Feeling angry: the effects of vaccine misinformation and refutational messages on negative emotions and vaccination attitude

Vaccine hesitancy: a structured review from a behavioral perspective (2015-2022)

Vaccine hesitancy, a complex behavioral phenomenon, poses a significant global health threat and has gained renewed attention amidst the COVID-19 pandemic. This paper scrutinized peer-reviewed literature on vaccine hesitancy published from 2015 to 2022, with a specific focus on behavioral perspectives, utilizing a Theories-Constructs-Variables-Contexts-Methods (TCVCM) framework. The study highlighted prominent theoretical approaches, abstract concepts, research variables, global contexts and academic techniques employed across a selected sample of 138 studies. The result is a consolidated overview of research and schematization of the factors influencing vaccine hesitancy and vaccination behaviors. These include individual-level, contextual, vaccine-specific, organizational, and public-policy-related dynamics. The findings corroborated the complexity of vaccine hesitancy and emphasized the difficulties of pursuing vaccine advocacy. The analysis also identified several directions for future research, and the need to conduct more contextual studies in low- and middle-income nations to bring out the cross-cultural nuances of vaccine hesitancy.

Conspiracy narratives and vaccine hesitancy: a scoping review of prevalence, impact, and interventions

Believing conspiracy narratives is frequently assumed to be a major cause of vaccine hesitancy, i.e., the tendency to forgo vaccination despite its availability. In this scoping review, we synthesise and critically evaluate studies that assess i) the occurrence of vaccine-related conspiracy narratives on the internet, ii) the prevalence of belief in vaccine-related conspiracy narratives, iii) the relationship between belief in conspiracy narratives and vaccination intention or vaccination uptake, and iv) interventions that reduce the impact of conspiracy narratives on vaccination intention.In July 2022, we conducted a literature search using three databases: PubMed, PsychInfo, and Web of Science. Following the PRISMA approach, of the 500 initially identified articles, 205 were eligible and analysed.The majority of identified studies were conducted in Europe and North America, were published in 2021 and 2022, and investigated conspiracy narratives around the COVID-19 vaccination. The prevalence of belief in various vaccine-related conspiracy narratives varied greatly across studies, from 2 to 77%. We identified seven experimental studies investigating the effect of exposure to conspiracy narratives on vaccination intentions, of which six indicated a small negative effect. These findings are complemented by the evidence from over 100 correlative studies showing a significant negative relationship between conspiracy beliefs and vaccination intention or uptake. Additionally, the review identified interventions (e.g., social norm feedback, fact-checking labels, or prebunking) that decreased beliefs in vaccine-related conspiracy narratives and, in some cases, also increased vaccination intentions. Yet, these interventions had only small effects.In summary, the review revealed that vaccine-related conspiracy narratives have spread to varying degrees and can influence vaccination decisions. Causal relationships between conspiracy beliefs and vaccination intentions remain underexplored. Further, the review identified a need for more research on interventions that can reduce the impact of conspiracy narratives.

Heuristic Information Processing as a Mediating Factor in the Process of Exposure to COVID-19 Vaccine Information and Misinformation Sharing on Social Media

Social media use for risk communication during the COVID-19 pandemic has caused considerable concerns about an overabundance of information, particularly misinformation. However, how exposure to COVID-19 information on social media can lead to subsequent misinformation sharing during the pandemic has received little research attention. This study adopted the social amplification of risk framework to delineate how exposure to COVID-19 vaccine information on social media can be associated with individuals' misinformation sharing through heuristic information processing. The role of social media trust was also examined. Results from an online survey (N = 1488) of Chinese Internet users revealed that exposure to COVID-19 vaccine information on social media was associated with misinformation sharing, mediated by both affect heuristics (i.e., negative affect toward the COVID-19 pandemic in general) and availability heuristics (i.e., perceived misinformation availability). Importantly, both high and low levels of trust in social media strengthened the mediating associations. While a low level of trust strengthened the association between exposure to COVID-19 vaccine information on social media and the affect heuristics, a high level of trust strengthened its association with the availability heuristics, both of which were associated with misinformation sharing. Our findings suggest that heuristic information processing is essential in amplifying the spread of misinformation after exposure to risk information on social media. It is also suggested that individuals should maintain a middle level of trust in social media, being open while critical of risk information on social media.

Have we found a solution for health misinformation? A ten-year systematic review of health misinformation literature 2013-2022

BACKGROUND

Health misinformation (HM) has emerged as a prominent social issue in recent years, driven by declining public trust, popularisation of digital media platforms and escalating public health crisis. Since the Covid-19 pandemic, HM has raised critical concerns due to its significant impacts on both individuals and society as a whole. A comprehensive understanding of HM and HM-related studies would be instrumental in identifying possible solutions to address HM and the associated challenges.

METHODS

Following the PRISMA procedure, 11,739 papers published from January 2013 to December 2022 were retrieved from five electronic databases, and 813 papers matching the inclusion criteria were retained for further analysis. This article critically reviewed HM-related studies, detailing the factors facilitating HM creation and dissemination, negative impacts of HM, solutions to HM, and research methods employed in those studies.

RESULTS

A growing number of studies have focused on HM since 2013. Results of this study highlight that trust plays a significant while latent role in the circuits of HM, facilitating the creation and dissemination of HM, exacerbating the negative impacts of HM and amplifying the difficulty in addressing HM.

CONCLUSION

For health authorities and governmental institutions, it is essential to systematically build public trust in order to reduce the probability of individuals acceptation of HM and to improve the effectiveness of misinformation correction. Future studies should pay more attention to the role of trust in how to address HM.

The fear factor: examining the impact of fear on vaccine hesitancy and anti-vaccine conspiracy beliefs

OBJECTIVES

While anti-vaccine conspiracy beliefs can reduce vaccine intentions, longitudinal research shows that vaccine hesitancy can increase conspiracy beliefs. In three experiments (N = 949), we examined the effect of fear about a vaccine on vaccine hesitancy and anti-vaccine conspiracy beliefs.

METHOD AND MEASURES

In Studies 1a (N = 221) and 1b (N = 508), participants were exposed to high fear (vs low fear) about a (fictional) vaccine before reporting vaccine hesitancy and anti-vaccine conspiracy beliefs. In Study 2, all participants were exposed to high fear before being asked to think about not getting vaccinated (vs vaccinated) against the (fictional) disease. Participants then reported their vaccine hesitancy, anti-vaccine conspiracy beliefs, and closeness to others who distrust official narratives.

