Online media use and COVID-19 vaccination in real-world personal networks

Abstract

Background: Most studies assessing the impact of online and social media usage on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fails to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research employing social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle, which combines online and offline interactions, affects vaccine acceptance. Objective: We examined how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European Union (EU) member state. Methods: We conducted 83 face-to-face interviews with participants from a living lab in Leresti, a small rural community in Romania, employing a Personal Network Analysis (PNA) framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as social alters). After excluding cases with missing data, our analysis proceeded with 61 complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we utilized a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the ego's preferred source of health and prevention information. This variable was categorized into three types: traditional media, online media (including social media), and a combination of both, with traditional media serving as the reference category. Results: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination odds (OR 0.75, 95% CI 0.32-1.78; P=.52). Additionally, our analysis reveals that alters in personal networks with vaccinated egos are more likely to be vaccinated themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Conclusion: Real-world networks combine offline and online human interactions with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes.