Facebook Recruitment of Vaccine-Hesitant Canadian Parents: Cross-Sectional Study

Challenges and Opportunities in Recruiting Research Participants Using Facebook: Lessons Learned from an Exemplar Study

BACKGROUND

Facebook is a prominent social medial platform frequently used for business marketing. Researchers are starting to recognize the utility of this platform for developing research awareness, information dissemination, and more recently participant recruitment.

PURPOSE

This paper will provide an overview of methods used in Facebook recruitment through an exemplar study. It will highlight successes and challenges and provide insight into future opportunities for its' use.

METHODS

Two methods of Facebook recruitment are outlined in this paper: the use of Facebook groups and paid advertising. A step-by-step guide highlights how researchers can implement these specific methods of Facebook recruitment.

RESULTS

Facebook was successfully utilized to recruit participants in the exemplar study. Recruitment was completed over a period of 82 days with a total cost of $157.09 Canadian dollars.

CONCLUSION

Facebook is a viable method of recruiting research participants. This method can be cost-effective, timely, and efficient in comparison to traditional research recruitment methods. However, one must balance the benefits and challenges of this type of recruitment.

Digital health literacy, vaccine information sources, and vaccine acceptance among parents in Ontario: Quantitative findings from a mixed methods study

Parents make important vaccination decisions for their children and many variables affect parents' decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents' digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across the continuum of vaccine hesitant to vaccine accepting is reported. An online survey of parents of young children living in Ontario, Canada was conducted in 2022. Multiple linear regression determined predictors of vaccine acceptance. 219 participants completed the survey and on average reported adequate digital health literacy skill. Healthcare providers were reported as the most commonly used source of vaccine information. Two models were retained that predicted vaccine acceptance, both models predicted about 50% of the variability in vaccine acceptance. Model A identified that trust predicted parent vaccine acceptance and model B identified that digital health literacy, and the vaccine information sources healthcare providers, family and friends, and alternate healthcare providers predicted vaccine acceptance. Family and friends and alternate healthcare providers negatively predicted vaccine acceptance. Most parents in our study had high levels of digital health literacy. Opportunities exist for further research and policy change focused on trust at a systemic public health level. While clinical level implications included the importance of healthcare providers as a vaccine information source and adequate digital health literacy to facilitate parental vaccine decision making. Continued efforts to develop awareness on the importance of digital health literacy among the public and healthcare providers is needed, including further research on the digital health literacy levels of Canadians.

Modification and Validation of the Vaccine Hesitancy Scale for Turkish Adult Vaccination

Background and Purpose: For public health, it is important to investigate vaccine hesitancy, determine populations reluctant for vaccines, and investigate barriers and facilitators for vaccination in these groups. This study aims to modify and validate the Vaccine Hesitancy Scale specific to adults in Turkish society. Methods: The study, which was designed as a methodological and survey type, was conducted using a Google questionnaire with 720 participants who met the inclusion criteria with a convenient sampling method. Results: After factor and reliability analysis, a 2-factor, 10-item scale with an acceptable and perfect range of fit index values emerged. It has been observed that individuals who are young, single, do not have children, have vaccine allergy, and do not believe that the vaccine will protect the society are adversely affected by the environment, and those who do not have COVID-19 and flu have a high level of hesitancy to vaccine. Conclusions: The Vaccine Hesitancy Scale is a valid and reliable tool to detect vaccine hesitation in adults in Turkish society.

Pushed to the Fringe - The Impact of Vaccine Hesitancy on Children and Families

Vaccine hesitancy has been described as any delay or refusal of vaccines despite their availability and is increasing in Australia and other middle to high-income countries. The aim of this study is to gain a deep understanding of the experiences and influences on vaccine hesitant children and their families. A qualitative interview approach was undertaken with vaccine hesitant parents and pregnant women (n = 12). Semi-structured interviews were conducted by telephone. Inductive thematic analysis was undertaken on data obtained using the guidelines of Braun and Clarke. Three main themes were identified in this study, including Pushed to the fringe; A culture of Distrust; and Coerced choices. The study revealed that vaccine hesitant parents felt isolated and pushed to the fringe of society. They also expressed dissatisfaction with the Australian "No Jab - No Pay" and "No Jab - No Play" legislation. This contributed to feelings of marginalization. Participants also cited a breakdown in the therapeutic relationships, which impacted their child's health. Additionally, a lack of sufficient information was received to achieve informed consent. These results suggest that there is a need for enhanced education for some health-care professionals, many of whom have reported being confronted by conversations with vaccine hesitant parents.

