Online mis/disinformation and vaccine hesitancy in the era of COVID-19: Why we need an eHealth literacy revolution

Vaccination uptake is influenced by many cues during health information seeking online

BACKGROUND

Much government response to improving vaccination uptake during the COVID-19 pandemic has focused on the problems of misinformation and disinformation. There may, however, be other signals within online health information that influence uptake of vaccination.

OBJECTIVE

This study identified the influence of various health information signals within online information communities on the intention of receiving the vaccine.

METHOD

A deductive approach was used to derive constructs from signalling theory. Constructs were validated by a convenience sample using a questionnaire. Structural equation modelling (SEM) was used to evaluate the measurement model, the structural model and the multigroup analysis.

RESULTS

The analysis showed a significant impact of signals derived from past experience, information asymmetry and source credibility constructs on the perceived quality of the vaccine service. The perceived quality also had a significant impact on the intention to receive the vaccine.

DISCUSSION

Signalling theory was able to explain the importance of health information signals perceived from online platforms on the intention of individuals to receive the vaccine.

CONCLUSION

Information asymmetry between information provider and receiver, perceived credibility of sources and perceived quality of the vaccination service may influence decisions about vaccination.

Get Health'e': A Pilot Test of a Digital Health Literacy Intervention for Young Adults

BACKGROUND

Young adults face a number of health concerns and are typically beginning to manage their health on their own. At the same time, this age group is more connected to digital technology than ever before, and studies show that young adults can struggle with digital health literacy skills.

OBJECTIVE

The online Get Health'e' Program consists of six modules addressing digital health literacy skills, including topics such as internet searches and social media. This study evaluates the program based on a usability and pilot study.

METHODS

Recruited participants ranged in age from 18 to 24 years and were predominantly White women. After an eligibility screening, half of the participants were randomly assigned to the program group. All 131 participants were administered two surveys, 2 weeks apart; the program group had access to the program for that week. Survey questions included demographics, the eHealth Literacy Scale (eHEALS), and six sets of five multiple-choice questions assessing digital health knowledge.

KEY RESULTS

Both groups showed an improvement of 1.0 points on the eHEALS scale, but a repeated measures analysis comparing scores for the program and control groups indicated no significant difference in score improvement between the two groups, F(1, 129) = 0.003, p = .96. The program group had an average improvement in quiz scores (from pre to post) from 1.6 to 2.3 which was better than score improvement in the control group across the six modules. The majority of participants in the program group found the program to be useful (67.2%) and informative (59.4%), and 93.8% said they would recommend it to someone they know.

CONCLUSIONS

The Get Health'e' program was well received by participants and led to an increase in digital health knowledge. Programs like this have the potential to raise awareness among youth about how to access and evaluate health information online. [HLRP: Health Literacy Research and Practice. 2024;8(4):e224-e235.].

Investigation of Public Acceptance of Misinformation Correction in Social Media Based on Sentiment Attributions: Infodemiology Study Using Aspect-Based Sentiment Analysis

BACKGROUND

The proliferation of misinformation on social media is a significant concern due to its frequent occurrence and subsequent adverse social consequences. Effective interventions for and corrections of misinformation have become a focal point of scholarly inquiry. However, exploration of the underlying causes that affect the public acceptance of misinformation correction is still important and not yet sufficient.

OBJECTIVE

This study aims to identify the critical attributions that influence public acceptance of misinformation correction by using attribution analysis of aspects of public sentiment, as well as investigate the differences and similarities in public sentiment attributions in different types of misinformation correction.

METHODS

A theoretical framework was developed for analysis based on attribution theory, and public sentiment attributions were divided into 6 aspects and 11 dimensions. The correction posts for the 31 screened misinformation events comprised 33,422 Weibo posts, and the corresponding Weibo comments amounted to 370,218. A pretraining model was used to assess public acceptance of misinformation correction from these comments, and the aspect-based sentiment analysis method was used to identify the attributions of public sentiment response. Ultimately, this study revealed the causality between public sentiment attributions and public acceptance of misinformation correction through logistic regression analysis.

RESULTS

The findings were as follows: First, public sentiments attributed to external attribution had a greater impact on public acceptance than those attributed to internal attribution. The public associated different aspects with correction depending on the type of misinformation. The accuracy of the correction and the entity responsible for carrying it out had a significant impact on public acceptance of misinformation correction. Second, negative sentiments toward the media significantly increased, and public trust in the media significantly decreased. The collapse of media credibility had a detrimental effect on the actual effectiveness of misinformation correction. Third, there was a significant difference in public attitudes toward the official government and local governments. Public negative sentiments toward local governments were more pronounced.

CONCLUSIONS

Our findings imply that public acceptance of misinformation correction requires flexible communication tailored to public sentiment attribution. The media need to rebuild their image and regain public trust. Moreover, the government plays a central role in public acceptance of misinformation correction. Some local governments need to repair trust with the public. Overall, this study offered insights into practical experience and a theoretical foundation for controlling various types of misinformation based on attribution analysis of public sentiment.

Development of a User-friendly Health Promotion Website to Spread Evidence-based Information in Italy

Introduction

Appropriate communication models and strategies are crucial in order to strengthen preventive and health promotion interventions via digital platforms. Today, 52.23% of the Italian population use the Internet as a source of health-related information. The aim of the "Insegna Salute" project was to create a website that would enable people to satisfy their knowledge health needs and increase their awareness in the field of prevention.

Methods

To develop the website, a qualitative literature research was carried out to collect an overview of effective online health communication strategies and tools before, during and after the COVID-19 pandemic. Further, we implemented the website insegnasalute.it according to the one-to-many (screen-to-face) communication model. The second part of the research focused on identifying tools to ensure the constant update of the platform. Finally, we proceeded with the creation of the visual identity.

Results

The research resulted in 28 sources regarding health communication, vaccine hesitancy, online health information seeking, visual identity, current digital and social trends and mis/disinformation. Many publications reported that healthcare professionals (HCPs) are the main providers of evidence-based information and the most effective agents against misinformation. Furthermore, most of the articles advocated the use of digital technologies, such as social media and websites, along with proactive and targeted communication strategies.

