Jump to section

• A deeper look at the co-design journey
• The challenge → Where the journey begins
• Aim and objectives
• The co-design roadmap → How we got there
• Key insights and transformations → What we discovered
• Future horizons → Where we are heading
• Conclusion
• About the authors
• References

A deeper look at the co-design journey

The Sharing Knowledge About Immunisation (SKAI) Adolescent Social Media Toolkit was co-designed with consumers to empower parents and carers to confidently access and share trusted, evidence-based adolescent vaccination information on social media.

The toolkit aims to:¹

• increase awareness and use of SKAI Adolescent vaccination communication resources 
• support positive conversations with healthcare professionals 
• address vaccine misinformation 
• strengthen vaccine acceptance 
• help reverse declining vaccination coverage among adolescents in Australia.

By partnering directly with consumers throughout the toolkit development, the project team transformed traditional static vaccination information into a dynamic and shareable communication experience that reflects how parents connect and engage with online health information in real-world social media environments.

The challenge → Where the journey begins

Understanding why traditional approaches fall short in social media 

The social media landscape

Parents and carers of adolescents are routinely exposed to vaccine information on social media, where misleading content can spread rapidly and shape attitudes toward the safety, effectiveness and importance of vaccines.^2,3

Research shows that high volumes of competing information, emotionally framed messages and platform algorithms can amplify misinformation and disinformation over evidence-based guidance.^2,3

In a recent US survey, healthcare professionals identified social media as the leading contributor to vaccine misinformation among patients – overtaking celebrities, television personalities and mass media – highlighting the significant influence of digital platforms on vaccine perceptions and decision-making.⁴

Exposure to repeated misinformation, emotionally charged narratives and peer-driven social media content can erode trust in healthcare authorities and systems, shape vaccine perceptions and social norms and contribute to vaccine hesitancy.^2–6

In digital environments – where misinformation can spread rapidly – trusted, empathetic and evidence-based communication strategies are increasingly important to support informed decision-making, strengthen vaccine confidence and encourage sustained engagement with credible immunisation information.^2–7

The communication gap

Traditional top-down public health communication approaches may have limited reach and resonance in crowded digital environments, particularly when messages are perceived as institutional, overly clinical, impersonal or disconnected from lived experiences, emotions and everyday parenting concerns.^5,6

The evidence for co-design

Australian and international evidence demonstrates that health initiatives designed with consumer input are more likely to be perceived as relevant, trusted and aligned with the needs, values and cultural contexts of intended audiences than traditional approaches.^8,9

Rather than relying on one-off consultation, the co-design process supports active partnership with consumers to better understand real-world motivations, perceived risks, language preferences and barriers to sharing vaccination information online.^8,9

Evidence also suggests that participatory approaches are particularly important in vaccine communication, where trust, tone, community voice and peer-to-peer sharing influence vaccine confidence and future decision-making.^7–9

The opportunity for impact

The research team sought to reimagine static, information-based vaccination resources as practical, consumer-centred, shareable communication experiences co-designed with parents and carers to better reflect real-world motivations, social media behaviours and everyday information-sharing practices.  

NCIRS partnered with members of its established Consumer Advisory Group (CAG) – a diverse network of parents, carers and community members contributing lived experience and reflective insights to inform immunisation research and communication.¹⁰

Aim and objectives

Defining what meaningful consumer engagement and impact looks like   

Overall aim

To co-design a consumer-informed social media toolkit that increases awareness, reach and use of the SKAI Adolescent website by empowering parents and carers to confidently access and share trusted, evidence-based adolescent vaccination information within their social media networks.¹¹

Specific objectives

• Ensure the toolkit is relevant, accessible and fit for purpose for health consumers¹¹
• Align toolkit structure and content with real-world social media behaviours across Facebook and Instagram¹¹
• Optimise toolkit messaging, tone of voice and visuals to be clear, plain-language, culturally neutral and relatable¹¹
• Reduce perceived risk, effort and hesitation associated with sharing vaccination information online¹¹
• Support peer-to-peer sharing of trusted vaccination information in ways that feel safe, authentic and socially acceptable within everyday online interactions¹¹
• Embed consumer insights directly into all toolkit design decisions¹¹

The co-design roadmap → How we got there

Building and refining the toolkit through iterative partnership with consumers

Co-design approach

A mixed-methods, evidence-informed, experience-based co-design (EBCD) approach was used across four phases of development, with members of the NCIRS CAG serving as Consumer Researchers to ensure the toolkit remained relevant, usable and grounded in real-world experience before rollout to the broader population of parents.^11,12

Phase 1. Needs assessment survey
Consumer Researchers completed an online survey exploring:¹¹

• social media use and posting behaviours
• confidence in sharing vaccination information online
• motivations for posting health and vaccination information
• perceived risks and barriers associated with online engagement.

Survey findings informed development of the first iteration of the toolkit to be used in the co-design workshop.¹¹

Phase 2. Co-design workshop
Facilitated co-design sessions explored social media communication preferences and engagement behaviours, including:¹¹

• tone of voice, language and communication styles
• visual design, content structure and calls-to-action
• sharing motivations and confidence to post vaccination information publicly
• moderation needs and responses to misinformation encountered online.

