Caught in the Crossfire: How Contradictory Information and Norms on Social Media Influence Young Women's Intentions to Receive HPV Vaccination in the United States and China

"HPV communication interventions may...consider mobilizing those who have received the vaccine to share their experiences and express their endorsement so that pro-vaccination norms can be established on social media."

Social media users can be exposed to a large volume of contradictory messages related to various health topics, including human papillomavirus (HPV). Studies show that exposure to social media messages can shape young female social media users' understanding of and attitudes toward HPV vaccines and their vaccination decisions. Furthermore, exposure to social media messages helps create normative perceptions of a particular behaviour. This study uses online survey data from the United States (US) and China to examine how contradictory information and social norms regarding HPV vaccines obtained through social media are related to the attitudes and intentions of women aged 18 to 25 years surrounding HPV vaccination.

A literature review of key concepts notes the roles of:

• Uncertainty, which emerges from ambiguous information. Social media sites are rife with myths and anecdotes about the HPV vaccine, including accounts of severe side effects; such misinformation can contradict scientific findings and lead to confusion.
• Normative social influences, which may occur when people make inferences about their peers' thoughts and behaviours based, for example, on their social media activities. The theory of planned behaviour (TPB) emphasises the effects of subjective norms on attitudes, which lead to behavioural intentions and behaviours. In the context of this study:
  • Injunctive norms on social media refer to a person's perceptions of approval of HPV vaccination among those with whom he or she interacts on social media.
  • Descriptive norms on social media refer to a person's perceptions of the prevalence of HPV vaccine uptake among those with whom he or she interacts on social media.
• Cultural dimension theory, which helps clarify that China is more collectivistic and has a higher tolerance for uncertainty than the US. It has been found that norms are less related to behavioural intentions in more individualistic cultures. Thus, in collectivistic cultures, social norms on social media, like those in real life, might exert more influence on people.

The researchers conducted cross-sectional online surveys of 133 US and 254 Chinese young women. Central findings:

• According to the descriptive statistics, the Chinese participants have more favourable attitudes toward and stronger intentions to receive the HPV vaccine, and they report higher levels of exposure to contradictory information, descriptive norms, and injunctive norms regarding HPV vaccination than their US counterparts. These findings might be explained by the relative newness of HPV vaccination in China.
• The survey found that exposure to contradictory information on social media had a greater negative association with intentions to receive HPV vaccination among the US participants than among the Chinese participants, while social norms supporting HPV vaccines had a stronger positive association with intentions to receive HPV vaccination among the Chinese participants than among the US participants. These findings highlight the effects of collectivistic cultures, which place greater pressures on individuals to identify with in-groups than individualistic cultures. That is, in China, people may be more sensitive to fellow social media users' approval or disapproval of HPV vaccination to avoid feeling alienated from the social media groups or communities to which they belong.
• The study also shows some similarities between the two cultural groups. For instance, the participants' attitudes are similarly associated with perceived contradictions in HPV vaccination-related messages. Furthermore, descriptive norms are related to behavioural intentions but not to attitudes: Upon seeing that other social media users have received the HPV vaccine, both the Chinese and American respondents were more inclined to do be vaccinated, and attitudes did not mediate this relationship in either group.

Among the practical implications:

• Given the prevalence of social media use among the younger generation, health communication practitioners in both countries may consider motivating those who have received an HPV vaccination to share their experiences on social media to influence those who have not.
• In the US, health institutions and social media platforms may work closely to identify how contradictory information about HPV vaccines is presented on social media and then make efforts to address confusion caused by such information by providing clear and easily understandable HPV information.
• Chinese practitioners may consider encouraging people who have received the HPV vaccine to not only share their experience but also express approval of the vaccine, while this might not be necessary in the US.

In conclusion: "cultural differences such as those identified in this study require practitioners to adopt culturally sensitive approaches when designing health campaigns for social media."