Conclusions

Vaccination hesitancy and other health prevention issues require accurate tools to build trust-based relationships between users and healthcare professionals. In line with the preventive guidelines issued by the Italian Ministry of Health, new tools, such as "Insegna Salute", integrate health knowledge with communication strategies. In the wake of the COVID-19 pandemic, preventive measures are essential to protect the population from misinformation spread and the probability of getting ill.

Do boys have the same intentions to get the HPV vaccine as girls? Knowledge, attitudes, and intentions in France

BACKGROUND

The vaccine coverage against human papillomavirus (HPV) vaccination remains low in France. The objective of this study was to study adolescent perceptions by comparing boys and girls, in order to build effective school-based interventions.

METHODS

This paper presents a cross-sectional study in French middle school pupils. They completed online questionnaires on their knowledge and attitudes toward the HPV vaccine, HPV vaccination status, their intention, reasons to vaccinate or not to vaccinate, and psychological antecedents of vaccination. A structural equation modeling (SEM) analysis was used to test the hypothesized model.

RESULTS

The participants are 818 pupils aged from 12 to 16 years (Mage = 13.78). Most pupils were in the pre-contemplative stage (62.7 % of boys and 40.8 % of girls). SEM analysis indicated that the relationship between the level of HPV knowledge, the representations of vaccines in general, and vaccine intention was mediated by attitudes towards the HPV vaccine among both boys and girls.

CONCLUSIONS

These findings reveal a high percentage of boys who do not feel concerned by the HPV vaccine and highlight the need to consider the psychological antecedents of vaccination in general in addition to the specific attitudes to the HPV vaccine.

The relation between eHealth literacy and healthy lifestyle behaviours in pregnant women

The aim of this study was to determine the relationship between eHealth literacy and healthy lifestyle behaviours among pregnant women. This cross-sectional study was conducted in five family health centres in a city in the western part of Turkey. The study sample consisted of 201 pregnant women who were admitted to the five family health centres between September and December 2022. A socio-demographic questionnaire, the eHealth Literacy Scale and the Healthy Lifestyle Behaviours in Pregnancy Scale were used to collect data. Multiple linear regression analysis was used to explore predictors of health-promoting behaviours. The mean score of the eHealth Literacy Scale was 29.37 ± 6.20. The mean score of the Healthy Lifestyle Behaviours Scale was 119.69 ± 13.58. Multiple linear regression showed that predictors of healthy lifestyle behaviours among pregnant women were eHealth literacy, using internet to access health information and gestational age. eHealth literacy was found to be an important factor affecting the healthy lifestyle behaviours of pregnant women. This study highlights the importance of considering pregnant women's eHealth literacy in interventions aimed at improving healthy lifestyle behaviours.

e-Health literacy and online health information utilization among Jordanians: A population-based study

Background

The internet has become an essential part of empowering people to access health-related information. Huge amounts of health-related information are available online, but few people have the skills to assess its validity and reliability. Accordingly, the concept of ehealth literacy competencies emerged to measure the skills necessary to validate such information. As a result, the purpose of this study was to assess Jordanian people's e-health literacy, online health information utilization, and associated factors.

Methods

This population-based cross-sectional study was conducted from March to December 2023.

Results

Results: The study found that participants rated their e-health literacy at 28.94 out of 40, indicating a sufficient level of health literacy, and their online health information utilization at 39.62, indicating a high level of engagement with online health resources. Furthermore, it is revealed that e-health literacy is associated with gender and geographic region, whereas online health information utilization is associated only with chronic disease.

Conclusion

In Jordan, there is a balance between traditional and online health information use. While healthcare providers and primary health centers are the main sources of information, Jordanians show a sufficient level of e-health literacy, with females and the capital region exhibiting higher levels. Furthermore, Jordanians were more likely to use online health information. Nevertheless, it is crucial to work on improving internet platforms to enhance the quality of online health-related information.

Understanding COVID-19 vaccine hesitancy in Canada

While Canada has had relatively high vaccination rates against COVID-19, specifically during earlier waves of the pandemic, vaccine hesitancy has continued to serve as a significant barrier to adequate protection against the virus and, more recently, booster vaccine uptake. This paper explores the processes underlying Canadians' perceptions of COVID-19 vaccines and their decisions to take or refuse them, as well as how public policy and health messaging about vaccination has influenced vaccination attitudes and behaviors. Our focus group interviews with 18 vaccinated and unvaccinated adult Canadians conducted during October 2021 reveal that, in some respects, COVID-19 vaccine hesitancy conforms to prior knowledge about some of the factors that affect vaccine attitudes (e.g., the influence of known medical providers) but deviates from current theoretical frameworks regarding general vaccine hesitancy. Specifically, these frameworks emphasize a lack of scientific knowledge and literacy ("knowledge deficit" accounts) or individuals' inability to incorporate rational risk perceptions into initial emotional responses to vaccines ("emotionality/irrationality" accounts). In contrast to the knowledge deficit account, we find that expressions of COVID-19 vaccine hesitancy were most frequently associated with an information surplus or inability to prioritize information from multiple and often contradictory sources. Furthermore, top-down pro-vaccination messaging often triggered significant pushback against what participants perceived as moral shaming of the unvaccinated. Our findings demonstrate the necessity for a new framework to understand and address vaccine hesitancy. A better theoretical account of vaccine hesitancy has important implications for future vaccination efforts, specifically within the context of new variants and low booster vaccination rates in Canada.

Human rotavirus strains circulating among children in the capital of China (2018-2022)_ predominance of G9P[8] and emergence ofG8P[8]

OBJECTIVE

This study aimed to update the genetic diversity of Rotavirus (RV) infections in children under five years old in Beijing, China.

METHODS

A 5-year active hospital-based surveillance for sporadic acute gastroenteritis (AGE) from January 2018 to December 2022 in the capital of China was performed. A total of 748 fecal samples from AGE patients were collected for followed by RV antigen detection by ELSIA, RNA detection by reverse transcription PCR, G/P genotyping and phylogenetic analyzing.

RESULTS

RV antigen was detected in 11.0% of the collected samples, with 54 samples confirmed to be RV RNA positive. G9 and G8 genotypes were identified in 43 (79.6%) and 7 (13.0%) samples, respectively, all of which were allocated to P[8]. The predominant G/P combination was G9P[8] (79.6%), following by G8P[8] (13.0%), G4P[8] (5.6%) and G3P[8] (1.9%). A significant change in G/P-type distribution was observed, with the G9P[8] being predominant from 2018 to 2021, followed by the emergence of an uncommon G8P[8] genotype, which was first reported in 2021 and became predominant in 2022. Blast analysis showed that one G1 isolate had a high similarity of 99.66% on nucleotide acid with RotaTeq vaccine strain with only one amino acid difference L150V. Additionally, one P[8] isolate was clustered into a branch together with RotaTeq vaccine strain G6P[8].

