Exploring Social Media Influences on Vaccine Decision-making in Parents: A Netnography

"With the increasing use of social media as a health information source, it is vital that healthcare providers are aware of this as well as the ease of gathering misinformation online..."

A major factor associated with vaccine hesitancy is thought to be the viral spread of misinformation by a small but active anti-vaccination movement. This movement relies heavily on the internet and social media to influence the decision-making of parents. This study explored the impact of Facebook interactions on the vaccine decision-making of parents, asking, "What social media factors have the capacity to influence vaccine decision-making and promote vaccine hesitancy?"

The study used a purpose-designed Facebook page as the means of exploring a purpose-designed online community with a particular focus on the culture, belief systems, and influences present. Paid promotional posts were placed on this page. The research-specific Facebook page was opened to vaccine-hesitant parents or caregivers and pregnant women aged between 18 and 50 years in January 2021. During 1 month of data collection, the page received 2,556 posts, and 1,332 people engaged with the page between August 3 and 30 2021. While all paid posts ceased at this time, the page continued to receive views, likes, and comments until it was closed in December 2021. Participants in this study were from predominantly within Australia, with a small number of international participants contributing to discussions. 

The study employed netnography, a form of qualitative inquiry that takes a less obtrusive and more naturalistic approach than ethnography. It includes not only the written word but also the connections, communication styles, and graphics. It has a strong focus on the meaning behind posts and tweets and includes an analysis of graphics and memes [a meme is an image, video, or piece of text, typically humorous in nature]. Both manual and computer-assisted thematic analyses were used to analyse the data obtained.

Three key themes were identified in this study and included the following:

1. Vaccine safety concerns: Discussion threads included commentary about the "toxic and poisonous" nature of many vaccines and emotive terms such as "toxic vaccines" and the intentional inclusion of neurotoxins in vaccines. The importance of "doing no harm" was also raised on several occasions, as was the use of dramatic and often inaccurate memes. One particularly emotional post referred to the stress placed upon a parent when deciding whether to immunise a second child after a previous severe reaction. While some participants were concerned about the safety of vaccines, others were of the belief that vaccines were unnecessary. One conversation thread used a conspiracy theory to discredit the importance of immunisation.
2. The emotional debate: Two sub-themes were identified in the emotional debate:
   • Fear, anxiety, aggression - Posts compared the health of vaccinated and unvaccinated people. Some participants used generalisations and assumptions to humiliate, alienate, and ostracise vaccine-hesitant participants and to garner the support of other pro-vaccine participants. From observation, it became evident that social norms were ignored in the online environment, with no apparent rules of etiquette or consideration of social mores, which resulted in administrator post moderation on several occasions.
   • Pro-vaccination commentary - Comments from the pro-vaccine majority were also highly emotive, with some using memes to explain the effect of immunisation over the last 200 years (see meme above). Others used their experiences in the healthcare industry to describe the side effects of vaccine-preventable diseases acquired in pregnancy.
3. COVID-19-vaccine-specific issues - Despite the Facebook page having a clear focus on pregnancy and parenting research, the focus of some conversations on COVID-19-specific issues was not unexpected, given the presence of the COVID-19 pandemic during the study and the effect it was having on the lives of everyone living through it. This theme included three sub-themes: Big Pharma, COVID-19 commentary, and mandated vaccination.

In short, the results indicated the presence of strong anti-vaccination sentiment combined with an infodemic of conspiracy theories, misinformation, and vitriol, with the potential to negatively impact parents seeking immunisation information. While there is currently no empirical link between social media participation and vaccine decision-making, the data obtained in this study demonstrate the degree of misinformation users are exposed to - even on a research-created social networking site (SNS).

According to the researchers, the findings have the potential to inform public policy through the demonstrated need for enhanced healthcare provider education and strategies to better communicate with vaccine-hesitant parents. Literature suggests that the internet and social media are information sources used in parallel to healthcare provider advice and do not necessarily replace professional advice. However, healthcare professionals must be aware of the need to provide accurate immunisation information, particularly when information seeking is at its peak: in early pregnancy and the first week of parenthood. Research has demonstrated that parents who acquire information from healthcare professionals are substantially less likely to refuse or delay immunisation. The present study highlights the need for a timely approach to communicating with vaccine-hesitant parents by educated and informed healthcare professionals who can provide accurate information, knowing that misinformation is readily accessible on social media. 

Reflecting on the methodology used in this study, the researchers describe significant advantages to the use of netnography. SNSs provide the opportunity for information seeking and sharing as well as an opportunity to participate or simply observe. This methodology provided a platform for parents with both pro- and anti-vaccination sentiments to share and seek information in an environment that was familiar and safe, thereby producing data from differing perspectives. This research has also demonstrated that it is possible to capture information from vaccine-hesitant parents in an online environment. A further advantage of this methodology is that data can be collected from a broad geographical area. "This study has improved the awareness of the potential influence of social media on vaccine decision-making whilst using a naturalistic approach."

In conclusion: "This study has shown that there is a need for timely and sensitive provision of immunization information in pregnancy and early parenting to limit the need for online information searching....By understanding the ease of access to misinformation, its effect on decision-making and being motivated to respond in an appropriate manner, healthcare providers will be better placed to respond to the information-seeking needs of parents and pregnant women in a timely manner."