Web-based Social Media Intervention to Increase Vaccine Acceptance: A Randomized Controlled Trial

HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents

Human papillomavirus (HPV) vaccination prevents 6 HPV-related cancers in men and women. Yet, rates of HPV vaccination among adolescents in the United States lag behind other developed nations, revealing a significant public health issue. This feasibility study tested a collaborative online learning environment to cultivate HPV vaccination champions. A 3-month training program recruited parents to serve as proponents and social media influencers to identify solutions to overcome barriers to HPV vaccination. A mixed methods study design included a pretest survey, three online asynchronous focus groups, a posttest survey, as well as a longitudinal follow-up survey at 6 months. Participants included 22 parents who self-identified as female (95.4%) and white (90.9%). Overall, there was a statistically significant difference in knowledge of HPV and HPV vaccination between pretest and posttest (p = 0.0042). This technology-mediated intervention increased parents' confidence and motivated them to speak more freely about HPV vaccination in-person and online with others in their social networks. Participants identified prevalent misinformation about HPV vaccination and learned how to effectively craft messages to address concerns related to safety and side effects, gender, understanding of risk, and sexual activity. Objective measures and qualitative open-ended assessment showed high intervention engagement and treatment satisfaction. All participants (100%) indicated that they enjoyed participating in the intervention. The effectiveness of this feasibility study suggests that social media is an appropriate platform to empower parents to counter vaccine hesitancy and misinformation through HPV vaccination information that is simple and shareable in-person and online.

Evaluating the effects of vaccine messaging on immunization intentions and behavior: Evidence from two randomized controlled trials in Vermont

The effectiveness of vaccines in reducing child morbidity and mortality worldwide relies on public acceptance. However, relatively little is known about the effects of vaccine communication on vaccine attitudes and immunization behavior. Previous research suggests that common communication approaches may be ineffective or even counterproductive, especially among vaccine-hesitant parents. However, these studies typically rely on observational data or self-reported measures of vaccination intention. Using novel research designs, we tested the attitudinal and behavioral effects of messages encouraging vaccination in both a survey experiment conducted among a large sample of parents in Vermont who expressed hesitancy about childhood immunizations and a field experiment among parents whose children were overdue for vaccines. We find that neither a message promoting immunization as a social norm nor a message correcting common misperceptions about vaccines was measurably more effective than a standard public health message at improving parents' attitudes toward vaccines, intention to vaccinate their children, or compliance with the recommended vaccine schedule. Our results highlight the need for more research on approaches to successfully reducing vaccine hesitancy among parents.

In-hospital and web-based intervention to counteract vaccine hesitancy in very preterm infants' families: a NICU experience

BACKGROUND

Vaccine hesitancy is a global problem, carrying significant health risks for extremely vulnerable population as that of preterm infants. Social media are emerging as significant tools for public health promotion. Our aim was to evaluate both the coverage and the timeliness of routine immunizations in a cohort of preterm infants (< 33 weeks of gestational age) at 24 months of age whose families have been subjected to in-hospital and web-based interventions to counteract vaccine hesitancy.

METHODS

For a period of 2 years parents of preterm infants were instructed during their follow up visits by a member of the NICU team to get correct informations about vaccines from a social network page. Vaccination rates of preterm infants were assessed at 24 months of chronological age with an electronic database and compared to both general population and historical cohort.

RESULTS

Coverage and timeliness of vaccinations at 24 months of age of 170 preterm infants were analyzed in December 2019. Gestational age and birth weight median (IQR) were, respectively, 31.0 (5.0) weeks and 1475.0 (843.8) g. Coverage rates were similar to those of the regional population (p > 0.05), while timeliness of administration was significantly delayed compared to the recommended schedule (p < 0.001). Age of administration was not correlated with either body weight and gestational age at birth (Spearman rank, p > 0.05). DTaP-IPV-HBV-Hib 2nd and 3rd doses, MMR and Varicella vaccines coverage data were higher compared to historical cohort (p < 0.05).

CONCLUSION

Increasing vaccine confidence through web-based interventions could have a positive impact on vaccination acceptance of parents of preterm infants, although timeliness results still delayed. There is a strong need to develop different and effective vaccination strategies to protect this very vulnerable population.

Parental COVID-19 vaccine hesitancy for children: vulnerability in an urban hotspot

OBJECTIVE

To compare hesitancy toward a future COVID-19 vaccine for children of various sociodemographic groups in a major metropolitan area, and to understand how parents obtain information about COVID-19.

METHODS

Cross-sectional online survey of parents with children < 18 years old in Chicago and Cook County, Illinois, in June 2020. We used logistic regression to determine the odds of parental COVID-19 vaccine hesitancy (VH) for racial/ethnic and socioeconomic groups, controlling for sociodemographic factors and the sources where parents obtain information regarding COVID-19.

RESULTS

Surveys were received from 1702 parents and 1425 were included in analyses. Overall, 33% of parents reported VH for their child. COVID-19 VH was higher among non-Hispanic Black parents compared with non-Hispanic White parents (Odds Ratio (OR) 2.65, 95% Confidence Interval (CI): (1.99-3.53), parents of publicly insured children compared with privately insured (OR 1.93, (1.53-2.42)) and among lower income groups. Parents receive information about COVID-19 from a variety of sources, and those who report using family, internet and health care providers as information sources (compared to those who don't use each respective source) had lower odds of COVID-19 VH for their children.

CONCLUSIONS

The highest rates of hesitancy toward a future COVID-19 vaccine were found in demographic groups that have been the most severely affected by the pandemic. These groups may require targeted outreach efforts from trusted sources of information in order to promote equitable uptake of a future COVID-19 vaccine.

Artificial Intelligence for Mental Health Care: Clinical Applications, Barriers, Facilitators, and Artificial Wisdom

Artificial intelligence (AI) is increasingly employed in health care fields such as oncology, radiology, and dermatology. However, the use of AI in mental health care and neurobiological research has been modest. Given the high morbidity and mortality in people with psychiatric disorders, coupled with a worsening shortage of mental health care providers, there is an urgent need for AI to help identify high-risk individuals and provide interventions to prevent and treat mental illnesses. While published research on AI in neuropsychiatry is rather limited, there is a growing number of successful examples of AI's use with electronic health records, brain imaging, sensor-based monitoring systems, and social media platforms to predict, classify, or subgroup mental illnesses as well as problems such as suicidality. This article is the product of a study group held at the American College of Neuropsychopharmacology conference in 2019. It provides an overview of AI approaches in mental health care, seeking to help with clinical diagnosis, prognosis, and treatment, as well as clinical and technological challenges, focusing on multiple illustrative publications. Although AI could help redefine mental illnesses more objectively, identify them at a prodromal stage, personalize treatments, and empower patients in their own care, it must address issues of bias, privacy, transparency, and other ethical concerns. These aspirations reflect human wisdom, which is more strongly associated than intelligence with individual and societal well-being. Thus, the future AI or artificial wisdom could provide technology that enables more compassionate and ethically sound care to diverse groups of people.