CONCLUSIONS

The study reveals that G8P[8] has become the predominant genotype in pediatric outpatients in China for the first time, indicating a significant change in the composition of RV genetic diversity. The importance of RVA genotyping in surveillance is emphasized, as it provides the basis for new vaccine application and future vaccine efficacy evaluation.

Vaccine Hesitancy Phenomenon Evolution during Pregnancy over High-Risk Epidemiological Periods-"Repetitio Est Mater Studiorum"

(1) Background: The recent epidemiological events were high-stress level generators for humanity, particularly for pregnant women, influencing their attitude, behavior, and decisions regarding vaccination during pregnancy or regarding their future child. The aim of this study was to analyze the anti-pertussis vaccination decision-shaping factors in pregnant women during two epidemiological periods: the measles epidemic and the COVID-19 pandemic. (2) Methods: Two groups of pregnant women were invited to be part of a medical education program, having as the main theme the infectious disease risks and their prevention through vaccination. Before launching the program, participants received a 12-item questionnaire. From a total number of 362 pregnant women enrolled in the study, 182 participated in 2019, and 180 participated in 2022. (3) Results: The socio-demographic data revealed that the age of pregnant women participating in medical education programs increased in 2022 by 1.7 years (p < 0.01). In vitro fertilization was reported in a significantly higher proportion (20% in 2022 vs 9.8% in 2019, p < 0.01). Participation in community-initiated educational programs almost doubled during the pandemic time from 18.7% in 2019 to 33.9% in 2022 (p < 0.01). Pertussis vaccine acceptancy (VA) dropped from 85% in 2019 to 44.4% in 2022 (p < 0.01) (4) Conclusions: In this study, we reported fast-growing vaccine hesitancy and severe declared vaccine reluctance. The results of this complex long-term study, which evaluated pregnant women over several years, showed a five-fold increase in the percentage of pregnant women who disagreed with personal pertussis vaccination. This draws attention to the risks of pertussis epidemic outbreaks in pregnant women and their future infants in the first couple of months of life before the initiation of vaccination.

A Comparative Case Study Analysis: Applying the HIPE Framework to Combat Harmful Health Information and Drive COVID-19 Vaccine Adoption in Underserved Communities

This descriptive, observational paper utilizes the comparative case study approach to analyze the application of the HIPE™ Framework to two health campaigns addressing vaccine hesitancy in underserved communities. Exposure to inaccurate/misleading health information impacts vaccination adoption, especially for individuals with low health/digital literacy. Underserved groups-like minority, racial/ethnic, or rural populations-typically have lower literacy and higher rates of vaccine hesitancy. Grounded in persuasion and behavioral change theory, the Health Information Persuasion Exploration (HIPE™) Framework was applied to the Black/Haitian community in Miami-Dade, Florida and the Migrant Agricultural Worker Community in Central Valley, California. The campaigns addressed each community's unique characteristics via Detect, Analyze, Design, and Evaluate phases of the HIPE framework. Both campaigns achieved their respective vaccine uptake goals. For Miami-Dade, over 850 vaccinations were administered (the goal was 800 vaccinations), and vaccination rates increased by 25.22%. In Central Valley, vaccination rates for 5-11-year-old children in Merced and Stanislaus counties increased about 20% and 14%, respectively, and overall vaccination rates increased compared to surrounding counties. Discussion of the results and recommendations for future research highlight the potential efficacy of applying the HIPE™ Framework for developing health campaigns and response strategies to improve health outcomes.

Factors influencing parents' hesitancy to vaccinate their children aged 5-11 years old against COVID-19: results from a cross-sectional study in Malaysia

Introduction

Vaccination programs have been rolled out across the globe to contain and mitigate the spread of the COVID-19 infection. Until recently, such programs were limited to adults and the older population, thereby limiting children from getting vaccinated. Recently, the Malaysian government rolled out vaccination for children aged 5-11 years. However, there are certain factors that might affect vaccination uptake among children. This study explores factors influencing parents' hesitancy to vaccinate children in Malaysia.

Method

A nationwide online cross-sectional convenience sampling survey from April 21, 2022 to June 3, 2022 was conducted. The study used descriptive statistics to inform about vaccine hesitancy among parents. Cross-tabulation was performed to calculate the frequency and percentage of vaccine hesitancy, quality of life, e-health literacy, and the 5C psychological antecedents of vaccination among parents with children 5-11 years in Malaysia. Graphical methods were used to portray the levels of e-health literacy and levels of 5C psychological antecedents of vaccination. The study used both bi-variate and multivariate analysis to understand the relationship between vaccine hesitancy and the socio-demo-economic factors, quality of life, e-health literacy and 5C psychological antecedents.

Results

Of 382 participants, almost one-third (33%) of participants reported vaccine hesitancy for their children. For 5C's psychological antecedents of vaccination, around one quarter (26.96%) reported disagreement for confidence in vaccination, almost half (52.36%) reported disagreement for vaccination complacency, three-fifths (60.99%) reported vaccination constraint, one quarter (25.92%) reported calculation antecedent, and almost one-third reported disagreement over collective responsibility antecedent (25.92%). Chi-square test revealed that gender, employment status, and parents' COVID-19 vaccination status were significantly associated (p<0.05) with vaccine hesitancy among parents. Assessing the influence of transactional e-health literacy, only the communication component contained a significant association (p<0.05). Among the 5C psychological antecedents, confidence, calculation, and collective responsibility were significantly associated (p<0.05) with vaccine hesitancy. Parents with secondary [OR: 8.80; CI: 2.44-31.79, (p<0.05)], post-secondary [OR: 5.21; CI: 2.10-13.41, (p<0.05)], and tertiary education [OR: 6.77; CI: 2.25-20.35, (p<0.05)] had significantly higher likelihood of vaccine hesitancy than those with primary education.