RESULTS

In Studies 1a and 1b, exposure to high fear (vs low fear) increased vaccine hesitancy, which was positively correlated with anti-vaccine conspiracy beliefs. The reverse model's effect was either smaller (Study 1a) or non-significant (Study 1b). In Study 2, fear and not wanting to vaccinate resulted in vaccine hesitancy, which then predicted anti-vaccine conspiracy beliefs and feeling closer to those distrusting official narratives.

CONCLUSION

Therefore, fear creates a response not to get vaccinated. A conspiracy belief may then justify this response.

Patient concerns and physician strategies for addressing COVID-19 vaccine hesitancy

OBJECTIVE

COVID-19 vaccination is critical for reducing serious illness and hospitalizations, yet many remain hesitant. We conducted a survey of frontline physicians to identify patient concerns and physician strategies to address COVID-19 vaccine-hesitancy.

METHODS

A national random sample of physicians in frontline specialties selected from a comprehensive list of practicing physicians in the U.S. were emailed a survey in August 2021. Multiple choice and open-ended questions inquired about patient concerns related to the COVID-19 vaccines and strategies used by physicians to counter vaccine misinformation and encourage vaccine-hesitant patients. Weighting was applied to achieve representativeness and reduce non-response bias. Network analysis examined co-occurring patient concerns. Open-ended responses on communication strategies were coded via thematic analysis. Multi-variable logistic regression examined associations between physician and pandemic characteristics with patient concerns and use of communication strategies.

RESULTS

531 physicians responded: primary care (241); emergency medicine (142); critical care (84); hospitalists (34); and infectious disease (30). Weighted response balance statistics showed excellent balance between respondents and nonrespondents. On average, physicians reported four patient vaccine concerns. Safety, side effects, vaccine misinformation, and mistrust in government were most common, and often co-occurring. 297 physicians described communication strategies: 180 (61 %) provided vaccine education and 94 (32 %) created a safe space for vaccine discussion. Narrative responses from physicians provided compelling examples of both successes and communication challenges arising from misinformation. Compared with emergency medicine, critical care (OR 2.45, 95 % CI 1.14, 5.24), infectious disease (OR 2.45, 95 % CI 1.00, 6.02), and primary care physicians (OR 1.66, 95 % CI 1.02, 2.70) were more likely to provide communication strategies.

CONCLUSIONS

Many physicians engage with vaccine hesitant patients using a variety of strategies. Dissemination of effective system and physician-level communication interventions could enhance physician success.

How Do Gain-Loss Frames and Cultural Arguments Persuade? Designing Effective Messages to Weaken College Students' Binge-Drinking Intentions

To design effective health messages, this study investigates the effects of gain-loss framing and relevant moderating effects in the context of college students' alcohol use. Specifically, based on an online experiment, we tested the moderation effects of message-sidedness and binge-drinking behaviors using a mediation model in which the association between gain-loss framing and behavioral intentions is mediated by attitudes toward binge-drinking. Four hundred thirty-four Korean college students participated in this study. Hayes' PROCESS Macro for SPSS was employed for the analysis. The results show that loss-framing significantly increased participants' unfavorable attitudes toward binge-drinking in the one-sided message condition. Moreover, attitudes toward binge-drinking were more significantly associated with behavioral intentions to binge-drink among heavy drinkers than among non-heavy drinkers. Our findings suggest important theoretical and practical implications for the development of message-framing strategies in health campaigns designed to prevent college students' binge-drinking in collectivistic societies where the cultural meaning of drinking extends beyond the individual realm to the larger social context.

An Environmental Uncertainty Perception Framework for Misinformation Detection and Spread Prediction in the COVID-19 Pandemic: Artificial Intelligence Approach

BACKGROUND

Amidst the COVID-19 pandemic, misinformation on social media has posed significant threats to public health. Detecting and predicting the spread of misinformation are crucial for mitigating its adverse effects. However, prevailing frameworks for these tasks have predominantly focused on post-level signals of misinformation, neglecting features of the broader information environment where misinformation originates and proliferates.

OBJECTIVE

This study aims to create a novel framework that integrates the uncertainty of the information environment into misinformation features, with the goal of enhancing the model's accuracy in tasks such as misinformation detection and predicting the scale of dissemination. The objective is to provide better support for online governance efforts during health crises.

METHODS

In this study, we embraced uncertainty features within the information environment and introduced a novel Environmental Uncertainty Perception (EUP) framework for the detection of misinformation and the prediction of its spread on social media. The framework encompasses uncertainty at 4 scales of the information environment: physical environment, macro-media environment, micro-communicative environment, and message framing. We assessed the effectiveness of the EUP using real-world COVID-19 misinformation data sets.

RESULTS

The experimental results demonstrated that the EUP alone achieved notably good performance, with detection accuracy at 0.753 and prediction accuracy at 0.71. These results were comparable to state-of-the-art baseline models such as bidirectional long short-term memory (BiLSTM; detection accuracy 0.733 and prediction accuracy 0.707) and bidirectional encoder representations from transformers (BERT; detection accuracy 0.755 and prediction accuracy 0.728). Additionally, when the baseline models collaborated with the EUP, they exhibited improved accuracy by an average of 1.98% for the misinformation detection and 2.4% for spread-prediction tasks. On unbalanced data sets, the EUP yielded relative improvements of 21.5% and 5.7% in macro-F1-score and area under the curve, respectively.

CONCLUSIONS

This study makes a significant contribution to the literature by recognizing uncertainty features within information environments as a crucial factor for improving misinformation detection and spread-prediction algorithms during the pandemic. The research elaborates on the complexities of uncertain information environments for misinformation across 4 distinct scales, including the physical environment, macro-media environment, micro-communicative environment, and message framing. The findings underscore the effectiveness of incorporating uncertainty into misinformation detection and spread prediction, providing an interdisciplinary and easily implementable framework for the field.

Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review

BACKGROUND

Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs.

OBJECTIVE

This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children.

METHODS

The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12).

CONCLUSIONS

The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.

