Comparing human papillomavirus vaccine concerns on Twitter: a cross-sectional study of users in Australia, Canada and the UK

Abstract

ObjectiveOpposition to human papillomavirus (HPV) vaccination is common on social media and has the potential to impact vaccine coverage. This study aims to conduct an international comparison of the proportions of tweets about HPV vaccines that express concerns, the types of concerns expressed and the social connections among users posting about HPV vaccines in Australia, Canada and the UK.DesignUsing a cross-sectional design, an international comparison of English language tweets about HPV vaccines and social connections among Twitter users posting about HPV vaccines between January 2014 and April 2016 was conducted. The Health Belief Model, one of the most widely used theories in health psychology, was used as the basis for coding the types of HPV vaccine concerns expressed on Twitter.SettingThe content of tweets and the social connections between users who posted tweets about HPV vaccines from Australia, Canada and the UK.Population16 789 Twitter users who posted 43 852 tweets about HPV vaccines.Main outcome measuresThe proportions of tweets expressing concern, the type of concern expressed and the proportions of local and international social connections between users.ResultsTweets expressing concerns about HPV vaccines made up 14.9% of tweets in Canada, 19.4% in Australia and 22.6% in the UK. The types of concerns expressed were similar across the three countries, with concerns related to ‘perceived barriers’ being the most common. Users expressing concerns about HPV vaccines in each of the three countries had a relatively high proportion of international followers also expressing concerns.ConclusionsThe proportions and types of HPV vaccine concerns expressed on Twitter were similar across the three countries. Twitter users who mostly expressed concerns about HPV vaccines were better connected to international users who shared their concerns compared with users who did not express concerns about HPV vaccines.

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons

“…4,11,16 Other social influences, including by a partner, family, friends, or online social network, can also influence parents' decision. 13,[16][17][18] It is likely that these factors have varying impact on parents depending on where they are in the decision-making process, which is obscured in much previous research investigating vaccination as a binary outcome (vaccinated or not). Literature on vaccine hesitancy highlights many reasons a parent may delay or refuse vaccination for their child.…”

HPV vaccine coverage in Australia and associations with HPV vaccine information exposure among Australian Twitter users

“…In a comparison between the United Kingdom, Canada, and Australia, Twitter users who were critical of HPV vaccines were found to be better connected across countries compared to users who posted other HPV vaccine information. 32 The attention of Twitter users in the United States was more likely to be consumed by North American stories presented in the mass media. 34 While these media-based controversies were not as dominant in the information diets of Australian Twitter users, news media appears to play a key role in shaping what people may have seen.…”

“…33 Topic modelling is applied by specifying in advance the number of topics that should be used to represent the set of documents but does not require the pre-specification of the nature of the topics, as would be typical of a supervised machine learning approach aiming to label tweets according to a predefined set of themes, such as Health Belief Model constructs. 32 We selected 30 topics based on a previous analysis of the clustering of topics within online communities, where we found that 30 exhibited the strongest levels of topic clustering. 33 Because topics are not specified in advance and topic modelling is not a supervised machine learning method, there is no way to objectively measure whether the topics represented within a tweet are consistent with the topics represented in other tweets assigned to the same cluster.…”

“…In our previous work on the representation of HPV vaccines on Twitter, we found that the opinions Twitter users express can be robustly predicted from who they follow; 30 that prior exposure to negative information about HPV vaccines is associated with later expression of negative opinions; 31 and that vaccine-critical Twitter users in Canada, the United Kingdom, and Australia tend to be better connected than vaccine-positive users. 32 In these studies, vaccine-critical tweets were identified using a supervised machine learning method that takes a manually-labelled sample and learns how best to classify subsequent tweets. In what follows, vaccinecritical is defined as being the expression of negative or opposing views about HPV vaccination.…”

Discordance Between Human Papillomavirus Twitter Images and Disparities in Human Papillomavirus Risk and Disease in the United States: Mixed-Methods Analysis

“…Twitter has been used extensively to study vaccine narratives, including those related to HPV, measles, and influenza [ 19 - 22 ]. Given Twitter’s user base of over 500 million and publicly available posts on HPV, it is a strategic site for health communicators to track HPV sentiment and target HPV vaccine messaging [ 23 - 25 ]. Massey et al examined tweet sentiment and content for 193,379 tweets from August 1, 2014 to July 31, 2015; positive tweets were more likely to mention prevention, whereas negative tweets increased the focus on side effects [ 20 ].…”