Timeliness of Early Childhood Vaccinations and Undervaccination Patterns in Montana

INTRODUCTION

Early childhood vaccination rates are lower in rural areas than those in urban areas of the U.S. This study's objective is to quantify vaccine timeliness and the prevalence of undervaccination patterns in Montana and to measure the associations between timeliness and series completion by age 24 months.

METHODS

Using records from January 2015 to November 2019 in Montana's centralized immunization information system, days undervaccinated were calculated for the combined 7-vaccine series. Undervaccination patterns indicative of certain barriers to vaccination, including parental vaccine hesitancy, were identified. Using multivariable log-linked binomial regression, the association between timing of vaccine delay and not completing the combined 7-vaccine series by age 24 months was assessed. Analyses were conducted in March 2020-August 2020.

RESULTS

Among 31,422 children, 38.0% received all vaccine doses on time; 24.3% received all doses, but some were received late; and 37.7% had not completed the combined 7-vaccine series. Approximately 18.7% had an undervaccination pattern suggestive of parental vaccine hesitancy, and 19.7% started all series but were missing doses needed for multidose series completion. Although falling behind on vaccinations at any age was associated with failing to complete the combined 7-vaccine series, being late at age 12-15 months had the strongest association (adjusted prevalence ratio=3.73, 95% CI=3.56, 3.91) compared with being on time at age 12-15 months.

CONCLUSIONS

Fewer than 2 in 5 Montana children were fully vaccinated on time for the combined 7-vaccine series. To increase vaccination rates, initiatives to increase vaccine confidence and remind parents to complete vaccine series are needed.

Using Machine Learning to Compare Provaccine and Antivaccine Discourse Among the Public on Social Media: Algorithm Development Study

BACKGROUND

Despite numerous counteracting efforts, antivaccine content linked to delays and refusals to vaccinate has grown persistently on social media, while only a few provaccine campaigns have succeeded in engaging with or persuading the public to accept immunization. Many prior studies have associated the diversity of topics discussed by antivaccine advocates with the public's higher engagement with such content. Nonetheless, a comprehensive comparison of discursive topics in pro- and antivaccine content in the engagement-persuasion spectrum remains unexplored.

OBJECTIVE

We aimed to compare discursive topics chosen by pro- and antivaccine advocates in their attempts to influence the public to accept or reject immunization in the engagement-persuasion spectrum. Our overall objective was pursued through three specific aims as follows: (1) we classified vaccine-related tweets into provaccine, antivaccine, and neutral categories; (2) we extracted and visualized discursive topics from these tweets to explain disparities in engagement between pro- and antivaccine content; and (3) we identified how those topics frame vaccines using Entman's four framing dimensions.

METHODS

We adopted a multimethod approach to analyze discursive topics in the vaccine debate on public social media sites. Our approach combined (1) large-scale balanced data collection from a public social media site (ie, 39,962 tweets from Twitter); (2) the development of a supervised classification algorithm for categorizing tweets into provaccine, antivaccine, and neutral groups; (3) the application of an unsupervised clustering algorithm for identifying prominent topics discussed on both sides; and (4) a multistep qualitative content analysis for identifying the prominent discursive topics and how vaccines are framed in these topics. In so doing, we alleviated methodological challenges that have hindered previous analyses of pro- and antivaccine discursive topics.

RESULTS

Our results indicated that antivaccine topics have greater intertopic distinctiveness (ie, the degree to which discursive topics are distinct from one another) than their provaccine counterparts (t₁₂₂=2.30, P=.02). In addition, while antivaccine advocates use all four message frames known to make narratives persuasive and influential, provaccine advocates have neglected having a clear problem statement.

CONCLUSIONS

Based on our results, we attribute higher engagement among antivaccine advocates to the distinctiveness of the topics they discuss, and we ascribe the influence of the vaccine debate on uptake rates to the comprehensiveness of the message frames. These results show the urgency of developing clear problem statements for provaccine content to counteract the negative impact of antivaccine content on uptake rates.

How can human-centered design build a story-based video intervention that addresses vaccine hesitancy and bolsters vaccine confidence in the Philippines? A mixedmethod protocol for project SALUBONG

INTRODUCTION

Since the onset of a dengue vaccine controversy in late 2017, vaccine confidence has plummeted in the Philippines, leading to measles and polio outbreaks in early 2019. This protocol outlines a human-centered design (HCD) approach to co-create and test an intervention that addresses vaccine hesitancy (VH) via narrative and empathy with and among families and healthcare workers. METHODS AND ANALYSIS: 'Salubong' is a Filipino term that means to welcome someone back into one's life, reinforcing notions of family ties and friendships. We apply this sentiment to vaccines. Following the phases of HCD, guided by a theoretical framework, and drawing from locally held understandings of faith and acceptance, we will conduct in-depth interviews (IDIs) and focus group discussions (FGDs) in rural and urban Filipino communities that witnessed dramatic increases in measles cases in recent years. During qualitative engagements with caretakers, providers, and policymakers, we will collect narratives about family and community perceptions of childhood vaccinations, public health systems and opportunities to restore faith. IDIs and FGDs will continuously inform the development of (and delivery mechanisms for) story-based interventions. Once developed, we will test our co-created interventions among 800 caretakers and administer a VH questionnaire prior to and immediately following the intervention encounter. We will use the feedback gained through the survey and Kano-style questionnaires to further refine the intervention. Considering the data collection challenges posed by the ongoing COVID-19 pandemic, we have developed workarounds to conduct data collection primarily online. We will use systematic online debriefings to facilitate comprehensive participation of the full research team.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Institutional Review Board of the Research Institute for Tropical Medicine (number 2019-44) and Ethical Commission of Heidelberg University, Faculty of Medicine (S-833/2019). Study findings will be disseminated in scientific conferences and published in peer-reviewed journals.

Characteristics of Antivaccine Messages on Social Media: Systematic Review

Background

Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines.

Objective

This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users’ web-based activities.

Methods

We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies.

Results

The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media.

Conclusions

Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users.

Quality over quantity: human papillomavirus vaccine information on social media and associations with adult and child vaccination

Human Papillomavirus (HPV) vaccination is recommended for adults aged 27-45 as a shared clinical decision with their healthcare provider. With the rise of social media as a vaccine information source, this study examined the extent of exposure to HPV vaccine content by social media platform and evaluated associations between HPV vaccine content on social media and HPV vaccine intent among both 27-45 year olds and their eligible children. U.S. participants (51% women, 9% Black, 8% Hispanic/Latinx), aged 27-45, were cross-sectionally surveyed online from April to May 2020 (n = 691). Outcomes included HPV vaccination intention (intend/do not intend) for themselves and, among participants with unvaccinated children aged 9-17 (n = 223), their eligible children. Adjusted odds ratios for HPV vaccine content and both outcomes were calculated. Extent of HPV vaccination exposure on social media was not associated with intention to vaccinate for HPV. Seeing mostly negative/mixed information about the HPV vaccine on social media was associated with lower odds of vaccination intention for adults (aOR = 0.34, 95% CI 0.15, 0.79) and adolescents (aOR = 0.34, 95% CI 0.21, 0.53). Viewing HPV vaccine information from social media as not credible was associated with lower odds of vaccine intent for adults (aOR = 0.17, 95% CI 0.07, 0.41) and adolescents (aOR = 0.16, 95% CI 0.10, 0.29). Although extent of HPV vaccine exposure on social media was not associated with vaccination outcomes, findings support developing quality social media strategies that increase the dissemination of positive and credible information in favor of HPV vaccination.