Does COVID-19 Message Fatigue Lead to Misinformation Acceptance? An Extension of the Risk Information Seeking and Processing Model

Based on the Risk Information Seeking and Processing Model, the present study examines whether COVID-19 message fatigue leads to greater information avoidance and heuristic processing, and consequently greater acceptance of misinformation. We conducted a survey of 821 Korean adults regarding their information seeking and processing regarding COVID-19 vaccination. Results of SEM analyses showed that COVID-19 message fatigue was (a) negatively related to information insufficiency and (b) positively related to information avoidance and heuristic processing. Information avoidance and heuristic processing were subsequently related to greater levels of misinformation acceptance. Theoretical and practical implications are discussed.

Assessing Changes in COVID-19 Vaccine Uptake and Intentions among the Brigada Digital Latino Social Media Audience: A Repeated Cross-Sectional Study

BACKGROUND

U.S. Latinos experienced disproportionate COVID-19 impacts in terms of morbidity and mortality. Vaccination against COVID-19 is an important strategy for mitigating health impacts, and yet, vaccine uptake was slower among U.S. Latino adults compared to other racial/ethnic groups. Vaccine hesitancy has been a significant barrier within Latino communities, and exposure to misinformation has been associated with negative attitudes toward vaccination. While some COVID-19 mitigation efforts have included community-based outreach, few studies have explored the impact of community-based digital messaging in Spanish to counter COVID-19 misinformation, build trust, and promote vaccination.

METHODS

To address this gap, we conducted a one-year repeated cross-sectional study to assess changes in COVID-19 vaccine uptake, intentions, and perceived norms, as well as barriers to accessing reliable information and levels of trust in COVID-19 information sources among Latino adults exposed to Brigada Digital de Salud social media content. This culturally-tailored content disseminated on Facebook, Instagram, and X platforms was amplified by community health workers and partners, and focused on COVID-19 risk and prevention, vaccine safety and efficacy, and correcting related misinformation.

RESULTS

Statistically significant increases in COVID-19 vaccination, intentions to vaccinate children, and vaccination subjective norms were observed from May 2022 (wave 1) to April 2023 (wave 2). Among perceived difficulties accessing information, respondents indicated the most difficulty in judging the reliability of COVID-19 information in the media; however, a statistically significant decrease in perceived difficulty was observed between waves. With regard to trust in COVID-19 information sources, levels of trust were highest for healthcare providers in both waves. From wave 1 to wave 2, there were statistically significant increases in trust in the FDA to ensure COVID-19 vaccine safety and trust in the federal government to ensure child COVID-19 vaccine safety.

CONCLUSIONS

Social media messaging by trusted community-based sources shows promise as a strategy for combating health misinformation and ameliorating information access gaps for language minority populations. This digital approach represents an important tool for deploying critical information to underserved populations in public health emergency and crisis contexts, and for supporting changes in attitudes, trust, and behaviors to improve health outcomes.

A Moderated Mediation Model of the Influence of Cynical Distrust, Medical Mistrust, and Anger on Vaccination Hesitancy in Nursing Staff

During the pandemic, nurses experienced anger that stemmed from a sense of threat, frustration, or even a sense of injustice. The purpose of this study was to examine the relationship between vaccination hesitancy, anger, cynicism, and medical mistrust among nurses, as there are no relevant studies in the literature. This study was conducted online by completing self-report questionnaires. The Dimensions of Anger Reactions-5, the 8-item "Cynical Distrust" scale, and the Medical Mistrust Multiformat Scale were used. For vaccination hesitancy, two questions with a 5-point scale were used: one question examining hesitancy to get vaccinated with the COVID-19 vaccine, and another question examining hesitancy to get vaccinated with the influenza vaccine. In total, 387 nurses (66 men and 321 women) participated in this study. Nurses showed statistically greater hesitancy toward the COVID-19 vaccine compared to hesitancy toward the influenza vaccine. The variation in vaccine hesitancy was explained by the scores in the Medical Mistrust Multiformat Scale, the Dimensions of Anger Reactions, and the Cynical Distrust Scale. The Medical Mistrust Multiformat Scale mediated the relationship between the Cynical Distrust Scale and total vaccine hesitancy. The Dimensions of Anger Reactions Scale significantly moderated the indirect effect of the Cynical Distrust Scale on total vaccine hesitancy through the Medical Mistrust Multiformat Scale. In conclusion, it is highly likely that anger is involved in reported vaccine hesitancy both by activating schemas of distrust in others and by adopting anti-systemic views of mistrust in the medical system.

COVID-19 vaccine-related misinformation identification among Chinese residents during a regional outbreak

Objectives

Misinformation about the COVID vaccines poses a significant challenge to vaccination efforts in many countries. This study examined Chinese citizens' ability to correctly identify COVID-19 vaccine misinformation in geographic areas with and without a regional outbreak. We also investigated the associations between misinformation identification and information source usage, source trust, perceived information quality, and demographic characteristics.

Setting

The online survey was conducted in four cities from June 8th to 15th, 2021 in Guangdong Province, two of which were experiencing a regional surge of COVID-19 delta variant infections, and four cities in Hunan Province, a neighboring province largely unaffected.

Participants

A total of 4,479 individuals aged 18 and above completed the online questionnaire. Given survey length, those who finished the study under 5 min were excluded, resulting in a final sample of 3,800.

Outcome measurements

Misinformation identification, source exposure, source trust, and perceived information quality.

Results

Results showed slightly higher levels of correct misinformation identification in surge vs. non-surge areas. Trust in official information sources was positively associated with correct misinformation identification in full sample analysis, while trust in informal sources was negatively associated with the same outcome. Perceived information quality was positively associated with correct misinformation identification in the full sample.

Conclusion

Information providers in China should enhance the quality of the vaccine information they provide, and the Chinese public should balance their usage of different sources of information to acquire vaccine knowledge.

Facing the Strain: The Persuasive Effects of Conversion Messages on COVID-19 Vaccination Attitudes and Behavioral Intentions

This study examined two-sided conversion messages in relation to one-sided advocacy messages in reducing vaccine hesitancy related to COVID-19 vaccine uptake. Results demonstrated that, for vaccine-hesitant participants, conversion messages increased pro-COVID-19 vaccination attitudes and behavioral intentions. For high vaccine-hesitant participants, the relationship between conversion messages and attitudes toward COVID-19 vaccinations was mediated through source credibility. For low vaccine-hesitant participants, mediation occurred through counterarguing. Findings have implications for health message tailoring related to COVID-19 vaccine uptake.