Exploring parents' views of the use of narratives to promote childhood vaccination online

BACKGROUND

Negative information about vaccines that spreads online may contribute to parents' vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination.

METHODS

We identified three ∼4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician's clinical experience with vaccine-preventable diseases (prevention of still existing diseases); and a mother's experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention.

RESULTS

Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider's and parent's narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web.

CONCLUSION

While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention.

Using web analytics data to identify platforms and content that best engage high-priority HIV populations in online and social media marketing advertisements

Background

Online advertisements on social media platforms are an important tool for engaging relevant populations in public health research. However, little is known about what platforms and ad characteristics are most effective in engaging high-priority HIV populations, including racial/ethnic and sexual minority individuals.

Methods

Data from this study were drawn from advertising campaigns conducted on popular websites and social media platforms that recruited for several nationwide randomized controlled trials of various HIV prevention and testing strategies among sexual minority men (SMM) from December 2019 until March 2022. Descriptive statistics and LASSO regression models were used to determine which platforms and ad characteristics were associated with significantly higher odds of engagement.

Results

Ads on Google search, Facebook, and Instagram yielded the most cost-effective engagement, while gay-oriented dating platforms and TrafficJunky yielded the highest percentage of users who appeared to meet basic eligibility criteria. The highest percentages of Black users were screened through ads on Jack'd, TrafficJunky, and Google search; for Hispanic/Latino users, Google search, Grindr, Facebook, and Instagram. Analyzing ad characteristics, we found ads that used suggestive content, animation, and included study or institution logos were associated with greater engagement. Ads that emphasized convenience of the research (e.g. mentioned participating "from home") and that depicted people of similar races/ethnicities were also associated with greater engagement among Black and Hispanic/Latino sexual minority men.

Conclusions

We found that advertisements on mainstream social media sites are most cost effective. Although gay-oriented dating platforms were much more effective at reaching the target population, they were considerably more expensive. We also identified ad characteristics that were particularly effective in engaging users. These results could inform the design of online public health outreach campaigns for similar populations to improve their engagement and reach. Findings also demonstrated the value of conducting focused research on the effectiveness of various online marketing strategies.

Public Attitude Towards COVID-19 Vaccination: Validation of COVID-Vaccination Attitude Scale (C-VAS)

Introduction

The fear of emergence of newer strains of SARS-CoV-2 as well as concerns of waning of protection after doses of COVID-19 vaccine has created a degree of global uncertainty surrounding the pandemic. Some of the emerging strains of SARS-CoV-2 have shown potential for causing serious disease and death, a threat that has been ameliorated by ensuring the vaccine coverage in populations. Still, the vaccine coverage remains unsatisfactory in certain populations. Hence, understanding and working on the factors which affect acceptance of the vaccine amongst the public can be considered a priority for public health as much as ensuring availability of the vaccines.

Objective

This research work aims to build and validate a scale to assess the public attitude towards COVID vaccination. The proposed scale has been named as COVID Vaccination Attitude Scale (C-VAS).

Materials and Methods

A three-stage process was used to develop the C-VAS which includes (1) item generation (deductive and inductive approach); (2) item-refinement (pre-testing and pilot testing, exploratory factor analysis (EFA); and (3) scale validation (confirmatory factor analysis, CFA). The sample size used for this research was 840. In order to overcome the issue of common method bias, the data was collected in two phases. The sample n1 (411) was used for EFA and the sample n2 (429) was employed for undertaking CFA. Common method bias was assessed to check if variations in responses are caused by the instrument instead of the actual dispositions of the respondents. Items of the scale were taken by reviewing the extant literature about vaccination, from the relevant established theories such as health belief model and by interviewing with domain experts. The content validity of the scale was determined.

Results

EFA extracted five factors, labelled as "Perceived Benefits", "Perceived Barriers", "Perceived Severity", "Health Motivation" and "Perceived Risk". To further validate the factor-item structure CFA was performed.

Conclusion

The measurement model was assessed by applying CFA to examine the reliability, accuracy and validity of the scale. Development of this scale can help in understanding factors that affect vaccine acceptability behavior. This can be used in promoting COVID vaccine coverage in countries and societies which still have low vaccination rates especially due to lack of acceptance of the vaccine. This scale also has the potential to understand public behavior in relation to similar future outbreaks and the acceptance of the mitigatory vaccines.

Facebook Recruitment for Children with Advanced Cancer and Their Parents: Lessons from a Web-based Pediatric Palliative Intervention Study

Participant recruitment for pediatric palliative intervention studies is a chronic challenge for researchers. Digital recruitment strategies, or digital technology-assisted recruitment methods used to remotely reach and enroll research subjects, can help address these recruitment challenges for pediatric palliative care clinical trials. This study (a) describes Facebook recruitment procedures targeting children with cancer and their parents for a pediatric palliative intervention randomized clinical trial, (b) reports recruitment results, and (c) discusses successful strategies to recruit pediatric populations via Facebook advertisements. Researchers used Facebook advertisements to recruit children with advanced cancer (aged 7 to 17 years) for a web-based legacy intervention. Between years 2015 and 2018, our research team enrolled 150 child-parent dyads (N= 300) to participate in the web-based legacy program. Results suggest that Facebook advertisements can be a successful tool to access and recruit pediatric populations with life-threatening conditions. Further research is needed to determine how innovative social-media recruitment strategies could be used in other populations of patients with serious illnesses and their caregivers to further advance the science in palliative care.

The feasibility, acceptability and preliminary efficacy of parent-targeted interventions in vaccination pain management of infants: a pilot randomized control trial (RCT)

Aim: To evaluate the feasibility, acceptability and preliminary efficacy of parent interventions for improving the use of pain management strategies during vaccination of infants, a two-armed pilot randomized control trial (RCT) was conducted. Materials & methods: 151 parents were randomized in two groups: Group 1) 'Be Sweet to Babies' videos and a tip sheet (n = 76); Group 2) As per Group 1 plus a motivational interviewing informed Affirmative Statements and Questions (AS&Q) (n = 75). Results & conclusion: Feasibility was evaluated by success of the recruitment (151 people in a week), rates of completed consent forms (85%), and surveys (59%). Over 94% satisfaction with interventions, processes and 88% intention to recommend the strategies to others determined the acceptability. Preliminary efficacy was evident by over 95% use of pain management strategies following the interventions. Clinical trial registration number: NCT03968432.

Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases

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.

Google AdWords and Facebook Ads for Recruitment of Pregnant Women into a Prospective Cohort Study With Long-Term Follow-Up

Objectives Several types of epidemiologic studies suffer from decreasing participation rates, resulting in potential selection bias and delay or termination of studies. We aimed to determine the feasibility of online methods for recruitment of pregnant women into a prospective cohort study. Methods In addition to traditional recruitment through prenatal care providers, we advertized participation in the PRegnancy and Infant DEvelopment (PRIDE) Study, an ongoing prospective cohort study with long-term follow-up in The Netherlands enrolling women in early pregnancy, through Google AdWords (30 days) and Facebook Ads (31 and 27 days) campaigns between September 2016 and January 2017. We calculated costs per eligible participant and compared demographics, health-related characteristics, and follow-up rates between participants recruited through online methods and prenatal care providers. Results During the study period, we recruited six women through AdWords (€54.28 per participant), 59 through Facebook (€10.17 per participant), and 327 through prenatal care providers (no valid cost estimate available). Facebook participants seemed to be younger (29.0 vs. 30.7 years), to have a higher body mass-index and/or low/intermediate education (27.0 vs. 24.0 kg/m² and 41 vs. 25%, respectively), and to start prenatal care in secondary care more often (12 vs. 5%) than participants recruited through prenatal care providers. Item non-response and loss to follow-up rates were higher among women recruited online than among those recruited through prenatal care providers. Conclusion Google AdWords did not contribute substantially, but Facebook Ads may complement traditional recruitment methods of pregnant women into prospective cohort studies, despite challenges that may threaten internal validity.

Development and psychometric properties of the public attitude towards vaccination scale - Health belief model

AIM

The aim of this study was to develop and psychometrically evaluate the Public Attitude Towards Vaccination Scale - Health Belief Model.

DESIGN

A methodological and prospective psychometric study.

METHOD

A three-phase construct was used to develop the Public Attitude Towards Vaccination Scale - Health Belief Model and to determine its psychometric properties: (1) creation of the item pool/conceptualization; (2) evaluation of the items; and (3) psychometric evaluation. This scale was tested using the construct validity (exploratory and confirmatory factor analyses) and the reliability analysis. A psychometric assessment of the scale was conducted with 586 individuals. Data were collected between January - April 2018.

RESULTS

Items of the scale were obtained by appraising the literature concerning vaccination and the other Health Belief Model scale and conducting interviews with mothers. The content validity ratio of this scale calculated according to experts' opinions ranged between 0.769 and 1.00. According to the exploratory factor analysis, there were five factors with an eigenvalue higher than 1 in the scale. These five factors accounted for 68.9% of the total variance. In confirmatory factor analysis, values of fit indices were excellent or acceptable. This scale had high internal consistency and test-retest reliability.

