages suggest a careful approach to tailoring. Concerns around inauthenticity may be minimized by ensuring SGM youth are included in message development and dissemination. This study describes the importance of being attentive to the tailoring preferences among the current generation of sexual and gender minority youth. Findings will inform social media-based messaging strategies that discourage nicotine vaping tailored for SGM youth in health campaign material design and evaluation, ensuring that tailored messages are designed in ways that avoid unintended consequences. The study also describes methods for effectively engaging SGM youth in research to improve the relevance of health education materials for this population and increase reach, which in turn can lead to reduction in vaping practices among SGM youth.

“Here’s what you can do to stop the spread”: Frames and mobilizing information in CDC’s social media messages during the COVID-19 pandemic

ABSTRACT Although there is a body of research on message frames and mobilizing information (MI), not enough attention has been paid to whether public health organizations are benefiting from the research in their social media messages during a public health crisis. To fill this research gap, this study aimed to examine how the CDC in the U.S. used gain and loss frames and MI in their Instagram posts about COVID-19 prevention and whether the use of such message strategies changed throughout the pandemic. A mixed-methods content analysis of a sample of 565 posts showed that the CDC overwhelmingly relied on gain frame, interactive MI, and tactical MI as their message strategies. The use of frames and MI was mostly consistent throughout the pandemic, although the target behavior changed. The supplemental analysis also revealed that loss-framed or gain- and loss-framed messages led to more user engagement. The findings highlighted the need for an evidence-based approach in social media messages by public health organizations. Theoretical and practical implications are discussed.

Effect of Messaging on Support for Breast Cancer Screening Cessation Among Older US Women

Many older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening. To investigate the effect of a message on older women's support for and intentions of stopping breast cancer screening. A 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate. A pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4). Support for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored. A total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P < .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P < .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy. In this randomized clinical trial, a breast cancer screening cessation message significantly increased older women's support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior. ClinicalTrials.gov Identifier: NCT05821023.

Evaluating University Attributes and Their Influence on Students’ Attitudes: The Mediating Role of Social Responsibility Communication

Understanding the salience of university attributes assists institutions in developing messaging strategies (using social responsibility communication (SRC) initiatives) to meet students’ needs. This research examines which university attributes hold the greatest significance and importance for students selecting a higher-education institution (HEI), focusing on the role of SRC as a mediator. An online survey with a sample of 120 university students was conducted. The findings indicate that the cost of education, employment opportunities, physical aspects and resources, and university image are important attributes. The study shows that while university attributes significantly predict SRC (Model 1), neither university attributes nor SRC significantly predicts student attitudes (Models 2 and 3). The mediation analysis confirms that SRC does not mediate the relationship between university attributes and students’ attitudes, suggesting that factors other than university attributes and SRC may play a more critical role in shaping students’ attitudes.

Using Online Memes to Communicate About Health: A Systematic Review.

We conducted a systematic review of the literature on online health memes to (a) detect and describe the available research, (b) identify key findings, and (c) delineate future research needs/opportunities. Databases, communication and public health journals, and ancestry search. Empirical studies, in English, published in peer-reviewed academic journals, and focused on memes to discuss health-related topics. We scrutinized 357 empirical articles and included 35. Descriptive summary of the locations where studies were conducted, the health topics addressed, theories and methods used, features of memes analyzed, study outcomes, and researchers' challenges. Most studies were conducted in the USA (n = 14); focused on COVID-19 (n = 15); were a-theoretical (n = 19); and quantitative (n = 19). Most explored the themes and use of the memes available online (n = 19); compared meme variations (n = 12) by health issue, content, or participants' group; examined meme' effects on health outcomes (n = 1); or evaluated memes as part of a health campaign (n = 3). We summarized the studies' limitations and key findings. Memes are a promising message strategy for health promotion and education, but more research is necessary. Considering the information retrieved, we provide five specific recommendations for future research directions when studying health memes, including suggestions on the multiple health issues to address and promising theories to adopt and expand.

Correcting misperceptions about very low nicotine cigarettes for cigarette-only smokers, dual/poly smokers, other tobacco users, and non-tobacco users

BackgroundThe U.S. Food and Drug Administration authorized the sale and marketing of two very low nicotine cigarettes (VLNC) as modified risk tobacco products. The misperception that VLNC are healthier than regular cigarettes is common. This study explores effective message strategies to inform the public about health risks associated with VLNC use, encourage cigarette smokers to try VLNC, and prevent other tobacco users and non-users from product initiation. MethodsFollowing the Reasoned Action approach, a VLNC educational message was developed based on the salient beliefs associated with behavioral intention. The message was tested in an online survey conducted in 2018, where 410 participants were randomly assigned to one of the two message conditions (no-message, VLNC message). Message effects were assessed across four tobacco-use groups (non-tobacco users, cigarette-only smokers, cigarette dual/poly smokers, other tobacco users). ResultsCompared to the no-message control, the VLNC message condition showed lower nicotine risk perception for all participants, lower misbelief in VLNC safety for non-users and cigarette-only smokers, higher belief in VLNC carcinogenicity for other tobacco users, stronger belief in second-hand smoke harm for cigarette dual/poly smokers and other tobacco users, and higher VLNC intention for cigarette-only smokers. ConclusionsDifferent messages are needed for different types of tobacco users. Both cigarette smokers and other tobacco users could benefit from messages that acknowledge the non-addictiveness but emphasize the health risks of VLNC. Regulators could consider making physical harm statements a requirement for VLNC packaging and marketing. New strategies need to be explored to inform cigarette dual/poly smokers.