Workshop findings informed refinements to the toolkit content, usability and functionality.¹¹

Phase 3. Real-world consumer piloting and reflections
Consumer Researchers tested draft posts within their own Facebook and Instagram accounts in real-world conditions to evaluate:¹¹

• clarity and usability
• comfort and confidence in sharing content publicly
• shareability and adaptability
• ability and confidence to respond to comments
• perceived barriers and motivations for posting vaccination content online.

Consumer reflections provided practical insights into how vaccination information is interpreted, personalised and shared within everyday social media settings.¹¹

This phase also highlighted how platform norms, audience perceptions and fear of online conflict could influence willingness to publicly share vaccination information.¹¹

Phase 4. Final prototype development
Findings were synthesised collaboratively and used to iteratively refine toolkit content, structure and functionality.¹¹

This included development of:¹¹

• visual-first content layouts
• concise and ready-to-use messaging
• practical moderation tips, guidance and decision pathways
• example responses to difficult or misinformed comments
• platform-specific posting guidance to support safe and confident online engagement.

Key insights and transformations → What we discovered

How real-world consumer feedback transformed the toolkit

Simplicity over complexity

Consumer Researchers consistently prioritised simplicity, intuitive use and ease of sharing over highly detailed information when engaging with and sharing vaccination content on Facebook and Instagram.¹¹

Reducing effort and cognitive load was essential to increasing toolkit sharing behaviour in real-world contexts.¹¹

Communication that can be rapidly understood, adapted and shared within fast-moving social media environments was also highlighted as important.¹¹

Everyday language

Consumer Researchers reported that shifting from clinical terminology to familiar, conversational language – such as using ‘teen’ rather than ‘adolescent’ – improved relatability, accessibility and engagement with peers.¹¹

This shift also helped reduce perceptions of authority-driven communication and supported more natural peer-to-peer engagement.¹¹

Removing jargon and technical social media terminology also improved readability and confidence to share content.¹¹

Transparency and trust

Consumer Researchers emphasised the importance of clearly positioning the toolkit as an independent, evidence-based resource.¹¹

Transparent communication about evidence sources, organisational independence and absence of pharmaceutical funding was considered important for building trust, credibility and willingness to share vaccination information.¹¹

Motivations for sharing

Consumer Researchers were more likely to confidently share vaccination posts when content aligned with personal values, such as protecting family and community.¹¹

This observation aligns with broader evidence that most parents engaging with vaccine information – even those with hesitancy – are primarily motivated by a desire to protect their children and community, making values-aligned, empathetic communication an especially powerful approach.⁷

They also described greater willingness to share content that felt practical, visually engaging and aligned with their identity as informed and caring parents.¹¹

Confidence in sharing toolkit content was further strengthened by practical moderation guidance and strategies to help manage difficult or misinformed comments.¹¹

Designed for sustained engagement

The toolkit adopted visual-first content formats, concise messaging, culturally neutral iconography, and ready-to-use content designed to encourage sustained engagement beyond one-off posting behaviour.¹¹

The intention was to reduce barriers to toolkit use by minimising the effort required to locate, interpret, adapt and share trusted adolescent vaccination information online.¹¹

Clear moderation guidance with example responses to misinformation and disinformation was seen as essential to improve the longevity of the toolkit.¹¹

Reflections on co-design

The EBCD approach enabled early identification of real-world usability challenges – and opportunities for enhancements – which may not have emerged through traditional development methods.¹¹

Ongoing collaboration reinforced that meaningful and iterative consumer partnership extends beyond consultation – and is essential to shaping a communication experience that is relevant, trustworthy and implementation ready.¹¹

Future horizons → Where we are heading

Extending the reach and real-world impact of the toolkit

Broader validation

Future work will expand testing to explore how consumer-informed social media communication can be adapted, implemented and evaluated across broader parent populations and diverse community settings.¹¹

Testing may also explore how communication preferences and engagement behaviours differ across culturally and linguistically diverse communities, rural populations and varying levels of vaccine confidence and intention.¹¹

This is particularly important given that Aboriginal and Torres Strait Islander adolescent vaccination coverage has declined at a greater rate than in other groups, underlining the importance of culturally adapted implementation.¹

Strategic partnerships

Implementation will involve collaboration with organisations including:¹¹

• Primary Health Networks (PHNs)
• NSW Health public health units
• Immunisation Foundation of Australia
• National Aboriginal Community Controlled Health Organisation (NACCHO)
• Consumer, multicultural and community organisations.

These partnerships can support scalability, cultural relevance, adaptation, implementation and dissemination of the toolkit across diverse communities and populations.¹¹

Impact evaluation

Future evaluation activities will assess:¹¹

• awareness, reach and engagement with toolkit content
• sharing behaviours and motivations among real-world users
• confidence in managing online interactions
• sustained toolkit use over time
• social media sentiment and audience feedback
• willingness to share evidence-based vaccination information
• impact on vaccine confidence, acceptance and sharing behaviours.