Conclusion

Highly educated parents are more skeptical and are more likely to perceive the vaccine as unsafe and ineffective for their children. It is critical to disseminate the required information about the vaccine safety to the educated group.

Public relations strategies employed by the Ghana Health Service to address COVID-19 vaccine hesitancy: a qualitative inquiry

BACKGROUND

Strategies for developing and advancing good public relations can be recognized in nearly all fields of life without making an exception for the healthcare industry. In the wake of the COVID-19 pandemic, matters of public health have gathered more force. The importance of effective public relations for improving healthcare is highlighted by the position that immediate access to reliable health information should be the hallmark of a just society. However, the strategies available for addressing major threats to the uptake of public health services such as mass vaccination campaigns are not properly studied and documented in the Ghanaian context. This organizational case study explored strategies used by healthcare professionals working with the Ghana Health Service (GHS) to address COVID-19-related vaccine hesitancy in the country.

METHODS

We performed a qualitative inquiry with semi-structured in-depth interviews conducted with 25 public health officials of the GHS. The interviews were timed to coincide with the mass deployment of COVID-19 vaccines in four Regions. Participants were recruited through purposive sampling. Data collected included demographic characteristics, perspectives on public relations strategies used in the past year to improve COVID-19 vaccine uptake as well as successes and pitfalls. Thematic analysis was performed with NVIVO software to generate themes from interview transcripts.

RESULTS

Four main themes emerged from the data analysis and these are presented. Healthcare workers perceived vaccine hesitancy to be a threat with the potential to undermine an important strategic organizational goal related to COVID-19 illness. In terms of PR strategies, we determined that a combination of informative, motivational, persuasive and coercive public relations strategies was employed by the Ghana Health Service to address the challenge of vaccine hesitancy. We further found that PR strategies were deployed across both traditional (print, radio, TV) and emerging/social media networks. Officials were optimistic that the strategies would produce results, but were uncertain whether they could attribute current successes or failures to the PR strategies used.

CONCLUSION

Since the onset of the COVID-19 pandemic, public relations strategies which have been employed by the Ghana Health Service to address vaccine hesitancy are characterized and catalogued. The nature of the audience and PR strategies employed suggests that the effect of these strategies may be short-lived unless they are constantly reinforced by the GHS. These findings show that effective PR strategies exist for addressing vaccine hesitancy in public health practice.

Sociocultural and moral narratives influencing the decision to vaccinate among rheumatic disease patients: a qualitative study

INTRODUCTION/OBJECTIVES

Vaccination is a process that involves individual, social, and ethical aspects, beyond public governance of vaccines or vaccination as a public health concern. The aim of this study is to describe the sociocultural and moral narratives that influence the decision to vaccinate in general and to vaccinate against COVID-19 specifically, among patients at the rheumatology units of two hospitals.

METHODS

Qualitative study involving individual semi-structured interviews following an interview guide. We conducted a thematic analysis using the ATLAS.ti software, with further triangulation to verify concordance and aid in the interpretation of the data from a medical anthropology framework and using a narrative ethics approach to gain insight into the participants' underlying moral values.

RESULTS

We interviewed 37 patients in total, along with 3 rheumatologists. Five core themes emerged from the analysis to understand the decision to vaccinate: (1) information about vaccines and disease, (2) perceived risk-benefit of vaccination, (3) the physician-patient relationship, (4) governance of vaccination programs, (5) attitudes towards vaccines. Individual and family experiences with vaccination are diverse depending on the type of vaccine. The COVID-19 vaccine, as a new medical technology, is met with more controversy leading to hesitancy.

CONCLUSIONS

The decision to vaccinate among Mexican rheumatic disease patients can sometimes involve doubt and distrust, especially for those with a lupus diagnosis, but ultimately there is acceptance in most cases. Though patients make and value autonomous decisions, there is a collective process involving sociocultural and ethical aspects. Key points • The complexity of vaccine decision-making is better identified through a narrative, qualitative approach like the one used in this study, as opposed to solely quantitative approaches • Sociocultural and moral perspectives of vaccination shape decision-making and, therefore, highlight the importance of including patients in the development of effective clinical practice guidelines as well as ethically justified public policy • Sociohistorical context and personal experiences of immunization influence vaccine decision-making much more than access to biomedical information about vaccines, showing that approaches based on the information deficit model are inadequate to fight vaccine hesitancy.

Impact of social media news on COVID-19 vaccine hesitancy and vaccination behavior

In order to take advantage of the power of social media to promote vaccination, this study reveals the mechanisms of positive and negative impacts of social media news on vaccine hesitancy and vaccination behavior. Based on the stimulus-organism-response (S-O-R) framework, we developed a research model to understand the effects of vaccine safety news and risk news from social media (external stimuli) on individuals' psychological organism (i.e., safety perception and risk perception) and consequent behavioral response, vaccine hesitancy and vaccination behavior. The proposed model was tested by partial least square structural equation modeling (PLS-SEM) on a sample gathered in China from September 2021 to November 2021 and from February 2022 to April 2022 (valid responses = 1579). The results found that the relationship between vaccine risk news from social media and risk perception was higher than the relationship between vaccine safety news from social media and safety perception. Individuals are more sensitive to vaccine risk news than safety news on social media. Moreover, both safety perception and risk perception explained the critical psychological mechanisms behind vaccine hesitancy. Interestingly, ego network density mitigated the effect of safety news on safety perception and the effect of risk news on risk perception. The findings contribute to the S-O-R model, the research on social media effects, and the literature on vaccination attitudes and behaviors. This study also informs public health officials about leveraging the power of social media to motivate the public to accept the COVID-19 vaccines.

Investigation of personal variables, technology usage, vaccine-related variables, social media-specific epistemological beliefs, media literacy, social impact strategies variables affecting vaccine hesitancy beliefs in the Covid-19 pandemic

Aim

In this study, personal variables, technology use cases, vaccine-related variables, social media-specific epistemological beliefs, media literacy, and social influence strategies were examined as predictors of Covid-19 vaccination hesitancy (VH) beliefs.

Subject and methods

The prediction design research model is used to detect the predictors of the dependent variable. The study group consists of 378 participants. Five different scales were used together with the self-description form as a data collection tool.