We Post It, U Reddit: Exploring the Potential of Reddit for Health Interventions Targeting College Populations

Reddit is an anonymous social media platform that allows users to create, modify, share, and discuss content. While this platform is widely used by mainstream audiences, little research exists on how Redditors respond to health information when it appears in general, non-health specific forums called subreddits. Guided by media system dependency theory, the purpose of this study was to anonymously intervene on college subreddits to explore how Redditors interacted with messages about smoke-free policy compliance. Two messages were posted two weeks apart on ten college subreddits, yielding 370 comments (per thread range = 66-0) and 552 Karma points (per thread range = 123-0). A content analytic approach was employed, identifying eight content themes, and classifying message tone. The most popular themes were general smoking [n = 85], animosity toward smoke-free policies/compliance [n = 68], and smoke-free policy/compliance support [n = 65]). Most comments expressed a neutral tone [n = 196]. Data suggest that Redditors are willing to interact with health content on their college subreddits to varying degrees, especially if this content conforms to norms of the subreddit and/or platform. Implications from the findings suggest important considerations for use of Reddit as a future site for health interventions.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population

BACKGROUND

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

OBJECTIVES

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

SEARCH METHODS

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

DATA COLLECTION AND ANALYSIS

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

MAIN RESULTS

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

AUTHORS' CONCLUSIONS

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

Addressing logistical barriers to childhood vaccination using an automated reminder system and online resource intervention: A randomized controlled trial

BACKGROUND

As the rates of vaccination decline in children with logistical barriers to vaccination, new strategies to increase vaccination are needed. The goal of this study was to develop and evaluate the effectiveness of the Vaccines For Babies (VFB) intervention, an automated reminder system with online resources to address logistical barriers to vaccination in caregivers of children enrolled in an integrated healthcare system. Effectiveness was evaluated in a randomized controlled trial.

METHODS

Qualitative interviews were conducted with parents of children less than two years old to identify logistical barriers to vaccination that were used to develop the VFB intervention. VFB included automated reminders to schedule the 6- and 12-month vaccine visit linking caregivers to resources to address logistic barriers, sent to the preferred mode of outreach (text, email, and/or phone). Parents of children between 3 and 10 months of age with indicators of logistical barriers to vaccination were randomized to receive VFB or usual well child care (UC). The primary outcome was percentage of days undervaccinated at 2 years of life. A difference in differences analysis was conducted.

RESULTS

Qualitative interviews with 6 parents of children less than 2 years of age identified transportation, scheduling challenges, and knowledge of vaccine timing as logistical barriers to vaccination. We enrolled 250 participants in the trial, 45% were loss to follow-up. There were no significant differences in vaccination uptake between those enrolled in UC or the VFB intervention (0.51%, p = 0.86). In Medicaid enrolled participants, there was a modest decrease in percentage of days undervaccinated in the VFB intervention compared to UC (6.3%, p = 0.07).

CONCLUSION

Automated Reminders and with links to heath system resources was not shown to increase infant vaccination uptake demonstrating additional resources are needed to address the needs of caregivers experiencing logistical barriers to vaccination.

Co-Created Messaging for Influenza Vaccination in a High-Risk Hispanic Community Provides Groundwork for COVID-19 Vaccine

Purpose: Influenza/pneumonia is the eighth leading cause of death in the United States. The 2020-2021 influenza season is predicted to be further impacted by COVID-19 infections. Historical data reflect disproportionate morbidity and mortality rates in the Hispanic population for influenza and COVID-19. Influenza vaccination rates remain low in the Hispanic community. We aim to improve vaccination through a community-led event, partnering with the Cristo Rey School Dallas, located in a zip code with a higher age-adjusted influenza/pneumonia mortality rate. A survey was administered to adults attending the Influenza vaccine event to understand attitudes and perceptions about influenza, vaccination, and effective messaging strategies for the campaign. Methods: Messaging was cocreated with student health ambassadors to promote immunization and delivered through trusted sources. The health department administered vaccines to individuals >age 3 at no cost. Adults were asked to complete a 19-question survey postvaccination offered in both English and Spanish. Results: Two hundred and forty-one of 394 (61.2%) participants completed the survey. Ninety-eight percent identified as Hispanic/Latino, and the majority of surveys were administered in Spanish. Among Spanish language participants, the church bulletins (57.3%) and Spanish language radio (30.5%) were reported to be most effective modes of messaging versus word of mouth (32.9%) and social media (26.3%) for English-speaking participants. Sixteen percent of participants surveyed had never received an influenza vaccine before this event. Conclusion: Cocreated messaging delivered by trusted sources in the Hispanic community led to a successful Influenza vaccine drive with the Dallas County health department.

What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments

Social media allow anti-vaxxers to quickly spread misinformation and false statements. This situation may lead to an increase in vaccine hesitancy. We wanted to characterize what arguments against COVID-19 vaccines run on Facebook in Poland. We analyzed Facebook comments related to the five events of the introduction of COVID-19 vaccines—announcements of the efficacy of the Pfizer-BioNTech (09.11.2020), Moderna (16.11.2020), and AstraZeneca (23.11.2020) vaccines, registration of the Pfizer-BioNTech vaccine by the European Medicines Agency (21.12.2020), and the first vaccination in Poland (27.12.2020). We collected the comments from fanpages of the biggest Polish media and then established their main anti-vaccine themes. We found that the negative arguments about COVID-19 vaccines can be divided into 12 categories. Seven of them are universal and also apply to other vaccines but five are new and COVID-19’ specific. The frequency of arguments from a given category varied over time. We also noticed that, while the comments were mostly negative, the reactions were positive. Created codebook of anti-vaccine COVID-19 arguments can be used to monitor the attitude of society towards COVID-19 vaccines. Real-time monitoring of social media is important because the popularity of certain arguments on Facebook changes rapidly over time.

