Facebook HPV vaccine campaign: insights from Brazil

A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review

BACKGROUND

Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal.

OBJECTIVE

This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes.

METHODS

We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects.

RESULTS

We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. "Engagement" is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages.

CONCLUSIONS

Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of "engagement."

TRIAL REGISTRATION

PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287257.

Effectiveness of chatbots on COVID vaccine confidence and acceptance in Thailand, Hong Kong, and Singapore

Chatbots have become an increasingly popular tool in the field of health services and communications. Despite chatbots' significance amid the COVID-19 pandemic, few studies have performed a rigorous evaluation of the effectiveness of chatbots in improving vaccine confidence and acceptance. In Thailand, Hong Kong, and Singapore, from February 11th to June 30th, 2022, we conducted multisite randomised controlled trials (RCT) on 2,045 adult guardians of children and seniors who were unvaccinated or had delayed vaccinations. After a week of using COVID-19 vaccine chatbots, the differences in vaccine confidence and acceptance were compared between the intervention and control groups. Compared to non-users, fewer chatbot users reported decreased confidence in vaccine effectiveness in the Thailand child group [Intervention: 4.3 % vs. Control: 17%, P = 0.023]. However, more chatbot users reported decreased vaccine acceptance [26% vs. 12%, P = 0.028] in Hong Kong child group and decreased vaccine confidence in safety [29% vs. 10%, P = 0.041] in Singapore child group. There was no statistically significant change in vaccine confidence or acceptance in the Hong Kong senior group. Employing the RE-AIM framework, process evaluation indicated strong acceptance and implementation support for vaccine chatbots from stakeholders, with high levels of sustainability and scalability. This multisite, parallel RCT study on vaccine chatbots found mixed success in improving vaccine confidence and acceptance among unvaccinated Asian subpopulations. Further studies that link chatbot usage and real-world vaccine uptake are needed to augment evidence for employing vaccine chatbots to advance vaccine confidence and acceptance.

Social media promotion, risk perception, and parental support for adolescent girls' HPV vaccination: Taking consideration of future consequences and sexual attitudes as moderators

HPV vaccine hesitancy in Asia is unique compared to western countries. Concerning whether social media promotion about HPV vaccine will be related with parental support for Chinese adolescent girls, we investigated the correlation among social media promotion, risk perception of HPV vaccine and parental support. Through the theoretical lens of Health Action Process Approach model (HAPA), we found that social media promotion could reduce the risk perception of HPV vaccine and promoted parental supportive decision, and risk perception played a mediation role between social media information exposure to vaccine and parental support. Consideration of future consequences has been found to play a moderating role between social media promotion and risk perception, and parents' sexual attitudes moderated the effect of social media promotion on parental support. Implications of the findings are discussed.

An Analysis of Factors Shaping Vaccine Attitudes and Behaviours in a Low-Trust Society Based on Structural Equation Modelling-The Case of Poland's Vaccination Programme against COVID-19

This study focuses on factors that shape vaccine attitudes and behaviours in the context of a low-trust society. Our analysis focuses on the Polish vaccination programme against COVID-19, primarily on (1) the evaluation of the information campaign, (2) trust in the institutions, (3) trust in other people, (4) attitudes toward vaccine safety and efficacy, (5) attitudes toward restrictions related to vaccination (e.g., restricted access to certain services for unvaccinated persons) and the introduction of mandatory vaccination, (6) the evaluation of the government's actions during the pandemic, and (7) political preferences. The study was conducted with a sample of 1143 adult residents in Poland (CATI). The explanation of the factors determining the COVID-19 vaccine was based on structural equation modelling (SEM). The model showed that the declared fact of vaccination was largely determined by a positive attitude toward restrictions related to vaccination and trust in vaccines. The formation of the provaccine attitude was to an extent determined by the assessment of the government's campaign and actions during pandemic. While institutional trust had a positive effect on support for the ruling coalition (0.56), the latter on its own had the opposite effect (-0.61) on the formation of provaccine attitude. In the group who both trust institutions and support the parties currently in power, there are more of those who simultaneously reject the restrictions and mandatory vaccination and remain sceptical about the safety and efficacy of COVID-19 vaccines than those who both trust in the vaccine safety and efficacy and accept the restrictions and mandatory vaccination. This indicates that in the context of strong political polarisation, ideological affiliations may play a greater role in shaping vaccine attitudes and behaviours than institutional trust.

Social Media–Based Interventions for Health Behavior Change in Low- and Middle-Income Countries: Systematic Review

Background

Despite the wealth of evidence regarding effective health behavior change techniques using digital interventions to focus on residents of high-income countries, there is limited information of a similar nature for low- and middle-income countries.

Objective

The aim of this review is to identify and describe the available literature on effective social media–based behavior change interventions within low- and middle-income countries.

Methods

This systematic review was conducted in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed, Embase, Elsevier, CINAHL, PsycInfo, and Global Index Medicus, and the final search was conducted on April 6, 2021. We excluded studies published before 2000 because of the subject matter. We included studies that evaluated interventions conducted at least partly on a social media platform.

Results

We identified 1832 studies, of which 108 (5.89%) passed title-abstract review and were evaluated by full-text review. In all, 30.6% (33/108) were included in the final analysis. Although 22 studies concluded that the social media intervention was effective, only 13 quantified the level of social media engagement, of which, few used theory (n=8) or a conceptual model (n=5) of behavior change.

Conclusions

We identified gaps in the settings of interventions, types and sectors of interventions, length of follow-up, evaluation techniques, use of theoretical and conceptual models, and discussions of the privacy implications of social media use.