Results

According to the results of the research, individuals who have positive perceptions about the safety of Covid-19 vaccines and who have received the Covid-19 vaccine have lower anti-vaccine beliefs. It is another situation that prevents the opposition to vaccination of those who research the source of information on social media. As a result, age, education and income level, social media usage experience, media literacy, and social influence strategies were not effective on the participants' anti-vaccine beliefs.

Conclusion

According to the findings of the study, positive perceptions about the safety of Covid-19 vaccines, being vaccinated against Covid-19, and researching a source of information on social media variables seem to be effective in laying the foundations for constructive interventions such as using anti-vaccine beliefs to guide, reduce or eliminate negative beliefs about vaccines.

Evidence-based policies in public health to address COVID-19 vaccine hesitancy

A fundamental basis for effective health-related policymaking of any democratic nation should be open and transparent communication between a government and its citizens, including scientists and healthcare professionals, to foster a climate of trust, especially during the ongoing COVID-19 mass vaccination campaign. Since misinformation is a leading cause of vaccine hesitancy, open data sharing through an evidence-based approach may render the communication of health strategies developed by policymakers with the public more effective, allowing misinformation and claims that are not backed by scientific evidence to be tackled. In this narrative review, we debate possible causes of COVID-19 vaccine hesitancy and links to the COVID-19 misinformation epidemic. We also put forward plausible solutions as recommended in the literature.

Characterizing discourses about COVID-19 vaccines on Twitter: a topic modeling and sentiment analysis approach

BACKGROUND

Evidence-based health communication is crucial for facilitating vaccine-related knowledge and addressing vaccine hesitancy. To that end, it is important to understand the discourses about COVID-19 vaccination and attend to the publics' emotions underlying those discourses.

METHODS

We collect tweets related to COVID-19 vaccines from March 2020 to March 2021. In total, 304,292 tweets from 134,015 users are collected. We conduct a Latent Dirichlet Allocation (LDA) modeling analysis and a sentiment analysis to analyze the discourse themes and sentiments.

RESULTS

This study identifies seven themes of COVID-19 vaccine-related discourses. Vaccine advocacy (24.82%) is the most widely discussed topic about COVID-19 vaccines, followed by vaccine hesitancy (22.29%), vaccine rollout (12.99%), vaccine facts (12.61%), recognition for healthcare workers (12.47%), vaccine side effects (10.07%), and vaccine policies (4.75%). Trust is the most salient emotion associated with COVID-19 vaccine discourses, followed by anticipation, fear, joy, sadness, anger, surprise, and disgust. Among the seven topics, vaccine advocacy tweets are most likely to receive likes and comments, and vaccine fact tweets are most likely to receive retweets.

CONCLUSIONS

When talking about vaccines, publics' emotions are dominated by trust and anticipation, yet mixed with fear and sadness. Although tweets about vaccine hesitancy are prevalent on Twitter, those messages receive fewer likes and comments than vaccine advocacy messages. Over time, tweets about vaccine advocacy and vaccine facts become more dominant whereas tweets about vaccine hesitancy become less dominant among COVID-19 vaccine discourses, suggesting that publics become more confident about COVID-19 vaccines as they obtain more information.

Do Socioeconomic Disparities Matter? Unraveling the Impacts of Online Vaccine Misinformation on Vaccination Intention During the COVID-19 Pandemic in China

Concerns have been raised about whether and how groups at high risk of COVID-19 are more likely affected by online vaccine misinformation during the pandemic. This study examined the associations between exposure to online vaccine misinformation and vaccination intention through vaccination perceptions and investigated the moderating role of individuals' socioeconomic status. eHealth literacy was also investigated as a protective factor that mediated the effect of socioeconomic status. A survey of 1,700 Chinese netizens revealed that increased exposure to online COVID-19 vaccine misinformation predicted lower vaccination intention, which was mediated by negative attitudes, lowered subjective norms, lowered perceived benefits, and higher perceived barriers toward vaccination. Socio-economic status (i.e. education, income, and residence), in general, did not guarantee individuals against the negative impacts of vaccine misinformation. eHealth literacy is critical in reducing susceptibility to vaccine misinformation during the COVID-19 pandemic.

The effect of disinformation about COVID-19 on consumer confidence: Insights from a survey experiment

Although the COVID-19 pandemic was accompanied by an infodemic about the origin of the virus and effectiveness of vaccines, little is known about the causal effect of this disinformation on the economy. This article fills in this void by examining the effects of disinformation about COVID-19 vaccines on consumer confidence by means of an original survey experiment in Dutch speaking communities of Belgium. Our findings show that the information set that impacts consumer confidence is much broader than previously assumed. We show that disinformation changes the perception of the effectiveness of vaccines which in turn indirectly impacts the future economic outlook, measured by the metric consumer confidence. Moreover, we find that the above effects are larger for respondents exposed to disinformation that is framed as containing 'scientific evidence' compared to 'conspiracy frames'.

Knowledge and willingness to receive a COVID-19 vaccine: a survey from Anhui Province, China

OBJECTIVES

Vaccinations can prevent COVID-19 and control its spread quickly and efficiently. This study aimed to investigate knowledge and willingness of geriatric care facility staff to receive a COVID-19 vaccine, and to provide a basis for the government to promote the COVID-19 vaccine and guide people to get vaccinated.

STUDY DESIGN

A cross-sectional study.

METHODS

Data on characteristics of the participants, knowledge about the COVID-19 vaccine, and willingness to get vaccinated for COVID-19 were collected through an online survey from May 19 to June 18, 2021. Statistical analyses were conducted with ANOVA, chi-square, logistic regression.

RESULTS

The survey illustrated that the highest score of COVID-19 vaccine knowledge was 50, the lowest 20, and the average 44.22. It also demonstrated that 91.3% of the participants had a good knowledge of COVID-19 vaccine, and that 97.3% participants were willing to receive the COVID-19 vaccine. The results showed that geriatric care facility staff had varied level of the COVID-19 vaccine knowledge depending upon their age, educational background, and other factors, and correspondingly, their willingness to receive COVID-19 vaccine was affected by their knowledge level of COVID-19 vaccine.

CONCLUSIONS

In general, the participants, the staff of geriatric care facilities in Anhui Province, had good mastery of the COVID-19 vaccine, and they were willing to get vaccinated. However, there still existed a few participants with poor knowledge, who were unwilling to get vaccinated against COVID-19. Government can guide people to accept vaccination by enhancing publicity about the effects and adverse reactions of COVID-19 vaccines.

