Supporting informed decision-making about vaccination: an analysis of two official websites

doi:10.1016/j.puhe.2019.09.007

Public Health

Volume 178, January 2020, Pages 112-119

https://doi.org/10.1016/j.puhe.2019.09.007 Get rights and content

Highlights

•
Internet is increasingly used for health information, including vaccination.
•
Online vaccine misinformation is often blamed for the increase in vaccine hesitancy.
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Vaccine-hesitant parents are looking for ‘balanced’ information on vaccines.
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Public health websites may not address the needs of vaccine-hesitant parents.

Abstract

Objective

To analyze the content of two official French-speaking websites that are used to inform the general public about recommended vaccines in France and Quebec.

Study design

Qualitative content analysis.

Methods

All pages that inform and educate parents regarding childhood vaccination were downloaded and analyzed according to evidence-informed risk communication metrics.

Results

A total of 32 webpages, 14 videos, and two infographics were included in the analysis. The following were the most frequent risk communication approaches: ‘debunking common misconceptions about vaccination’ or ‘answering common questions about vaccines.’ Harm and benefit information focused primarily on the risks of vaccine-preventable diseases and the risks of adverse events after immunization. Most materials used qualitative terminology to describe the risk (e.g., vaccines are among the safest tools, adverse events are rare). Very few materials provided numeric likelihood of harms and benefits. When numeric information was stated, they were only presenting the risks of the diseases or number of cases in an outbreak. The approaches used to debunk misconceptions generally focused on the myth itself rather than the correct information. Few materials used visual aids (e.g., graphics, pictures, icons arrays, etc.) to convey important information.

Conclusions

It is often assumed that misinformation and rumors about vaccination found online is a leading cause of the increase in vaccine hesitancy. Existing communication materials could be improved to better align with best practices in risk communication. Given the availability of confusing and conflicting vaccine narratives, it is crucial that authoritative communication materials aim to build trust and support informed choices about vaccination.

Introduction

Vaccine hesitancy, defined as the reluctance to receive recommended vaccinations despite the availability of vaccination services,¹ is a significant threat to the success of vaccination programs² (World Health Organization [WHO] statement). It is often assumed that misinformation and rumors about vaccination found online is a leading cause of the increase in vaccine hesitancy.3, 4, 5 Internet has become an essential source of information for parents, and several quantitative studies showed that undertaking a detailed research on vaccination, using Internet and other sources of information, was strongly associated with intending not to vaccinate the child.6, 7, 8, 9 Qualitative studies also showed that most vaccine-hesitant parents highly valued the importance of being informed about vaccination before making a decision as well as their capacities to search and assess the information available online.¹⁰^,¹¹

The studies that have examined vaccination-related content on websites or social media platforms have shown that the quality of information is highly variable, with a substantial volume of anti-vaccine and inaccurate information.12, 13, 14, 15, 16, 17, 18 As of today, most researches focused on the analysis of vaccine critical websites or arguments and tactics used against vaccination.¹³^,¹⁶^,¹⁹ Very little attention has been paid to the content and approaches used by health authorities to promote vaccination online.¹⁹^,²⁰

Public health professionals and front-line vaccine providers should rely on effective communication to inform parents about vaccine recommendations. More information alone is unlikely to dramatically change vaccine acceptance.²¹^,²² But the communication of information is one of the primary tools at the disposal of public health professionals. Being informed about which vaccines are needed, for whom and when is the basis of the vaccination decision-making process. Given the amount of financial and human resources invested in developing and diffusing communication materials about vaccination, it is critical to understand how to optimize these tools to ensure that they work (or can be used) as intended. In this context, the purpose of this study was to evaluate the content of webpages on childhood vaccination of two official websites dedicated to vaccine promotion, in Québec and France, respectively.

Section snippets

Data collection: the Quebec and France websites

Two websites developed in Quebec and France by public health institutions to inform health professionals,^c the parents, and the general public about vaccination were selected: Vaccination info-service (http://www.vaccination-info-service.fr/—France) and pages on vaccination on Québec.ca (https://www.quebec.ca/—Canada).

Results

In total, 32 webpages (27 from the French website and five from the Quebec website), 14 videos (six from the French website and eight from the Quebec website), and two infographics (both from the French website) were downloaded (Table 1). The webpages presenting general information on childhood vaccination were included, and webpages on specific vaccine and vaccination schedule were excluded from the analysis (Table 2).

Discussion

Success of public health policies interventions are closely related to social environment as well as health education that should be based on accurate information. The increasing use of Internet and social media as a source of health information, combined with the decreasing rates of vaccination have prompted the calls for the development of online communication strategies to address the needs and interests of vaccine-hesitant parents.¹⁶ Our analysis of two authoritative websites on vaccination

Ethical approval

Not required.

Funding

This work was supported by the Canadian Immunization Research Network.

Competing interest

None.