Detecting adherence to the recommended childhood vaccination schedule from user-generated content in a US parenting forum

Vaccine hesitancy is considered as one of the leading causes for the resurgence of vaccine preventable diseases. A non-negligible minority of parents does not fully adhere to the recommended vaccination schedule, leading their children to be partially immunized and at higher risk of contracting vaccine preventable diseases. Here, we leverage more than one million comments of 201,986 users posted from March 2008 to April 2019 on the public online forum BabyCenter US to learn more about such parents. For 32% with geographic location, we find the number of mapped users for each US state resembling the census population distribution with good agreement. We employ Natural Language Processing to identify 6884 and 10,131 users expressing their intention of following the recommended and alternative vaccination schedule, respectively RSUs and ASUs. From the analysis of their activity on the forum we find that ASUs have distinctly different interests and previous experiences with vaccination than RSUs. In particular, ASUs are more likely to follow groups focused on alternative medicine, are two times more likely to have experienced adverse events following immunization, and to mention more serious adverse reactions such as seizure or developmental regression. Content analysis of comments shows that the resources most frequently shared by both groups point to governmental domains (.gov). Finally, network analysis shows that RSUs and ASUs communicate between each other (indicating the absence of echo chambers), however with the latter group being more endogamic and favoring interactions with other ASUs. While our findings are limited to the specific platform analyzed, our approach may provide additional insights for the development of campaigns targeting parents on digital platforms.

The importance and effectiveness of vaccines is generally high, but concerns toward vaccination contribute to eroding confidence in vaccination. Recently, alternative vaccination schedules are becoming popular as they allow parents to selectively delay or refuse certain vaccines depending on their specific concerns. Not being expressly anti-vaccination, these parents are challenging to identify on social media, however understanding the determinants of their hesitancy toward vaccines could help addressing parents’ concerns through targeted interventions. In this work, we create a Natural Language Processing pipeline to automatically identify parents who state their adherence to the recommended or alternative vaccination schedule on a popular parenting forum, BabyCenter US. We find that these users have distinct interests and different experiences with vaccination, although they frequently share similar sources of information (e.g., .gov websites). Differently from what is observed on most popular digital platforms like Facebook or Twitter, where users communicate mainly with like-minded users, Babycenter users communicate between each other independently of the vaccination schedule they adopt. These observations suggest that parenting fora may be a more suitable medium to develop intervention aiming to influence positively the vaccination behavior of parents.

What Is the State-of-the-Art in Clinical Trials on Vaccine Hesitancy 2015-2020?

BACKGROUND

Vaccine hesitancy is related to a delay in acceptance or refusal of vaccination.

AIM

to perform a systematic review of clinical trials on vaccine hesitancy (2015-2020).

METHODS

a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). Five databases were screened-PubMed, Cochrane Library, DOAJ, SciELO and b-on-which comprise multiple resources.

KEYWORDS

"Vaccine hesitancy" and ("randomized controlled trial" or "clinical trial").

INCLUSION CRITERIA

trials about "vaccine hesitancy" enrolling patients and/or health professionals (2015-2020).

EXCLUSION CRITERIA

studies about other topics, repeated and qualitative studies, reviews and papers written in languages other than English, Portuguese, French or Spanish.

RESULTS

a total of 35 trials out of 90 were selected (19 PubMed, 14 Cochrane Library, 0 DOAJ, 0 SciELO and 2 b-on). Selected trials were classified into five topics: children/pediatric (n = 5); online or electronic information (n = 5); vaccination against a specific disease (n = 15) (e.g., influenza or COVID-2019); miscellaneous (n = 4); and educational strategies (n = 6).

CONCLUSION

the provision of online or electronic information (e.g., through virtual reality, social websites of experts, or apps), communication-based interventions and training of health professionals, residents or subjects seemed to improve vaccine hesitancy.

Media usage predicts intention to be vaccinated against SARS-CoV-2 in the US and the UK

There is existing evidence of a relationship between media use and vaccine hesitancy. Four online questionnaires were completed by general population samples from the US and the UK in June 2020 (N = 1198, N = 3890, N = 1663, N = 2237). After controls, all four studies found a positive association between intention to be vaccinated and usage of broadcast and print media. The three studies which operationalised media usage in terms of frequency found no effect for social media. However, the study which operationalised media use in terms of informational reliance found a negative effect for social media. Youth, low household income, female gender, below degree-level of education, and membership of other than white ethnic groups were each also found to be associated with lower intentions to be vaccinated in at least two of the four studies. In all four studies, intention to be vaccinated was positively associated with having voted either for Hillary Clinton in the 2016 US presidential elections or for Labour Party candidates in the 2019 UK general election. Neither of the UK studies found an association with having voted for Conservative Party candidates, but both US studies found a negative association between intention to be vaccinated and having voted for Donald Trump. The consistent finding of greater intention to be vaccinated among users of legacy media but not among users of social media suggests that social media do not currently provide an adequate replacement for legacy media, at least in terms of public health communication. The finding of a negative association with social media in the study which measured informational reliance rather than frequency is consistent with the view that uncritical consumption of social media may be acting to promote vaccine hesitancy.

Losing ground at the wrong time: trends in self-reported influenza vaccination uptake in Switzerland, Swiss Health Survey 2007-2017

OBJECTIVES

We studied time trends in seasonal influenza vaccination and associations with socioeconomic and health-related determinants in Switzerland, overall and in people aged ≥65 years.

DESIGN

Three cross-sectional surveys.

PARTICIPANTS

Individuals who participated in the Swiss Health Surveys 2007, 2012 and 2017. We calculated the proportion reporting influenza vaccination in the last 12 months, and performed multivariable logistic regression analyses.

RESULTS

We included 51 582 individuals in this analysis. The median age was 49 years (IQR 25-64), and 27 518 were women (53.3%). The proportion of reporting a history of influenza vaccination overall was 31.9% (95% CI 31.4 to 32.4); and dropped from 34.5% in 2007 to 28.8% in 2017. The uptake of vaccination within the past 12 months was 16% in 2007 and similar in 2012 and 2017 (around 14%). In people with chronic disease, uptake dropped from 43.8% in 2007 to 37.1% in 2012 and to 31.6% in 2017 (p<0.001). In people aged ≥65 years, uptake dropped from 47.8% in 2007 to 38.5% in 2012 to 36.2% in 2017 (p<0.001). In logistic regression, self-reported vaccination coverage decreased in the 65-75 years old (adjusted OR (aOR) 0.56, 95% CI 0.48 to 0.66 between 2007 and 2012; aOR 0.89, 95% CI 0.77 to 1.03 between 2012 and 2017). Uptake was positively associated with the ≥65 age group, living in French-speaking and urban areas, history of smoking, bad self-reported health status, private/semiprivate health insurance, having a medical profession and having any underlying chronic disease.

CONCLUSION

Influenza vaccination coverage was low in older and chronically ill persons. Significant efforts are required in preparing for the influenza season 2020/2021 to reduce the double burden of COVID-19 and seasonal influenza. These efforts should include campaigns but also novel approaches using social media.

