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Dolinski D, Kulesza W, Muniak P, Dolinska B, Węgrzyn R, Izydorczak K. Media intervention program for reducing unrealistic optimism bias: The link between unrealistic optimism, well-being, and health. Appl Psychol Health Well Being 2021; 14:499-518. [PMID: 34693650 PMCID: PMC9298214 DOI: 10.1111/aphw.12316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/14/2021] [Accepted: 10/06/2021] [Indexed: 01/22/2023]
Abstract
Unrealistic optimism is the tendency to perceive oneself as safer than others in situations that equally threaten everybody. By reducing fear, this bias boosts one's well-being; however, it is also a deterrent to one's health. Three experiments were run in a mixed-design on 1831 participants to eliminate unrealistic optimism (measured by two items-probability of COVID-19 infection for oneself and for others; within-subjects) toward the probability of COVID-19 infection via articles/videos. A between-subject factor was created by manipulation. Ostensibly, daily newspaper articles describing other people diligently following medical recommendations (experiment 1) and videos showing people who did not follow these recommendations (experiment 2) reduced unrealistic optimism. The third experiment, which included both articles and videos, replicated these results. These results can be applied to strategies for written and video communications that can be used by governments and public health agencies as best practices concerning not only COVID-19 but also any subsequent public health threat while promoting proactive, optimal, and healthy functioning of the individual.
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Affiliation(s)
- Dariusz Dolinski
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Wojciech Kulesza
- Warsaw Faculty, Centre for Research on Social Relations, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Paweł Muniak
- Warsaw Faculty, Centre for Research on Social Relations, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | | | - Rafał Węgrzyn
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Kamil Izydorczak
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
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2
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Wang J, Lai WF. News coverage of drug development: implications for the conveyance of health information. BMC Public Health 2021; 21:1799. [PMID: 34620158 PMCID: PMC8495447 DOI: 10.1186/s12889-021-11849-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Technical information regarding health-related advances is sometimes esoteric for the general public. News media, therefore, plays a key role in public health promotion via health information conveyance. In this study, we use China as a sample country and analyze the claims and frames in news coverage of health-related advances, with special focus on news coverage of the development and performance of newly developed or tested drugs. METHODS A keyword search was performed to retrieve news articles from four representative news agencies in China. In total, 3029 news reports were retrieved, of which 128 were selected for further analysis. RESULTS Four aspects of news coverage of drug development were identified: (1) the characteristics of new drugs covered, (2) the sources of information, (3) the accuracy of health information in newspapers, and (4) textual features of news coverage. CONCLUSIONS Our findings reveal that guidelines should be established to facilitate more systematic news reporting on health-related advances. Additionally, literacy among the general public and professionalism in health information conveyance should be promoted to negate the "illusion of knowing" about health-related advances.
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Affiliation(s)
- Jiangtao Wang
- Section of Science, Southern Weekly, Guangzhou, China.,School of Life and Health Sciences, The Chinese University of Hong Kong (Shenzhen), Shenzhen, 518172, China
| | - Wing-Fu Lai
- School of Life and Health Sciences, The Chinese University of Hong Kong (Shenzhen), Shenzhen, 518172, China. .,School of Education, University of Bristol, Bristol, UK.
