Pro-Vaccination Personal Narratives in Response to Online Hesitancy about the HPV Vaccine: The Challenge of Tellability

"...analysis of a Mumsnet thread where indecision about the HPV vaccine is allegedly resolved by a hard-to-tell narrative has highlighted the tellability challenges involved in sharing different types of pro-vaccination narratives about HPV."

Experimental studies have shown that narratives can be effective persuasive tools in addressing vaccine hesitancy, including regarding the vaccine against the human papillomavirus (HPV). This paper presents an analysis of a thread from the online parenting forum Mumsnet Talk where an initially undecided Original Poster is persuaded to vaccinate their child against HPV by a respondent's narrative of cervical cancer that they describe as difficult to share. This paper considers this particular narrative alongside all other narratives that precede the decision announced on the Mumsnet thread. It shows how producing pro-vaccination narratives about HPV involves challenges regarding "tellability": what makes the events in a narrative reportable or worth telling. The researchers suggest that the findings have implications for the context-dependent nature of tellability, the role of parenting forums in vaccination-related discussions, and narrative-based communication about vaccinations more generally.

Evidence cited in the paper indicates that 50%-85% of people in a wide range of countries report turning to the internet for information about health-related issues. Parenting sites such as Mumsnet are well-documented sources of information, support, and discussion about a variety of issues, including health concerns and childhood vaccinations. Founded in 2000, Mumsnet Talk is associated with an open, straight-talking approach to parenting discussions; despite, or perhaps because of the perceived frank and forthright nature of this platform, contributors to particular topics and threads on Mumsnet Talk also form online discourse communities in which it is possible to share otherwise untellable parenting experiences, such as maternal regret.

The thread that is the focus of this article appeared under the largest topics on Mumsnet Talk AIBU (Am I Being Unreasonable?) and dates from July 9 2012, shortly after the Gardasil vaccine was approved for use in the United Kingdom (UK). The author of the Original Post describes themselves as "very pro-vaccination" but reports second thoughts about having consented to their daughter receiving three doses of the "cervical cancer jab" at school due to concerns about the "side effects" of the newly introduced Gardasil vaccine. The writer also points out that they did not receive the vaccine themselves but had "safe sex and smear tests", suggesting that this is an alternative way of keeping oneself safe from HPV infection. This experience leads them to consider withdrawing their consent and to ask for advice on Mumsnet Talk. About 11 hours later on the same day, another contributor ("Taylor") posted a lengthy personal narrative of having developed cancer that includes details that would be untellable in many other contexts. The Original Poster announces the following morning that, in spite of previously "heading towards an anti vax position", they have decided to consent to their daughter's vaccination thanks to the replies on the thread, especially Taylor's.

The paper analyses how this process unfolded, including the notion of tellability as a cline (a continuum), with a context-dependent threshold between events that are too predictable and mundane (or non-tellable) versus those that make good narrative material. The telling of potentially untellable elements of Taylor's narrative is facilitated not only by the anonymity provided by Mumsnet but also by similar elements being included (with less detail and spread across narratives) in preceding posts. These elements collaboratively raise the upper threshold of the tellability cline for this specific thread, creating a space in which Taylor's story can be told, albeit after an explicit negotiation of that upper threshold.

However, at the lower threshold of the cline of tellability, the challenge is caused by the limited tellability of smooth experiences of vaccination. From a public health perspective, vaccination with no or minimal side effects is the outcome that should be experienced by as many people as possible, but, inevitably, that outcome also creates poor storytelling material. The contributors to the Mumsnet thread mostly negotiate this tellability challenge by including additional, more tellable, details, such as difficulties around the decision-making process. This type of approach - in particular, acknowledging how difficult such decisions can be - is one way in which public health bodies and healthcare professionals could make uneventful vaccination stories more engaging and relatable. Moreover, although this paper has shown this challenge in the context of HPV vaccination, it applies to narratives of uneventful vaccine uptake more generally.

The study also highlights the importance of anonymous online communities in collectively raising the upper threshold of tellability, enabling intimate and uncomfortable revelations to be made. Stories involving self-disclosure and transgressive or taboo topics may be told in pursuit of intimacy and be appreciated by receivers because of the courage and openness demonstrated by the teller. The fact that a hard-to-tell narrative is named as the catalyst that changed the Original Poster's mind from indecision to vaccine uptake, along with the other supportive responses it receives, are examples of this phenomenon.

In conclusion: the results "point towards the crucial importance of engagement with vaccine hesitant individuals and communities over longer periods of time (to allow for trust and relationships to develop, and for stories to be told), as well as to the vital role of real lived-experience accounts and peer-to-peer interactions in addressing vaccine hesitant attitudes in ways that are appropriate for different communities at different points in time."