Stories about HPV Vaccine in Social Media, Traditional Media, and Conversations

"[S]tories may be a powerful tool for encouraging - or discouraging - vaccination."

Research has shown that parental declination is one barrier to timely human papillomavirus (HPV) vaccination, with over one-third of United States (US) parents reporting they have ever refused or delayed HPV vaccination for their children. To date, HPV vaccination decision-making research has often focused on the factual information and advice parents receive from healthcare providers and other professional sources. Less is known about how narrative communication - stories from media and social interactions - shape parents' HPV vaccination decisions. Thus, this study sought to characterise parents' exposure to such stories, as well as associations between story exposure and vaccination behaviour. Ultimately, the study seeks to identify opportunities to better align narrative communication, with the goals of raising HPV vaccination coverage and protecting adolescents from future HPV cancers.

From November 2017 to January 2018, the researchers conducted an online, cross-sectional survey of parents of US adolescents who had not yet completed the HPV vaccine series. The 1,263 parents who participated answered questions about whether they had heard stories of people who were harmed by HPV vaccine or who got diseases that the HPV vaccine could have prevented.

Almost half (564/1,263; 45%) of parents had heard HPV vaccine stories, which were about vaccine harms only (19%), vaccine-preventable diseases (VPDs) only (11%), or both (15%). Among the 564 parents exposed to HPV vaccine stories, parents heard stories about HPV VPDs via conversations (33%), traditional media (19%), somewhere else (17%), and social media (11%). They heard stories about HPV vaccine harms via social media (30%), traditional media (29%), conversations (24%), and somewhere else (10%). Conversations were more often a channel for stories about VPDs diseases (p < 0.01). Traditional and social media were more often channels for stories about harms (both p < 0.01). The researchers suggest that future research to assess the interaction between story type and behaviour by communication channel could reveal whether parents are more likely to be influenced by information on certain channels versus others.

Parents who heard only stories about harms were less likely than those who heard no stories to have initiated HPV vaccination (23% vs. 33%, adjusted odds ratio (aOR): 0.48; 95% confidence interval (CI): 0.33:0.69). They were more likely to have delayed (79% vs. 66%, aOR: 2.00; 95% CI: 1.09:3.71) or refused (72% vs. 24%, aOR: 8.87; 95% CI: 4.09:19.25) HPV vaccination. Exposure to both stories about harms and VPDs was similarly associated with initiation, delay, and refusal. Exposure to only stories about VPDs was not associated with initiation, delay, or refusal. Parents who reported hearing stories about HPV vaccine harms only or stories of both harms and VPDs had lower HPV vaccination intentions.

These findings suggest that many parents of US adolescents are exposed to stories about HPV vaccination, and that stories about HPV vaccine harms may be especially powerful. Contrary to the researchers' expectations, there was little evidence to suggest a positive association between hearing stories about HPV VPDs - that is, the preventive benefits of vaccination - and vaccination behaviour. These findings align with research demonstrating that negative information is more influential in shaping perceptions and decisions than positive information.

The researchers indicate that future research should evaluate specific strategies to counter misinformation found in stories of HPV vaccine harms. Alternatively, public health communication campaigns may need more effective strategies for developing narrative content that promotes the preventive benefits of vaccination, particularly in the context of traditional and social media. Finally, healthcare providers have been found to play a highly influential role in parents' vaccination decisions and can be an antidote to vaccine-critical stories, such as stories of HPV vaccine harms.