Exploring vaccine hesitancy: the twofold role of critical thinking

With the progress of the vaccination campaign against the SARS-COV-2, we are ever closer to reaching that part of the population that refuses or is hesitant about vaccination. This study investigated the association between critical thinking motivation factors (i.e., intrinsic value of critical thinking and expectancy of one's critical thinking ability), conspiracy mentality, intolerance of uncertainty and hesitancy toward vaccination. A sample of 390 participants completed an online survey during April 2021. Across participants, results indicate that conspiracy mentality and expectancy about personal ability as a critical thinker positively predict vaccine hesitancy. On the contrary, the intrinsic value attributed to critical thinking, intolerance of uncertainty, and education are negatively associated with hesitancy. While the findings confirm existing evidence, particularly on the detrimental role of conspiracy mentality on vaccine acceptance, they also shed light on the double-faced role exercised by critical thinking. Practical implications and future directions are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04165-w.

Effectiveness of the Booster of SARS-CoV-2 Vaccine among Japanese Adolescents: A Cohort Study

Vaccination is effective in preventing COVID-19-related hospitalization among all age groups, but there is limited evidence on the effectiveness of the booster of the SARS-CoV-2 vaccine among adolescents. We analyzed the data on the status of SARS-CoV-2 infection and their vaccination profiles in adolescents aged 13-18 years in Soma city (Fukushima, Japan) (n = 1835) from 14 May to 15 June 2022. The crude incidence rate and 95% confidence interval were calculated with the negative-binomial regression model after classifying the immunization status. The crude effectiveness of a booster administration to prevent infections was estimated as 86.4% (95% confidence interval: 57.2-95.7) when compared with the primary vaccination alone. The results of this study support that the community-based mass vaccination campaign of a booster dose among adolescents has additional protection from COVID-19 during the period of the B.1.1.529 (omicron) variant wave.

Climate change, vaccines, GMO: The N400 effect as a marker of attitudes toward scientific issues

While the psychological predictors of antiscience beliefs have been extensively studied, neural underpinnings of the antiscience beliefs have received relatively little interest. The aim of the current study is to investigate whether attitudes towards the scientific issues are reflected in the N400 potential. Thirty-one individuals were asked to judge whether six different issues presented as primes (vaccines, medicines, nuclear energy, solar energy, genetically-modified organisms (GMO), natural farming) are well-described by ten positive and ten negative target words. EEG was recorded during the task. Furthermore, participants were asked to rate their own expertise in each of the six topics. Both positive and negative target words related to GMO elicited larger N400, than targets associated with vaccines and natural farming. The results of the current study show that N400 may be an indicator of the ambiguous attitude toward scientific issues.

Agency and liminality during the COVID-19 pandemic: Why information literacy cannot fix vaccine hesitancy

This article employs a sociological and dialogical information perspective to identify what shape information literacy practice takes for people who are hesitant about the COVID-19 vaccine. An information perspective places information and people’s relations with information at the centre of the inquiry. The study carried out 14 semi-structured interviews with UK adults who had not yet received or taken up their invitation to have the COVID-19 vaccine. Outcomes of this study suggest that information literacy practices related to vaccine hesitancy emerged through the liminal space and in relation to agentic performance, which was catalysed through engagement with experiential, corporeal and social information. This study has implications for the teaching of information literacy, in particular, the idea that being informed is an affirmative action that will automatically empower learners to make appropriate choices.

The Usage of Digital Health Technology of the Elderly in Hong Kong and the Role of Technology Readiness and eHealth Literacy: A Path Analysis (Preprint)

BACKGROUND

Although digital health technologies (DHTs) help many people maintain a healthy life, including those of advanced age, these technologies are of little use to older adult populations if they are not being adopted in daily life. Thus, it is critical to identify ways to help older adults recognize and try new technologies and maintain their use of them to maximize the benefits of these technologies in a digital-based society.

OBJECTIVE

Our study aimed (1) to assess the current usage of DHT among older adults in Hong Kong and (2) to examine how high and low levels of eHealth literacy in this group affects the relationship between the Technology Readiness and Acceptance Model (TRAM) and attitudes and intention toward DHT.

METHODS

A total of 306 adults over 60 years of age in Hong Kong participated in this study. After conducting confirmatory factor analysis to validate the measurement model, the hypothesized model was tested using structural equation modeling.

RESULTS

Optimism was significantly related to perceived usefulness, while optimism, innovativeness, and discomfort were significantly associated with perceived ease of use. Both perceived usefulness and perceived ease of use were significantly linked to attitude toward the use of DHTs. Meanwhile, attitude significantly predicted usage intention. Additionally, the results revealed the differences in the relationships of the TRAM between participants with high and low levels of eHealth literacy. The influence of optimism and innovativeness on perceived ease of use was stronger for the higher-level group than for the lower-level group, and the influence of discomfort for the higher-level group was much weaker.

CONCLUSIONS

The findings provided partial support for the impact of eHealth literacy on encouraging older adults to use DHT and obtain health benefits from it. This study also suggests providing assistance and guidelines for older adults to narrow the aging-related technology gap and to further explore the associations of eHealth literacy, the TRAM, and actual behaviors.

Perceived Information Distortion about COVID-19 Vaccination and Addictive Social Media Use among Social Media Users in Hong Kong: The Moderating Roles of Functional Literacy and Critical Literacy

During the COVID-19 pandemic, distorted information about the COVID-19 vaccination is widely disseminated through social media. The present study examined the association between perceived information distortion about COVID-19 vaccination on social media, individuals’ functional and critical literacy, and addictive social media use (SMU), as well as the moderating roles of functional and critical literacy in the association between perceived information distortion and addictive SMU among social media users in Hong Kong. A web-based, cross-sectional survey was conducted among 411 Chinese citizens from June to August 2021. Findings showed that after adjusting for significant background variables, including age, gender, marital status, education, occupation, and income, functional literacy was negatively associated with addictive SMU. In addition, significant moderation effects of functional literacy and critical literacy were also observed, such that a positive association between perceived information distortion on social media and addictive SMU was significant among participants with lower functional literacy or higher critical literacy. Findings highlight the importance of improving functional literacy in addictive SMU prevention for social media users. Special attention should also be paid to the potential influence of critical literacy on addictive SMUs.

COVID-19 vaccination hesitancy in Italian healthcare workers: a systematic review and meta-analysis

INTRODUCTION

As for other vaccines, vaccination hesitancy may be a determining factor in the success (or otherwise) of the COVID-19 immunization campaign in healthcare workers (HCWs).

AREAS COVERED

To estimate the proportion of HCWs in Italy who expressed COVID-19 vaccine hesitancy, we conducted a systematic review of the relevant literature and a meta-analysis. Determinants of vaccine compliance and options suggested by these studies to address vaccine hesitancy among HCWs were also analyzed. Seventeen studies were included in the meta-analysis and systematic review, selected from scientific articles available in the MEDLINE/PubMed, Google Scholar and Scopus databases between January 1, 2020 and January 25, 2022. The vaccine hesitancy rate among HCWs was 13.1% (95%CI: 6.9-20.9%). The vaccine hesitancy rate among HCWs investigated before and during the vaccination campaign was 18.2% (95%CI=12.8-24.2%) and 8.9% (95%CI=3.4-16.6%), respectively. That main reasons for vaccine hesitation were lack of information about vaccination, opinion that the vaccine is unsafe, and fear of adverse events.

EXPERT OPINION

Despite strategies to achieve a greater willingness to immunize in this category, mandatory vaccination appears to be one of the most important measures that can guarantee the protection of HCWs and the patients they care for.

Perception and Coverage of Conventional Vaccination among University Students from Rouen (Normandy), France in 2021

The aim of this study was to assess vaccination perception and the prevalence of the overall vaccination coverage (VC) and associated factors among university students. An online study was conducted among students of a university in Rouen (Normandy), France, in January 2021, with questions about the VC and perception of the vaccines. The convenience sample included 3089 students (response rate of 10.3%), with a mean age of 20.3 (SD = 1.9). The overall VC was 27.8% (39.2% for the healthcare students (HCS) and 21.3% for the non-HCS; p < 0.0001). Confidence (efficacy and security) was lower than the conviction of usefulness. The characteristics associated with VC were having the intention to be vaccinated against COVID-19, high perceptions of usefulness for their own health, having confidence in the vaccines’ efficacy and security, and a high estimated level of knowledge about vaccination. Education about the general interest and mechanism of action of vaccines could improve the perception of vaccines. Then, it is relevant to improve vaccination literacy and confidence in university students, who, as future adults and parents, will vaccinate themselves and their children; as well as healthcare students who are future healthcare workers and, therefore, will vaccinate and counsel their patients.

Willingness and Influencing Factors to Receive COVID-19 Vaccination Among Chinese Medical Students

Objectives

The aim of this study is to evaluate the desire of medical students in China to get vaccinated or not get vaccinated and the reasons for either decision.

Methods

A cross-sectional survey was conducted from 11 March and 12 March 2021, by administering an online questionnaire to the Chinese medical students. Data entry and analysis were conducted using IBM SPSS ver. 26.0.

Results

Of 3,047 students who completed the survey, 37.9% (1,154) of participants indicated that they would be vaccinated against COVID-19, while 62.1% (1,893) declared that they would not. Attitudes to the COVID-19 vaccine (p = 0.000), levels of eHealth Literacy (p = 0.000), the impact of COVID19 (p = 0.000), concerns about the COVID-19 vaccine (p = 0.000) and gender (p = 0.000) strong associations with willingness to receive the COVID-19 vaccine.

Conclusion

The willingness to receive COVID-19 vaccination was sub-optimal among medical students in China. Educational interventions to improve medical students' perceptions and acceptance toward the COVID-19 vaccine are needed.

Factors Associated with Limited Vaccine Literacy: Lessons Learnt from COVID-19

Compared to many other developed countries, South Africa has a lower uptake of COVID-19 vaccinations. Although not widely researched, there is evidence that vaccine literacy (VL) is positively associated with vaccination uptake. Therefore, this study aimed to assess levels of VL among the adult population in South Africa, as well as to identify factors associated with limited VL. A cross-sectional, anonymous online survey was conducted during September 2021. The survey, which included the standardized Health Literacy about Vaccination in adulthood (HLVa) Scale, was widely advertised, yielding a total of 10,466 respondents. The average scores for the two HLVa sub-scales were relatively high: functional (M = 2.841, SD 0.799) and interactive-critical (M = 3.331, SD 0.559) VL. A proposed ‘limited’ VL score (score value ≤ 2.50) was observed in 40% of respondents for functional literacy and 8.2% of respondents for interactive-critical literacy. The main factors associated with limited VL included lower levels of education, lower socio-economic status, not being vaccinated against COVID-19, self-identifying as Black/African or Colored (i.e., people of mixed ethnic descent), having poorer health, and being a woman. The significant association between VL and vaccination uptake provides an impetus for policy makers such as the South African Department of Health to promote VL in the attempt to increase COVID-19 vaccination uptake.

Mis-Dis Information in COVID-19 Health Crisis: A Narrative Review

BACKGROUND

In this narrative review, we address the COVID-19 pandemic mis-dis information crisis in which healthcare systems have been pushed to their limits, with collapses occurring worldwide. The context of uncertainty has resulted in skepticism, confusion, and general malaise among the population. Informing the public has been one of the major challenges during this pandemic. Misinformation is defined as false information shared by people who have no intention of misleading others. Disinformation is defined as false information deliberately created and disseminated with malicious intentions.

OBJECTIVE

To reach a consensus and critical review about mis-dis information in COVID-19 crisis.

METHODS

A database search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase and CinAhl. Databases used the MeSH-compliant keywords of COVID-19, 2019-nCoV, Coronavirus 2019, SARS-CoV-2, misinformation, disinformation, information, vaccines, vaccination, origin, target, spread, communication.

RESULTS

Both misinformation and disinformation can affect the population's confidence in vaccines (development, safety, and efficacy of vaccines, as well as denial of the severity of SARS-CoV infection). Institutions should take into account that a great part of the success of the intervention to combat a pandemic has a relationship with the power to stop the misinformation and disinformation processes. The response should be well-structured and addressed from different key points: central level and community level, with official and centralized communication channels. The approach should be multifactorial and enhanced by the collaboration of social media companies to stop misleading information, and trustworthy people both working or not working in the health care systems to boost the power of the message.