CONCLUSION

This study successfully developed the Public Attitude Towards Vaccination Scale - Health Belief Model. In addition to researchers, this scale can be used by nurses while providing counselling for people with vaccine hesitancy/refusal.

IMPACT

This measurement tool can be used to understand and address 'vaccine hesitancy' by researchers. The results of the research using this measurement tool will provide valuable information to policymakers for preventing vaccine hesitancy. The validity and reliability of this scale can easily be conducted in different languages.

Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial

BACKGROUND

Seasonal influenza vaccination (SIV) coverage among young children remains low worldwide. Mobile social networking apps such as WhatsApp Messenger are promising tools for health interventions.

OBJECTIVE

This was a preliminary study to test the effectiveness and parental acceptability of a social networking intervention that sends weekly vaccination reminders and encourages exchange of SIV-related views and experiences among mothers via WhatsApp discussion groups for promoting childhood SIV. The second objective was to examine the effect of introducing time pressure on mothers' decision making for childhood SIV for vaccination decision making. This was done using countdowns of the recommended vaccination timing.

METHODS

Mothers of child(ren) aged 6 to 72 months were randomly allocated to control or to one of two social networking intervention groups receiving vaccination reminders with (SNI+TP) or without (SNI-TP) a time pressure component via WhatsApp discussion groups at a ratio of 5:2:2. All participants first completed a baseline assessment. Both the SNI-TP and SNI+TP groups subsequently received weekly vaccination reminders from October to December 2017 and participated in WhatsApp discussions about SIV moderated by a health professional. All participants completed a follow-up assessment from April to May 2018.

RESULTS

A total of 84.9% (174/205), 71% (57/80), and 75% (60/80) who were allocated to the control, SNI-TP, and SNI+TP groups, respectively, completed the outcome assessment. The social networking intervention significantly promoted mothers' self-efficacy for taking children for SIV (SNI-TP: odds ratio [OR] 2.69 [1.07-6.79]; SNI+TP: OR 2.50 [1.13-5.55]), but did not result in significantly improved children's SIV uptake. Moreover, after adjusting for mothers' working status, introducing additional time pressure reduced the overall SIV uptake in children of working mothers (OR 0.27 [0.10-0.77]) but significantly increased the SIV uptake among children of mothers without a full-time job (OR 6.53 [1.87-22.82]). Most participants' WhatsApp posts were about sharing experience or views (226/434, 52.1%) of which 44.7% (101/226) were categorized as negative, such as their concerns over vaccine safety, side effects and effectiveness. Although participants shared predominantly negative experience or views about SIV at the beginning of the discussion, the moderator was able to encourage the discussion of more positive experience or views and more knowledge and information. Most intervention group participants indicated willingness to receive the same interventions (110/117, 94.0%) and recommend the interventions to other mothers (102/117, 87.2%) in future.

CONCLUSIONS

Online information support can effectively promote mothers' self-efficacy for taking children for SIV but alone it may not sufficient to address maternal concerns over SIV to achieve a positive vaccination decision. However, the active involvement of health professionals in online discussions can shape positive discussions about vaccination. Time pressure on decision making interacts with maternal work status, facilitating vaccination uptake among mothers who may have more free time, but having the opposite effect among busier working mothers.

TRIAL REGISTRATION

Hong Kong University Clinical Trials Registry HKUCTR-2250; https://tinyurl.com/vejv276.

User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis

BACKGROUND

More people are searching for immunization information online and potentially being exposed to misinformation and antivaccination sentiment in content and discussions on social media platforms. As vaccination coverage rates remain suboptimal in several developed countries, and outbreaks of vaccine-preventable diseases become more prevalent, it is important that we build on previous research by analyzing themes in online vaccination discussions, including those that individuals may see without actively searching for information on immunization.

OBJECTIVE

The study aimed to explore the sentiments and themes behind an unsolicited debate on immunization in order to better inform public health interventions countering antivaccination sentiment.

METHODS

We analyzed and quantified 117 user-driven open-ended comments on immunization posted in the Comments section of a Facebook advertisement that targeted Canadian parents for recruitment into a larger study on immunization. Then, 2 raters coded all comments using content analysis.

RESULTS

Of 117 comments, 85 were posted by unique commentators, with most being female (65/85, 77%). The largest proportion of the immunization comments were positive (51/117, 43.6%), followed by negative (41/117, 35.0%), ambiguous (20/117, 17.1%), and hesitant (5/117, 4.3%). Inaccurate knowledge (27/130, 20.8%) and misperceptions of risk (23/130, 17.7%) were most prevalent in the 130 nonpositive comments. Other claims included distrust of pharmaceutical companies or government agencies (18/130, 13.8%), distrust of the health care system or providers (15/130, 11.5%), past negative experiences with vaccination or beliefs (10/130, 7.7%), and attitudes about health and prevention (10/130, 7.7%). Almost 40% (29/74, 39%) of the positive comments communicated the risks of not vaccinating, followed by judgments on the knowledge level of nonvaccinators (13/74, 18%). A total of 10 positive comments (10/74, 14%) specifically refuted the link between autism and vaccination.

CONCLUSIONS

The presence of more than 100 unsolicited user-driven comments on a platform not intended for discussion, nor providing any information on immunization, illustrates the strong sentiments associated with immunization and the arbitrariness of the online platforms used for immunization debates. Health authorities should be more proactive in finding mechanisms to refute misinformation and misperceptions that are propagating uncontested online. Online debates and communications on immunization need to be identified by continuous monitoring in order for health authorities to understand the current themes and trends, and to engage in the discussion.

Studying Cannabis Use Behaviors With Facebook and Web Surveys: Methods and Insights

The rapid and wide-reaching expansion of internet access and digital technologies offers epidemiologists numerous opportunities to study health behaviors. One particularly promising new data collection strategy is the use of Facebook’s advertising platform in conjunction with Web-based surveys. Our research team at the Center for Technology and Behavioral Health has used this quick and cost-efficient method to recruit large samples and address unique scientific questions related to cannabis use. In conducting this research, we have gleaned several insights for using this sampling method effectively and have begun to document the characteristics of the resulting data. We believe this information could be useful to other researchers attempting to study cannabis use or, potentially, other health behaviors. The first aim of this paper is to describe case examples of procedures for using Facebook as a survey sampling method for studying cannabis use. We then present several distinctive features of the data produced using this method. Finally, we discuss the utility of this sampling method for addressing specific types of epidemiological research questions. Overall, we believe that sampling with Facebook advertisements and Web surveys is best conceptualized as a targeted, nonprobability-based method for oversampling cannabis users across the United States.

Science and Politics in the Polio Vaccination Debate on Facebook: A Mixed-Methods Approach to Public Engagement in a Science-Based Dialogue

This study examines the ways in which the public discusses and debates the scientific issue of vaccinations in the online social media environment of Facebook. We apply a mixed-methods approach, where a qualitative analysis is combined with a quantitative analysis of the characteristics of the debate on polio vaccinations in a Facebook group dedicated to parental and professional dialogue. The qualitative analysis suggested that dialogue became more political than scientific overall, yet the quantitative analysis showed that the discussants did not abandon the scientific nature of the issue at hand.

Internet Exposure Associated With Canadian Parents' Perception of Risk on Childhood Immunization: Cross-Sectional Study

BACKGROUND

There is a large presence of provaccination and antivaccination content on the Internet. The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment. No other studies have investigated the association between seeking vaccine information online and Canadian parents' perception of risk on childhood immunization.

OBJECTIVE

We aimed to investigate the potential association between seeking vaccine information on the Internet and Canadian parents' perception of risk on childhood immunization in order to quantify the perceived association and increase our understanding on the impact of the Internet to help guide public health interventions.

METHODS

We analyzed this association in two population samples: a self-selecting Web-based sample of Canadian parents recruited through Facebook (n=966) and a population-based sample of parents recruited by random digit dialing (RDD; n=951). The outcome was parental perception of vaccine safety on a seven-point ordinal scale from "not safe" to "extremely safe." An ordinal regression model was used to investigate if Internet information seeking on childhood vaccination predicted parental perception of vaccine safety.

RESULTS

After adjusting for income level, Internet reliability, age of parent, and region, the odds of perceiving vaccines as less safe rather than more safe were 1.6 times higher (95% CI 1.3-2.1) for parents who used the Internet to search for vaccination information compared to parents who did not search the Internet in the Web-based sample, and 2.0 times higher (95% CI 1.6-2.5) in the population-based RDD sample.

CONCLUSIONS

The results suggest the Internet is significantly associated with Canadian parents' negative perception of vaccine risk. Governmental and scientific sectors should consider the development and implementation of Web-based vaccine interventions to promote confidence in immunization.