Social Media Initiative in Ukraine: Analysis of Online Conversations on Polio, Vaccination, and Routine Immunization

Editor's note: The Communication Initiative (The CI) is tasked with supporting country-focused reviews of polio communication, with extensive and growing reference to the relationship with routine immunisation. Those reviews take many different forms, depending on the nature of the challenges being faced and the health context in each country. Several dynamics within Ukraine, which experienced a polio outbreak in September 2015, led The CI to focus on social networks and social media for this review. For instance, in this country, the main spaces of public conversations on the key development issues, including child health, are through social media platforms. Social media can bypass the normal filters for health information, which in this case is the all-too-common misinformation provided by the medical community. What follows is a synopsis, largely gleaned from the Executive Summary, of the analytical paper that emerged from this country review process.

With the rise of online social media in the past few years, there is a great interest in the influence of such networks on health behaviours - in particular, child immunisation and vaccination. Prior to the research reported in this paper, attempts to understand the role of social media in child immunisation and vaccination processes were based on quantitative approaches, such as collecting online messages that directly mentioned polio and vaccination or analysing users' interactions in a particular social media space. This study used a unique experimental approach of social media mapping to discover platforms where communities of parents, health and education professionals, and other civil society actors gather naturally.

Specifically, this study examined how different communities in Ukraine use social media to communicate and search for information by applying a qualitative approach based on manual search and monitoring of popular and thematic social media spaces on Facebook and Vkontakte networks. Analysis of active discussions and information shared within pages revealed the level of communities' engagement and intentions to initiate and respond to vaccination-related conversations. Moreover, the study examined trending topics on routine immunisation during October-November 2016, drawing conclusions about possible implications of circulated online pro- and anti-vaccination content for parents' vaccination decision making. This monitoring timeframe coincided with the renewal of a mass child immunisation campaign after a temporary shortage of vaccines that greatly influenced the dynamic of social media conversations.

The findings illustrate the essential difference between usage of Facebook and Vkontakte networks by different communities. Professional communities, such as doctors and teachers, gather on Facebook to communicate about profession-related issues, while on the Vkontakte network, the audience is divided by personal interests, which includes immunising children. The majority of parents gather to discuss various topics about upbringing and child health in specifically organised groups on Vkontakte. While the most active discussions occurred in these groups on Vkontakte, with limited presence of professionals, this study illustrates the visible communication gap between professionals and the more general audience, who use different communication platforms, in this case, being active on different social media networks.

Monitoring of city groups demonstrates a similar tendency in audience preferences to communicate about personal experiences through the Vkontakte network. Groups unite residents of particular cities with variable numbers of followers but with the same level of active communication within spaces. This city group phenomenon demonstrates communities' interest in receiving very specific localised information related to their living environment.

According to data collected, engagement in vaccination-related conversations and initial positive or negative viewpoints varies in different communities. For example, topics of vaccination and child immunisation are not among teachers' and educators' priorities, while the majority of pages for medical workers contain positive articles about vaccines and child immunisation from social media channels of the Ministry of Health in Ukraine (MOH) or the United Nations Children’s Fund (UNICEF) in Ukraine. City public pages and groups play the important role of informing parents about delivery of vaccines to local hospitals. At the same time, parents' groups on Vkontakte network represent unique examples of social media spaces that unite a significant audience of mothers willing to share their vaccination-related experiences and listen to advice from their counterparts. This knowledge is essential for identifying the intended group to be reached by a communication strategy and mechanisms of possible intervention.

The quality of information disseminated on social media networks is affected by the fact that official institutions, as well as international and national organisations, maintain their accounts on Facebook but have turned away from using Vkontakte for political and ethical reasons. This absence of official sources to disseminate credible information about child immunisation along with the inability to address parents' concerns on social media foster the cultivation of misinformation and common myths about vaccines. The number of social media spaces that promote anti-vaccination views are more influential and substantive on the Vkontakte network, especially those spaces registered in Russia but easily accessible to the Ukrainian audience. Communities with negative opinions appeared to be more vocal on social media. Also, vaccination is a topic that can generate a high level of emotional involvement. Therefore, parents tend to communicate in dramatic ways experiences such as minor side effects after vaccination, considering them to be abnormal and dangerous to children's health and rarely correlating them with conditions of vaccine-preventable diseases.

Results of this analysis suggest several mechanisms to increase active and accurate communication about vaccines and immunisation across both Facebook and Vkontakte and the spaces and processes within each. The recommendations below can be considered experimental and utilise different tactics and approaches. They can be applied in addition and complementary to those already implemented by communication specialists. In brief:

• Increase the presence of credible facts and information within social media networks, especially on the Vkontakte network, in the form of compelling visuals and infographics.
• Create/support a resource on the Vkontakte network with the word "vaccination (прививка)" in the headline.
• Intervene into social media spaces of professionals (health care workers, teachers, etc.) with credible information about polio, vaccination, and child immunisation.
• Create a coordinated communication platform for experts with active social media profiles.
• Reach parents' groups and ensure expert engagement in discussions to address public questions and concerns.
• Monitor the dynamics and influence of anti-vaccination advocates on social media.
• Meet audience demand for localised and practical information related to their living environment.
• Plan effective communication on social media in advance of mass delivery of certain vaccines.
• Ensure that the government and immunisation partners have an emergency response plan in place should a communication-related issue emerge, such as widespread reporting of adverse events following immunisation (AEFIs) or questionable vaccine quality. There needs to be a strong social media component to that plan.
• Continue comprehensive monitoring of social media networks and online conversations.

"Overall, the recorded low quality of information on the Vkontakte network can be increased by constant sharing of reliable materials and the foundation of a new information source on this network. There is an urgent need for that type of action to counter easily circulated misinformation and build a strong image of vaccination in order to increase and maintain child immunization rates in Ukraine."

Click here for the 25-page paper in PDF format.
Click here for a 38-slide presentation of the paper in PDF format.