Infant vaccination education preferences among low-income pregnant women

Childhood vaccination is an important public health intervention, yet many children remain under-vaccinated. The objective of this study was to examine infant vaccination education preferences in a population of low-income pregnant women by ethnicity, nativity, and language. Pregnant women 14–44 y old (n = 335) attending a participating low-income reproductive health clinic in southeast Texas from May 26-July 21, 2017, and who completed a paper survey offered in English and Spanish were included. Participants were asked to complete questions about their demographic characteristics and preferences about infant vaccination education. To examine differences in vaccine education preferences by participant demographic characteristics, chi-squared tests, or Fisher’s exact tests and one-way analysis of variance (ANOVA) were conducted using Stata SE Version 15.1 with α = 0.05. Nearly half (47.5%) of participants considered pregnancy the best time to get information about infant vaccination and were most likely (40.6%) to indicate the nurse who gives vaccines during pregnancy as the health-care worker with whom they would like to discuss infant vaccination. There were no demographic differences in preferred timing of vaccine education delivery or provider who delivers vaccine education. Prenatal, nurse-delivered vaccine educational programs would be well accepted in this low-income population.

Challenges and Opportunities in Social Media Research in Gastroenterology

In recent years, social media has transformed how we as gastroenterologists communicate with each other and has grown into an arena of knowledge and peer support for patients. Gastroenterologists commonly use social media for education networking, patient populations use social media for peer support and advocacy, but little is known about how gastroenterologists can use social media to conduct thoughtful and rigorous patient-centered research. Therefore, we aim to introduce the scope of social media research, highlight prominent examples in gastroenterology, and review innovative opportunities and unique challenges to using and studying social media for research.

Does the Narrative Voice Influence Parental Perceptions of Pediatrician Blogs?

OBJECTIVE

To determine parental perceptions of pediatrician blog posts by narrative voice.

METHODS

Three blog posts each on 2 topics (vaccines and sleep) were written by an established physician blogger and varied by narrative voice (personal, third person objective and mixed). Topics were chosen to be applicable to all parents. Blog posts were evaluated by a communications expert, 2 research investigators, and 3 parents to confirm differences in narrative voice. We sampled parents of children 0 to 18 years old in 4 primary and subspecialty care clinics, and 1 inpatient medical unit. Participants were randomized to read 2 blog posts (1 per topic) that varied by narrative voice. Participants rated their perceptions of the accuracy, reliability, and appeal for each blog posts on a 5-point Likert Scale. The Kruskal-Wallis test was used to compare the distribution of parental rankings for accuracy, reliability, and appeal.

RESULTS

The average participant age (n = 258) was 39.8 (SD 9.7), 83% were female. Blog posts written in the third person objective voice were rated as more accurate and reliable than those in the personal or mixed voice. There was effect modification by topic, with parents rating the sleep blog posts as more accurate than the vaccine blog posts. There was no difference in the appeal of information by narrative voice or topic of blog post.

CONCLUSIONS

The narrative voice used to convey information on pediatrician blog posts can influence reader perception of accuracy and reliability. Physician bloggers can enhance parental trust of their content using study findings.

Global Measles Epidemic Risk: Current Perspectives on the Growing Need for Implementing Digital Communication Strategies

A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as “vaccine hesitancy” and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people’s positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization.

The impact of a Facebook campaign among mothers on HPV vaccine uptake among their daughters: A randomized field study

OBJECTIVE

The popularity of social networks provide an incredible opportunity to enhance the impact of preventive medicine programs. We aimed to assess whether a targeted Facebook campaign among mothers may increase the uptake of human Papilloma virus (HPV) immunization among their 8th-grade daughters.

METHODS

This field study was conducted among the members of a state-mandated health organization in Israel. Included were all 21,592 members who were mothers to 14 year-old daughters in the 2018-19 school-year. A total of 17,271 (80%) were randomly allocated to the campaign arm and the rest (n=4,321) were selected as a reference group. The Facebook ads addressed issues and concerns regarding HPV-related diseases and HPV vaccine. Main outcome measures were Facebook metrics on exposure to campaign and HPV immunization among eighth grade daughters of the study participants.

RESULTS

Between 8/2018-10/2018, Facebook ads were shown 1.8-million times (a reach of 88%). The uptake of HPV vaccine among daughters of women allocated to the campaign arm (55.3%) was similar (p = 0.749) to 55.0% in the control group. The only significant differences between study groups were observed when stratifying by SES level. In the lowest SES quartile, Facebook campaign significantly (p = .02) reduced vaccine uptake (35% vs. 39.0%), with a relative risk of 0.90 (95%CI: 0.82-0.98), while in the second SES quartile, Facebook campaign increased vaccine uptake from 52.6% to 55.8%, with a RR of 1.06 (95%CI,1.00-1.12). Among mothers in higher SES levels, daughters of exposed and unexposed mothers had similar immunization rates.

CONCLUSIONS

Facebook campaign may increase the uptake of HPV vaccine among daughters to mothers of medium-to-low SES level, but it may reduce vaccination among lower SES groups.

The Experience of VaccinarSinToscana Website and the Role of New Media in Promoting Vaccination

The Department of Health Sciences (University of Florence) developed a regional website “VaccinarSinToscana” in order to provide information on vaccines and communicate with the general population, as well as the healthcare community, at a regional and local level. The aim of this paper is to present the VaccinarSinToscana website framework and analyze the three-year activity of the website and the related social network account on Facebook in terms of dissemination and visibility. In the first three years since its launch, the VaccinarSinToscana portal has increased its visibility: the number of single users, visits and single web pages has grown exponentially. Our results also demonstrate how the Facebook account launch contributed enormously to the increase in the visibility of the website. The objective for the future of the VaccinarSinToscana portal is to grow further, in order to reach out to an even wider audience.

Social media use and human papillomavirus awareness and knowledge among adults with children in the household: examining the role of race, ethnicity, and gender

BACKGROUND

Though human papillomavirus (HPV) vaccination is a safe and effective method of protecting against associated cancers, uptake rates remain low among adolescents. Few studies have examined how social media use contributes to HPV-related knowledge gaps among parents and caregivers.

OBJECTIVE

To investigate the association between social media use and HPV-related awareness and knowledge with a focus on differences by gender and race/ethnicity among a nationally representative sample of adults with children in the household.

METHODS

We used data from the Health Information National Trends (HINTS) Survey (2017-2019) (N = 2,720). Multivariate logistic regressions were used to examine the association of social media use on HPV awareness and knowledge outcomes.

RESULTS

Compared to non-users, engaging in one, two, three, or four social media behaviors were associated with greater HPV awareness (aOR: 2.09; 95%CI: 1.18-3.70, aOR: 2.49; 95%CI: 1.40-4.42, aOR: 2.64; 95%CI: 1.15-6.05, and aOR: 2.44; 95%CI: 1.11-5.36, respectively). Increased social media use was associated with increased HPV vaccine awareness. Men, African American, Hispanic, and Asian American respondents were less likely to be aware of HPV or HPV vaccine. Social media use was not associated with cancer knowledge.

