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In this online survey of 1,733 US adults in December 2021, respondents believed COVID-19 vaccines are less beneficial and less safe for someone who had already had COVID-19. Those who experienced COVID-19 after being vaccinated believed that the vaccines are less beneficial and less safe than those who had not. Findings highlight the need to better communicate evolving evidence of COVID-19 vaccine benefit and safety and to tailor communications to peoples' COVID-19 history and vaccination status. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Communicating about COVID-19 vaccine side effects and efficacy is crucial for promoting transparency and informed decision-making, but there is limited evidence on how to do so effectively. Design: A within-subjects experiment. Setting: Online survey from January 21 to February 6, 2021. Subjects: 596 US Veterans and 447 non-Veterans. Intervention: 5 messages about COVID-19 vaccine side effects and 4 messages about COVID-19 vaccine efficacy. Measures: COVID-19 vaccine interest (1 = "I definitely do NOT want the vaccine" to 7 = "I definitely WANT the vaccine" with the midpoint 4 = "Unsure"). Confidence about COVID-19 vaccine efficacy (1= "Not at all confident," 2 = "Slightly confident," 3 = "Somewhat confident," 4 = "Moderately confident," 5 = "Extremely confident"). Results: Compared to providing information about side effects alone (M = 5.62 [1.87]), messages with additional information on the benefits of vaccination (M = 5.77 [1.82], P <.001, d z =.25), reframing the likelihood of side effects (M = 5.74 [1.84], P <.001, d z =.23), and emphasizing that post-vaccine symptoms indicate the vaccine is working (M = 5.72 [1.84], P <.001, d z =.17) increased vaccine interest. Compared to a vaccine efficacy message containing verbal uncertainty and an efficacy range (M = 3.97 [1.25]), messages conveying verbal certainty with an efficacy range (M = 4.00 [1.24], P =.042, d z=.08), verbal uncertainty focused on the upper efficacy limit (M = 4.03 [1.26], P <.001, d z =.13), and communicating the point estimate with certainty (M = 4.02 [1.25], P <.001, d z =.11) increased confidence. Overall, Veteran respondents were more interested (M Veterans = 5.87 [1.72] vs M NonVeterans = 5.45 [2.00], P <.001, d =.22) and confident (M Veterans = 4.13 [1.19] vs M NonVeterans = 3.84 [1.32], P <.001, d =.23) about COVID-19 vaccines than non-Veterans. Conclusions: These strategies can be implemented in large-scale communications (e.g., webpages, social media, and leaflets/posters) and can help guide healthcare professionals when discussing vaccinations in clinics to promote interest and confidence in COVID-19 vaccines. [ABSTRACT FROM AUTHOR]