Observation of public sentiment toward human papillomavirus vaccination on Twitter

The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis

BACKGROUND

Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy.

OBJECTIVE

In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities.

METHODS

To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities.

RESULTS

We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community.

CONCLUSIONS

Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively.

Analysis of vaccine messages on social media (Twitter) in Scandinavia

Vaccine hesitancy is listed as one of the top 10 global health threats by the WHO. Existing studies investigating the relationship between vaccine hesitancy and social media have found that misinformation and vaccine concerns on social media can cause significant declines in vaccine coverage rates. The objective of this study was to provide insight into the dynamics of vaccine messages on Twitter in Scandinavia (Denmark, Norway, Sweden), by analyzing tweets in local languages during 2019. A validated measure, the 5C scale, was used to map relevant predictors of vaccination behavior, capturing the factors confidence (in vaccines and the system that delivers them), complacency (not perceiving diseases as high risk), constraints (structural and psychological barriers), calculation (engagement in extensive information searching) and collective responsibility (willingness to protect others). A total of 1794 tweets met the inclusion criteria (DK: 48%, NO: 15%, SE: 37%), predominantly tweeted by private users (86%). The HPV vaccine was mentioned in 81% of tweets. Tweets were classified as expressing confidence (61%), complacency (18%), constraints (15%), calculation (15%), and collective responsibility (4%). Confidence in vaccines and the system that delivers them was expressed in 57%. A lack of confidence was expressed in 4% of all tweets, in combination with calculation in 39%. Analyzing public sentiment toward vaccination on Twitter is a useful tool to leverage for better understanding of the dynamics behind vaccine hesitancy. This analysis could provide actionable information for healthcare professionals and public health authorities to mitigate online misinformation and public vaccine concerns.

Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review

Background

Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring.

Objective

The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations.

Methods

A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles’ titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses.

Results

This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes).

Conclusions

Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design.

The sources and correlates of exposure to vaccine-related (mis)information online

Objectives

To assess the quantity and type of vaccine-related information Americans consume online and its relationship to social media use and attitudes toward vaccines.

Methods

Analysis of individual-level web browsing data linked with survey responses from representative samples of Americans collected between October 2016 and February 2019.

Results

We estimate that approximately 84% of Americans visit a vaccine-related webpage each year. Encounters with vaccine-skeptical content are less frequent; they make up only 7.5% of vaccine-related pageviews and are encountered by only 18.5% of people annually. However, these pages are more likely to be published by untrustworthy sources. Moreover, skeptical content exposure is more common among people with less favorable vaccine attitudes. Finally, usage of online intermediaries is frequently linked to vaccine-related information exposure. Google use is differentially associated with subsequent exposure to non-skeptical content, whereas exposure to vaccine-skeptical webpages is associated with usage of webmail and, to a lesser extent, Facebook.

Conclusions

Online exposure to vaccine-skeptical content is relatively rare, but vigilance is required given the potential for exposure among vulnerable audiences.

Understanding the decision to immunize: insights into the information needs and priorities of people who have utilized an online human papillomavirus (HPV) vaccine decision aid tool

Setting

People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention.

Intervention

In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people’s decision-making about the vaccine.

Outcomes

Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked “what is HPV”, suggesting that many people in Alberta now have basic knowledge about the virus.

Implications

Results provide a real-time “pulse” on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.

It's not all about autism: The emerging landscape of anti-vaccination sentiment on Facebook

BACKGROUND

Due in part to declining vaccination rates, in 2018 over 20 states reported at least one case of measles, and over 40,000 cases were confirmed in Europe. Anti-vaccine posts on social media may be facilitating anti-vaccination behaviour. This study aimed to systematically characterize (1) individuals known to publicly post anti-vaccination content on Facebook, (2) the information they convey, and (3) the spread of this content.

METHODS

Our data set consisted of 197 individuals who posted anti-vaccination comments in response to a message promoting vaccination. We systematically analysed publicly-available content using quantitative coding, descriptive analysis, social network analysis, and an in-depth qualitative assessment. The final codebook consisted of 26 codes; Cohen's κ ranged 0.71-1.0 after double-coding.

RESULTS

The majority (89%) of individuals identified as female. Among 136 individuals who divulged their location, 36 states and 8 other countries were represented. In a 2-mode network of individuals and topics, modularity analysis revealed 4 distinct sub-groups labelled as "trust," "alternatives," "safety," and "conspiracy." For example, a comment representative of "conspiracy" is that poliovirus does not exist and that pesticides caused clinical symptoms of polio. An example from the "alternatives" sub-group is that eating yogurt cures human papillomavirus. Deeper qualitative analysis of all 197 individuals' profiles found that these individuals also tended to post material against other health-related practices such as water fluoridation and circumcision.

CONCLUSIONS

Social media outlets may facilitate anti-vaccination connections and organization by facilitating the diffusion of centuries old arguments and techniques. Arguments against vaccination are diverse but remain consistent within sub-groups of individuals. It would be valuable for health professionals to leverage social networks to deliver more effective, targeted messages to different constituencies.

Toward Real-Time Infoveillance of Twitter Health Messages

There is growing interest in conducting public health research using data from social media. In particular, Twitter "infoveillance" has demonstrated utility across health contexts. However, rigorous and reproducible methodologies for using Twitter data in public health are not yet well articulated, particularly those related to content analysis, which is a highly popular approach. In 2014, we gathered an interdisciplinary team of health science researchers, computer scientists, and methodologists to begin implementing an open-source framework for real-time infoveillance of Twitter health messages (RITHM). Through this process, we documented common challenges and novel solutions to inform future work in real-time Twitter data collection and subsequent human coding. The RITHM framework allows researchers and practitioners to use well-planned and reproducible processes in retrieving, storing, filtering, subsampling, and formatting data for health topics of interest. Further considerations for human coding of Twitter data include coder selection and training, data representation, codebook development and refinement, and monitoring coding accuracy and productivity. We illustrate methodological considerations through practical examples from formative work related to hookah tobacco smoking, and we reference essential methods literature related to understanding and using Twitter data.