CONCLUSIONS

Increased social media use is associated with an increased awareness of HPV and HPV vaccine for adults with children in the household. Social media-based efforts can be utilized to increase knowledge of the benefits of HPV vaccination as cancer prevention, which may be a precursor to reducing HPV vaccine hesitancy and encouraging uptake to decrease cancer incidence rates among vulnerable populations.

Parental Online Information Access and Childhood Vaccination Decisions in North America: Scoping Review

Background

Immunizing children throughout their early years prevents the spread of communicable disease and decreases the morbidity and mortality associated with many vaccine-preventable diseases. Searching online allows individuals rapid access to health information.

Objective

The purpose of this review was to develop an understanding of the existing literature of parents’ online health information-seeking behaviors to inform their vaccination choices for their children and to identify gaps in the literature around parents’ use of online health information and their vaccination choices.

Methods

A scoping review of peer-reviewed literature from Canada and the United States was performed. The following databases were utilized to perform the search: PubMed, CINAHL, Nursing & Allied Health Database, Scopus, and PsycINFO. The purpose of this review was to examine parents’ use of online information seeking related to vaccine information and to understand how parents utilize this information to inform decisions about vaccinating their children. Of the 34 papers included in the review, 4 relevant themes and subthemes were identified: information seeking, online information resources, online vaccine content, and trust in health care providers.

Results

Examination of the literature revealed conflicting information regarding parents’ use of social media and online resources to inform decisions around vaccinating their children. There is evidence of significant misinformation regarding vaccine risks online. Parents’ digital health literacy levels are unknown and may affect their ability to appraise online vaccination information.

Conclusions

Parents are seeking vaccine information from online sources. However, the influence of online vaccine information on parental vaccine practices remains uncertain.

Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies

Parental vaccine hesitancy is becoming an increasingly important public health concern in the United States. In March 2020, an assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 months were not following the recommended early childhood immunization schedule. Furthermore, a 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Vaccine hesitancy is now associated with a decrease in vaccine coverage and an increase in vaccine-preventable disease outbreaks and epidemics in the United States. Many studies have focused on understanding and defining the new socio-medical term, vaccine hesitancy; few have attempted to summarize past and current health communication interventions and strategies that have been successful or unsuccessful in tackling this growing phenomenon. This systematic literature review will attempt to aid public health professionals with a catalogue of health communication interventions and strategies to ultimately address and prevent parental vaccine hesitancy in the long term. Out of 1239 search results, a total of 75 articles were included for analysis, ranging from systematic reviews, quantitative surveys, and experimental designs to ethnographic and qualitative studies. For the presentation of results, a taxonomy was used to organize communication interventions according to their intended purpose. The catalogue of interventions was further broken down into specific components and themes that were identified in the literature as essential to either the success or failure in preventing and addressing parental vaccine hesitancy towards childhood vaccines.

Beliefs towards vaccination and trust in the scientific community in Italy

BACKGROUND

In 2017 the Italian government introduced compulsory vaccination for Italian school children for ten diseases, in response to an alarmingly decrease in coverage and measles outbreak. A hot social debate arose around the issue of the law. Studies on the opinion of Italians on this topic are rare, so we investigated the socio-cultural profile of Italians about beliefs towards vaccination.

METHODS

Data were extracted from the Italian section of the European Social Survey (ESS), conducted by the Italian National Institute for Public Policies Analysis during 2017. The main outcome assessed was the opinion about the supposed harmfulness of vaccines. We analysed the association between the outcome and a selected group of socio-cultural characteristics, with a specific interest in examining the interaction between our main outcome and the perceived trust in the scientific community in regards to vaccines. A principal component analysis was then performed for determining the socio-cultural profile of respondents.

RESULTS

Among the 2,626 subjects interviewed face to face, 19% believed that vaccines were harmful and 10% did not have trust in the scientific community in regards to vaccines. Out of the respondents who believed in the harmfulness of vaccines, 29% neither had trust in the scientific community. Principal Component Analysis suggested that this group (Anti-vax/science sceptic) was characterised by low participation in political and cultural life, being male, older of age and politically oriented towards the right. People agreeing about harmfulness of vaccines are mostly males, have a lower education level, poor attendance in political and cultural life and are politically oriented to the right.

CONCLUSIONS

The ESS survey is unique in its capacity to deal with emerging themes of the social debates. Results paint a picture of the opinions of Italians on vaccines. This profile may be useful for policymakers to design targeted vaccination campaigns and to intervene more efficaciously in the public debate.

Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey

BACKGROUND AND OBJECTIVES

The World Health Organization has designated vaccine hesitancy as 1 of the 10 leading threats to global health, yet there is limited current national data on prevalence of hesitancy among US parents. Among a nationally representative sample of US parents, we aimed to (1) assess and compare prevalence of hesitancy and factors driving hesitancy for routine childhood and influenza vaccination and (2) examine associations between sociodemographic characteristics and hesitancy for routine childhood or influenza vaccination.

METHODS

In February 2019, we surveyed families with children using the largest online panel generating representative US samples. After weighting, we assessed hesitancy using a modified 5-point Vaccine Hesitancy Scale and labeled parents as hesitant if they scored >3.

RESULTS

A total of 2176 of 4445 parents sampled completed the survey (response rate 49%). Hesitancy prevalence was 6.1% for routine childhood and 25.8% for influenza vaccines; 12% strongly and 27% somewhat agreed they had concerns about serious side effects of both routine childhood and influenza vaccines. A total of 70% strongly agreed that routine childhood vaccines are effective versus 26% for influenza vaccine (P < .001). In multivariable models, an educational level lower than a bachelor's degree and household income <400% of the federal poverty level predicted hesitancy about both routine childhood and influenza vaccines.

CONCLUSIONS

Almost 1 in 15 US parents are hesitant about routine childhood vaccines, whereas >1 in 4 are hesitant about influenza vaccine. Furthermore, 1 in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines, and only 1 in 4 believe influenza vaccine is effective. Vaccine hesitancy, particularly for influenza vaccine, is prevalent in the United States.

Behavior Change Techniques Included in Reports of Social Media Interventions for Promoting Health Behaviors in Adults: Content Analysis Within a Systematic Review

BACKGROUND

Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development.

OBJECTIVE

This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults.

METHODS

We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs.

RESULTS

Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity.

CONCLUSIONS

This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence.

Applying lessons from vaccination hesitancy to address birth dose Vitamin K refusal: Where has the trust gone?

Refusal of intramuscular Vitamin K at birth is an emerging public health issue resulting in increased rates of intracranial bleeding. Parents who refuse this intervention bear epidemiologic resemblance to vaccine-refusing parents, are geographically clustered and share a mistrust of public health interventions. We review the prevalence of Vitamin K refusal and discuss individual and societal recommendations that may reduce Vitamin K refusal, adapted from vaccine hesitancy literature. We note the prevalence of misinformation on social media as a contributor to refusal and explore how changes in healthcare practices may influence growing physician mistrust. We propose solutions to the issue including state-based mandates and a pervasive social media strategy to combat misinformation as a contributor to Vitamin K refusal.