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Cited by (16)

A systematic review of communication interventions for countering vaccine misinformation
2023, Vaccine
Misinformation and disinformation around vaccines has grown in recent years, exacerbated during the Covid-19 pandemic. Effective strategies for countering vaccine misinformation and disinformation are crucial for tackling vaccine hesitancy. We conducted a systematic review to identify and describe communications-based strategies used to prevent and ameliorate the effect of mis- and dis-information on people’s attitudes and behaviours surrounding vaccination (objective 1) and examined their effectiveness (objective 2).
We searched CINAHL, Web of Science, Scopus, MEDLINE, Embase, PsycInfo and MedRxiv in March 2021. The search strategy was built around three themes(1) communications and media; (2) misinformation; and (3) vaccines. For trials addressing objective 2, risk of bias was assessed using the Cochrane risk of bias in randomized trials tool (RoB2).
Of 2000 identified records, 34 eligible studies addressed objective 1, 29 of which also addressed objective 2 (25 RCTs and 4 before-and-after studies). Nine ‘intervention approaches’ were identified; most focused on content of the intervention or message (debunking/correctional, informational, use of disease images or other ‘scare tactics’, use of humour, message intensity, inclusion of misinformation warnings, and communicating weight of evidence), while two focused on delivery of the intervention or message (timing and source). Some strategies, such as scare tactics, appear to be ineffective and may increase misinformation endorsement. Communicating with certainty, rather than acknowledging uncertainty around vaccine efficacy or risks, was also found to backfire. Promising approaches include communicating the weight-of-evidence and scientific consensus around vaccines and related myths, using humour and incorporating warnings about encountering misinformation. Trying to debunk misinformation, informational approaches, and communicating uncertainty had mixed results.
This review identifies some promising communication strategies for addressing vaccine misinformation. Interventions should be further evaluated by measuring effects on vaccine uptake, rather than distal outcomes such as knowledge and attitudes, in quasi-experimental and real-life contexts.
A coordinated strategy to develop and distribute infographics addressing COVID-19 vaccine hesitancy and misinformation
2022, Journal of the American Pharmacists Association
Citation Excerpt :
In this survey study, infographics or humorous graphics were slightly preferred to photos of patients or the disease itself.18 Still, few materials use visual aids to convey important information about vaccines.19 Health care workers consistently rank high in the Gallup poll of most trusted professionals and saw a boost in these ratings in 2020.20
Visual communication strategies are becoming increasingly prevalent for conveying information to health professionals as well as to the general public. The potential of social media for rapid knowledge dissemination using infographics was recognized early in the coronavirus disease (COVID-19) pandemic by health professionals.
The purpose of this study was to describe a coalition of health professionals’ approach to developing infographics about COVID-19 vaccines and the reach and engagement of those infographics when shared through social media.
Infographics were created by a core team within the coalition following a stepwise approach. Each underwent a multistep review process, readability evaluation, and translation into Spanish. Infographics were then shared through multiple social media platforms. They were grouped into 1 of 3 categories for this analysis: COVID-19 vaccine series, myth debunkers, or other.
All infographics had greater outreach, impressions, and engagement on Twitter than they did on other platforms. When comparing the 3 groups, no 1 infographic type was consistently performing higher than the others.
Each infographic reached thousands to tens of thousands of people. We do not know whether those who viewed these infographics changed their perspective on vaccination, so we are unable to draw a conclusion about their impact on vaccine hesitancy based on this study alone.
COVID-19 vaccine safety questions and answers for healthcare providers (CONSIDER)
2021, Vaccine
Just-in-Time, but Still Planned: Lessons Learned From Speeding up the Development and Implementation of an Intervention to Promote COVID-19 Vaccination in University Students
2023, Health Promotion Practice
Optimisation of risk and crisis communication of governments, authorities and public health institutions—challenges in long-lasting crises illustrated by the COVID-19 pandemic
2023, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
Exploring parents’ views of the use of narratives to promote childhood vaccination online
2023, PLoS ONE

View all citing articles on Scopus

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Original ResearchSupporting informed decision-making about vaccination: an analysis of two official websites

Highlights

Abstract

Objective

Study design

Methods

Results

Conclusions

Introduction

Section snippets

Data collection: the Quebec and France websites

Results

Discussion

Ethical approval

Funding

Competing interest

Vaccine

Vaccine

Lancet Infect Dis

Vaccine

Ebiomedicine

Vaccine

Soc Sci Med

Ten threats to global health in 2019

The influence of vaccine-critical websites on perceiving vaccination risks

J Health Psychhol

What makes anti-vaccine websites persuasive? A content analysis of techniques used by anti-vaccine websites to engender anti-vaccine sentiment

J Commun Healthc

Source credibility and the biasing effect of narrative information on the perception of vaccination risks

J Health Commun

The impact of social networks on parents' vaccination decisions

Pediatrics

Determinants of parents' decision to vaccinate their children against rotavirus: results of a longitudinal study

Health Educ Res

A postpartum vaccination promotion intervention using motivational interviewing techniques improves short-term vaccine coverage: PromoVac study

BMC Public Health

Parental vaccine concerns, information source, and choice of alternative immunization schedules

Hum Vaccines Immunother

Vaccine rejecting parents' engagement with expert systems that inform vaccination programs

J bioeth Inq

Understanding the perceived logic of care by vaccine-hesitant and vaccine-refusing parents: a qualitative study in Australia

PLoS One

Antivaccination activists on the World wide web

Arch Dis Child

Googling children's health: reliability of medical advice on the internet

Arch Dis Child

Content and design attributes of antivaccination web sites

J Am Med Assoc

Vaccine criticism on the World wide web

J Med Internet Res

Original Research
Supporting informed decision-making about vaccination: an analysis of two official websites