Factors associated with COVID-19 vaccination hesitancy in South Korea: A cross-sectional study

Vaccination against COVID-19 has been promoted as a way to protect oneself and others from infection. To ensure the comprehensive acceptance of COVID-19 vaccines, the factors that affect COVID-19 vaccination hesitancy should be examined. This study aimed to identify the factors that affect COVID-19 vaccination hesitancy among Korean adults, focusing on COVID-19 knowledge and attitudes toward vaccination. This was a cross-sectional study conducted with 2286 Korean adults aged 20-64 years. Demographic characteristics, knowledge regarding COVID-19, and attitudes toward vaccination were assessed. A generalized linear model with Poisson regression was used to identify factors associated with COVID-19 vaccination hesitancy. Approximately 67% of the COVID-19 knowledge-related questions were correctly answered. A neutral attitude toward vaccination and relatively low vaccination hesitancy were found. COVID-19 vaccination hesitancy was affected by individuals' attitudes toward vaccination, as well as their gender and age, but not by their knowledge. Interventions or policies considering gender and age could be helpful in reducing COVID-19 vaccination hesitancy. Strategies to disseminate more accurate and novel information related to the COVID-19 vaccines should be implemented.

Fighting the infodemic: the 4 i Framework for Advancing Communication and Trust

BACKGROUND

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing "infodemic" has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

METHODS

A multi-pronged search strategy was used to identify tools and approaches for combatting health-related misinformation and disinformation. The search strategy included a scoping review of academic literature; a review of gray literature from organizations involved in public health communications and misinformation/disinformation management; and a review of policies and infodemic management approaches from all U.S. state health departments and select local health departments. A team of annotators labelled the main feature(s) of each tool or approach using an iteratively developed list of tags.

RESULTS

We identified over 350 infodemic management tools and approaches. We introduce the 4 i Framework for Advancing Communication and Trust (4 i FACT), a modified social-ecological model, to characterize different levels of infodemic intervention: informational, individual, interpersonal, and institutional. Information-level strategies included those designed to amplify factual information, fill information voids, debunk false information, track circulating information, and verify, detect, or rate the credibility of information. Individual-level strategies included those designed to enhance information literacy and prebunking/inoculation tools. Strategies at the interpersonal/community level included resources for public health communicators and community engagement approaches. Institutional and structural approaches included resources for journalists and fact checkers, tools for managing academic/scientific literature, resources for infodemic researchers/research, resources for infodemic managers, social media regulation, and policy/legislation.

CONCLUSIONS

The 4 i FACT provides a useful way to characterize the current ecosystem of infodemic management strategies. Recognizing the complex and multifaceted nature of the ongoing infodemic, efforts should be taken to utilize and integrate strategies across all four levels of the modified social-ecological model.

The Influence of Social Media and Institutional Trust on Vaccine Hesitancy in France: Examining Direct and Mediating Processes

Vaccine hesitancy (VH) remains an ongoing challenge in French society. This project explored how institutional trust and preference for information via social media (PISM) drive hesitancy. Across a large, nationally represented population, our findings show that PISM and trust are strongly correlated measures, with both independently predicting VH. Subsequent mediation tests show that social media operates as primarily an indirect contributor to VH through trust. Additional tests involving VH and non-VH typologies revealed that institutional trust consistently predicts greater general support for vaccines and reduced distrust in vaccination. Conversely, PISM directly drives vaccine distrust, with its impact on non-hesitancy fully mediated by institutional trust. Overall, these findings point to the relevance for researchers and public health deciders to address the nature by which people utilize social media information resources and how that interacts with levels of trust for national institutions.

Russian Troll Vaccine Misinformation Dissemination on Twitter: The Role of Political Partisanship

Although vaccine misinformation has been a longstanding problem, the growth of social media and divides based on political ideology have raised novel concerns. One noteworthy example involves the Russian Internet Research Agency's deployment of operatives on Twitter (i.e., trolls) working to sow discord among the American public. We examine 1,959 tweets made by trolls between 2015 and 2017 about vaccination to better understand their efforts to spread vaccine misinformation. Our results indicate that misinformation was more likely to be perpetuated by left and right trolls than nonpartisan trolls. There was, however, relatively little user engagement with vaccine tweets containing misinformation and no differences in engagement with misinformation shared by partisan and nonpartisan trolls. Trends in the psycholinguistic properties of language in trolls' vaccine tweets suggest that right and left trolls were more likely to include cognitive process words (i.e., insight, causation, discrepancy, certainty, differentiation, and tentativeness) than were nonpartisan trolls.

How Misinformation and Rebuttals in Online Comments Affect People's Intention to Receive COVID-19 Vaccines: The Roles of Psychological Reactance and Misperceptions

This study investigated how exposure to negative and misleading online comments about the COVID-19 vaccination persuasive messages and the ensuing corrective rebuttals of these comments affected people's attitudes and intentions regarding vaccination. An online experiment was performed with 344 adults in the United States. The results showed that rebuttals by the Centers for Disease Control and Prevention, rather than those by social media users, indirectly increased people's willingness to receive the vaccine by reducing their psychological reactance to persuasive messages and their belief in the misinformation contained in the comments. Rebuttals by social media users became more effective in reducing reactance when people initially had stronger pro-vaccination attitudes.

A systematic review of communication interventions for countering vaccine misinformation

BACKGROUND

Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people's attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2).

METHODS

We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2).

RESULTS

Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine 'intervention approaches' were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other 'scare tactics', use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results.

CONCLUSION

This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.