Studying Public Perception about Vaccination: A Sentiment Analysis of Tweets

Text analysis has been used by scholars to research attitudes toward vaccination and is particularly timely due to the rise of medical misinformation via social media. This study uses a sample of 9581 vaccine-related tweets in the period January 1, 2019 to April 5, 2019. The time period is of the essence because during this time, a measles outbreak was prevalent throughout the United States and a public debate was raging. Sentiment analysis is applied to the sample, clustering the data into topics using the term frequency-inverse document frequency (TF-IDF) technique. The analyses suggest that most (about 77%) of the tweets focused on the search for new/better vaccines for diseases such as the Ebola virus, human papillomavirus (HPV), and the flu. Of the remainder, about half concerned the recent measles outbreak in the United States, and about half were part of ongoing debates between supporters and opponents of vaccination against measles in particular. While these numbers currently suggest a relatively small role for vaccine misinformation, the concept of herd immunity puts that role in context. Nevertheless, going forward, health experts should consider the potential for the increasing spread of falsehoods that may get firmly entrenched in the public mind.

Engagement design in studies on pregnancy and infant health using social media: Systematic review

Social media utilization is prevalent among reproductive-age women. The literature on how researchers engage women in studies using social media platforms is scarce. This systematic review analyzed participant engagement design in studies using social media and focused on pregnancy and infant health.

METHODS

A literature search of EBSCO and PubMed databases was conducted. Included studies had to be completed with quantitative data, focus on pregnancy, postpartum or infant health, and use social media in the research process. A matrix of three engagement designs (passive, interactive, independent) and three research processes (recruitment, data analysis, intervention) was used for analysis.

FINDINGS

Thirty-one articles that reported 30 studies met the inclusion criteria. Of these, four were randomized controlled trials (RCT), four were non-RCT interventions, and 22 were observational/descriptive studies. The main purpose of using social media was for recruitment (n = 16), data analysis (n = 6), intervention (n = 8), or both recruitment and intervention (n = 1). Passive engagement was a fundamental design approach in all studies to access a data source that was either the participant or the data provided by the participants in social media. Interactive engagement, mostly for recruitment and intervention, was to engage participants in completing study enrollment or in interacting with the study team or fellow participants. Independent engagement involved off-line activities and appeared sporadically in intervention studies.

CONCLUSIONS

Passive and interactive engagement designs are more frequently used than independent engagement design. Researchers should select suitable designs when studying pregnancy and infant health using social media.

A Values-Tailored Web-Based Intervention for New Mothers to Increase Infant Vaccine Uptake: Development and Qualitative Study

BACKGROUND

Vaccine hesitancy among parents leads to childhood undervaccination and outbreaks of vaccine-preventable disease. As the reasons for vaccine hesitancy are diverse, there is often not enough time during regular clinical visits for medical providers to adequately address all the concerns that parents have. Providing individually tailored vaccine information via the internet before a clinical visit may be a good mechanism for effectively allaying parents' vaccination concerns while also being time efficient. Including tailoring based on values is a promising, but untested, approach to message creation.

OBJECTIVE

This study aimed to describe the process by which we developed a Web-based intervention that is being used in an ongoing randomized controlled trial aimed at improving the timeliness of infant vaccination by reducing parental vaccine hesitancy.

METHODS

Development of the intervention incorporated evidence-based health behavior theories. A series of interviews, surveys, and feedback sessions were used to iteratively develop the intervention in collaboration with vaccination experts and potential end users.

RESULTS

In all, 41 specific content areas were identified to be included in the intervention. User feedback elucidated preferences for specific design elements to be incorporated throughout the website. The tile-based architecture chosen for the website was perceived as easy to use. Creating messages that were two-sided was generally preferred over other message formats. Quantitative surveys identified associations between specific vaccine values and vaccination beliefs, suggesting that values tailoring should vary, depending on the specific belief being endorsed.

CONCLUSIONS

Using health behavior theories, qualitative and quantitative data, and significant expert and end user input, we created a novel, Web-based intervention to improve infant vaccination timeliness. The intervention is based on tailoring messages according to each individual's values and beliefs. This intervention is currently being tested in a controlled randomized clinical trial.

Current practice and attitudes towards vaccination during pregnancy: a survey of GPs across England

Background

Antenatal vaccines are commonly delivered in primary care, yet the views of GPs regarding these programmes have been neglected in research to date.

Aim

To establish the attitudes and current practice of GPs towards antenatal vaccination and their views on the optimal location for delivery of this service.

Design and setting

A multicentre online survey questionnaire.

Method

A questionnaire was sent to GPs across England between December 2018 and January 2019.

Results

The majority of 1586 responders considered antenatal vaccination safe (96% for influenza, 89% pertussis). GPs were significantly less confident in their knowledge of pertussis compared with influenza vaccination (64% versus 80% were confident, P <0.001), and many desired further education (59% versus 48%, P <0.001). Few (37%) discussed vaccination with pregnant women regularly, but most (80%) felt their recommendation would influence decision making. Those with greater confidence in their knowledge of pertussis and influenza vaccination, and who were >2 years since qualifying, discussed vaccination significantly more often (odds ratio [OR] 3.52, P <0.001; OR 2.34, P = 0.001; OR 1.76, P = 0.003, respectively), regardless of whether they routinely saw pregnant women. Most (83%) reported that antenatal vaccination was GP led in their region, yet only 26% thought it should be primarily GP based. GPs expressed disconnect from antenatal care, and many suggested that midwives and/or secondary care should take greater responsibility for the delivery of antenatal vaccination.

Conclusion

There is support among GPs to embed vaccination programmes within routine antenatal care. Further educational resources, specifically designed for the needs of GPs, are needed to facilitate opportunistic discussion with pregnant women about vaccination.

Evidence-based strategies to increase vaccination uptake: a review

PURPOSE OF REVIEW

To summarize evidence-based strategies for improving pediatric immunization rates including physician behaviors, clinic and public health processes, community-based and parent-focused interventions, and legal and policy approaches RECENT FINDINGS: Studies continue to show the effectiveness of audit and feedback, provider reminders, standing orders, and reminder/recall to increase immunization rates. Provider communication strategies may improve immunization rates including use of a presumptive approach and motivational interviewing. Centralized reminder/recall (using a state Immunization Information System) is more effective and cost-effective compared to a practice-based approach. Recent work shows the success of text messages for reminder/recall for vaccination. Web-based interventions, including informational vaccine websites with interactive social media components, have shown effectiveness at increasing uptake of pediatric and maternal immunizations. Vaccination requirements for school attendance continue to be effective policy interventions for increasing pediatric and adolescent vaccination rates. Allowance for and ease of obtaining exemptions to vaccine requirements are associated with increased exemption rates.

