The London Borough of Havering: Using the COM-B framework to develop a vaccine take up strategy

The London Borough of Havering has adopted a systematic approach to encourage vaccine take-up.


Challenge

This is part of a series of case-studies published on 20 April 2021.

While most people are eager to get vaccinated, there is a significant proportion who are lacking confidence. Vaccine confidence is a complex issue that has to be addressed on a number of fronts.

Approach

The London Borough of Havering has adopted a systematic approach to encourage vaccine take-up. They used the COM-B model as a foundation for developing an overarching strategy to address vaccine confidence. The COM-B model is a framework that highlights three main levers that can lead to behaviour change. According to this framework, people are more likely to perform a behaviour if they have: 1) the capability (skills, ability and knowledge), 2) the opportunity (the social and physical environment that makes a specific behaviour possible), and 3) the motivation (impulses, habits, needs or intentions).

Havering has also applied the COM-B model to tackle specific target populations whereby evidence suggests they are more hesitant, for example people from Black ethnic minorityy, certain faith groups and Health and Social Care workers.

Outcome

The application of the COM-B framework helped the council develop several initiatives. Together, these initiatives address the three main factors required to change behaviour and increase vaccine uptake:

Capability

 The council is raising awareness on the benefits and risks of COVID-19 vaccines by 1) delivering local and national communications that emphasise accurate information about the vaccine via numerous channels; 2) organising online public meetings for residents with the NHS Medical Director and other health professional and local authority’s Director of Public Health; 3) sharing stories of residents who have been vaccinated or have the intention of doing so on social media and the council’s bulletin, and; 4) by having a public health consultant and a health psychologist provide conversational skills training, underpinned by motivational interviewing, to Vaccination Ambassadors. Vaccination Ambassadors are community activists whose role is to have conversations with individuals who may be unsure/ambivalent about having the vaccination. A survey conducted by ADASS found that interactive events have the highest impact.

Opportunity

The council is improving access to vaccination by 1) working collaboratively with the NHS by using their local knowledge to identify sites suitable for residents, and 2) providing information on transport options and offering free parking at vaccination sites.

Motivation

The council is prompting people's motivation to get vaccinated by launching a "Better Days Ahead" campaign. The campaign's goal is to instil confidence in a brighter future and frame the vaccine as the primary way out of the crisis. Some local providers give cash rewards to the staff who have had vaccination. Four community groups will also be offered a grant to promote vaccination through peer support and motivation, to co-design targeted messages with cultural insights and to give feedback to improve access to vaccination.

Key learning

Vaccine confidence is a complex issue and has to be addressed from multiple fronts. The COM-B model sheds light on the three main areas to focus on.

Quick wins

Below are some ‘quick wins’ that Havering has applied:

  • Use ‘vaccination ambassadors’ to encourage peers to get vaccinated.
  • Share stories of people who got vaccinated and countries with high vaccine coverage to establish a social norm around vaccination and motivate others to do the same.
  • Involve trusted health authorities when organising online FAQ sessions or events to address resident’s concerns and correct misinformation.

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