Trial Registration

PROSPERO CRD42020223572; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=223572

Young adults' preferences for influenza vaccination campaign messages: Implications for COVID-19 vaccine intervention design and development

Background

Health campaign interventions, particularly those tailored to the target audience's needs and preferences, can cost-effectively change people's attitudes and behaviors towards better health decision-making. However, there is limited research on how to best tailor seasonal influenza vaccination campaigns for young adults. Vaccination is vital in protecting young adults and their social circles (vulnerable populations like older adults) from the influenza virus and critical in shaping these emerging adults' vaccination habits in the long run. However, amid the prevalence of easily-accessible, attention-grabbing, and often malicious false and misinformation (e.g., COVID-19 vaccine conspiracy theories), it may be more challenging to develop vaccination messages that resonate with young adults well enough to attract their attention. Therefore, to bridge the research gap, this study examines young adults' preferences for seasonal influenza vaccination campaigns to inform effective intervention design and development.

Methods

Qualitative survey questions were developed to gauge young adults' preferences for seasonal influenza vaccination campaigns. A total of 545 young adults (73.9% female, Mage ​= ​19.89, SD ​= ​1.44) from a large University offered complete answers to a cross-sectional online survey. Braun and Clarke's thematic analysis procedures were adopted to guide the data analysis process.

Results

Thematic analysis revealed that young adults prefer seasonal influenza vaccination campaigns that rely on (1) quality and balanced information from (2) credible information sources, positioned in the (3) relevant health contexts, (4) emphasize actionable messages, and incorporate (5) persuasive campaign design. Interestingly, while many participants underscored the importance of fear-appeal messages in persuading them to take health actions, some young adults also suggested avoiding fear campaigns due to discomfort.

Conclusions

Insights of the study can inform seasonal influenza vaccination design and development, and have the potential to shed light on vaccination messaging in other vaccine contexts, such as COVID-19 vaccines. Results also underscore the need for health experts and government officials to adopt a more nuanced approach when selecting persuasive campaign appeals. While some young adults may resonate well with fear appeals, others may not. Future research could examine the underlying mechanisms that drive young adults' preference for vaccination campaign intervention to enrich the literature further.

Influenza and Measles-MMR: two case study of the trend and impact of vaccine-related Twitter posts in Spanish during 2015-2018

Social media, and in particularly Twitter, can be a resource of enormous value to retrieve information about the opinion of general population to vaccines. The increasing popularity of this social media has allowed to use its content to have a clear picture of their users on this topic. In this paper, we perform a study about vaccine-related messages published in Spanish during 2015-2018. More specifically, the paper has focused on two specific diseases: influenza and measles (and MMR as its vaccine). By also including an analysis about the sentiment expressed on the published tweets, we have been able to identify the type of messages that are published on Twitter with respect these two pathologies and their vaccines. Results showed that in contrary on popular opinions, most of the messages published are non-negative. On the other hand, the analysis showed that some messages attracted a huge attention and provoked peaks in the number of published tweets, explaining some changes in the observed trends.

Human papillomavirus (HPV) vaccination coverage in Brazil: spatial and age cohort heterogeneity

OBJECTIVE

To estimate the coverage of the first and second dose of the human papillomavirus (HPV) vaccine in Brazil according to microregion, comparing cohorts of girls aged 14, 15, and 16 years in 2017, and investigate the association between spatial heterogeneity in vaccination coverage and sociodemographic variables.

METHODS

Information about the doses administered from 2013 to 2017 by age was gathered from the National Immunization Program. The number of girls aged seven, eight, and nine years living in each microregion in 2010 was obtained from the 2010 Brazilian Census. For the analysis, the cumulated vaccination coverage per microregion (n = 558) was categorized as low (< 80%) and adequate (≥ 80%), and a random intercept logistic model was adjusted, with adequate vaccination coverage as the outcome. The random effect (federative unit) was included to identify the correlation between microregions that belong to the same state.

RESULTS

The percentage of microregions with adequate vaccination coverage was significantly higher in the first dose (between 91.8 and 159.2%), regardless of the cohort. The coverage of the second dose was lower (between 7 and 79.9%), with heterogeneity associated with the degree of urbanization and households with private bathrooms in the municipality. The random effect showed a strong explanatory power, suggesting important differences among Brazilian states as to the outreach of vaccination coverage.

CONCLUSION

Although the HPV vaccine is available through the Immunization Program, the findings of the present study point to a difficulty in achieving adequate vaccination coverage.

Cross-Protective IgG and IgA Antibodies against Oncogenic and Non-Oncogenic HPV Genotypes

OBJECTIVE

The aim of the study was to describe the course of IgG/IgA immune response in women immunized with bivalent vaccine and in women non-vaccinated with HPV infection, as well as evaluating the cross-protection against non-vaccine HPV types.

METHODS

Serum and cervical mucus samples were collected from infected and vaccinated women for HPV detection/genotyping and for detection of IgG/IgA anti-HPV/VLP (Virus-like Particles) by ELISA.

RESULTS

The median absorbance detected in serum samples for anti-HPV-IgG antibodies was higher in vaccinated women when compared to HPV infected women (p <0.01), however, the median absorbance in cervical mucus samples for anti-HPV-IgA was higher in infected women when compared to vaccinated women (p <0.01). Additionally, our analyses also provided additional evidence for cross-protective efficacy of the HPV-16/18 vaccine against HPV-82, -6, -11, -13, -61, -72 and -74.

CONCLUSION

The IgG antibodies were significantly more detected in the serum of vaccinated women, while the IgA was found in greater quantities in cervical samples from those infected by the virus. In addition, there is evidence that the bivalent vaccine provides cross-protection against other non-oncogenic viral subtypes.
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