Further implementation research may also examine audience engagement through SKAI Adolescent website analytics and social media performance metrics.¹¹

Future evaluation may also examine whether peer-to-peer sharing of trusted vaccination information contributes to greater confidence when engaging in vaccination discussions with healthcare professionals.¹¹

Conclusion

The SKAI Adolescent Social Media Toolkit demonstrates how EBCD can transform traditional vaccination information into a practical, consumer-centred communication experience aligned with how parents and carers access, interpret, personalise and share information within everyday digital environments.¹¹

By partnering with consumers and embedding their insights throughout development, the project identified barriers, motivations and communication behaviours that informed iterative refinements to the toolkit and strengthened its trustworthiness, relevance, usability and real-world application.¹¹  

Ongoing evaluation will be needed following implementation among the broader parent population in Australia to assess the behavioural impact of the toolkit and identify relevant enhancements to support longevity.¹¹

At a time when adolescent vaccination coverage in Australia is declining and digital misinformation is growing, this co-design partnership model offers a replicable, evidence-informed approach to transforming trusted vaccination information into communication that parents and carers are more likely to engage with, share within their networks and use to inform their vaccination decisions.^1,2,7,11

Explore SKAI Adolescent resources 

About the authors

Dylan Maiden is Marketing and Communication Officer at NCIRS, with over 15 years of experience developing evidence-based communication and stakeholder engagement strategies across healthcare, research and government sectors.

Kathleen Prokopovich is a Senior Research Officer at NCIRS who leads the development of new content for the Sharing Knowledge About Immunisation (SKAI) website and the administration of the NCIRS Social Science Unit Consumer Advisory Group and Consumer Researcher Program.

Catherine Hughes, a mother of 2 daughters, founded the Immunisation Foundation of Australia after losing her son, Riley, to whooping cough in 2015, and has chaired the NCIRS Social Science Unit Community Advisory Group since 2022.

Rochelle Oei-Hicks is an experienced clinician, medical educator, researcher, consumer and mother of 2 children, who is passionate about improving health literacy and patient outcomes for all Australians.

Puspa Sherlock is a single mother of 5 children with Aboriginal, European, Asian and Australian heritage. She has a background in mental health advocacy and consumer health research, and is passionate about providing insights, perspectives and feedback on immunisation topics on behalf of the communities she represents as well as sharing valuable resources.

Sue Williamson is a consumer with a background in nursing and experience in caring for patients who have faced life-threatening outcomes from vaccine-preventable diseases, including measles, who is passionate about improving healthcare access and equity barriers for people living in rural areas.

Jackson Young is Marketing and Communication Manager at NCIRS, with extensive experience working in government-funded health organisations, where he has implemented and led a wide range of marketing and communications initiatives in Australia and the United Kingdom.

Madeleine Smith manages media strategy and media liaison at NCIRS, with experience in broad public health and consumer campaigns. 

Salema Barrett leads marketing, communications and engagement strategy development and implementation at NCIRS.

References

1. National Centre for Immunisation Research and Surveillance (NCIRS). Annual Immunisation Coverage Report 2025 – Summary. Available from: https://ncirs.org.au/immunisation-coverage-data-and-reports/annual-immunisation-coverage-report-2025-summary
2. Ruggeri K, Vanderslott S, Yamada Y, et al. Behavioural interventions to reduce vaccine hesitancy driven by misinformation on social media. BMJ 2024;384:e076542. 
3. Rodrigues F, Ziade N, Jatuworapruk K, et al. The impact of social media on vaccination: a narrative review. Journal of Korean Medical Science 2023;38(40):e326.
4. Eiden AL, Drakeley S, Modi K, et al. Attitudes and beliefs of healthcare providers toward vaccination in the United States: A cross-sectional online survey. Vaccine 2024;42(26):126437.
5. Kite J, Chan L, MacKay K, et al. A model of social media effects in public health communication campaigns: systematic review. Journal of Medical Internet Research 2023;25:e46345 
6. Cooper S, Gadanya MA, Kaawa-Mafigiri D, et al. Using social media to build confidence in vaccines: lessons from community engagement and social science research in Africa. BMJ 2024;384:e075564. 
7. O’Leary ST, Danchin M. Childhood vaccine hesitancy. New England Journal of Medicine 2026;doi:10.1056/NEJMcp2516616.
8. Vargas C, Zorbas C, Longworth GR, et al. Exploring co-design: a systematic review of concepts, processes, models, and frameworks used in public health research. Journal of Public Health 2025;47(4):e616–e639. 
9. National Health and Medical Research Council (NHMRC). Statement on consumer and community involvement in health and medical research. Canberra: NHMRC; 2016. Available from: https://www.nhmrc.gov.au/about-us/publications/statement-consumer-and-community-involvement-health-medical-research 
10. National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS Social Science Consumer Advisory Group (CAG). Available from: https://ncirs.org.au/our-work/social-science-immunisation 
11. National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS Social Science Consumer Advisory Group (CAG). SKAI Adolescent Social Media Toolkit Co Design. Data on file.
12. Morley C, Jose K, Hall SE, et al. Evidence-informed, experience-based co-design: a novel framework integrating research evidence and lived experience in priority-setting and co-design of health services. BMJ Open 2024;14:e084620.