No Time to Lie: Examining the Identity of Pro-vaccination and Anti-vaccination Supporters through User-generated Content

"The study ultimately aims to support the development of targeted health communication that is better aligned with the personal values of specific group identities in order to improve vaccination literacy."

Critics who have challenged the overarching narratives, power dynamics, and perceived institutional control embedded in pervasive societal norms of modern society have inspired the formation of various social movements, including the anti-vaccine movement. Anti-vaccination arguments have been intertwined with broader considerations of social change, with skepticism among anti-vaccination supporters signifying the eroded credibility of universal truth of postmodernistic society. A significant portion of health-related debates unfold within the online realm, where the primary source of information for users is not always specialised authorities but also other users through user-generated health content (UGHC). This study examines the role of UGHC in vaccine uptake by delving into the social identity of pro-vaccination and anti-vaccination supporters. The objective is to generate insights into how personal values drive the formation of identity in the case of pro- or anti-vaccination supporters.

The paper opens with a review of existing literature on UGHC and on the group identity of pro- and anti-vax groups. This section explains how the study applies the theory of basic human values (Schwartz, 1992), which argues that a handful of personal values underpin attitudes and behaviour, to the health-related domain. Specifically, Schwartz identifies 10 basic values, which are incorporated in higher-order domains of conservation (conformity, tradition, security) vs. openness to change (hedonism, stimulation, self-direction) and self-transcendence (universalism, benevolence) vs. self-enhancement (power and achievement). As values are predictors of threat perception, including health threats, the paper argues that personal values shape one's social identity in the sphere of health. Identity is described as any category label that a person associates with, and it provides a clear picture of how a person within the category label looks, thinks, feels, and acts. Every category label can become an identity (for instance, a pro-vaccine or anti-vaccine identity) as soon as the individual integrates it into their own personality.

For the study, the researchers constructed a textual dataset based on 142,596 tweets. The database included tweets posted in the United Kingdom between January 1 2021 and July 31 2021. The data were analysed in three steps. First, the linguistic characteristics of the textual data, together with the underlying personal values of the text creators, were identified using Linguistic Inquiry and Word Count (LIWC) software. Second, the identified personal values were used as an input for the moderation analysis, which examined the relationship between personal values and social identity for pro- and anti-vaccination groups. Finally, an automated, in-depth text analysis was conducted in Mathematica to understand the narratives created by both groups.

The pattern of results emerging from the regression analysis demonstrates that anti-vaccination and pro-vaccination supporters have a clear difference in their personal values. The results suggest that individuals who value novelty and change tend to have a stronger identity. However, this relationship is weakened for those in the anti-vax group, indicating that their anti-vax beliefs may be conditioning the effect of openness on identity. The positive relationship between self-transcendence (empathy and concern for others) and identity suggests that individuals who value empathy and care for others tend to have a stronger sense of self. This relationship is weakened for those in the anti-vax group, indicating that their anti-vax beliefs may interfere with their concern for others.

Examining the two opposing narratives that emerged from the tweets, the findings suggest that the members of these two groups have their own social identity characteristics that place them into two separate subcultures. While the group of vaccination supporters is guided by warm feelings such as gratitude, happiness, and hope, individuals belonging to the anti-vaccination group express negative sentiments and are driven by fear. Moreover, these two groups have opposing motivations. The behavioural intentions of the pro-vaccination group are driven by the need to control the spread of a virus, the benefits of vaccines, fear of the risk of infection, and acceptance of limited vaccination side effects. At the same time, behaviours within the anti-vaccination group are motivated by fear of the side effects and risks of the vaccine. Finally, the UGHC that anti-vax supporters created was centred so-called alternative lifestyle(s) that encompass(es) a set of norms and practices that are seen as better or more correct than those associated with mainstream medicine and science.

From a stakeholder's perspective, these findings mean that policymakers, public communicators, pharmaceutical companies, non-profit organidations, and all those involved in health-related communication need to strategically approach and create specific communication campaigns for two distinct groups: pro-vaccination and anti-vaccination supporters. For example, despite the concept of freedom being relevant to both groups, communication campaigns seeking to reach the  anti-vax group should aim to limit their fear of losing personal freedom while emphasising the real risk of death from the health treat (e.g. virus, future disease, etc.).

Indeed, seeking to reach the anti-vaccination group as an independent audience is also crucial; otherwise, there is a risk that the anti-vaccination group will create non-peer-reviewed UGHC content on their own, which is often based on misinformation. Suggestions for reaching the anti-vaccination group include:
 

• Because the findings support a community-centred approach, policymakers should trace the roots of the anti-vaccination group and map relevant communities aligned with this group.
• Once these roots are identified, policymakers should craft a message that addresses anti-vax group members' concerns and embed that message in the community in order to engage in open debate and provide a space for questions.
• This message should also be promoted outside the anti-vax community to provide an early warning about new misinformation being circulated by anti-vaccination community members to circumvent this misinformation from influencing the general public's opinion about vaccines.
• Policymakers should identify vaccination advocates and train them to address common questions raised by vaccination opponents, as direct community engagement has been shown to have success in influencing people attitudes towards vaccines.

At the same time, to reach the pro-vaccination group, public health communicators and pharmaceutical companies should actively seek to brand themselves as experts worth following or as sources of reliable and updated health information on social media like Twitter. Their communication should be focused on hope rather than fear. Pro-vax supporters also require a communication campaign based on prompt information provided in a simple (i.e., not overly technical) language through well-thought-out communication.

In conclusion: "Understanding how users create health-related content based on their personal values is crucial. Acknowledging and appreciating the diverse personal values and identities within different groups in the vaccination discourse can inform health communication efforts, aligning these efforts with the specific values of each group. This targeted communication is vital for effectively conveying relevant peer-reviewed health information amid the abundance of health-related user-generated content."