Social Media and Vaccination Narrative Communication
Social Media and Vaccination Narrative Communication
This paper examines current research regarding vaccination narratives on social media platforms such as Facebook, Twitter and YouTube.
Table of Contents Introduction ......................................................................................................................................... 3 Rise of the Web 2.0 and the Personal Narrative ........................................................................... 4 Vaccination and Social Media Research ........................................................................................ 5 Facebook .......................................................................................................................................... 6 Twitter ............................................................................................................................................... 7 YouTube ........................................................................................................................................... 7 Discussion and Recommendations ................................................................................................ 8 References ........................................................................................................................................... 9
Jessica Lucas May 2015
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Introduction In late 2014, Disneyland in California became an epicenter for a major measles outbreak. Though not the first, this high profile story caught the attention of the media and the resulting coverage brought vaccination hesitancy into focus, blaming low vaccination rates for the outbreak (Halsey & Salmon, 2015). Fueled by stories and narratives linking vaccines to autism, many parents have refused or delayed vaccinating their children and these new low vaccination rates have led to a deficiency in herd immunity1, causing outbreaks of diseases we have not seen in decades. (Mnookin, 2011). Other vaccines, such as HPV and influenza, also suffer from misinformation and a skewed perception of risk. This is, at the core, a communication problem. We have the medical technology to prevent these diseases. We don’t have effective tools to counteract public mistrust of this technology.
Research indicates the importance of personal narratives, both positive and negative, on vaccination intent and the influence of exemplars on an individual’s decision making process DeWitt et al., 2008; Betsch et al., 2011; Nan, 2015). It is not entirely clear exactly how narratives effect health decisions (Winterbottom et al., 2008) and research indicates that emotional narratives do make some difference in vaccination decision-making (Betsch, et al., 2011; Nan, 2015). There is, however, room for debate (Nyhan et al., 2014). The role of narratives and the effects on vaccination intent are important for health communicators understand.
The focus for research on vaccination narratives, I argue, should be social media. Social media, by its very nature, stokes the creation of personal narratives. Therefore social media provides both a snapshot of current public opinion and a source for further research. This study will examine current research on social media and vaccination narratives and then propose health communication directives that focus on these social media platforms and suggest further research questions.
1
Herd immunity occurs when a large portion of a population is sufficiently vaccinated enough to protect those who do not have immunity such as babies too young for the vaccination (Mnookin, 2011). Herd immunity prevents diseases from becoming outbreaks, since a significant portion of the population cannot pass on the disease.
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Rise of the Web 2.0 and the Personal Narrative Anti-vaccination sentiments have existed since the advent of the first vaccine against smallpox in the early 1800s (Dub et al., 2015). The UK’s compulsory vaccination laws in the mid-19th century resulted in the first anti-vaccination leagues (Wolfe & Sharp, 2002). The United States saw similar pushback in the early 20 th century, however by the 1950s and 1960s new vaccination programs (including MMR) were introduced and there was a wide acceptance of vaccines. (Dub et al., 2015). Decreases in outbreaks and deaths continued throughout the 20 th century as a result of these vaccination programs (Dud et al., 2015). The anti-vaccinationists saw another resurgence with the 1982 documentary ‘DTP: Vaccination Roulette’. This led to the creation of anti-vaccination advocacy groups, some of which are still active today (Dub et al., 2015). In 1998, the now discredited Wakefield paper linked the measles, mumps, and rubella (MMR) vaccination with the rising autism rates (Mnookin, 2011). While anti-vaccination groups have been around for a long time, the majority of the people still believed in vaccinations. Prior to the 21st century, anti-vaccination advocacy groups did not have the ability to spread their messages effectively (Dub et al., 2015). The current vaccination debate has emerged from these fringe advocacy groups onto the world stage due in a large part to Web 2.0, typically defined by the rise of user-generated content and the proliferation of social media platforms that globally connect people and ideas (Witteman & Zikmund-Fisher, 2012 ). Kata argues that these characteristics of Web 2.0 have created a medical paradigm that “questions the legitimacy of science and authority, stressing the need for patients to hold more power” (2012). Web 2.0 allows people to interact with an unprecedented amount information and ideas and not all of the information comes from legitimate sources. Authority is questioned when everyone acts as an expert (Kata, 2012). The predominance of negative information on the internet and negative vaccination narratives create an environment the skews the perception of risk (Witteman et. al., 2012). Therefore health decisions are no longer placed in the hands of doctors but filtered through the influence of media and social groups (Kata, 2012; Polzer, 2014). These influences rely heavily on personal narratives, which provides a powerful message - often extremely emotional and relatable (Betch et al., 2011). Social media provides a forum for personal narratives impacts health decisions in ways that were not possible prior to Web 2.0.
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Research has indicated that narratives are more persuasive than statistical data in influencing decisions (DeWitt et al., 2008; Betsch et al., 2011; Nan, 2015). There are several reasons why narratives work better than pure statistical facts. One factor is the inability for individuals, regardless of education, to clearly understand how statistics work (called low numeracy) which affects a large percentage of the population (Reyna et al., 2009). Two other key theoretical frameworks may also explain the successful role of narratives in vaccination health decisions and are thus used in research: exemplification theory and the fuzzy-trace theory. Exemplification theory states that people shape their perceptions of risk based on exemplars, or people with widely accepted personal experience, rather than statistical or factual information when making a health decision (Peter et al., 2014; Witterman, 2012). The fuzzy-trace theory states that while people perceive information in two ways, both objectively and subjectively, the subjective - or gist - is more likely to influence decisions (Reyna, 2012). Basically, people tend to make decisions based not on detailed facts but on the general gist of information. Low numeracy, exemplification and gist contribute to the impact narratives have on health decision making.
Narratives also illuminate the way people think about adverse effects. Since vaccination is a prevention tool, success is based the unobservable maintenance of good health. Adverse effects, whether caused by or correlated with a vaccine, garner more narrative stories (Betch et al. 2011, Witteman et. al. 2012). Exposure to these negative narratives skew perceived risk even though the statistical evidence shows these negative outcomes are rare or not related to vaccination (Betch et al. 2012). Narratives that depict adverse effects have more power.
For parental decision-making about vaccines, adherence to social norms is a main indicator for vaccination intent (Brunson, 2013). Parents whose social groups advocate for vaccination are more likely to do so and also disapprove of non-vaccinating parents (Brunson, 2013). The internet has more negative narratives than positive (Betch et. al., 2011) (Witteman et. al., 2012) and social networks provide misleading or confusing information (White, 2014). Parents who rely heavily internet are therefore exposed to a higher percentage of negative narratives.
Vaccination and Social Media Research Since it is clear that personal narratives play such a large role in health decision-making, it is important to research how vaccination information and vaccination narratives appear in social 5|Lucas
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media. However, true qualitative and quantitative studies regarding vaccinations and social media are difficult given the volume of data and the difficulty in accessing the data in real-time. The following table summarizes the studies focusing on vaccination and social media discussed in this paper. Table 1: Social Media and Vaccination Studies Study and Date
SM Platform
Type of Vaccine
Buchanan & Beckett, 2014
General
Peter et.al., 2014
Flu General
Love et. al., 2013
General
Briones et. al., 2012
YouTube
HPV
Salathe et.al., 2011
Flu H1N1
Facebook Launched in 2004, Facebook is a primary social media platform. Users build and experience narratives through status updates, commenting on a friend’s status, or liking posts and pages (Page, 2012). The study of health narratives on Facebook are few. One examining personal testimonials regarding breastfeeding found that Facebook narratives have a persuasive affect and that credibility is assessed by page popularity (Jin et al., 2015). With regards to vaccination narratives, there are no studies that specifically target narratives as a research focus, although there are some that look at vaccination information on Facebook.
In a 2014 study, Buchanan & Beckett found that Facebook hosts a lot of vaccine misinformation with a higher percentage of activity on anti-vaccination pages. However, the amount members for both pro and anti-vaccination pages were similar (Buchanan & Beckett, 2014), proving that while the anti –vaccination camp is active, it is not necessarily larger. It is unclear how this may influence vaccine decisions as the study had a very small sample size, particularly given the vastness of the Facebook network. The authors were also limited to a finite period of time and thus could not assess over a seasonal or annual changes.
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Under the auspices of exemplification theory, another 2014 study of Facebook examined the post and comment ‘likes’, by both pro-vaccination and anti-vaccination exemplars. The study comes close to examining narratives as Facebook users create identity and narrative threads through the use of ‘likes’ for pages and individuals (Page, 2012). The authors concluded that while there is evidence of exemplification theory for the power of user comments to influence attitudes, additional ‘likes’ were inconclusive (Peter et al, 2014). The participants were shown mockup Facebook pages with anonymous comments and likes, which is the complete opposite of real Facebook page or feed. Facebook users curate their Facebook communities with people they typically ‘know’ and tend to join pages and groups that already align with their attitudes and opinions. This study therefore exists well outside of true environmental conditions.