Examining the Effect of Message Strategies on Peruvian Mothers´ Intentions to Increase Fruit Intake Among Children

Background The Peruvian population does not meet the recommended guidelines for daily consumption of fruits and vegetables and, thus, social marketing approaches are needed in order to improve this behavior. Focus of the Article The focus of this study was on changing intentions to engage in a recommended health behavior by experimentally testing one component of a social marketing strategy, namely the effect of messages to motivate mothers to increase the fruit consumption of their children. Research Question What type of messages, either those communicating the advantages of engaging in the recommended behavior or those communicating the norms about the behavior, are better at increasing mothers’ intentions to give 3 daily fruits to their children? Importance to the Social Marketing Field This study identifies methodological steps that can guide future social marketing approaches to test the effect of messages in the area of behavior change. Methods A total of 285 mothers completed an online survey with an experiment built in. Mothers were randomly assigned to one of three conditions: a gain-framed messages condition, a normative messages condition and a no message condition (control condition) and then answered questions about the dependent variables. Results Results showed that exposure to messages communicating information about the advantages of engaging in the behavior increased mothers’ attitudes and intentions to give 3 daily fruits to their children; however, messages communicating information about descriptive norms did not increase mothers’ perceived norms or intentions. Recommendations for Research or Practice Social marketing approaches that address low levels of fruit consumption among children can benefit from message strategies that target mothers and that focus on communicating the advantages of giving more fruits to their children.

COVID-19 vaccine messaging for young adults: Examining framing, other-referencing, and health beliefs.

This study investigates the interaction between message framing and point-of-reference (self vs. others) for vaccine benefits on young adults' COVID-19 vaccine confidence and intentions. It also examines how COVID-19-related health beliefs-such as perceived severity of COVID-19 and perceived benefits of obtaining the vaccine to protect others-mediate these interactions. In a 2 (framing: gain vs. loss) × 3 (reference point: self, others, university community) between-subjects experiment (Fall 2021), 202 participants ages 18-23 were shown animated messages with embedded manipulations to convey vaccine information. Moderated mediation models tested the conditional indirect effects of framing on vaccine confidence and intentions. Reference point significantly moderated the effect of framing on the perceived severity of COVID-19. More specifically, and somewhat contrary to previous literature, perceived severity was highest when messages emphasized gains for others. In turn, perceived severity correlated positively with vaccine confidence and intentions, resulting in a significant conditional indirect effect. Despite its positive relationship with COVID-19 vaccine confidence and intentions, perceived benefit to others was not a significant mediator. This study provides evidence for the role of reference point in moderating the effect of gain-loss message framing on COVID-19 vaccine attitudes and intentions. However, the findings differ from past research, suggesting other-gain messages may be an optimal strategy for promoting these vaccine outcomes for young adults. Overall, findings have implications for developing tailored messaging strategies that account for the nature of targeted populations and the evolving perceptions of the disease and its associated messaging campaigns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Media Users’ Engagement with Fear Appeal Elements in Government’s Health Crisis Communication via State-Owned Media

Government health messaging is significant to the containment of public health crises. Such communication may benefit from using fear appeal, a message strategy for promoting health and preventing diseases. Yet little scholarly attention has been paid to how fear appeal is employed in government messaging to promote social media engagement through online actions including likes, shares, and comments. These actions play a meaningful role in addressing communication exigencies within the context of health crises. In this study, quantitative content analysis and corpus linguistics methods were employed to analyze fear appeal-related elements in COVID-19 messages sent by a state-owned media outlet on social media. The results show that when compared to messages without threat, messages conveying threat elicited significantly more comments, in which emotions and perceptions to threat and efficacy were exhibited, while messages containing both threat and efficacy generated more engagement in comparison to messages with threat alone. Moreover, while subdimensions under efficacy were positive predictors of engagement, those under threat were primarily found to have exerted negative effects. The findings provide insights into how fear appeal elements can be employed in government health crisis communication to engage the public.