SUMMARY

Strategies to increase vaccination rates include interventions that directly impact physician behavior, clinic and public health processes, patient behaviors, and policy. Combining multiple strategies to work across different settings and addressing different barriers may offer the best approach to optimize immunization coverage.

Promoting immunization resiliency in the digital information age

The avalanche of online information on immunization is having a major impact on the percentage of the population who choose to get vaccinated. Vaccine misinformation spreads widely with the interactive Web 2.0 and social media; this can bury science-based information. A plethora of immunization misinformation online is affecting trust in health care professionals and in public immunization programs. There are no simple solutions to this, but seven evidence-based strategies can help. First, listen to patients' and parents' concerns, and demonstrate responsiveness by adopting best immunization practices, such as pain mitigation. Second, recognize and alert others to anti-immunization tactics, namely, conspiracy theories, fake experts, selectivity, demands that vaccines be 100% safe and effective, misrepresentation and false logic. Third, avoid unproductive debates with those who have strongly held views, both in person and when using social media. Be respectful, stick to your key message, identify where to find useful information and exit. Fourth, consider establishing an attractive, easily searchable online presence that reflects the complex art of persuasion. Emphasize the benefits of vaccine, use reader-friendly graphics and highlight facts with stories to strengthen your case. Fifth, work with social media platform providers, not to stifle freedom of expression, but to help ensure that misinformation is not favoured in searches. Sixth, promote curriculum development in the schools to improve students' understanding of the benefits and safety of immunization and to foster critical thinking skills. To do this, optimize the use of age-appropriate comics and interactive learning tools such as electronic games. Seventh, to shift the narrative in specific communities with low vaccination rates, work with community leaders to build tailored programs that foster trust and reflect local values.

Parental Perceptions of the Internet and Social Media as a Source of Pediatric Health Information

OBJECTIVE

1) To evaluate differences in how parents use the Internet and social media for health information by child age. 2) To examine parental perceptions of health information on social media.

METHODS

We conducted a cross-sectional survey of parents of children 0 to 18 years seen in clinics and an inpatient medical unit. Survey questions focused on: patterns of Internet and social media use, for what topics, and parental ratings of the accuracy, reliability, and appeal of information from social media. Parents' responses were categorized by age of their youngest child in years (0-4, 5-11, 12-18).

RESULTS

A total of 258 parents completed the survey. The mean age was 39.8 years, 83% were female, 59% were white. The most common topics parents read about online were: sleep, mental health, and car safety. Nearly all parents (96%) used social media, with 68% using social media for health information. There were no significant differences in the proportion of parents who reported using social media for health information by child age. Only half of parents discussed information from social media with their physician. Parents of children age ≥5 years rated health information on social media as significantly more accurate than parents of younger children. There were no significant differences in ratings of reliability and appeal by child age.

CONCLUSIONS

Parents of children of all ages use social media for a variety of important topics related to child health. As many parents do not discuss it with their physician, there are missed opportunities for pediatricians to provide high-quality information.

Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT

INTRODUCTION

Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women.

STUDY DESIGN

RCT.

SETTING/PARTICIPANTS

This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018.

INTERVENTION

Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal.

MAIN OUTCOME MEASURES

Tdap and influenza vaccination. These outcomes were analyzed separately.

RESULTS

For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively.

CONCLUSIONS

Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01873040.

Survey of Adult Influenza Vaccination Practices and Perspectives Among US Primary Care Providers (2016-2017 Influenza Season)

BACKGROUND

Seasonal influenza vaccination is recommended for all adults; however, little is known about how primary care physicians can communicate effectively with patients about influenza vaccination.

OBJECTIVE

To assess among general internal medicine (GIM) and family physicians (FP) regarding adult influenza vaccination: (1) recommendation and administration practices, (2) barriers to discussing and perceived reasons for patient refusal, and (3) factors associated with physician self-efficacy in convincing patients to be vaccinated.

DESIGN

Email and mail survey conducted in February-March 2017 PARTICIPANTS: Nationally representative sample of GIM and FP MAIN MEASURES: Factor analysis was used to group similar items for multivariable analysis of barriers and strategies associated with high physician self-efficacy about convincing patients to be vaccinated (defined as disagreeing that they could do nothing to change resistant patients' minds).

KEY RESULTS

Response rate was 67% (620/930). Ninety-eight percent always/almost always recommended influenza vaccine to adults ≥ 65 years, 90% for adults 50-64 years, and 75% for adults 19-49 years. Standing orders (76%) and electronic alerts (64%) were the most commonly used practice-based immunization strategies. Frequently reported barriers to discussing vaccination were other health issues taking precedence (41%), time (29%), and feeling they were unlikely to change patients' minds (24%). Fifty-eight percent of physicians reported high self-efficacy about convincing patients to be vaccinated; these providers reported fewer patient belief barriers contributing to vaccine refusal (RR = 0.93 per item; 95% CI (0.89-0.98); Cronbach's α = 0.70), were more likely to report using both fact- (1.08/item; (1.03-1.14); 0.66) and personal experience-based (1.07/item; (1.003-1.15); 0.65) communication strategies, and were more likely to work in practices using patient reminders for influenza vaccine (1.32; (1.16-1.50)).

CONCLUSIONS

Physicians identified barriers to successfully communicating about adult influenza vaccination but few effective strategies to counter them. Interventions to promote self-efficacy in communication and under-utilized practice-based immunization strategies are needed.

Hepatitis B Birth Dose: First Shot at Timely Early Childhood Vaccination

INTRODUCTION

Current U.S. recommendations state that newborns weighing ≥2,000 grams should receive a birth dose of hepatitis B vaccine, yet approximately one quarter do not receive this first dose as scheduled. The relationship between timely receipt of the first hepatitis B vaccine and other early childhood vaccines remains unclear.

METHODS

Washington State newborns (birth weight ≥2,000 grams) who received birth hospitalization care at an urban academic medical center between 2008 and 2013 were included. Multivariable logistic regression was used to assess whether hepatitis B vaccine receipt during the birth hospitalization was associated with completing the seven-vaccine series by 19 months, adjusting for select sociodemographic, clinical, and birth hospitalization characteristics. Analyses were conducted in 2017-2018.

RESULTS

Of the 9,080 study participants, 75.5% received hepatitis B vaccine during the birth hospitalization, and 53.6% completed the seven-vaccine series by 19 months. Overall, 60.0% of infants vaccinated against hepatitis B during the birth hospitalization completed the seven-vaccine series by 19 months compared with 33.8% of those who were unvaccinated at discharge (p<0.001). The odds of series completion were nearly 3 times higher among infants who received versus did not receive hepatitis B vaccine during the birth hospitalization (AOR=2.92, 95% CI=2.61, 3.26).

CONCLUSIONS

Infants who received hepatitis B vaccine during their birth hospitalization had higher odds of receiving all recommended vaccines by 19 months independent of other factors associated with vaccine receipt. Understanding the factors that influence this first parental vaccine decision and how hepatitis B vaccine delay or declination may affect subsequent vaccination requires further research.