Promotion over pixels: a mixed-methods analysis of vaccine communication strategies in Plateau State, Nigeria

Rationale The COVID-19 pandemic prompted the implementation of multiple public health strategies to encourage vaccine uptake. Among these, digital media campaigns, community outreach programmes and promotional efforts have been widely used. However, there remains limited understanding of their relative effectiveness in influencing vaccine acceptance, particularly within the Nigerian context. Objective This study aimed to assess the relationship between digital media campaigns, community outreach programmes and promotional efforts and their influence on COVID-19 vaccine acceptance in Plateau State, Nigeria, while identifying which strategy had the most significant impact. Methods A cross-sectional mixed-methods design was employed. Quantitative data were collected from 300 adult respondents using a structured questionnaire, while qualitative data were obtained through key informant interviews. Descriptive statistics, Spearman’s correlation and regression analyses were used to analyse the quantitative data, and thematic analysis was applied to qualitative responses. Results Promotion efforts exhibited the strongest positive correlation with vaccine acceptance (Spearman’s rho=0.490, p<0.01), followed by community outreach programmes (rho=0.414, p<0.01) and digital media campaigns (rho=0.239, p<0.01). Regression analysis showed that promotional efforts accounted for 24.0% of the variance in vaccine acceptance (R 2 =0.240), while community outreach and digital campaigns accounted for 17.1% and 5.7%, respectively. The sample was predominantly educated and older, which may have influenced receptiveness to certain communication strategies. Conclusions All three strategies were significantly associated with vaccine acceptance, with promotional efforts being the most impactful. These findings highlight the importance of prioritising community-based promotional campaigns, supported by outreach programmes and digital media, particularly in settings with varying access and trust in health systems.