Willingness to receive a vaccine is influenced by adverse events following immunisation experienced by others

An adverse event following immunization (AEFI) can have consequences for an individual's future decision making and may contribute to vaccine hesitancy. AEFIs vary in severity and can be experienced directly (by an individual themselves) or indirectly (through witnessed or recounted events). We sought to measure the prevalence of specific AEFIs and understand which AEFIs have the greatest associations with reduced willingness to receive a vaccine and how injection anxiety may moderate the relationship. We conducted a cross-sectional online survey with both qualitative and quantitative elements in a sample of adults aged 18 years and over in Australia. Nineteen percent of the 1050 respondents reported experiencing an AEFI that they found stressful. Those who experienced an AEFI reported significantly higher levels of injection anxiety than those who did not. Within the group who reported experiencing an AEFI, respondents were significantly less likely to be willing to receive a COVID-19 vaccine if they reported: indirect exposure to an uncommon/rare AEFI compared with other AEFIs (aOR:0.39; 95% CI: 0.18-0.87); indirect exposure to a scientifically unsupported AEFI compared with other AEFIs (aOR:0.18; 95% CI: 0.05-0.57). Direct exposure to an AEFI was not associated with willingness to receive a COVID-19 vaccine. For those who reported experiencing an AEFI, the odds of willingness to receive a COVID-19 vaccine decreased significantly with an increase in injection anxiety (aOR:0.94; 95% CI: 0.9-0.98). Our results suggest that more is needed to mitigate the consequences of AEFIs on vaccine willingness. Empathically acknowledging at a community level, the experience of both real and perceived AEFIs and incorporating accounts of positive vaccination experiences in vaccine hesitancy interventions may be useful.

The spread of COVID-19 vaccine information in Arabic on YouTube: A network exposure study

Objective

The Arabic-speaking world had the lowest vaccine rates worldwide. The region's increasing reliance on social media as a source of COVID-19 information coupled with the increasing popularity of YouTube in the Middle East and North Africa region begs the question of what COVID-19 vaccine content is available in Arabic on YouTube. Given the platform's reputation for being a hotbed for vaccine-related misinformation in English, this study explored the COVID-19 vaccine-related content an individual is likely to be exposed to on YouTube when using keyword-based search or redirected to YouTube from another platform from an anti-vaccine seed video in Arabic.

Methods

Only using the Arabic language, four networks of videos based on YouTube's recommendations were created in April 2021. Two search networks were created based on Arabic pro-vaccine and anti-vaccine keywords, and two seed networks were created from conspiracy theory and anti-vaccine expert seed videos. The network exposure model was used to examine the video contents and network structures.

Results

Results show that users had a low chance of being exposed to anti-vaccine content in Arabic compared to the results of a previous study of YouTube content in English. Of the four networks, only the anti-vaccine expert network had a significant likelihood of exposing the user to more anti-vaccine videos. Implications were discussed.

Conclusion

YouTube deserves credit for its efforts to clean up and limit anti-vaccine content exposure in Arabic on its platform, but continuous evaluations of the algorithm functionality are warranted.

Science Denial

Abstract. Science denial has adverse consequences at individual and societal levels and even for the future of our planet. The present article aimed to answer the question: What leads people to deny even the strongest evidence and distrust the scientific method? The article provides a narrative review of research on the underpinnings of science denial, with the main focus on climate change denial. Perspectives that are commonly studied separately are integrated. We review key findings on the roles of disinformation and basic cognitive processes, motivated reasoning (focusing on ideology and populism), and emotion regulation in potentially shaping (or not shaping) views on science and scientific topics. We also include research on youth, a group in an important transition phase in life that is the future decision-makers but less commonly focused on in the research field. In sum, we describe how the manifestations of denial can stem from cognitive biases, motivating efforts to find seemingly rational support for desirable conclusions, or attempts to regulate emotions when feeling threatened or powerless. To foster future research agendas and mindful applications of the results, we identify some research gaps (most importantly related to cross-cultural considerations) and examine the unique features or science denial as an object of psychological research. Based on the review, we make recommendations on measurement, science communication, and education.

"I Just Don't Know What to Believe": Sensemaking during the COVID-19 Pandemic among Criminal Legal Involved Communities

During the COVID-19 pandemic in the United States, those involved with the criminal legal system experience disproportionate vulnerability to infection, transmission, and mortality, facing additional systemic barriers due to criminal legal involvement (CLI) (e.g., prior incarcerations or probationary status affecting employability or housing security). We use Weick's (1979) model of sensemaking as a theoretical framework to inform our examination of CLI individuals' experiences during the pandemic. The primary objective of this paper is to explore the process of sensemaking amid misinformation, trust/mistrust, and vulnerability during the pandemic among CLI communities in three central states (Illinois, Louisiana, and Arkansas). We conducted seven online focus groups (n = 44), between December 2020 and January 2021, from the targeted communities about their awareness of misinformation, trusted or distrusted sources, attitudes about COVID-19 health behaviors (including testing, protective behaviors such as mask-wearing and social distancing, and vaccination), and experiences with the criminal legal system during the pandemic. The concept of equivocality was at the core of the narratives shared among participants, with uncertainty emerging as a meta-theme across all focus groups. The findings of this study should prove useful for those who are developing messaging to combat mis/disinformation and overcome mis/distrust with the medical system and government institutions among those who are disenfranchised.

Framing Effects on US Adults’ Reactions to COVID-19 Public Health Messages: Moderating Role of Source Trust

Increasing politicization of health guidance and fluctuating trust in public health institutions have challenged effective coronavirus disease 2019 (COVID-19) public health communication in the United States. Applying the extended parallel process model, this research reports findings from two online survey experiments conducted at different points in the pandemic regarding two advocated risk reduction behaviors. Analyses test US adults’ emotional and argument strength reactions to experimental tweets attributed to the Centers for Disease Control (CDC) and Prevention which vary with regards to advocated behavior (social distancing; vaccination), emotional appeal, wellbeing orientation (individual vs. collective), and content frame (health vs. economic outcomes). Trust in the CDC is treated as a potential moderator. Results of path analyses indicated that emotional appeal and content frame had little impact on emotional or cognitive responses to the social distancing tweets, though unvaccinated adults with low trust in the CDC experienced greater hope and fear responses to tweets emphasizing collective benefits of vaccination. Hope reactions in both studies predicted greater perceived response efficacy for the advocated behavior, particularly among those with low CDC trust, while message annoyance undermined efficacy among low trust participants. Particularly among adults with low trust in the CDC, fear reactions led to reduced efficacy. Perceived efficacy of vaccination predicted greater intention to receive a COVID-19 vaccine, controlling for prior intention. Messages which inspire hope with regards to risk reduction behaviors and include sound arguments may be more motivating than fear-appeal messages, particularly among individuals with low levels of trust in public health institutions.