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3
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The Use of Exaggerative Language in News Articles About Cystic Fibrosis Therapies : Exaggerative Language Describing Cystic Fibrosis Therapies. J Gen Intern Med 2021; 36:1437-1439. [PMID: 32607933 PMCID: PMC8131412 DOI: 10.1007/s11606-020-05768-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022]
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4
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Who Guides Vaccination in the Portuguese Press? An Analysis of Information Sources. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042189. [PMID: 33672276 PMCID: PMC7926976 DOI: 10.3390/ijerph18042189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
Sources of information are a key part of the news process as it guides certain topics, influencing the media agenda. The goal of this study is to examine the most frequent voices on vaccines in the Portuguese press. A total of 300 news items were analysed via content analysis using as sources two newspapers from 2012 to 2017. Of all the articles, 97.7% included a source (n = 670). The most frequent were “governmental organisations”, “professional associations” and the “media”. Less frequent sources were “university scientists”, “governmental scientific bodies”, “consumer groups”, “doctors”, “scientific companies”, “NGOs” and “scientific journals”. Most articles used only non-scientific sources (n = 156). A total of 94 articles used both categories and 43 used exclusively scientific sources. Our findings support the assertion that media can be an instrument to disseminate information on vaccines. Nevertheless, despite being present in most articles, the number of sources per article was low, therefore not presenting a diversity of opinions and there was a lack of scientific voices, thus suggesting lower quality of the information being offered to the audience.
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Vaccine Hesitancy in the Age of Coronavirus and Fake News: Analysis of Journalistic Sources in the Spanish Quality Press. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218136. [PMID: 33158059 PMCID: PMC7662702 DOI: 10.3390/ijerph17218136] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/02/2023]
Abstract
The study of the quality press and the use of sources is relevant to understand the role of journalists in scientific controversies. The objective was to examine media sourcing patterns, using the case of vaccines as a backdrop. Articles were retrieved from the national quality press in Spain. Content analysis was undertaken on the sources and on other variables such as tone, frames and journalistic genre. The software myNews and NVivo were used for data collection and coding, while SPSS and Excel were used for statistical analysis. Findings indicate that sources related to the government, professional associations and scientific companies are the most frequently used, confirming the central role of government institutions as journalistic sources. These were followed by university scientists, scientific journals and clinicians. On the other hand, NGOs and patients groups were included in fewer than 5% of the articles. More than 30% included none or just one source expressing unbalanced perspectives. Frequent use of certain source types, particularly governmental, may indicate state structures of power. The study provides a better understanding of journalistic routines in the coverage of vaccines, including fresh perspectives in the current COVID-19 pandemic.
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6
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Du L, Lin S, Kamenova K. Framing Ethical Concerns and Attitudes towards Human Gene Patents in the Chinese Press. Asian Bioeth Rev 2020; 12:307-323. [PMID: 33717340 PMCID: PMC7747419 DOI: 10.1007/s41649-020-00136-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022] Open
Abstract
This study examines the representations of human gene patents in Chinese newspapers. We conducted a qualitative content analysis of news articles published between 2006 and 2017 to identify the major themes in media coverage, ethical considerations, perceptions of risks and benefits, and attitudes towards the patentability of human genes. The results show that two key ethical concerns were expressed by journalists: (1) that it is morally wrong to own or patent human genes and (2) that gene patents could potentially impede patients' access to healthcare services. Nonetheless, the press coverage has tended to be largely favorable (57.8%), rather than opposed (17.8%) to human gene patenting. There were no normative claims that human genes should not be patentable in China, which indicates a generally positive attitude towards patentability in media discourse. Most articles that expressed criticism toward gene patenting discussed challenges in other countries, with significant attention given to the United States Supreme Court's ruling in the Myriad case that invalidated Myriad Genetics' patents on the BRCA1 and BRCA2 genes. Overall, the newspapers were uncritical of the Chinese gene patenting regime. News reporting on the issue was highly suggestive of a strong pro-commercialization stance, although some discussions emphasized potential risks over benefits. Our analysis highlights the need for balanced media reporting on human gene patents in China and a top-down approach to engage the public in substantive discussions on the ethical and societal implications of the existing patent regime.
