Misinformation and other elements in HPV vaccine tweets: an experimental comparison

Longitudinal analysis of behavioral factors and techniques used to identify vaccine hesitancy among Twitter users: Scoping review

While vaccines have played a pivotal role in the fight against infectious diseases, individuals engage in online resources to find vaccine-related support and information. The benefits and consequences of these online peers are unclear and mainly cause a behavioral shift in user sentiment toward vaccination. This scoping review aims to identify the community and individual factors that longitudinally influence public behavior toward vaccination. The secondary aim is to gain insight into techniques and methodologies used to extract these factors from Twitter data. We followed PRISMA-ScR guidelines to search various online repositories. From this search process, a total of 28 most relevant articles out of 705 relevant studies. Three main themes emerged including individual and community factors influencing public attitude toward vaccination, and techniques employed to identify these factors. Anti-vax, Pro-vax, and neutral are the major communities, while misinformation, vaccine campaign, and user demographics are the common individual factors assessed during this reviewing process. Twitter user sentiment (positive, negative, and neutral) and emotions (fear, trust, sadness) were also discussed to identify the intentions to accept or refuse vaccines. SVM, LDA, BERT are the techniques used for topic modeling, while Louvain, NodeXL, and Infomap algorithms are used for community detection. This research is notable for being the first systematic review that emphasizes the dearth of longitudinal studies and the methodological and underlying practical constraints underpinning the lucrative implementation of an explainable and longitudinal behavior analysis system. Moreover, new possible research directions are suggested for the researchers to perform accurate human behavior analysis.

Addressing message fatigue for encouraging COVID-19 vaccination

During the prolonged COVID-19 pandemic, health communication researchers and practitioners should be aware of the unintended effects of message fatigue. Message fatigue is a motivational state caused by repeated and prolonged exposure to similar health-related messages that induces resistance to health behaviors. Messages encouraging COVID-19 vaccination tend to focus on scientific evidence and efficacy information. However, prolonged exposure to similarly framed repeated pro-COVID-19 vaccination messages may cause message fatigue, generate psychological reactance, and lead to ineffective persuasive outcomes. Scholars of message fatigue argue that health communication practitioners should select a less common frame to reduce fatigue responses and increase favorable attitudes toward message recommendations. Entering the second year since COVID-19 vaccination has begun, to reduce message fatigue, future pro-COVID-19 vaccination communication should increase the diversity of messages different than the frequently used types. This opinion piece proposes alternative dissemination of cognitive, affective, narrative, and non-narrative pro-COVID-19 vaccination messages.

Fact-Checking Cancer Information on Social Media in Japan: Retrospective Study Using Twitter

BACKGROUND

The widespread use of social media has made it easier for patients to access cancer information. However, a large amount of misinformation and harmful information that could negatively impact patients' decision-making is also disseminated on social media platforms.

OBJECTIVE

We aimed to determine the actual amount of misinformation and harmful information as well as trends in the dissemination of cancer-related information on Twitter, a representative social media platform. Our findings can support decision-making among Japanese patients with cancer.

METHODS

Using the Twitter app programming interface, we extracted tweets containing the term "cancer" in Japanese that were posted between August and September of 2022. The eligibility criteria were the cancer-related tweets with the following information: (1) reference to the occurrence or prognosis of cancer, (2) recommendation or nonrecommendation of actions, (3) reference to the course of cancer treatment or adverse events, (4) results of cancer research, and (5) other cancer-related knowledge and information. Finally, we selected the top 100 tweets with the highest number of "likes." For each tweet, 2 independent reviewers evaluated whether the information was factual or misinformation, and whether it was harmful or safe with the reasons for the decisions on the misinformation and harmful tweets. Additionally, we examined the frequency of information dissemination using the number of retweets for the top 100 tweets and investigated trends in the dissemination of information.

RESULTS

The extracted tweets totaled 69,875. Of the top 100 cancer-related tweets with the most "likes" that met the eligibility criteria, 44 (44%) contained misinformation, 31 (31%) contained harmful information, and 30 (30%) contained both misinformation and harmful information. Misinformation was described as Unproven (29/94, 40.4%), Disproven (19/94, 20.2%), Inappropriate application (4/94, 4.3%), Strength of evidence mischaracterized (14/94, 14.9%), Misleading (18/94, 18%), and Other misinformation (1/94, 1.1%). Harmful action was described as Harmful action (9/59, 15.2%), Harmful inaction (43/59, 72.9%), Harmful interactions (3/59, 5.1%), Economic harm (3/59, 5.1%), and Other harmful information (1/59, 1.7%). Harmful information was liked more often than safe information (median 95, IQR 43-1919 vs 75.0 IQR 43-10,747; P=.04). The median number of retweets for the leading 100 tweets was 13.5 (IQR 0-2197). Misinformation was retweeted significantly more often than factual information (median 29.0, IQR 0-502 vs 7.5, IQR 0-2197; P=.01); harmful information was also retweeted significantly more often than safe information (median 35.0, IQR 0-502 vs 8.0, IQR 0-2197; P=.002).

CONCLUSIONS

It is evident that there is a prevalence of misinformation and harmful information related to cancer on Twitter in Japan and it is crucial to increase health literacy and awareness regarding this issue. Furthermore, we believe that it is important for government agencies and health care professionals to continue providing accurate medical information to support patients and their families in making informed decisions.

Intervention studies to encourage HPV vaccination using narrative: A scoping review

OBJECTIVE

This review aimed to provide an overview of intervention studies that aimed to encourage HPV vaccination using narratives.

METHODS

We searched MEDLINE, CINAHL, PsycINFO, and PsycARTICLES for English language articles that quantitatively examined the persuasive effect of narratives on encouraging HPV vaccination through interventions.

RESULTS

A total of 25 studies were identified. Most studies were conducted in the United States of America, adopted a convenient sampling of university students, measured vaccination intention as the primary outcome, and used text messages in the interventions. A minority of the studies measured vaccination behavior and examined the long-term effects of persuasion. Narratives were as effective as didactics and statistics in encouraging HPV vaccination in most included studies. The findings were mixed or scarce for the effect of combining narratives and statistics, and the person (the first vs. third), narrator, framing, and content of narratives.

CONCLUSION

More findings from a broader range of well-designed studies are needed to determine which narratives can encourage HPV vaccination across different populations.

PRACTICE IMPLICATIONS

Findings indicated using narratives can be a part of repertoire of messages encouraging HPV vaccination.

Realizing the Tobacco Endgame: Understanding and mobilizing public support for banning combustible cigarette sales in the United States

BACKGROUND

There is little research on public support for banning the sale and purchase of combustible cigarettes even though a ban is an essential step towards achieving the endgame for tobacco products.

PURPOSE

We report the first studies designed to (a) examine predictors of support for a ban (Study 1), and (b) test interventions to increase such support (Studies 2-4).

METHODS

In Study 1, current, former, and never smokers (N = 479) were randomized to conditions measuring their willingness to ban the sale of cigarettes vs. an unspecified product. Smokers were randomized to a persuasive communication in Study 2 and a paradoxical thinking intervention in Study 3 (Ns = 300 and 302, respectively). In Study 4 (N = 336), we randomized smokers to self-persuasion and issue-framing interventions.

RESULTS

Whereas nonsmokers were willing to ban the sale of both cigarettes and equivalent products, current and former smokers exempted cigarettes from a ban. Reactance to prohibition and perceived effectiveness predicted willingness to ban cigarette sales in all three smoking status groups (Study 1). Neither persuasive communication nor paradoxical thinking increased support for banning cigarette sales in Studies 2-3. However, self-persuasion and framing the ban as "protecting Americans from avoidable harm" both led to increased support for banning cigarette sales (Study 4).

CONCLUSIONS

Reactance and doubt about the effectiveness of banning the sale of cigarettes are key barriers to supporting a ban. Self-persuasion and issue framing may be effective means of mobilizing policy support among smokers. The present research offers new insights relevant to promoting the "Tobacco Endgame" and helps specify directions for future research on public support for health policies.

Characterizing U.S. mothers with high human papillomavirus vaccine intent yet unvaccinated adolescents

HPV vaccination rates remain suboptimal in the United States. While the current literature focuses on expressly hesitant parents, few studies have examined parents with "high intent", or those indicating they definitely will vaccinate and have had the opportunity but not yet vaccinated their adolescents. Our objective was to differentiate characteristics of mothers with high intent from those who already vaccinated their adolescents using various socioeconomic, previous vaccine decision-making, and healthcare provider relationship-related variables. English-speaking mothers or female guardians of adolescents ages 11-14 years living in low HPV vaccine uptake states within the U.S. in September 2018 were recruited from a national survey panel as part of a larger study. We assessed HPV vaccine status of their adolescents and categorized respondents into two categories: Already Vaccinated and High Intent. We assessed differences using a multivariable logistic regression model. Among 2406 mothers, 18% reported high intent vs. 82% already having vaccinated. Mothers with high intent were more likely to identify as non-Hispanic White (p = 0.01), to have a younger adolescent (p < 0.001), and to report not receiving a provider HPV vaccination recommendation (p < 0.001). Mothers who estimated that half/more (vs. less) of their child's friends have received/will receive the vaccine had higher odds of already vaccinating (p < 0.001). Our findings suggest that clinicians may be able to improve HPV vaccination uptake within their practices by giving repeated, high-quality recommendations to parents of children who are not yet vaccinated. Additionally, these findings indicate perceived social norms may play a large role in on-time vaccine uptake. Reassuring hesitant parents that most parents accept the vaccine may also improve uptake in clinical practice.

COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample

Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.

Do social media campaigns foster vaccination adherence? A systematic review of prior intervention-based campaigns on social media

The COVID-19 pandemic has demonstrated the importance of large-scale campaigns to facilitate vaccination adherence. Social media presents unique opportunities to reach broader audiences and reduces the costs of conducting national or global campaigns aimed at achieving herd immunity. Nonetheless, few studies have reviewed the effectiveness of prior social media campaigns for vaccination adherence, and several prior studies have shown that social media campaigns do not increase uptake rates. Hence, our objective is to conduct a systematic review to examine the effectiveness of social media campaigns and to identify the reasons for the mixed results of prior studies. Our methodology began with a search of seven databases, which resulted in the identification of 92 interventions conducted over digital media. Out of these 92 studies, only 15 adopted social media campaigns for immunization. We analyzed these 15 studies, along with a coding scheme we developed based on reviews of both health interventions and social media campaigns. Multiple coders, who were knowledgeable about social media campaigns and healthcare, analyzed the 15 cases and obtained an acceptable level of inter-coder reliability (> .80). The results from our systematic review show that only a few social media campaigns have succeeded in enhancing vaccination adherence. In addition, few campaigns have utilized known critical success factors of social media to induce vaccination adherence. Based on these findings, we discuss a set of research questions that informatics scholars should consider when identifying opportunities for using social media to resolve one of the most resilient challenges in public health. Finally, we conclude by discussing how the insights drawn from our systematic reviews contribute to advancing theories, such as social influence and the health belief model, into the realm of social media-based health interventions.

HPV and COVID-19 vaccines: Social media use, confidence, and intentions among parents living in different community types in the United States

Our study measured parental confidence and intention/uptake of two adolescent vaccines (HPV and COVID-19), focusing on differences among community types including urban, suburban, and rural. Although social media provides a way for misinformation to spread, it remains a viable forum for countering misinformation and engaging parents with positive vaccine information across community types. Yet, little is understood about differences in social media use and vaccine attitudes and behaviors for parents living in rural, suburban and urban areas. We sought to determine how to better reach parents living in different community types with targeted social media channels and messaging. In August 2021, we used a cross-sectional survey programmed in Qualtrics to collect data from 452 parents of children ages 9 to 14 living in different community types across the United States. Participants came from a survey panel maintained by CloudResearch. Survey questions asked about demographics, political affiliation, community type, social media use, health and vaccine information sources, and attitudes and behaviors regarding the HPV and COVID-19 vaccines. Our sample of parents (n = 452) most frequently used Facebook (76%), followed by YouTube (55%), and Instagram (43%). When comparing social media use by community type, parents used the top platforms at similar rates. Social media use was associated with vaccine confidence and intention/uptake in unadjusted models but not in adjusted models. Further, there were no significant differences in HPV vaccine confidence or intention/uptake by community type (i.e., rural, suburban, urban). For the COVID-19 vaccine, parents in rural communities were less likely to have vaccine confidence and intention/uptake in the unadjusted model. For both HPV and COVID-19 vaccines, political affiliation was the only common factor associated with both vaccine confidence and intention/uptake. Parents who identified as Democrat compared to Republican had greater confidence in the vaccines and had higher odds of vaccine intention/uptake for their children. Although rurality has been associated with vaccine confidence in the past we did not find that in our study. Instead, political affiliation appeared to explain most of the variation in vaccine confidence and intention/uptake, suggesting that more research is needed to identify best practices for using social media to reach parents with different political beliefs.

Scaling up the discovery of hesitancy profiles by identifying the framing of beliefs towards vaccine confidence in Twitter discourse

Our study focused on the discovery of how vaccine hesitancy is framed in Twitter discourse, allowing us to recognize at-scale all tweets that evoke any of the hesitancy framings as well as the stance of the tweet authors towards the frame. By categorizing the hesitancy framings that propagate misinformation, address issues of trust in vaccines, or highlight moral issues or civil rights, we were able to empirically recognize their ontological commitments. Ontological commitments of vaccine hesitancy framings couples with the stance of tweet authors allowed us to identify hesitancy profiles for two most controversial yet effective and underutilized vaccines for which there remains substantial reluctance among the public: the Human Papillomavirus and the COVID-19 vaccines. The discovered hesitancy profiles inform public health messaging approaches to effectively reach Twitter users with promise to shift or bolster vaccine attitudes.

Social media-assisted interventions on human papillomavirus and vaccination-related knowledge, intention and behavior: a scoping review

Social media holds the potential to engage adolescents and young adults and to facilitate interventions improving Human Papillomavirus Vaccine (HPVV). This article systematically reviewed the literature on Cochrane Library, PubMed, Web of Science, EMBASE, Scopus and CINAHL. Interventions delivered or facilitated by social media with outcomes of HPV-related knowledge, awareness, attitude, vaccination intention and behavior were included. Standardized forms were used to abstract the basic characteristics, settings, guiding theories and key findings of the interventions. Twenty-four studies met the eligibility criteria. Sixteen were educational interventions, and the other eight investigated the effect of social media message contents on improving Human Papillomavirus (HPV)-related outcomes. The studies were published between 2015 and 2021. The most frequently used social media platforms were Facebook, and the most commonly adopted theory was the health belief model (HBM). Existing interventions have shown preliminary but promising effects in improving HPV awareness and knowledge. Still, such improvements have not always been translated to improved behavioral intentions and vaccination rates. The contents and phrasing of social media messages and pre-existing individual characteristics of social media users moderated intervention effectiveness. Social media could be a valuable tool for engaging participants and delivering HPV interventions. Future interventions should apply stronger theory bases.

Associations Between Human Papillomavirus Vaccine Decisions and Exposure to Vaccine Information in Social Media

PURPOSE

Exposure to different types of vaccine information in social media can result in parents making disparate vaccine decisions, including not following national guidelines for human papillomavirus (HPV) vaccination. We sought to characterize parents' exposure to and engagement with information about HPV vaccination in social media, and the associations between exposure to such information and vaccine decisions for their adolescent children.

METHODS

In 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents who use social media. The survey assessed whether parents have seen information in favor, against, or mixed about HPV vaccination. Multivariable logistic regressions assessed correlates of vaccine decisions, including HPV vaccine initiation, delay, and refusal.

RESULTS

Sixty-one percent of parents reported that their children have initiated HPV vaccination. Over one-third of parents (37%) reported seeing HPV vaccine information on social media, which was either in favor (20%), against (5%), or a mix (12%). Parents exposed to information in favor were more likely than those who saw no information to have initiated HPV vaccination (OR = 1.74, 95% CI:1.24, 2.44). Parents exposed to information against vaccination were more likely to have delayed (OR = 3.29, 95% CI:1.66, 6.51) or refused (OR = 4.72, 95% CI:2.35, 9.50) HPV vaccination. Exposure to mixed information was also significantly associated with vaccine delay and refusal.

DISCUSSION

Our findings suggest that the type of information seen on social media regarding HPV vaccination may influence the decisions parents make about vaccinating their children. Efforts should be sought to increase online information in favor of HPV vaccination and combat vaccine misinformation in social media.