Communication Is Not a Virus: COVID-19 Vaccine-Critical Activity on Facebook and Implications for the 'Infodemic' Concept

In February 2020 the World Health Organization declared an 'infodemic' in relation to COVID-19. The label infers that people are being contaminated by 'misinformation' as they would be by a virus. However, this metaphor conveys a simplistic empirical understanding of communication, which may encourage 'information control' responses. This article argues for the importance of understanding the diverse factors that impact the effectiveness of communication - including the context in which it is received, and the emergent properties created through communication processes. Analyzing 'vaccine-critical' Facebook activity in Australia between 1 December 2020 and 28 February 2022, we find that controlling access to or censoring vaccine-critical misinformation does not lead to a reduction in vaccine-critical narratives. Rather, discussions continue based on more tenable political and social arguments. Further, bans antagonize vaccine-critical Facebook users and encourage them to move to other platforms where they may be radicalized. Crucially, recruitment to vaccine-critical sites accelerated following both bans of 'misinformation' and the introduction of vaccine mandates, suggesting that such responses can lead to increased discontentment. Accordingly, we call for researchers, policy makers and media platforms to engage with a more nuanced view of communication, acknowledging the powerful role of audiences' uses and gratifications in determining the effectiveness of public health messaging.

Supporting Vaccination on TikTok During the COVID-19 Pandemic: Vaccine Beliefs, Emotions, and Comments

TikTok has been one of the most important social media platforms where pandemic-related information converged and has been disseminated. However, how vaccination-related visual content, particularly pro-vaccine videos, influences audiences remains unclear. Using Betsch et al.’s 5C model and Ekman’s basic emotion model, we identified 200 trending videos under the hashtag #vaccine on TikTok, and examined the types of vaccine-related beliefs and emotions expressed in videos and the relationship between beliefs, emotions, and supportive comments. Confidence and joy were the most frequently expressed belief and emotion, respectively; confidence (B = 14.84, P < 0.05), surprise (B = 11.29, P < 0.05), and sadness (B = 37.49, P < 0.01) predicted the number of supportive comments. This study expands the 5C framework of vaccine hesitancy into the analysis of pro-vaccine content on social media and offers detailed insights into the specific type of beliefs and emotions and their effects. Practical implications regarding how to address vaccine hesitancy are discussed.

A comprehensive examination of association between belief in vaccine misinformation and vaccination intention in the COVID-19 context

Misinformation about COVID-19 vaccines is widely available in the public communication environment. Exposure to the misinformation may increase perceived risk of and evoke negative emotions toward COVID-19 vaccines that may eventually reduce COVID-19 vaccination intentions. The negative influences of misinformation may vary by aspects of individuals' social networks. Expanding the reasoned action approach, we proposed a comprehensive model to examine the roles of misinformation beliefs, perceived risk, fear, worry, and social networks in explaining COVID-19 vaccination intentions. We tested the model using survey data of South Korean adults, collected when the Korean government launched its nationwide vaccination program in April 2021 (n = 744). The results from our step-by-step path analyses indicated that COVID-19 vaccination intentions had positive direct associations with vaccination-specific factors such as attitudes toward, injunctive norms on, and perceived behavioral control over COVID-19 vaccination. Perceived risk was also directly linked to intentions. Among these factors, attitudes and injunctive norms were most strongly related to intentions. Misinformation beliefs and worry had negative indirect relationships with intentions via the mediation of these variables directly connected to intentions. The negative influences of misinformation beliefs were greater among respondents reported stronger tie strengths. Theoretical and practical implications were discussed.

Emotions and Incivility in Vaccine Mandate Discourse: Natural Language Processing Insights

Background

Despite vaccine availability, vaccine hesitancy has inhibited public health officials' efforts to mitigate the COVID-19 pandemic in the United States. Although some US elected officials have responded by issuing vaccine mandates, others have amplified vaccine hesitancy by broadcasting messages that minimize vaccine efficacy. The politically polarized nature of COVID-19 information on social media has given rise to incivility, wherein health attitudes often hinge more on political ideology than science.

Objective

To the best of our knowledge, incivility has not been studied in the context of discourse regarding COVID-19 vaccines and mandates. Specifically, there is little focus on the psychological processes that elicit uncivil vaccine discourse and behaviors. Thus, we investigated 3 psychological processes theorized to predict discourse incivility-namely, anxiety, anger, and sadness.

Methods

We used 2 different natural language processing approaches: (1) the Linguistic Inquiry and Word Count computational tool and (2) the Google Perspective application programming interface (API) to analyze a data set of 8014 tweets containing terms related to COVID-19 vaccine mandates from September 14, 2021, to October 1, 2021. To collect the tweets, we used the Twitter API Tweet Downloader Tool (version 2). Subsequently, we filtered through a data set of 375,000 vaccine-related tweets using keywords to extract tweets explicitly focused on vaccine mandates. We relied on the Linguistic Inquiry and Word Count computational tool to measure the valence of linguistic anger, sadness, and anxiety in the tweets. To measure dimensions of post incivility, we used the Google Perspective API.

Results

This study resolved discrepant operationalizations of incivility by introducing incivility as a multifaceted construct and explored the distinct emotional processes underlying 5 dimensions of discourse incivility. The findings revealed that 3 types of emotions-anxiety, anger, and sadness-were uniquely associated with dimensions of incivility (eg, toxicity, severe toxicity, insult, profanity, threat, and identity attacks). Specifically, the results showed that anger was significantly positively associated with all dimensions of incivility (all P<.001), whereas sadness was significantly positively related to threat (P=.04). Conversely, anxiety was significantly negatively associated with identity attack (P=.03) and profanity (P=.02).

Conclusions

The results suggest that our multidimensional approach to incivility is a promising alternative to understanding and intervening in the psychological processes underlying uncivil vaccine discourse. Understanding specific emotions that can increase or decrease incivility such as anxiety, anger, and sadness can enable researchers and public health professionals to develop effective interventions against uncivil vaccine discourse. Given the need for real-time monitoring and automated responses to the spread of health information and misinformation on the web, social media platforms can harness the Google Perspective API to offer users immediate, automated feedback when it detects that a comment is uncivil.