Twitter Twitter, which was founded in 2006, maintains a narrative discourse 140 characters at a time. This truncated form of storytelling nevertheless can influence health decisions. In a 2013 study of Twitter, Love et al. found an overall positive attitude towards vaccination, with the exception of certain topics, such as HPV and herpes vaccines. Salathe et at. studied the sentiments or viewpoints related to the influenza A(H1N1) vaccine as the pandemic and vaccine distribution occurred from August 2009 to January 2010. They found that Twitter users sharing similar viewpoints tended to reaffirm each other, creating a situation where “personal opinions affect the individual medical decisions” (2011). These Twitter communities were polarized – either predominantly positive or negative in the sentiments regarding the vaccine (Salathe et al., 2011). Like Facebook, the current studies of Twitter indicate that this narrative form does impact health decisions.
YouTube In a recent study of HPV vaccination information on YouTube, the majority of videos were negative and most came from news sources with a small percentage of user-generated videos (Briones et al., 2012). This study compared to earlier research on HPV and YouTube (Ache & Wallace, 2008) and found and increase in negativity. While a problematic development, the study’s main conclusion is how quickly YouTube attitudes can change. It is also worth noting that while the user-generated content- the narrative content- of the 2012 study was small in 7|Lucas
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comparison, it represented the second largest category and indicated an increase from the earlier study (Briones et al., 2012). The relative small sample size of the narrative content is suspect for a declaration of increased negativity requiring further study into this social media platform.
While these studies are a good start to proving the role of narratives and vaccination opinions on social media, we need more conclusive research.
Discussion and Recommendations Social media and Web 2.0 played a large role in allowing anti-vaccination advocates to gain a foothold dissemination of bogus research and claims. One interesting development is that Web 2.0 is swinging the pendulum away from anti-vaccination rhetoric towards vaccination acceptance. A close reading of the studies I discussed reveal a subtle shift towards pro-MMR vaccination sentiments (Brunson, 2013; Buchanan & Beckett, 2014). In a recent article on Slate, the author’s personal narrative of her own child’s adverse vaccination reaction still highlighted the message of the importance of vaccines and why she intends to continue to vaccinate (Savage, 2015). Popular culture is also taking a more pro-vaccination stance by comments from influential celebrities, such as John Oliver 2 and a backlash against celebrities who promote anti-vaccination rhetoric, such as Jenny McCarthy 3. However we are not yet out of the woods. With regards to the HPV vaccination, the studies indicate that there is still lot of misinformation and negative sentiments (Love et al., 2013; Briones et al., 2012). Vaccination is still a hotly debated topic and one that is important in health communication.
The current limited research on social media and vaccination narratives invites further study of personal narratives on social media and vaccination intent. Topics that may include studying the differences in gender, income, education, political or religious affiliation and geographical location. The HPV vaccination, which current research indicates has more negative bias, needs
2
On February 3, 2015, The Daily Show contained a segment promoting vaccinations. http://thedailyshow.cc.com/videos/5t2dw1/les-measlesrables 3 Backlash on Jenny McCarthy’s Twitter feed http://www.slate.com/blogs/bad_astronomy/2014/03/17/jenny_mccarthy_antivaxxer_gets_remedied_on_twitter .html
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further research on how narratives regarding this vaccination and attitudes towards sexual health affect decision-making.
In order to synthesize the existing research on personal narratives and vaccination decisionmaking, I will use the spiral of silence theory, first postulated by Elisabeth Noelle-Neumann in the 1970s. When people observe their opinions in an environment, such as the internet, they tend to voice those opinions more readily or conversely, if the opinion is not seen, they remain silent (Noelle-Neumann, 1977). “An opinion that is being reinforced in this way appears stronger than it really is” (Noelle-Neumann, 1977). The dissemination of vaccination information on the internet follows this theory, giving undue weight to the opinions of anti-vaccination groups (Betch et. al., 2011) (Witteman et. al., 2012). Combining this idea with the current research on social media platforms, health communicators can use the following recommendations:
Since users of social media create their own communities of shared opinions and interests (Page, 2012) (Love et. al., 2011), the opinions expressed in these communities will appear stronger according to the spiral of silence theory. Health communicators should encourage positive vaccination narratives in these closed groups.
Since page popularity increases credibility (Jin et. al., 2015), the opinions on popular pages will appear stronger and have greater influence over attitudes. Narratives on popular pages may be more persuasive.
Since health decisions are greatly influenced by social norms (Brunson, 2013), narratives that coincide with social norms may be more effective.
While further research into these recommendations is required, personal narratives should be used in social media related health campaigns or to influence groups or individuals.
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