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Affiliation(s)
- Li Du
- Faculty of Law, University of Macau, Taipa, Macau SAR
| | - Sijie Lin
- Faculty of Law, University of Macau, Taipa, Macau SAR
- C&C Lawyers & Notaries, Macau, Macau SAR
| | - Kalina Kamenova
- Canadian Institute for Genomics and Society, Toronto, Ontario Canada
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7
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Catalan-Matamoros D, Peñafiel-Saiz C. Exploring the relationship between newspaper coverage of vaccines and childhood vaccination rates in Spain. Hum Vaccin Immunother 2020; 16:1055-1061. [PMID: 32017659 DOI: 10.1080/21645515.2019.1708163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Despite the effectiveness of vaccines being well established and recognized by the research community, eleven European countries have adopted mandatory vaccination programs because of vaccine hesitancy. Lack of information and fake news are considered the main reasons. The media are a powerful tool for spreading vaccine-related information. The study of media effects on vaccine uptake has received little attention in Europe.Objective: To explore the association of childhood vaccination rates in Spain with vaccine-related coverage in print media.Methods: A content analysis of newspaper coverage of vaccines was conducted. The study variables were: national vaccination rates, article publication dates, tone and main theme of the articles. We conducted a correlation analysis to assess the association between media coverage and childhood vaccine uptake.Results: While vaccine coverage with positive and neutral tones significantly increased during the study period (p < .001), the number of articles with a negative tone remained unchanged (p = .306). There was a significant and inverse correlation between negative newspaper coverage and childhood vaccine uptake (r = -.771, p < .05). During 2016 and 2017, although the media reporting declined, vaccination rates kept increasing. The most frequent themes were about the development of the Ebola vaccine, and the chickenpox and meningitis vaccine crises.Conclusions: Our findings expand the understanding of media role on vaccination and suggest that the media need to be considered as an important player during vaccination campaigns. The study points to the important educational role of the media in public health.
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Affiliation(s)
- Daniel Catalan-Matamoros
- Department of Communication Studies, University Carlos III of Madrid, Madrid, Spain.,Health Research Centre, University of Almeria, Almeria, Spain.,Research Group for Analysis and Anticipation Journalism, University of Nebrija, Madrid, Spain
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8
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Foss HS, Oldervoll A, Fretheim A, Glenton C, Lewin S. Communication around HPV vaccination for adolescents in low- and middle-income countries: a systematic scoping overview of systematic reviews. Syst Rev 2019; 8:190. [PMID: 31370886 PMCID: PMC6670236 DOI: 10.1186/s13643-019-1100-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 07/05/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection causes cervical cancer. More than 80% of those diagnosed with cervical cancer live in low- and middle-income countries (LMICs). The World Health Organization recommends vaccination as a public health measure against cervical cancer. Communication interventions are able to change how people think about vaccination and are thus instrumental in addressing vaccine hesitancy. Our aim was to provide a broad scoping overview of the available evidence on communication with adolescents, parents, and other stakeholders around HPV vaccination for adolescents, with a specific focus on LMICs. METHODS We conducted a systematic scoping overview of systematic reviews addressing a range of questions regarding communication around HPV vaccination. We considered reviews published between 2007 and 2018 focusing on communication around HPV vaccination and that searched for qualitative or quantitative studies for inclusion. We searched the Epistemonikos database which includes reviews from multiple electronic databases. Two overview authors screened titles and abstracts and examined potentially eligible reviews in full text. Data extraction was performed by one overview author and verified by a second. We assessed the reliability of the included reviews using an adapted version of AMSTAR 2. RESULTS We included twelve reviews in our overview. Four reviews assessed the effectiveness of communication interventions. These interventions intended to inform or educate about HPV and HPV vaccination, such as videos and fact sheets, or to remind or recall, such as text message reminders. Eight reviews assessed factors associated with HPV vaccination uptake, including communication-related factors such as whether the vaccine was recommended by a physician and people's knowledge regarding the vaccine. Nine reviews searched for studies from LMICs, but most found only a small number of studies from these countries. CONCLUSIONS The small number of studies identified from LMICs is of concern as these countries face the largest burden of disease related to HPV. This scoping overview also found and excluded a number of reviews because of important methodological limitations, highlighting the need for future reviews to use appropriate methods. The overview indicates areas in which further primary studies are needed on HPV vaccination communication in LMICs. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/agzb4/.
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Affiliation(s)
| | - Ann Oldervoll
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Claire Glenton
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Simon Lewin
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
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Bossema FG, Burger P, Bratton L, Challenger A, Adams RC, Sumner P, Schat J, Numans ME, Smeets I. Expert quotes and exaggeration in health news: a retrospective quantitative content analysis. Wellcome Open Res 2019; 4:56. [PMID: 31346551 PMCID: PMC6619368 DOI: 10.12688/wellcomeopenres.15147.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2019] [Indexed: 12/25/2022] Open
Abstract
Background This research is an investigation into the role of expert quotes in health news, specifically whether news articles containing a quote from an independent expert are less often exaggerated than articles without such a quote. Methods Retrospective quantitative content analysis of journal articles, press releases, and associated news articles was performed. The investigated sample are press releases on peer-reviewed health research and the associated research articles and news stories. Our sample consisted of 462 press releases and 668 news articles from the UK (2011) and 129 press releases and 185 news articles from The Netherlands (2015). We hand-coded all journal articles, press releases and news articles for correlational claims, using a well-tested codebook. The main outcome measures are types of sources that were quoted and exaggeration of correlational claims. We used counts, 2x2 tables and odds ratios to assess the relationship between presence of quotes and exaggeration of the causal claim. Results Overall, 99.1% of the UK press releases and 84.5% of the Dutch press releases contain at least one quote. For the associated news articles these percentages are: 88.6% in the UK and 69.7% in the Netherlands. Authors of the study are most often quoted and only 7.5% of UK and 7.0% of Dutch news articles contained a new quote by an expert source, i.e. one not provided by the press release. The relative odds that an article without an external expert quote contains an exaggeration of causality is 2.6. Conclusions The number of articles containing a quote from an independent expert is low, but articles that cite an external expert do contain less exaggeration.
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Affiliation(s)
- Francien G. Bossema
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
- Computational Imaging, Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | - Peter Burger
- Media Studies, Leiden University, Leiden, The Netherlands
| | - Luke Bratton
- School of Psychology, Cardiff University, Cardiff, UK
| | | | | | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, UK
| | - Joop Schat
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E. Numans
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ionica Smeets
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
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10
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Zimmermann BM, Aebi N, Kolb S, Shaw D, Elger BS. Content, evaluations and influences in newspaper coverage of predictive genetic testing: A comparative media content analysis from the United Kingdom and Switzerland. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2019; 28:256-274. [PMID: 30583711 DOI: 10.1177/0963662518816014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Predictive genetic testing often entails challenging decisions about preventive measures and uncertain health-related risk predictions. Because of its increasing availability, it is important to assess how to debate it publicly. Newspaper content analysis represents a common and reliable way to investigate public discourse retrospectively. We thus quantitatively compare broadsheet newspaper coverage about predictive genetic testing in the United Kingdom and Switzerland during the period of 2011-2016 regarding content, evaluations, stakeholder influence, and trigger events. British coverage was more extensive and positive and included more personal stories. Swiss coverage had more focus on political issues. Angelina Jolie's announcement about her double mastectomy was the most important coverage trigger. Researchers were the most frequently cited stakeholder group, but stakeholders from government and civil society were also represented. Our results thus reflect a movement toward a more active public engagement with predictive genetic testing. The findings help to improve and enrich public engagement regarding predictive genetic testing.