Cognitive Networks Extract Insights on COVID-19 Vaccines from English and Italian Popular Tweets: Anticipation, Logistics, Conspiracy and Loss of Trust

Monitoring social discourse about COVID-19 vaccines is key to understanding how large populations perceive vaccination campaigns. This work reconstructs how popular and trending posts framed semantically and emotionally COVID-19 vaccines on Twitter. We achieve this by merging natural language processing, cognitive network science and AI-based image analysis. We focus on 4765 unique popular tweets in English or Italian about COVID-19 vaccines between December 2020 and March 2021. One popular English tweet contained in our data set was liked around 495,000 times, highlighting how popular tweets could cognitively affect large parts of the population. We investigate both text and multimedia content in tweets and build a cognitive network of syntactic/semantic associations in messages, including emotional cues and pictures. This network representation indicates how online users linked ideas in social discourse and framed vaccines along specific semantic/emotional content. The English semantic frame of “vaccine” was highly polarised between trust/anticipation (towards the vaccine as a scientific asset saving lives) and anger/sadness (mentioning critical issues with dose administering). Semantic associations with “vaccine,” “hoax” and conspiratorial jargon indicated the persistence of conspiracy theories and vaccines in extremely popular English posts. Interestingly, these were absent in Italian messages. Popular tweets with images of people wearing face masks used language that lacked the trust and joy found in tweets showing people with no masks. This difference indicates a negative effect attributed to face-covering in social discourse. Behavioural analysis revealed a tendency for users to share content eliciting joy, sadness and disgust and to like sad messages less. Both patterns indicate an interplay between emotions and content diffusion beyond sentiment. After its suspension in mid-March 2021, “AstraZeneca” was associated with trustful language driven by experts. After the deaths of a small number of vaccinated people in mid-March, popular Italian tweets framed “vaccine” by crucially replacing earlier levels of trust with deep sadness. Our results stress how cognitive networks and innovative multimedia processing open new ways for reconstructing online perceptions about vaccines and trust.

Exposure Effects or Confirmation Bias? Examining Reciprocal Dynamics of Misinformation, Misperceptions, and Attitudes Toward COVID-19 Vaccines

This longitudinal study integrates exposure effects and confirmation bias under the theoretical framework of dynamic motivation activation (DMA) to examine the dynamic reciprocity of misinformation, misperceptions, and attitudes in the context of COVID-19 vaccination. Results from a three- national survey showed that misinformation exposure, misperceptions, and attitudes toward COVID-19 vaccines reinforced themselves over time. Further, misperceptions reduced subsequent pro-vaccine attitudes, and pro-vaccine attitudes in turn decreased subsequent misperceptions. Longitudinal mediation analysis also indicated that attitudes reinforced themselves through misperceptions. Surprisingly, we did not find a significant impact of misinformation exposure on subsequent misperceptions or effects of attitudes on subsequent misinformation exposure. These findings highlight the importance of addressing misperceptions regarding COVID-19 vaccines and provide insights for theoretical development in research on exposure effects and confirmation bias.

Psychosocial Determinants of COVID-19 Vaccination Intention Among White, Black, and Hispanic Adults in the US

BACKGROUND

COVID-19 vaccine uptake is an urgent public health priority.

PURPOSE

To identify psychosocial determinants (attitudes, normative pressure, and perceived behavioral control) of COVID-19 vaccination intentions for U.S. White, Black, and Hispanic adults, and how COVID-19 misperceptions, beliefs about the value of science, and perceived media bias relate to these determinants.

METHODS

Longitudinal online survey using two national samples (18-49 years old/50 years and older), each stratified by racial/ethnic group (n = 3,190). Data were collected in October/November 2020 and were weighted by race group to be representative.

RESULTS

Path analyses showed that more positive attitudes about getting vaccinated predict intention across age and racial/ethnic groups, but normative pressure is relevant among older adults only. Belief in the value of science was positively associated with most determinants across all groups, however the association of COVID-19 misperceptions and perceived media bias with the determinants varied by age group.

CONCLUSIONS

Messages that emphasize attitudes toward vaccination can be targeted to all age and racial/ethnic groups, and positive attitudes are universally related to a belief in the value of science. The varying role of normative pressure poses messages design challenges to increase vaccination acceptance.

The Effects of Media Encouragements on Coronavirus Vaccination Decision and Public Interest in Traveling Abroad

A lack of knowledge exists about individuals’ vaccination decisions and their relation to their tourism behaviors. In this regard, this study examines the willingness of international travelers to take a COVID-19 vaccine prior to traveling. A quantitative research design with a survey method and the ordinary least square (OLS) multiple regression analysis was used to test the hypotheses. The media encouragement positively affected the travelers’ attitude toward the behavior and their injunctive social norm, whereas the travelers’ attitude toward the behavior and injunctive social norm positively affected their COVID-19 vaccination intention. The regression results also proved the mediating effect of both attitudes toward the behavior and injunctive social norm in the relationship between media encouragement and COVID-19 vaccination intention. This research successfully provided evidence regarding the role of media encouragement in travelers’ willingness to take the COVID-19 vaccination.

The prevalence and determinants of COVID-19 vaccine hesitancy in the age of infodemic

Background

Addressing COVID-19 vaccine hesitancy is key to ending the COVID-19 pandemic. Communication and media environments are potential drivers of vaccine hesitancy. It is worthwhile to examine the relationship between social media use and COVID-19 vaccine hesitancy.

Objective

This study aims to understand the prevalence and determinants of COVID-19 vaccine hesitancy.

Methods

Questionnaires were administered to 463 participants in mainland China. Factor analysis, correlation analysis, and linear regression models were utilized to examine the prevalence and influencing factors of COVID-19 vaccine hesitancy in China, as well as the relationship between social media use, media trust, health information literacy, and COVID-19 vaccine hesitancy.

Results

Lack of confidence and risk were identified as factors of COVID-19 vaccine hesitancy. Age, occupation status and income levels were significantly associated with COVID-19 vaccine hesitancy. In addition, we observed that frequency of social media use, diversity of social media use, media trust and health information literacy were significantly correlated with COVID-19 vaccine hesitancy.

Conclusion

Increased frequency and diversity of social media use, media trust and health information literacy can mitigate COVID-19 vaccine hesitancy and promote COVID-19 vaccination.