Evaluating strategies to recruit health researchers to participate in online survey research

BackgroundEngaging researchers as research subjects is key to informing the development of effective and relevant research practices. It is important to understand how best to engage researchers as research subjects.MethodsA 24 factorial experiment, as part of a Multiphase Optimization Strategy, was performed to evaluate effects of four recruitment strategy components on participant opening of an emailed survey link and survey completion. Participants were members of three US-based national health research consortia. A stratified simple random sample was used to assign potential survey participants to one of 16 recruitment scenarios. Recruitment strategy components were intended to address both intrinsic and extrinsic sources of motivation, including: $50 gift, $1,000 raffle, altruistic messaging, and egoistic messaging. Multivariable generalized linear regression analyses adjusting for consortium estimated component effects on outcomes. Potential interactions among components were tested. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).ResultsSurveys were collected from June to December 2023. A total of 418 participants were included from the consortia, with final analytical sample of 400 eligible participants. Out of the final sample, 82% (341) opened the survey link and 35% (147) completed the survey. Altruistic messaging increased the odds of opening the survey (aOR 2.02, 95% CI: 1.35–2.69, p = 0.033), while egoistic messaging significantly reduced the odds of opening the survey (aOR 0.56, 95%CI 0.38–0.75, p = 0.08). The receipt of egoistic messaging increased the odds of completing the survey once opened (aOR 1.81, 95%CI: 1.39–2.23, p < 0.05). There was a significant negative interaction effect between the altruistic appeal and egoistic messaging strategies for survey completion outcome. Monetary incentives did not a have a significant impact on survey completion.ConclusionIntrinsic motivation is likely to be a greater driver of health researcher participation in survey research than extrinsic motivation. Altruistic and egoistic messaging may differentially impact initial interest and survey completion and when combined may lead to improved rates of recruitment, but not survey completion. Further research is needed to determine how to best optimize message content and whether the effects observed are modified by survey burden.

Effectiveness of femvertising communications on social media: how brand promises and motive attributions impact brand equity and endorsement outcomes

PurposeWith the growing importance of conscientious branding, companies are increasingly adopting messages of female empowerment in their social media communications. However, this is not without risk, as stakeholders may be suspicious of femwashing. Therefore, companies need to develop appropriate messaging strategies to increase the effectiveness of their femvertising communications.Design/methodology/approachA between-subjects 3 × 1 online experiment was conducted to examine the influence of different messaging strategies (symbolic, philanthropic and explicit brand promises) and respective stakeholders' attributions of a company’s femvertising motives on brand equity and endorsement outcomes.FindingsThe results show that philanthropic and explicit brand promises have more positive effects on brand equity and endorsement outcomes than symbolic brand promises. In addition, motive attributions towards the firm’s femvertising messages were found to moderate the influence of message strategies on endorsement outcomes.Originality/valuePrevious research on the effects of femvertising has been inclined towards short-term performance factors like purchase intentions. This study contributes to the literature by examining its impacts on more strategic intangible assets such as brand equity. Furthermore, while prior studies on femvertising effects have so far focused primarily on the influence of recipients’ characteristics and less on the side of the communicators, this study illuminates the potential of different messaging strategies for effective femvertising communicating.

Navigating vaccination choices: The intersecting dynamics of institutional trust, belonging and message perception among Congolese migrants in London, UK (a reflexive thematic analysis).

The COVID-19 pandemic disproportionately impacted intersectionally marginalised migrants, revealing systemic disparities in health outcomes and vaccine uptake. Understanding the underlying social and structural factors influencing health behaviours is necessary to develop tailored interventions for migrants, but these factors have been seldom explored. This qualitative study aimed to explore contextual factors shaping COVID-19 vaccination decision-making among Congolese migrants in the UK.A community-based participatory research study was designed and led by a community-academic partnership in London, UK (2021-2022). Peer-led, semi-structured interviews were conducted in Lingala with 32 adult Congolese migrants and explored beliefs, perceptions and lived experiences of migration, healthcare, vaccination and the COVID-19 pandemic. Reflexive thematic analysis generated two themes and a model conceptualising the vaccination decision-making process. Participants and community partners were financially compensated; ethics was granted by the University of London ethics committee (REC: 2021.0128).Participants highlighted the incompatibility of lockdown restrictions with their communal culture, which intensified feelings of exclusion and alienation. Concerns about COVID-19 vaccination were attributed to safety and effectiveness, partly informed by experiences and legacies of racial discrimination and exploitation. Inequality in the pandemic response and COVID-19 outcomes heightened participants' sense that their views and needs were being overlooked, and government sources and information were perceived as coercive. Our model depicts the interplay between institutional trust, belonging, and message perception, which shaped participants' vaccination decisions and led to (non-)engagement with COVID-19 vaccination. This research enhances understanding of how social and contextual factors may influence migrants' engagement with health interventions. It underscores the importance of partnering with migrant communities to understand their needs in context and co-design tailored interventions and inclusive messaging strategies that promote trust and belonging. Implementing systemic changes to address structural inequalities will be crucial to create an environment that supports engagement with health-protective behaviours and enhances health outcomes among migrant communities.