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Affiliation(s)
| | - Noah Aebi
- Institute for Biomedical Ethics, University of Basel, Switzerland
| | - Steffen Kolb
- HTW Berlin-University of Applied Sciences, Germany
| | - David Shaw
- Institute for Biomedical Ethics, University of Basel, Switzerland; Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Switzerland; Center for Legal Medicine, University of Geneva, Switzerland
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11
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Bossema FG, Burger P, Bratton L, Challenger A, Adams RC, Sumner P, Schat J, Numans ME, Smeets I. Expert quotes and exaggeration in health news: a retrospective quantitative content analysis. Wellcome Open Res 2019; 4:56. [PMID: 31346551 PMCID: PMC6619368 DOI: 10.12688/wellcomeopenres.15147.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 10/13/2023] Open
Abstract
Background This research is an investigation into the role of expert quotes in health news, specifically whether news articles containing a quote from an independent expert are less often exaggerated than articles without such a quote. Methods Retrospective quantitative content analysis of journal articles, press releases, and associated news articles was performed. The investigated sample are press releases on peer-reviewed health research and the associated research articles and news stories. Our sample consisted of 462 press releases and 668 news articles from the UK (2011) and 129 press releases and 185 news articles from The Netherlands (2015). We hand-coded all journal articles, press releases and news articles for correlational claims, using a well-tested codebook. The main outcome measures are types of sources that were quoted and exaggeration of correlational claims. We used counts, 2x2 tables and odds ratios to assess the relationship between presence of quotes and exaggeration of the causal claim. Results Overall, 99.1% of the UK press releases and 84.5% of the Dutch press releases contain at least one quote. For the associated news articles these percentages are: 88.6% in the UK and 69.7% in the Netherlands. Authors of the study are most often quoted and only 7.5% of UK and 7.0% of Dutch news articles contained a new quote by an expert source, i.e. one not provided by the press release. The relative odds that an article without an external expert quote contains an exaggeration of causality is 2.6. Conclusions The number of articles containing a quote from an independent expert is low, but articles that cite an external expert do contain less exaggeration.
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Affiliation(s)
- Francien G. Bossema
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
- Computational Imaging, Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | - Peter Burger
- Media Studies, Leiden University, Leiden, The Netherlands
| | - Luke Bratton
- School of Psychology, Cardiff University, Cardiff, UK
| | | | | | - Petroc Sumner
- School of Psychology, Cardiff University, Cardiff, UK
| | - Joop Schat
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E. Numans
- Department Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ionica Smeets
- Department of Science Communication and Society, Leiden University, Leiden, The Netherlands
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12
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Catalan-Matamoros D, Peñafiel-Saiz C. A visual content analysis of vaccine coverage in the print media. Hum Vaccin Immunother 2019; 15:2453-2459. [PMID: 30852936 DOI: 10.1080/21645515.2019.1589289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Visual imagery is essential in the media and is broadly recognised to increase attention, recall information, improve comprehension and even change adherence to clinical guidelines. Despite the social debate about vaccination, the study of vaccine media images has received little attention. Therefore, this study aims to analyse the visual content of newspaper coverage of vaccines and to identify some key patterns that might be more likely to influence audience understanding. Coverage from 2012 to 2017 about vaccines was retrieved from the flagship Spanish newspapers El Pais and El Mundo. An imagery content analysis was undertaken for 131 articles. Results reveal that images are commonly used in the print media, appearing in 56% (n = 74) of articles about vaccines. Images were mostly located in the top area of the page (p < .001), and each image occupied about 28% of the total surface in the page. Each article included 1 image on average, and 76% (n = 64) of visual resources were photography and the frames 'human interest' and 'conflict' were the most frequent ones. The themes of the images focused most commonly on the action of vaccination, vaccines as such, the biological aspects of the vaccine and research. The study provides descriptive knowledge related to the use of visual contents coverage about vaccines in the print media. We suggest further research on the influence of visual contents in the context of vaccines as well as a collaboration between public health experts and designers to create effective visual contents and messages.
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Affiliation(s)
- Daniel Catalan-Matamoros
- Department of Journalism and Communication, University Carlos III of Madrid , Madrid , Spain.,Research group of Health Sciences CTS-451, University of Almeria , Almeria , Spain
| | - Carmen Peñafiel-Saiz
- Department of Journalism, University of the Basque Country , Bilbao , Spain.,Research Group of Media,Society, Education, University of the Basque Country , Bilbao , Spain
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