Impact of Refutational Two-Sided Messages on Attitudes Toward Novel Vaccines Against Emerging Infectious Diseases During the COVID-19 Pandemic

Two-sided messages that include two perspectives (i.e., risks and benefits) are more effective than one-sided messages that convey only one perspective (usually only the benefits). Refutational two-sided messages are effective for communicating risks regarding vaccines. To examine the effectiveness of refutational two-sided messages in risk communication regarding novel vaccines against emerging infectious diseases, we conducted the randomized controlled study based on a 3 × 3 × 2 mixed design (Intervention 1: vaccines against subcutaneous influenza, “novel severe infectious disease,” or intranasal influenza; intervention 2: one-sided, non-refutational two-sided, or refutational two-sided messages; two questionnaires) using a Japanese online panel. Participants completed questionnaires before and after receiving an attack message (negative information). We evaluated the impact of attack messages on the willingness to be vaccinated, and the anticipated regret of inaction (ARI). Among 1,184 participants, there was a significant difference in the willingness to be vaccinated among the message groups (p < 0.01). After receiving the attack message, willingness to be vaccinated decreased in the one-sided message group and increased in the non-refutational two-sided and refutational two-sided message groups. Additionally, ARI in the refutational two-sided message groups was significantly higher than in the one-sided groups (p = 0.03). In conclusion, two-sided messages are more effective than one-sided messages in terms of willingness to be vaccinated. Furthermore, the high ARI in the refutational two-sided message group indicated that refutational two-sided messages were more effective than one-sided messages for communicating the risks of vaccines, especially those against emerging infectious diseases.

Facilitators and Barriers of COVID-19 Vaccine Promotion on Social Media in the United States: A Systematic Review

Background and Objectives: Information regarding the COVID-19 pandemic has spread internationally through a variety of platforms, including social media. While efforts have been made to help reduce the spread of misinformation on social media, many platforms are still largely unregulated. The influence of social media use on vaccination promotion is not fully understood. This systematic review aims to identify facilitators and barriers associated with vaccine promotion through social media use. Materials and Methods: Reviewers analyzed 25 articles and identified common themes. Facilitators of vaccine promotion included an increase in the efforts of social media companies to reduce misinformation, the use of social media to spread information on public health and vaccine promotion, and the positive influence towards vaccinations of family and friends. Results and Conclusions: Identified barriers to vaccine promotion included the spread of misinformation, decreased vaccine acceptance among users of social media for COVID-19 related information due to polarization, and a lack of regulation on social media platforms. The results of this review provide insight for improving public health campaign promotion on social media and can help inform policy on social media regulation and misinformation prevention.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

Unlocking Conspiracy Belief Systems: How Fact-Checking Label on Twitter Counters Conspiratorial MMR Vaccine Misinformation

This study tested whether a simple fact-checking label on Twitter effectively reduces vaccine conspiracy beliefs, misinformation engagement intentions, and vaccination intentions. A web-based experiment (N = 206) of adults living in the United States through Amazon Mechanical Turk (MTurk) was conducted for the measles-mumps-rubella (MMR) vaccine in March 2020. The results showed that the fact-checking label attached to the conspiratorial misinformation post significantly reduced MMR vaccine conspiracy beliefs compared to the no fact-checking (misinformation-only) condition but did not directly affect MMR misinformation engagement intentions and MMR vaccination intentions. In addition, we found that the fact-checking label effectively decreased vaccine conspiracy beliefs and misinformation engagement intentions for those whose prior favorable attitudes toward MMR vaccination were relatively low. Based on our findings, we suggest that public health professionals and health communicators use the fact-checking label as a promising tool for countering conspiracy theories about vaccination. However, they should further seek alternative ways to limit the public's engagement in misinformation-related activities on social media and promote health protective behavioral intentions, given the limited effects of fact-checking labels.

Understanding Human Papillomavirus Vaccine Promotions and Hesitancy in Northern California Through Examining Public Facebook Pages and Groups

Human papillomavirus (HPV) vaccination coverage among adolescents is lower in rural regions and remains under the 80% coverage goal by Healthy People 2030. Through both sentiment analysis and topic modeling, this research examines how local health agencies and groups in nine Northern California counties promote HPV vaccines through Facebook and how target populations react to promotion posts in comments that elucidate their sentiments and hesitancy toward HPV vaccination. In January 2021, we identified 2,105 public Facebook pages and 1,065 groups related to health within the counties and collected a total of 212 posts and 505 comments related to the HPV vaccine. The posts were published between 2010 and 2021, with the majority (83%) published after 2017. There were large variations of Facebook activities across counties. We categorized four counties with HPV vaccination initiation rates below 40% as low-coverage counties and five counties with rates above 40% as high-coverage counties. In general, low-coverage counties had fewer Facebook activities in comparison to high coverage. Results showed that, on average, comments about the HPV vaccine exhibited more positive emotion, more negative emotion, and more anger than the posts. Overall, thematic topics that emerged from posts centered around awareness and screening of HPV and cervical cancer, STI testing services, information sources, and calls to action for health services. However, comment topics did not correspond to posts and were mostly related to vaccine hesitancy, discussing vaccine risks, safety concerns, and distrust in vaccine science, citing misinformation. When comparing high- versus low-coverage counties, posts expressed similar sentiments; however, comments within high-coverage counties expressed more anger than in low-coverage counties. Comments from both high- and low-coverage counties expressed concerns with vaccine safety, risks, and injury. It is important to note that commenters exchanged information sources and tried to address misinformation themselves. Our results suggest that the promotion of HPV vaccines from public Facebook pages and groups is limited in frequency and content diversity. This illustrates problems with generalized social media vaccination promotion without community tailoring and addressing specific hesitancy concerns. Public health agencies should listen to the thoughts of targeted audiences reflected through comments and design relevant messages to address these concerns for HPV vaccination promotion.

Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach

BACKGROUND

COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines.

OBJECTIVE

This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context.

METHODS

We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups.

RESULTS

Laypeople are more prevailing in the COVID-19 vaccine-related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the "safety of Chinese-made vaccine" topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference.

CONCLUSIONS

Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as "qualitatively different" in perspective rather than "quantitatively different" in scientific knowledge. Among those questions closely associated with medical expertise, the "qualitatively different" characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively.