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Flood T, Hughes CM, Wilson I, McLaughlin M. Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003100. [PMID: 38630731 PMCID: PMC11023437 DOI: 10.1371/journal.pgph.0003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.
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Affiliation(s)
- Terri Flood
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Ciara M. Hughes
- School of Health Sciences, Ulster University, Londonderry, Derry, United Kingdom
| | - Iseult Wilson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Marian McLaughlin
- School of Psychology, Ulster University, Londonderry, Derry, United Kingdom
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2
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Hansen RK, Baiju N, Gabarron E. Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review. J Med Internet Res 2023; 25:e50276. [PMID: 38147375 PMCID: PMC10777282 DOI: 10.2196/50276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 12/27/2023] Open
Abstract
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.
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Affiliation(s)
- Rita-Kristin Hansen
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Nikita Baiju
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Elia Gabarron
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
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Barakat M, Abdaljaleel M, Atawneh N, Alkhazaleh R, Aburumman D, Hamed E, Sallam M. Pervasive Parental Hesitancy and Resistance towards Measles Rubella Vaccination in Jordan. Vaccines (Basel) 2023; 11:1672. [PMID: 38006004 PMCID: PMC10674877 DOI: 10.3390/vaccines11111672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance have posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the measles rubella (MR) vaccine among parents in Jordan and to identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan, which could signal a public health alarm in the country. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine's safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.
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Affiliation(s)
- Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931, Jordan;
- MEU Research Unit, Middle East University, Amman 11831, Jordan
| | - Maram Abdaljaleel
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
| | - Nada Atawneh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Rawan Alkhazaleh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Dana Aburumman
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Eman Hamed
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Amman 11942, Jordan
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 11942, Jordan
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4
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Choi J, Tamí-Maury I, Cuccaro P, Kim S, Markham C. Digital Health Interventions to Improve Adolescent HPV Vaccination: A Systematic Review. Vaccines (Basel) 2023; 11:vaccines11020249. [PMID: 36851127 PMCID: PMC9963303 DOI: 10.3390/vaccines11020249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Digital technologies are being increasingly utilized in healthcare to provide pertinent and timely information for primary prevention, such as vaccination. This study aimed to conduct a systematic review to describe and assess current digital health interventions to promote HPV vaccination among adolescents and parents of adolescents, and to recommend directions for future interventions of this kind. Using appropriate medical subject headings and keywords, we searched multiple databases to identify relevant studies published in English between 1 January 2017 and 31 July 2022. We screened and selected eligible studies for inclusion in the final analysis. We reviewed a total of 24 studies, which included interventions using text messages (4), mobile apps (4), social media and websites (8), digital games (4), and videos (4). The interventions generally improved determinants of HPV vaccination, such as HPV-related knowledge, vaccine-related conversations, and vaccination intentions. In particular, text message and social media interventions targeted improved vaccine uptake behaviors, but little meaningful change was observed. In conclusion, digital health interventions can cost-effectively provide education about HPV vaccination, offer interactive environments to alleviate parental vaccine hesitancy, and ultimately help adolescents engage in HPV vaccine uptake.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Irene Tamí-Maury
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Paula Cuccaro
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Sooyoun Kim
- Institute of Health and Environment, Seoul National University, Seoul 08826, Republic of Korea
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- Correspondence:
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Saunders C, Sierpe A, Stevens G, Elwyn G, Cantrell M, Engel J, Gonzalez M, Hayward M, Huebner J, Johnson L, Jimenez A, Little R, McKenna C, Onteeru M, Oo Khine M, Pogue J, Salinas Vargas JL, Schmidt P, Thomeer R, Durand MA. "Something for us": Co-development of the COVID-19 Social Site, a web app for long-term care workers. J Med Internet Res 2022; 24:e38359. [PMID: 35926074 PMCID: PMC9506501 DOI: 10.2196/38359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population. Objective We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway). Methods Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3). Results In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application. Conclusions An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals.
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Affiliation(s)
- Catherine Saunders
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Ailyn Sierpe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Matthew Cantrell
- National Association of Health Care Assistants, Carl Junction, US
| | - Jaclyn Engel
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Melissa Gonzalez
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | | | | | - Lisa Johnson
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | | | | | | | - Manu Onteeru
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - May Oo Khine
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Jacqueline Pogue
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - José Luis Salinas Vargas
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Peter Schmidt
- Department of Neurology, NYU Grossman School of Medicine, New York City, US
| | - Rachael Thomeer
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, US.,Centre for Epidemiology and Research in Population Health, Université de Toulouse, Toulouse, FR
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6
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Durach F, Buturoiu R, Craiu D, Cazacu C, Bargaoanu A. Crisis of confidence in vaccination and the role of social media. Eur J Paediatr Neurol 2022; 36:84-92. [PMID: 34933130 DOI: 10.1016/j.ejpn.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 12/08/2021] [Accepted: 12/08/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The aim of this paper is to review the current situation of vaccine hesitancy, with emphasis on children with neurological disorders, and to present the role social media plays in this situation. METHODS A literature review using the following search words was performed: vaccine∗ OR immune∗ AND hesitancy OR confidence AND social media. RESULTS The search retrieved 277 results; 17 duplicates and 234 irrelevant articles were excluded. 43 articles were fully analyzed. CONCLUSIONS An increasing number of parents are becoming vaccine hesitant. Their motives are complex and nuanced and involve factors related to vaccine safety and efficiency, perceived personal risks and benefits, socio-demographic and psychological characteristics. Attitudes toward vaccination differ in adolescents from their parents. In children with neurological disorders, factors involved in vaccination decision included physicians' knowledge of neurological diseases and parents' concerns that vaccination would exacerbate the chronic disorder. Unfortunately, the current pandemic is associated with an increase in vaccine hesitancy and brought forward unique determinants. The social media platforms can be a tool for the anti-vaccine movement to spread misinformation, but it can also be valued as a way for promoting health and pro-vaccine information.
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Affiliation(s)
- Flavia Durach
- National University of Political Studies and Public Administration, Bulevardul Expozitiei 30A, postal code 012244, Bucharest/S1, Romania.
| | - Raluca Buturoiu
- National University of Political Studies and Public Administration, Bulevardul Expozitiei 30A, postal code 012244, Bucharest/S1, Romania.
| | - Dana Craiu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Department of Neurosciences, Pediatric Neurology Discipline II, Strada Dionisie Lupu No. 37, postal code: 020021, Bucharest/S2, Romania; Alexandru Obregia Clinical Hospital, Pediatric Neurology Clinic, Center of Expertise for Rare Disorders in Pediatric Neurology, EpiCARE member, Sos. Berceni 10, Bucharest/S4, Romania.
| | - Cristina Cazacu
- Alexandru Obregia Clinical Hospital, Pediatric Neurology Clinic, Center of Expertise for Rare Disorders in Pediatric Neurology, EpiCARE member, Sos. Berceni 10, Bucharest/S4, Romania.
| | - Alina Bargaoanu
- National University of Political Studies and Public Administration, Bulevardul Expozitiei 30A, postal code 012244, Bucharest/S1, Romania.
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7
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Zein S, Abdallah SB, Al-Smadi A, Gammoh O, Al-Awaida WJ, Al-Zein HJ. Factors associated with the unwillingness of Jordanians, Palestinians and Syrians to be vaccinated against COVID-19. PLoS Negl Trop Dis 2021; 15:e0009957. [PMID: 34882673 PMCID: PMC8659347 DOI: 10.1371/journal.pntd.0009957] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 10/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is expected to continue to inflect immense burdens of morbidity and mortality, not to mention the sever disruption of societies and economies worldwide. One of the major challenges to managing COVID-19 pandemic is the negative attitudes towards vaccines and the uncertainty or unwillingness to receive vaccinations. We evaluated the predictors and factors behind the negative attitudes towards COVID-19 vaccines in 3 countries in the Middle East. METHODS A cross-sectional, self-administered survey was conducted between the 1st and the 25th of December, 2020. Representative sample of 8619 adults residing in Jordan, West Bank, and Syria, completed the survey via the Web or via telephone interview. The survey intended to assess intent to be vaccinated against COVID-19 and to identify predictors of and reasons among participants unwilling/hesitant to get vaccinated. RESULTS The total of the 8619 participants included in this study were the ones who answered the question on the intent to be vaccinated. Overall, 32.2% of participants (n = 2772) intended to be vaccinated, 41.6% (n = 3589) didn't intend to get vaccinated, and 26.2% (n = 2258) were not sure. The main factors associated with the willingness to take the vaccine (yes responses) included females, 18-35 years old, Syrians and Jordanians, a large family size, and having received a flu vaccine last year. Reasons for vaccine hesitancy included the lack of rigorous evaluation of the vaccine by the FDA and the possible long-term health risks associated with the vaccines (the wait-and-see approach). CONCLUSION This survey, conducted in December when the number of cases and deaths per day due to COVID-19 were at or near peak levels of the initial surge in the three regions under investigation. The survey revealed that most of survey's participants (67.8%) were unwilling/hesitant to get vaccinated against COVID-19 with the lack of trust in the approval process of the vaccine being the main concern; the two main characteristics of those participants were more than 35 years old and participants holding a Bachelor's degree or higher. Targeted and multi-pronged efforts will be needed to increase acceptance of COVID-19 vaccine in Jordan, West Bank and Syria.
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Affiliation(s)
- Sima Zein
- Faculty of Science, Department of Biology and Biotechnology, American University of Madaba, Madaba, Jordan
| | - Sarah B. Abdallah
- Faculty of Science, Department of Biology and Biotechnology, American University of Madaba, Madaba, Jordan
| | - Ahmed Al-Smadi
- Princess Salma Faculty of Nursing, Department of Adult Health Nursing, Al al-Bayt University, Irbid, Jordan
| | - Omar Gammoh
- Faculty of Health Sciences, Department of Pharmacy, American University of Madaba, Madaba, Jordan
| | - Wajdy J. Al-Awaida
- Faculty of Science, Department of Biology and Biotechnology, American University of Madaba, Madaba, Jordan
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8
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Li L, Wood CE, Kostkova P. Vaccine hesitancy and behavior change theory-based social media interventions: a systematic review. Transl Behav Med 2021; 12:243-272. [PMID: 34850217 PMCID: PMC8848992 DOI: 10.1093/tbm/ibab148] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is widely acknowledged that vaccine hesitancy is a multifaceted problem that cannot be addressed by a single strategy. Behavior change theories and social media tools may together help to guide the design of interventions aimed at improving vaccination uptake. This systematic review aims to identify the breadth and effectiveness of such theories and tools. The systematic review search was performed in PubMed, Scopus, ACM, Cochrane Library, ProQuest, and Web of Science databases for studies between January 2011 and January 2021 that applied social media tools to increase vaccine confidence or improve vaccination uptake. The literature search yielded a total of 3,065 publications. Twenty articles met the eligibility criteria, 12 of which were theory-based interventions. The result shows that the Health Belief Model was the most frequently deployed theory, and the most common social media tool was educational posts, followed by dialogue-based groups, interactive websites, and personal reminders. Theory-based interventions were generally more measurable and comparable and had more evidence to trigger the positive behavior change. Fifteen studies reported the effectiveness in knowledge gain, intention increase, or behavior change. Educational messages were proved to be effective in increasing knowledge but less helpful in triggering behavior change. Dialogue-based social media intervention performed well in improving people’s intention to vaccinate. Interventions informed by behavior change theory and delivered via social media platforms offer an important opportunity for addressing vaccine hesitancy. This review highlights the need to use a multitheory framework and tailoring social media interventions to the specific circumstances and needs of the target audience in future interventions. The results and insights gained from this review will be of assistance to future studies.
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Affiliation(s)
- Lan Li
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Caroline E Wood
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
| | - Patty Kostkova
- UCL Centre for Digital Public Health in Emergencies (dPHE), Institute for Risk and Disaster Reduction, University College London (UCL), London, UK
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9
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Sundstrom B, Cartmell KB, White AA, Russo N, Well H, Pierce JY, Brandt HM, Roberts JR, Ford ME. HPV Vaccination Champions: Evaluating a Technology-Mediated Intervention for Parents. Front Digit Health 2021; 3:636161. [PMID: 34713108 PMCID: PMC8522013 DOI: 10.3389/fdgth.2021.636161] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Human papillomavirus (HPV) vaccination prevents 6 HPV-related cancers in men and women. Yet, rates of HPV vaccination among adolescents in the United States lag behind other developed nations, revealing a significant public health issue. This feasibility study tested a collaborative online learning environment to cultivate HPV vaccination champions. A 3-month training program recruited parents to serve as proponents and social media influencers to identify solutions to overcome barriers to HPV vaccination. A mixed methods study design included a pretest survey, three online asynchronous focus groups, a posttest survey, as well as a longitudinal follow-up survey at 6 months. Participants included 22 parents who self-identified as female (95.4%) and white (90.9%). Overall, there was a statistically significant difference in knowledge of HPV and HPV vaccination between pretest and posttest (p = 0.0042). This technology-mediated intervention increased parents' confidence and motivated them to speak more freely about HPV vaccination in-person and online with others in their social networks. Participants identified prevalent misinformation about HPV vaccination and learned how to effectively craft messages to address concerns related to safety and side effects, gender, understanding of risk, and sexual activity. Objective measures and qualitative open-ended assessment showed high intervention engagement and treatment satisfaction. All participants (100%) indicated that they enjoyed participating in the intervention. The effectiveness of this feasibility study suggests that social media is an appropriate platform to empower parents to counter vaccine hesitancy and misinformation through HPV vaccination information that is simple and shareable in-person and online.
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Affiliation(s)
- Beth Sundstrom
- Department of Communication, College of Charleston, Charleston, SC, United States
| | - Kathleen B Cartmell
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Ashley A White
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Nicole Russo
- Department of Communication, College of Charleston, Charleston, SC, United States
| | - Henry Well
- South Carolina Cancer Alliance, Columbia, SC, United States
| | | | - Heather M Brandt
- St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, TN, United States
| | - James R Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Marvella E Ford
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
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10
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Luo S, Xin M, Wang S, Zhao J, Zhang G, Li L, Li L, Tak-fai Lau J. Behavioural intention of receiving COVID-19 vaccination, social media exposures and peer discussions in China. Epidemiol Infect 2021; 149:e158. [PMID: 33888165 PMCID: PMC8267342 DOI: 10.1017/s0950268821000947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 02/05/2023] Open
Abstract
The study aimed to investigate behavioural intentions to receive free and self-paid COVID-19 vaccinations (BICV-F and BICV-SP) among Chinese university students if the vaccine was 80% effective with rare mild side effects, to examine their associations with social media exposures and peer discussions regarding COVID-19 vaccination, and to explore the mediational role of perceived information sufficiency about COVID-19 vaccination. An online anonymous survey (N = 6922) was conducted in November 2020 in five Chinese provinces. Logistic regression and path analysis were adopted. The prevalence of BICV-F and BICV-SP were 78.1% and 57.7%. BICV-F was positively associated with the frequencies of passive social media exposure (adjusted odds ratio (AOR) = 1.32, P < 0.001), active social media interaction (AOR = 1.13, P < 0.001) and peer discussions (AOR = 1.17, P < 0.001). Indirect effects of the three factors on BICV-F via perceived information sufficiency were all significant (P < 0.001). The direct effect of active social media interaction on BICV-F was significantly negative (P < 0.001). Similar associations/mediations were observed for BICV-SP. The COVID-19 vaccination intention of Chinese university students needs improvement. Boosting social media exposures and peer discussions may raise students' perceived information sufficiency and subsequently increase their vaccination intention. Considering the potential negative effect of active social media interaction, caution is needed when using social media to promote COVID-19 vaccination.
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Affiliation(s)
- Sitong Luo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong SAR, China
| | - Meiqi Xin
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong SAR, China
| | - Suhua Wang
- Graduate School of Baotou Medical College, Baotou Medical College, Baotou, Inner Mongolia, China
| | - Junfeng Zhao
- Department of Psychology, School of Education, Henan University, Kaifeng, China
| | - Guohua Zhang
- Department of Psychology, School of Psychiatry, Wenzhou Medical University, Wenzhou, China
| | - Lijuan Li
- School of Public Health, Dali University, Dali, Yunnan, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Joseph Tak-fai Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territory, Hong Kong SAR, China
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Puri N, Coomes EA, Haghbayan H, Gunaratne K. Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases. Hum Vaccin Immunother 2020; 16:2586-2593. [PMID: 32693678 PMCID: PMC7733887 DOI: 10.1080/21645515.2020.1780846] [Citation(s) in RCA: 534] [Impact Index Per Article: 133.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 06/04/2020] [Indexed: 01/12/2023] Open
Abstract
Despite major advances in vaccination over the past century, resurgence of vaccine-preventable illnesses has led the World Health Organization to identify vaccine hesitancy as a major threat to global health. Vaccine hesitancy may be fueled by health information obtained from a variety of sources, including new media such as the Internet and social media platforms. As access to technology has improved, social media has attained global penetrance. In contrast to traditional media, social media allow individuals to rapidly create and share content globally without editorial oversight. Users may self-select content streams, contributing to ideological isolation. As such, there are considerable public health concerns raised by anti-vaccination messaging on such platforms and the consequent potential for downstream vaccine hesitancy, including the compromise of public confidence in future vaccine development for novel pathogens, such as SARS-CoV-2 for the prevention of COVID-19. In this review, we discuss the current position of social media platforms in propagating vaccine hesitancy and explore next steps in how social media may be used to improve health literacy and foster public trust in vaccination.
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Affiliation(s)
- Neha Puri
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eric A. Coomes
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hourmazd Haghbayan
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Social and Preventative Medicine, Université Laval, Québec, Canada
| | - Keith Gunaratne
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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12
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Olson O, Berry C, Kumar N. Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies. Vaccines (Basel) 2020; 8:vaccines8040590. [PMID: 33049956 PMCID: PMC7712553 DOI: 10.3390/vaccines8040590] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 12/28/2022] Open
Abstract
Parental vaccine hesitancy is becoming an increasingly important public health concern in the United States. In March 2020, an assessment of the latest CDC National Immunization Survey data found that more than one-third of U.S. children between the ages of 19 and 35 months were not following the recommended early childhood immunization schedule. Furthermore, a 2019 national survey found that approximately 1 in 4 parents reported serious concerns towards vaccinating their children. Vaccine hesitancy is now associated with a decrease in vaccine coverage and an increase in vaccine-preventable disease outbreaks and epidemics in the United States. Many studies have focused on understanding and defining the new socio-medical term, vaccine hesitancy; few have attempted to summarize past and current health communication interventions and strategies that have been successful or unsuccessful in tackling this growing phenomenon. This systematic literature review will attempt to aid public health professionals with a catalogue of health communication interventions and strategies to ultimately address and prevent parental vaccine hesitancy in the long term. Out of 1239 search results, a total of 75 articles were included for analysis, ranging from systematic reviews, quantitative surveys, and experimental designs to ethnographic and qualitative studies. For the presentation of results, a taxonomy was used to organize communication interventions according to their intended purpose. The catalogue of interventions was further broken down into specific components and themes that were identified in the literature as essential to either the success or failure in preventing and addressing parental vaccine hesitancy towards childhood vaccines.
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Affiliation(s)
- Olivia Olson
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
- Correspondence: (O.O.); (N.K.)
| | | | - Nirbhay Kumar
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA
- Correspondence: (O.O.); (N.K.)
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Abstract
PURPOSE OF REVIEW In the wake of multiple recent outbreaks of the measles and other vaccine-preventable diseases, it is crucial to understand and address parental concerns about vaccination. The purposes of this review are: to identify the causes of vaccine resistance, to elucidate the variables that have led to the success or failure of interventions to date, and to consider implications for pediatricians treating children whose parents are vaccination-resistant. RECENT FINDINGS Recent research draws on insights from cognitive science to understand vaccine resistance and to develop more effective interventions. Studies show that vaccine resistors are more likely to value lifestyle liberty, to favor individualistic over hierarchical worldviews, and to believe in conspiracy theories. Interventions that seek primarily to correct erroneous beliefs about the dangers of vaccination are likely to fail or even backfire. On the other hand, intervention strategies, such as motivational interviewing, in which the provider elicits and shows respect for parents' values and concerns while empowering them to make well informed and well reasoned decisions, are more likely to be successful. Parents cite a trusting relationship with their pediatrician as the most important factor influencing their decision to vaccinate. SUMMARY Pediatricians are in the best position to successfully apply insights from cognitive science and intervention research to overcome vaccination-hesitancy.
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Thorpe M, Taylor J, Cole R. Parents' use of information accessed through social media to make immunisation decisions for their young children. Health Promot J Austr 2020; 32:189-196. [PMID: 32187407 DOI: 10.1002/hpja.336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 01/19/2023] Open
Abstract
ISSUE ADDRESSED Social media, while available to parents to inform decisions about their child's health, including immunisation, is a new area of exploration in public health. To effectively source, interpret and use such information, parents need to be health literate. This pilot study explored how parents of young children under 7 years of age obtained, understood and used immunisation information available through social media to inform immunisation decisions for their children. METHODS Purposive sampling followed by a snowball technique was used to recruit parents with one or more children under 7 years of age living in the Brisbane North and Sunshine Coast regions, Australia. Face-to-face interviews collected qualitative data in relation to how parents obtained, understood and used information sourced via social media to make immunisation decisions for their children. RESULTS All participants were passively exposed to immunisation information on social media through Facebook, YouTube, Instagram, Pinterest, LinkedIn and Twitter, but did not report proactively searching for information. The majority understood the immunisation information obtained, however, did not perceive it as credible and used other sources to clarify credibility, including their health care professional. Some participants interacted with the information, but none used it to make immunisation decisions for their children. CONCLUSIONS Whilst parents of children under 7 years of age are exposed to immunisation information on social media, they do not use this information to make immunisation decisions for their children, and rely on health care professionals for credible information. SO WHAT?: Given health care providers are perceived by parents of young children as credible sources of immunisation information and parents are regularly exposed to immunisation information via social media, further exploration of the potential role of health care professionals in the dissemination of credible immunisation information via social media platforms is warranted.
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Affiliation(s)
- Madelaine Thorpe
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jane Taylor
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Rachel Cole
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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15
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Dempsey A, Kwan BM, Wagner NM, Pyrzanowski J, Brewer SE, Sevick C, Narwaney K, Resnicow K, Glanz J. A Values-Tailored Web-Based Intervention for New Mothers to Increase Infant Vaccine Uptake: Development and Qualitative Study. J Med Internet Res 2020; 22:e15800. [PMID: 32134394 PMCID: PMC7082734 DOI: 10.2196/15800] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/30/2019] [Accepted: 12/16/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Vaccine hesitancy among parents leads to childhood undervaccination and outbreaks of vaccine-preventable disease. As the reasons for vaccine hesitancy are diverse, there is often not enough time during regular clinical visits for medical providers to adequately address all the concerns that parents have. Providing individually tailored vaccine information via the internet before a clinical visit may be a good mechanism for effectively allaying parents' vaccination concerns while also being time efficient. Including tailoring based on values is a promising, but untested, approach to message creation. OBJECTIVE This study aimed to describe the process by which we developed a Web-based intervention that is being used in an ongoing randomized controlled trial aimed at improving the timeliness of infant vaccination by reducing parental vaccine hesitancy. METHODS Development of the intervention incorporated evidence-based health behavior theories. A series of interviews, surveys, and feedback sessions were used to iteratively develop the intervention in collaboration with vaccination experts and potential end users. RESULTS In all, 41 specific content areas were identified to be included in the intervention. User feedback elucidated preferences for specific design elements to be incorporated throughout the website. The tile-based architecture chosen for the website was perceived as easy to use. Creating messages that were two-sided was generally preferred over other message formats. Quantitative surveys identified associations between specific vaccine values and vaccination beliefs, suggesting that values tailoring should vary, depending on the specific belief being endorsed. CONCLUSIONS Using health behavior theories, qualitative and quantitative data, and significant expert and end user input, we created a novel, Web-based intervention to improve infant vaccination timeliness. The intervention is based on tailoring messages according to each individual's values and beliefs. This intervention is currently being tested in a controlled randomized clinical trial.
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Affiliation(s)
- Amanda Dempsey
- University of Colorado, Denver, Aurora, CO, United States
| | - Bethany M Kwan
- University of Colorado, Denver, Aurora, CO, United States
| | - Nicole M Wagner
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, United States
| | | | - Sarah E Brewer
- University of Colorado, Denver, Aurora, CO, United States
| | - Carter Sevick
- University of Colorado, Denver, Aurora, CO, United States
| | - Komal Narwaney
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, United States
| | - Kenneth Resnicow
- University of Michigan, Department of Health Behavior & Health Education, School of Public Health, Ann Arbor, MI, United States
| | - Jason Glanz
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, United States
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16
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Vrdelja M, Učakar V, Kraigher A. From mandatory to voluntary vaccination: intention to vaccinate in the case of policy changes. Public Health 2019; 180:57-63. [PMID: 31855620 DOI: 10.1016/j.puhe.2019.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/06/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was to assess the association between sociodemographic characteristics and attitudes according to health belief model (HBM) attributes with the intention to vaccinate children in cases of non-mandatory vaccination to support informed decisions in planned revision of our vaccination policy. STUDY DESIGN This is a cross-sectional study carried out on a random sample of 3,854 women with young children in Slovenia. METHODS The participants' attitudes were grouped within six HBM attributes (perceived susceptibility, severity, benefits, barriers, clue to action and self-efficacy). Possible associations between the intention to vaccinate children in cases of non-mandatory vaccination and sociodemographic characteristics or attitudinal attributes according to HBM were explored in univariate analyses by calculating odds ratios (ORs) with 95% confidence interval (CI) estimates. RESULTS Just more than half (56.2%; 95% CI: 53.8-58.5%) of the women reported on their intention to vaccinate their children in the case of non-mandatory vaccination, and 23.4% (95% CI: 21.4-25.5%) were undecided. There were no significant sociodemographic predictor variables in relation to this intention. Those who perceived higher susceptibility to vaccine-preventable diseases or the benefits of vaccination were more likely to intend to vaccinate in the case of non-mandatory vaccination (OR = 5.70; 95% CI: 4.64-7.00) and (OR = 7.62; 95% CI: 5.96-9.76). Perceived barriers to vaccinate (fear of side-effects or lack of comprehensive information from physicians) and parents not getting enough useful information in general as a clue to action were significant predictors of an intention not to vaccinate. CONCLUSIONS Our results show that a mandatory vaccination policy is an important factor in ensuring high levels of vaccination coverage in Slovenia. In future, more comprehensive communication activities focused on vaccine-preventable diseases and the benefits and safety of vaccination (for the education of parents and their healthcare providers) are needed to diminish the reliance on a mandatory vaccination policy.
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Affiliation(s)
- M Vrdelja
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia.
| | - V Učakar
- National Institute of Public Health, Trubarjeva 2, 1000, Ljubljana, Slovenia
| | - A Kraigher
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
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Hwang J, Shah DV. Health Information Sources, Perceived Vaccination Benefits, and Maintenance of Childhood Vaccination Schedules. HEALTH COMMUNICATION 2019; 34:1279-1288. [PMID: 29869894 DOI: 10.1080/10410236.2018.1481707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Parental concerns over the safety or necessity of childhood vaccination have increased over the past decades. At the same time, there has been a proliferation of vaccine-related information available through a range of health information sources. This study investigates the associations between evaluations of health information sources, parental perceptions of childhood vaccination benefits, and the maintenance of vaccination schedules for their children. Specifically, this study aims to (a) incorporate social media into the battery of health information sources and (b) differentiate households with a childhood autism diagnosis and those without, given unsubstantiated but persistent concerns about vaccine safety and autism. Analyzing a sample of U.S. households, a total of 4,174 parents who have at least one child under the age of 18 were analyzed, including 138 of parents of households with a childhood autism diagnosis. Results show that the more the parents value interpersonal communication and magazines as sources of health information, the more they perceive vaccination benefits, and the more the value they put on television, the better they keep vaccination schedules up-to-date for their children. On the other hand, social media are negatively associated with their perceptions of vaccination benefits. Although parents of children diagnosed with autism are less likely to perceive vaccination benefits, no interaction effects with evaluations of health information sources are found on parental perceptions of vaccination benefits or maintenance of schedules.
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Affiliation(s)
- Juwon Hwang
- School of Journalism and Mass Communication, University of Wisconsin-Madison
| | - Dhavan V Shah
- School of Journalism and Mass Communication, University of Wisconsin-Madison
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18
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O'Leary ST, Narwaney KJ, Wagner NM, Kraus CR, Omer SB, Glanz JM. Efficacy of a Web-Based Intervention to Increase Uptake of Maternal Vaccines: An RCT. Am J Prev Med 2019; 57:e125-e133. [PMID: 31471001 DOI: 10.1016/j.amepre.2019.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Tetanus, diphtheria, and acellular pertussis (Tdap) and influenza vaccines are recommended for pregnant women in each pregnancy, yet uptake is suboptimal. This study tested the efficacy of an online vaccine resource in increasing uptake of Tdap and influenza vaccines among pregnant women. STUDY DESIGN RCT. SETTING/PARTICIPANTS This study was conducted among women in the third trimester of pregnancy in an integrated healthcare system in Colorado in September 2013-July 2016, with data analysis in 2017-2018. INTERVENTION Women were randomly assigned to 1 of 3 arms: website with vaccine information and interactive social media components, website with vaccine information only, or usual care. Participants in the website with vaccine information and interactive social media components and website with vaccine information only arms had access to the same base vaccine content. The website with vaccine information and interactive social media components also included a blog, discussion forum, and "Ask a Question" portal. MAIN OUTCOME MEASURES Tdap and influenza vaccination. These outcomes were analyzed separately. RESULTS For influenza (n=289), women in both the website with vaccine information and interactive social media components (OR=2.19, 95% CI=1.06, 4.53) and website with vaccine information only (OR=2.20, 95% CI=1.03, 4.69) arms had higher vaccine uptake than the usual care arm. The proportions of women receiving the influenza vaccine were 57%, 55%, and 36% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. For Tdap (n=173), there were no significant differences in vaccine uptake between study arms. The proportions of women receiving Tdap were 71%, 69%, and 68% in the website with vaccine information and interactive social media components, website with vaccine information only, and usual care arms, respectively. CONCLUSIONS Web-based vaccination information sent to pregnant women can positively influence maternal influenza vaccine uptake. Because of potential scalability, the impact of robust vaccination information websites should be studied in other settings. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Sean T O'Leary
- Department of Pediatrics, University of Colorado, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Saad B Omer
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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Archibald MM, Scott SD. Learning from usability testing of an arts-based knowledge translation tool for parents of a child with asthma. Nurs Open 2019; 6:1615-1625. [PMID: 31660190 PMCID: PMC6805259 DOI: 10.1002/nop2.369] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/05/2019] [Accepted: 08/19/2019] [Indexed: 01/18/2023] Open
Abstract
Aim Digital, art‐ and story‐based resources can be viable and engaging knowledge translation strategies in health care. Understanding the usability of these approaches can help maximize their impact. The aim of this work is to understand what aspects of ‘My Asthma Diary’, an art‐based digital knowledge translation tool for parents of children with asthma, has an impact on usability. Design Sequential explanatory mixed methods pilot study. Methods Eighteen parents of children with asthma reviewed ‘My Asthma Diary’ in a paediatric emergency department and completed a usability questionnaire. Follow‐up interviews were conducted with five parents and analysed with qualitative description. Results We identified four themes which complemented the quantitative results: (a) the eBooks are relatable and mirror personal experience; (b) the digital format is convenient and easy to navigate; (c) the narrative structure aids learning; and (d) the narrative and illustrations are synergistic. We summarize core usability considerations for subsequent research and creative knowledge translation tool development in other contexts.
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Affiliation(s)
- Mandy M Archibald
- Helen Glass Centre for Nursing University of Manitoba Winnipeg MB Canada
| | - Shannon D Scott
- Faculty of Nursing Level 3 Edmonton Clinic Health Academy University of Alberta Edmonton AB Canada
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20
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Vrdelja M, Kraigher A, Vercic D, Kropivnik S. The growing vaccine hesitancy: exploring the influence of the internet. Eur J Public Health 2019; 28:934-939. [PMID: 29982349 DOI: 10.1093/eurpub/cky114] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Vaccination coverage is dropping in several countries, including Slovenia. More and more people hesitate or even reject vaccinations. As the influence of the internet grows, the question becomes how to communicate about vaccination to parents in order to prevent this drop in vaccination coverage among children. Methods For the first time in Europe, the Situational Theory of Publics (STOP) has been used in the field of vaccination to segment mothers to subpublics, and to prescribe a clearly defined form of communication for each of the segmented groups. In the survey, 1704 mothers participated who gave birth in 2014 and 2015 in Slovenia. Results The study showed that mothers react passively to information on vaccination no matter whether they come across it coincidentally or intentionally. Most often, they seek information about vaccination from friends or online. The more concerned they are about the safety of vaccines, the more they search for information about vaccination, and their communication is consequently more active. The mothers that problematize the safety of vaccines more, and are afraid of their adverse events tend to be in favour of alternative options. Conclusions Our research demonstrated that the STOP can be applied to the field of vaccination. There is a huge need for intensive professional communication about vaccination on the internet and social media. The improvement of the communicational competences of doctors and healthcare workers is essential to achieve better communication with parents and the media, and needs to be focused on mothers and pregnant women.
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Affiliation(s)
- Mitja Vrdelja
- Communication Department, National Institute of Public Health, Ljubljana, Slovenia
| | - Alenka Kraigher
- Center for Communicable Diseases, National Institute of Public Health, Ljubljana, Slovenia
| | - Dejan Vercic
- Department of Communication, Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Samo Kropivnik
- Chair of Marketing Communications and Public Relations, Faculty of Social Sciences, University of Ljubljana, Ljubljana, Slovenia
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Shoup JA, Narwaney KJ, Wagner NM, Kraus CR, Gleason KS, Albright K, Glanz JM. Social Media Vaccine Websites: A Comparative Analysis of Public and Moderated Websites. HEALTH EDUCATION & BEHAVIOR 2018; 46:454-462. [PMID: 30596265 DOI: 10.1177/1090198118818253] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The internet is an important source of vaccine information for parents. We evaluated and compared the interactive content on an expert moderated vaccine social media (VSM) website developed for parents of children 24 months of age or younger and enrolled in a health care system to a random sample of interactions extracted from publicly available parenting and vaccine-focused blogs and discussion forums. The study observation period was September 2013 through July 2016. Three hundred sixty-seven eligible websites were located using search terms related to vaccines. Seventy-nine samples of interactions about vaccines on public blogs and discussion boards and 61 interactions from the expert moderated VSM website were coded for tone, vaccine stance, and accuracy of information. If information was inaccurate, it was coded as corrected, partially corrected or uncorrected. Using chi-square or Fisher's exact tests, we compared coded interactions from the VSM website with coded interactions from the sample of publicly available websites. We then identified representative quotes to illustrate the quantitative results. Tone, vaccine stance, and accuracy of information were significantly different (all p < .05). Publicly available vaccine websites tended to be more contentious and have a negative stance toward vaccines. These websites also had inaccurate and uncorrected information. In contrast, the expert moderated website had a more civil tone, minimal posting of inaccurate information, with very little participant-to-participant interaction. An expert moderated, interactive vaccine website appears to provide a platform for parents to gather accurate vaccine information, express their vaccine concerns and ask questions of vaccine experts.
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Affiliation(s)
| | | | | | | | | | | | - Jason M Glanz
- 1 Kaiser Permanente Colorado, Denver, CO, USA.,3 University of Colorado Denver, Aurora, CO, USA
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22
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Reich JA. "We are fierce, independent thinkers and intelligent": Social capital and stigma management among mothers who refuse vaccines. Soc Sci Med 2018; 257:112015. [PMID: 30442504 DOI: 10.1016/j.socscimed.2018.10.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/21/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
Despite measurable benefits of childhood vaccines, mothers with high levels of social privilege are increasingly refusing some or all vaccines for their children. These mothers are often clustered geographically or networked socially, providing information, emotional support, and validation for each other. Mothers who reject vaccines may face disapproval from others, criticism in popular culture, negative interactions with healthcare providers, and conflicts with people they know, which serve to stigmatize them. This article uses qualitative data from in-depth interviews with parents who reject vaccines, ethnographic observations, and analyses of online discussions to examine the role of social capital in networks of vaccine-refusing mothers. Specifically, this article explores how mothers provide each other information critical of vaccines, encourage a sense of one's self as empowered to question social expectations around vaccination, provide strategies for managing stigma that results from refusing vaccines, and define a sense of obligation to extend social capital to other mothers. In examining these strategies and tensions, we see how social capital can powerfully support subcultural norms that contradict broader social norms and provide sources of social support. Even as these forces are experienced as positive, they work in ways that actively undermine community health, particularly for those who are the most socially vulnerable to negative health outcomes from infection.
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Lockhart S, Dempsey AF, Pyrzanowski J, O'Leary ST, Barnard JG. Provider and Parent Perspectives on Enhanced Communication Tools for Human Papillomavirus Vaccine-Hesitant Parents. Acad Pediatr 2018; 18:776-782. [PMID: 30177028 DOI: 10.1016/j.acap.2018.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Human papillomavirus (HPV) vaccine initiation and completion rates remain far below the Healthy People 2020 goal, suggesting that additional tools and training may be needed to help medical staff provide a quality recommendation. As part of a larger pragmatic trial, we conducted a qualitative study to understand how a multifaceted communication intervention used by medical staff with HPV vaccine-hesitant parents can improve HPV vaccination rates in the primary care setting. METHODS At 8 primary care intervention clinics in the Denver metro area, medical staff and parents of adolescent boys and girls ages 11 to 17 years eligible to start the HPV vaccine series at a recent well care visit were recruited for study participation. Focus groups with medical staff and in-depth interviews with hesitant parents were conducted during the post-intervention period. All data were recorded, transcribed, and analyzed using established qualitative methods. RESULTS Twenty parents and 46 medical staff participated. All parents and medical staff felt that the overall intervention was beneficial and should continue to be used and preferred the HPV vaccine fact sheet component. Medical staff reported that communication trainings (intervention component) that taught a presumptive approach and motivational interviewing were the most beneficial for introducing the HPV vaccine and for countering HPV vaccine hesitancy, respectively. Least favorable components were the decision aid, disease images, and parent website. CONCLUSIONS Select components of a multifaceted communication intervention were seen as beneficial to HPV vaccine-hesitant parents and medical staff. Future studies should look at how to implement these intervention components in a greater number of primary care settings.
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Affiliation(s)
- Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado.
| | - Amanda F Dempsey
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado; Department of Pediatrics, Division of General Pediatrics
| | - Jennifer Pyrzanowski
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado
| | - Sean T O'Leary
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado; Department of Pediatrics, Division of Infectious Disease, University of Colorado School of Medicine, Aurora, Colo
| | - Juliana G Barnard
- Adult and Child Consortium for Health Outcomes Research and Delivery Service, University of Colorado School of Medicine and Children's Hospital Colorado; Department of Pediatrics, Division of General Pediatrics
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Daley MF, Narwaney KJ, Shoup JA, Wagner NM, Glanz JM. Addressing Parents' Vaccine Concerns: A Randomized Trial of a Social Media Intervention. Am J Prev Med 2018; 55:44-54. [PMID: 29773490 PMCID: PMC8606186 DOI: 10.1016/j.amepre.2018.04.010] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/01/2018] [Accepted: 04/02/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Successful strategies are needed to address parental vaccine hesitancy, a significant public health issue. The study objective was to assess whether an Internet-based platform with vaccine information and interactive social media components improved parents' vaccine-related attitudes. STUDY DESIGN A three-arm RCT. SETTING/PARTICIPANTS The study was conducted in a large Colorado integrated healthcare organization. Parents were enrolled during September 2013 through October 2015 and followed through November 2016; data were analyzed in 2017. Parents, recruited during pregnancy, were given a survey about vaccine-related attitudes at enrollment (i.e., baseline) and when their child was aged 3-5 months and 12-15 months (Timepoints 1 and 2, respectively). Parental vaccine hesitancy was assessed at baseline. INTERVENTION Study participants were randomized to the following: a study website with vaccine information and social media components (VSM arm); a website with vaccine information only (VI); or usual care. MAIN OUTCOME MEASURES Change in parental vaccine attitudes over time by baseline degree of vaccine hesitancy. RESULTS Among 1,093 study participants, 945 (86.5%) completed all three surveys. Comparing baseline with Timepoint 1 among vaccine-hesitant parents, the VSM and VI arms were associated with significant improvements in attitudes regarding vaccination benefits compared to usual care (VSM mean change 0.23 on a 5-point scale, 95% CI=0.05, 0.40, VI mean change 0.22, 95% CI=0.04, 0.40). Comparing baseline with Timepoint 2 among hesitant parents, the VSM and VI arms were also associated with significant reductions in parental concerns about vaccination risks compared to usual care (VSM mean change -0.37, 95% CI= -0.60, -0.14, VI mean change -0.31, 95% CI= -0.55, -0.07). Self-efficacy around vaccine decision making also improved among vaccine-hesitant parents. No intervention effect was observed among parents not vaccine-hesitant at baseline. CONCLUSIONS Among vaccine-hesitant parents, an Internet-based intervention improved parents' attitudes about vaccines. TRIAL REGISTRATION This study was registered at www.clinicaltrials.gov NCT01873040.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Nicole M Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado; Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
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“It just forces hardship”: impacts of government financial penalties on non-vaccinating parents. J Public Health Policy 2018; 39:156-169. [DOI: 10.1057/s41271-017-0116-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Getman R, Helmi M, Roberts H, Yansane A, Cutler D, Seymour B. Vaccine Hesitancy and Online Information: The Influence of Digital Networks. HEALTH EDUCATION & BEHAVIOR 2017; 45:599-606. [DOI: 10.1177/1090198117739673] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims. This article analyzes the digital childhood vaccination information network for vaccine-hesitant parents. The goal of this study was to explore the structure and influence of vaccine-hesitant content online by generating a database and network analysis of vaccine-relevant content. Method. We used Media Cloud, a searchable big-data platform of over 550 million stories from 50,000 media sources, for quantitative and qualitative study of an online media sample based on keyword selection. We generated a hyperlink network map and measured indegree centrality of the sources and vaccine sentiment for a random sample of 450 stories. Results. 28,122 publications from 4,817 sources met inclusion criteria. Clustered communities formed based on shared hyperlinks; communities tended to link within, not among, each other. The plurality of information was provaccine (46.44%, 95% confidence interval [39.86%, 53.20%]). The most influential sources were in the health community (National Institutes of Health, Centers for Disease Control and Prevention) or mainstream media ( New York Times); some user-generated sources also had strong influence and were provaccine (Wikipedia). The vaccine-hesitant community rarely interacted with provaccine content and simultaneously used primary provaccine content within vaccine-hesitant narratives. Conclusion. The sentiment of the overall conversation was consistent with scientific evidence. These findings demonstrate an online environment where scientific evidence online drives vaccine information outside of the vaccine-hesitant community but is also prominently used and misused within the robust vaccine-hesitant community. Future communication efforts should take current context into account; more information may not prevent vaccine hesitancy.
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Affiliation(s)
- Rebekah Getman
- Harvard School of Dental Medicine, Boston, MA, USA
- Northeastern University College of Social Sciences and Humanities, Boston, MA, USA
| | | | | | - Alfa Yansane
- Harvard School of Dental Medicine, Boston, MA, USA
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Glanz JM, Wagner NM, Narwaney KJ, Kraus CR, Shoup JA, Xu S, O’Leary ST, Omer SB, Gleason KS, Daley MF. Web-based Social Media Intervention to Increase Vaccine Acceptance: A Randomized Controlled Trial. Pediatrics 2017; 140:peds.2017-1117. [PMID: 29109107 PMCID: PMC8574135 DOI: 10.1542/peds.2017-1117] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Interventions to address vaccine hesitancy and increase vaccine acceptance are needed. This study sought to determine if a Web-based, social media intervention increases early childhood immunization. METHODS A 3-arm, randomized controlled trial was conducted in Colorado from September 2013 to July 2016. Participants were pregnant women, randomly assigned (3:2:1) to a Web site with vaccine information and interactive social media components (VSM), a Web site with vaccine information (VI), or usual care (UC). Vaccination was assessed in infants of participants from birth to age 200 days. The primary outcome was days undervaccinated, measured as a continuous and dichotomous variable. RESULTS Infants of 888 participants were managed for 200 days. By using a nonparametric rank-based analysis, mean ranks for days undervaccinated were significantly lower in the VSM arm versus UC (P = .02) but not statistically different between the VI and UC (P = .08) or between VSM and VI arms (P = .63). The proportions of infants up-to-date at age 200 days were 92.5, 91.3, and 86.6 in the VSM, VI, and UC arms, respectively. Infants in the VSM arm were more likely to be up-to-date than infants in the UC arm (odds ratio [OR] = 1.92; 95% confidence interval [CI], 1.07-3.47). Up-to-date status was not statistically different between VI and UC arms (OR = 1.62; 95% CI, 0.87-3.00) or between the VSM and VI arms (OR = 1.19, 95% CI, 0.70-2.03). CONCLUSIONS Providing Web-based vaccine information with social media applications during pregnancy can positively influence parental vaccine behaviors.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nicole M. Wagner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Komal J. Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Courtney R. Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Stanley Xu
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Sean T. O’Leary
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Saad B. Omer
- Department of Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kathy S. Gleason
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Vaccine Hesitancy: Where We Are and Where We Are Going. Clin Ther 2017; 39:1550-1562. [DOI: 10.1016/j.clinthera.2017.07.003] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 11/24/2022]
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Sousa VEC, Dunn Lopez K. Towards Usable E-Health. A Systematic Review of Usability Questionnaires. Appl Clin Inform 2017; 8:470-490. [PMID: 28487932 PMCID: PMC6241759 DOI: 10.4338/aci-2016-10-r-0170] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 02/26/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The use of e-health can lead to several positive outcomes. However, the potential for e-health to improve healthcare is partially dependent on its ease of use. In order to determine the usability for any technology, rigorously developed and appropriate measures must be chosen. OBJECTIVES To identify psychometrically tested questionnaires that measure usability of e-health tools, and to appraise their generalizability, attributes coverage, and quality. METHODS We conducted a systematic review of studies that measured usability of e-health tools using four databases (Scopus, PubMed, CINAHL, and HAPI). Non-primary research, studies that did not report measures, studies with children or people with cognitive limitations, and studies about assistive devices or medical equipment were systematically excluded. Two authors independently extracted information including: questionnaire name, number of questions, scoring method, item generation, and psychometrics using a data extraction tool with pre-established categories and a quality appraisal scoring table. RESULTS Using a broad search strategy, 5,558 potentially relevant papers were identified. After removing duplicates and applying exclusion criteria, 35 articles remained that used 15 unique questionnaires. From the 15 questionnaires, only 5 were general enough to be used across studies. Usability attributes covered by the questionnaires were: learnability (15), efficiency (12), and satisfaction (11). Memorability (1) was the least covered attribute. Quality appraisal showed that face/content (14) and construct (7) validity were the most frequent types of validity assessed. All questionnaires reported reliability measurement. Some questionnaires scored low in the quality appraisal for the following reasons: limited validity testing (7), small sample size (3), no reporting of user centeredness (9) or feasibility estimates of time, effort, and expense (7). CONCLUSIONS Existing questionnaires provide a foundation for research on e-health usability. However, future research is needed to broaden the coverage of the usability attributes and psychometric properties of the available questionnaires.
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Affiliation(s)
- Vanessa E C Sousa
- Vanessa E. C. Sousa, PhD, MSN, University of Illinois at Chicago, College of Nursing, Department of Health Systems Science, 845 South Damen St., Chicago, IL 60612, , Phone: 773-814-0517
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Maertens JA, Jimenez-Zambrano AM, Albright K, Dempsey AF. Using Community Engagement to Develop a Web-Based Intervention for Latinos about the HPV Vaccine. JOURNAL OF HEALTH COMMUNICATION 2017; 22:285-293. [PMID: 28276945 DOI: 10.1080/10810730.2016.1275890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Human papillomavirus (HPV) infection is pervasive among sexually active women and men, and Hispanic women are at particularly high risk as they have higher rates of invasive cervical cancer compared to other racial or ethnic groups in the United States. There is a need for interventions to increase HPV vaccination among this high-risk population. This study investigated how to modify a previously developed web-based intervention that provided individually tailored information about HPV to improve its use among the Latino population. A community-oriented modification approach incorporated feedback from a community advisory committee, and focus groups among the Latino population, to modify the intervention. Several themes emerged including a need for basic information about HPV and HPV vaccination, changes to make the intervention appear less clinical, and incorporation of information addressing barriers specific to the Latino community. This work was done in preparation for a randomized trial to assess the impact of this modified intervention on HPV vaccination attitudes and uptake among Latino young adults and parents of adolescents. If effective, our intervention could be a resource for reducing HPV vaccination concerns, improving immunization rates, and educating Latinos about HPV and the HPV vaccine outside of the time boundaries of the traditional clinical encounter.
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Affiliation(s)
- Julie A Maertens
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Andrea M Jimenez-Zambrano
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
| | - Karen Albright
- b Department of Sociology and Criminology , University of Denver , Denver , Colorado , USA
| | - Amanda F Dempsey
- a Adult and Child Consortium for Health Outcomes Research and Delivery Science , University of Colorado Denver , Denver , Colorado , USA
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Ames HMR, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev 2017; 2:CD011787. [PMID: 28169420 PMCID: PMC5461870 DOI: 10.1002/14651858.cd011787.pub2] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Childhood vaccination is an effective way to prevent serious childhood illnesses, but many children do not receive all the recommended vaccines. There are various reasons for this; some parents lack access because of poor quality health services, long distances or lack of money. Other parents may not trust vaccines or the healthcare workers who provide them, or they may not see the need for vaccination due to a lack of information or misinformation about how vaccinations work and the diseases they can prevent.Communication with parents about childhood vaccinations is one way of addressing these issues. Communication can take place at healthcare facilities, at home or in the community. Communication can be two-way, for example face-to-face discussions between parents and healthcare providers, or one-way, for instance via text messages, posters or radio programmes. Some types of communication enable parents to actively discuss vaccines and their benefits and harms, as well as diseases they can prevent. Other communication types simply give information about vaccination issues or when and where vaccines are available. People involved in vaccine programmes need to understand how parents experience different types of communication about vaccination and how this influences their decision to vaccinate. OBJECTIVES The specific objectives of the review were to identify, appraise and synthesise qualitative studies exploring: parents' and informal caregivers' views and experiences regarding communication about childhood vaccinations and the manner in which it is communicated; and the influence that vaccination communication has on parents' and informal caregivers' decisions regarding childhood vaccination. SEARCH METHODS We searched MEDLINE (OvidSP), MEDLINE In-process and Other Non-Index Citations (Ovid SP), Embase (Ovid), CINAHL (EbscoHOST), and Anthropology Plus (EbscoHost) databases for eligible studies from inception to 30 August 2016. We developed search strategies for each database, using guidelines developed by the Cochrane Qualitative Research Methods Group for searching for qualitative evidence as well as modified versions of the search developed for three related reviews of effectiveness. There were no date or geographic restrictions for the search. SELECTION CRITERIA We included studies that utilised qualitative methods for data collection and analysis; focused on the views and experiences of parents and informal caregivers regarding information about vaccination for children aged up to six years; and were from any setting globally where information about childhood vaccinations was communicated or distributed. DATA COLLECTION AND ANALYSIS We used maximum variation purposive sampling for data synthesis, using a three-step sampling frame. We conducted a thematic analysis using a constant comparison strategy for data extraction and synthesis. We assessed our confidence in the findings using the GRADE-CERQual approach. High confidence suggests that it is highly likely that the review finding is a reasonable representation of the phenomenon of interest, while very low confidence indicates that it is not clear whether the review finding is a reasonable representation of it. Using a matrix model, we then integrated our findings with those from other Cochrane reviews that assessed the effects of different communication strategies on parents' knowledge, attitudes and behaviour about childhood vaccination. MAIN RESULTS We included 38 studies, mostly from high-income countries, many of which explored mothers' perceptions of vaccine communication. Some focused on the MMR (measles, mumps, rubella) vaccine.In general, parents wanted more information than they were getting (high confidence in the evidence). Lack of information led to worry and regret about vaccination decisions among some parents (moderate confidence).Parents wanted balanced information about vaccination benefits and harms (high confidence), presented clearly and simply (moderate confidence) and tailored to their situation (low confidence in the evidence). Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment (moderate confidence).Parents viewed health workers as an important source of information and had specific expectations of their interactions with them (high confidence). Poor communication and negative relationships with health workers sometimes impacted on vaccination decisions (moderate confidence).Parents generally found it difficult to know which vaccination information source to trust and challenging to find information they felt was unbiased and balanced (high confidence).The amount of information parents wanted and the sources they felt could be trusted appeared to be linked to acceptance of vaccination, with parents who were more hesitant wanting more information (low to moderate confidence).Our synthesis and comparison of the qualitative evidence shows that most of the trial interventions addressed at least one or two key aspects of communication, including the provision of information prior to the vaccination appointment and tailoring information to parents' needs. None of the interventions appeared to respond to negative media stories or address parental perceptions of health worker motives. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several review findings. Further research, especially in rural and low- to middle-income country settings, could strengthen evidence for the findings where we had low or very low confidence. Planners should consider the timing for making vaccination information available to parents, the settings where information is available, the provision of impartial and clear information tailored to parental needs, and parents' perceptions of health workers and the information provided.
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Affiliation(s)
- Heather MR Ames
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
- University of OsloInstitute of Health and SocietyOsloNorway
| | - Claire Glenton
- Norwegian Institute of Public HealthGlobal Health UnitPilestredet Park 7OsloNorway0130
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 4404OsloNorway0403
- Medical Research Council of South AfricaHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
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Frew PM, Chung Y, Fisher AK, Schamel J, Basket MM. Parental experiences with vaccine information statements: Implications for timing, delivery, and parent-provider immunization communication. Vaccine 2016; 34:5840-5844. [PMID: 27789148 DOI: 10.1016/j.vaccine.2016.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined Vaccine Information Statements (VIS) dissemination practices and parental use and perceptions. METHODS We conducted a national online panel survey of 2603 US parents of children aged <7. Primary outcomes included reported VIS receipt, delivery timing, reading experiences, and perceived utility. RESULTS Most parents received a VIS (77.2%; [95% CI: 74.5-79.7%]), 59.7% [56.6-62.7%] before vaccination but 14.5% [12.5-16.8%] reported receiving it after their child's immunization; 15.1% [13.0-17.6%] were unsure of receipt status or timing; another 10.7% [9.0-12.6%] reported non-receipt of a VIS. Less than half who received a VIS before vaccination completed it before vaccination (46.2% [42.4, 50.0%]), but most who read at least some found the information useful (95.7% [93.8-97.0%]). Parents who delayed or refused at least one recommended non-influenza vaccine reported fewer opportunities to ask providers VIS questions. CONCLUSIONS Most parents report receiving VIS before vaccination as per federal guidelines. Continued effort is needed to enhance VIS distribution practice and parent-provider VIS content communication.
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Affiliation(s)
- Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, United States; Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, United States; Emory University, Rollins School of Public Health, Hubert Department of Global Health, United States; U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States.
| | - Yunmi Chung
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Allison Kennedy Fisher
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
| | - Jay Schamel
- Oak Ridge Institute for Science and Education (ORISE), United States
| | - Michelle M Basket
- U.S. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, United States
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Abstract
Effective well-child care includes developmental surveillance and screening to identify developmental delays and subsequent interventions. Electronic health records (EHRs) have been widely adopted to improve efficiency and appropriate clinical practice. Developmental surveillance tools have been introduced. This article summarizes a conceptual framework for application and highlights the principles and tools of EHRs applied to developmental assessment, including interoperability, health information exchange, clinical decision support systems, consumer health informatics, dashboards, and patient portals. Further investigation and dedicated resources will be required for successful application to developmental surveillance and screening.
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Affiliation(s)
- Timothy Ryan Smith
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS 66160, USA.
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Vaccine Hesitancy: Causes, Consequences, and a Call to Action. Am J Prev Med 2015; 49:S391-8. [PMID: 26337116 DOI: 10.1016/j.amepre.2015.06.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/03/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
Vaccine hesitancy reflects concerns about the decision to vaccinate oneself or one's children. There is a broad range of factors contributing to vaccine hesitancy, including the compulsory nature of vaccines, their coincidental temporal relationships to adverse health outcomes, unfamiliarity with vaccine-preventable diseases, and lack of trust in corporations and public health agencies. Although vaccination is a norm in the U.S. and the majority of parents vaccinate their children, many do so amid concerns. The proportion of parents claiming non-medical exemptions to school immunization requirements has been increasing over the past decade. Vaccine refusal has been associated with outbreaks of invasive Haemophilus influenzae type b disease, varicella, pneumococcal disease, measles, and pertussis, resulting in the unnecessary suffering of young children and waste of limited public health resources. Vaccine hesitancy is an extremely important issue that needs to be addressed because effective control of vaccine-preventable diseases generally requires indefinite maintenance of extremely high rates of timely vaccination. The multifactorial and complex causes of vaccine hesitancy require a broad range of approaches on the individual, provider, health system, and national levels. These include standardized measurement tools to quantify and locate clustering of vaccine hesitancy and better understand issues of trust; rapid, independent, and transparent review of an enhanced and appropriately funded vaccine safety system; adequate reimbursement for vaccine risk communication in doctors' offices; and individually tailored messages for parents who have vaccine concerns, especially first-time pregnant women. The potential of vaccines to prevent illness and save lives has never been greater. Yet, that potential is directly dependent on parental acceptance of vaccines, which requires confidence in vaccines, healthcare providers who recommend and administer vaccines, and the systems to make sure vaccines are safe.
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Abstract
The recent United States measles epidemic has sparked another contentious national discussion about childhood vaccination. A growing number of parents are expressing concerns about the safety of vaccines, often fueled by misinformation from the internet, books, and other nonmedical sources. Many of these concerned parents are choosing to refuse or delay childhood vaccines, placing their children and surrounding communities at risk for serious diseases that are nearly 100% preventable with vaccination. Between 10% and 15% of parents are asking physicians to space out the timing of vaccines, which often poses an ethical dilemma for physicians. This trend reflects a tension between personal liberty and public health, as parents fight to control the decisions that affect the health of their children and public health officials strive to maintain high immunization rates to prevent outbreaks of vaccine-preventable diseases. Interventions to address this emerging public health issue are needed. We describe a framework by which web-based interventions can be used to help parents make evidence-based decisions about childhood vaccinations.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, United States of America
| | - Courtney R. Kraus
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, United States of America
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