CONCLUSIONS

The response should be well-structured and addressed from different key points: central level and community level, with official and clearly centralized communication channels. The approach should be multifactorial and enhanced from the collaboration of social media companies to stop misleading information, and trustworthy people both working and not working in the health care systems to boost the power of a message based on scientific evidence.

Hesitancy towards COVID-19 vaccines on social media in Canada

To effectively end the pandemic, the acceptance of effective vaccines against COVID-19 is critical. Comments posted in online platforms act as a barometer for understanding public concerns regarding vaccination and can be used to inform communication strategies for the 'moveable middle'. The aim of this exploratory study was to identify online dialogue regarding the nature of vaccine hesitancy related to COVID-19 vaccine(s). We analyzed user comment threads in response to news reports regarding COVID-19 vaccines on the Canadian Broadcasting Corporation national news website (with as many as 9.4 million unique visitors per day). User comments (n = 1145) were extracted from 19 articles between March 2020 and June 15th, 2020. Comments were then coded inductively for content to establish a coding framework that was subsequently applied to the dataset. Our data provide empirical support for misrepresentation as a form of misinformation and further demonstrate the utility of social media content as data for social research that informs public health communication materials. The data point to the need for, and value of, rapid communication interventions to foster vaccine acceptance. False information will continue to create challenges for delivering COVID-19 vaccines. Communication strategies to get ahead of the pace of misinformation are critical, particularly in light of boosters and the possibility of COVID-19 vaccination on an annual basis.

Psycho-behavioural factors influencing COVID-19 vaccine hesitancy among Korean adults: The moderating role of age

Aims

This study aimed to identify the psycho‐behavioural factors influencing coronavirus disease 2019 (COVID‐19) vaccine hesitancy among Korean adults. We examined the primary effects of eHealth literacy, social responsibility and self‐efficacy on COVID‐19 vaccine hesitancy using the information‐motivation‐behavioural skills (IMB) model. The moderating effect of age on the relationship between psycho‐behavioural factors and COVID‐19 vaccine hesitancy was also examined.

Design

The study used a cross‐sectional survey design.

Methods

An online survey was completed by 500 Korean adults (253 men and 247 women) aged 20–60 years. Data collection took place in May 2021. The constructed hypothetical model for eHealth literacy, social responsibility, self‐efficacy and age was evaluated using partial least squares structural equation modelling (PLS‐SEM).

Results

eHealth literacy, social responsibility and self‐efficacy had significant negative effects on COVID‐19 vaccine hesitancy. Age had a significant moderating effect on COVID‐19 vaccine hesitancy. The moderating effects of age on the relationship between eHealth literacy and COVID‐19 vaccine hesitancy and between social responsibility and COVID‐19 vaccine hesitancy enhanced the explanatory power by high effect size. The overall fitness of the hypothetical model was good. The standardized root mean square residual value was 0.007, which explained 18.5% of the COVID‐19 vaccine hesitancy.

Conclusion

To reduce COVID‐19 vaccine hesitancy among Korean adults, a strategic approach that considers age should be adopted to enhance eHealth literacy, social responsibility and self‐efficacy.

Impact

The findings of this study suggest that providing correct health information online related to the COVID‐19 vaccine is likely to be effective in decreasing COVID‐19 vaccine hesitancy in older individuals, whereas inspiring a sense of social responsibility is more likely to be effective in younger individuals. These strategic nursing interventions could contribute to improving COVID‐19 vaccination rates among Korean adults.

Vaccine Hesitancy Under the Magnifying Glass: A Systematic Review of the Uses and Misuses of an Increasingly Popular Construct

Resistance to vaccines has hindered attempts to contain and prevent outbreaks of infectious diseases for centuries. More recently, however, the term "vaccine hesitancy" has been used to describe not necessarily outright resistance but also a delay in acceptance or uncertainty regarding vaccines. Given concerns about hesitancy and its impact on vaccine uptake rates, researchers increasingly shifted the focus from resistance to vaccines toward vaccine hesitancy. Acknowledging the urgency to accurately assess the phenomenon, it is critical to understand the state of the literature, focusing on issues of conceptualization and operationalization. To carry out this systematic review, we collected and analyzed all published empirical articles from 2000 to 2021 that explicitly included quantitative self-report measures of vaccine hesitancy (k = 86). Using a mixed-method approach, the review demonstrates and quantifies crucial inconsistencies in the measurement of the construct, lack of clarity in regard to the determination of who should or should not be defined as hesitant, and overreliance on unrepresentative samples. Crucially, our analysis points to a potential systematic bias toward exaggerating the level of hesitancy in the population. Modeling a vaccine hesitancy co-citation network, the analysis also points to the existence of insular academic silos that make it harder to achieve a unified measurement tool. Theoretical and practical implications for academics, practitioners, and policymakers are discussed.

COVID-19 Vaccine Hesitancy: The Role of Information Sources and Beliefs in Dutch Adults

COVID-19 vaccine hesitancy may be regarded as a new pandemic hindering the elimination of or coping with COVID-19. This study assessed reasons for COVID-19 vaccine hesitancy using the I-Change Model (ICM) by considering the role of informational and psychosocial factors. A cross-sectional online survey using a convenience sample was conducted among Dutch adults (n = 240). The questionnaire assessed information factors, predisposing factors, awareness factors, motivational factors, preparatory actions, and vaccination intention. Vaccine hesitant participants (n = 58, 24%) had lower levels of education, more often paid work, and tended to have a religion other than Catholicism. They used written media less often and tended to visit websites of public health organizations less often, but used messaging services like WhatsApp more frequently. All participants had neutral intentions towards checking information credibility. Vaccine hesitant respondents had less knowledge about vaccination, lower perceived severity of getting sick and dying of COVID-19, and reported fewer exposures to cues about the advantages of COVID-19 vaccination. They were less convinced of the emotional and rational advantages of COVID-19 vaccination and expressed more negative feelings about it. They also reported more negative social norms concerning COVID-19 vaccination, and lower self-efficacy to get vaccinated and to cope with potential side-effects. The regression model explained 58% of the variance in vaccination intention. The results suggest that strategies are needed to: 1. Reduce fake news and stimulate information checking to foster well-informed decision-making; 2. Target both rational and emotional consequences of COVID-19, in addition to strategies for optimizing levels of knowledge. Campaigns should acknowledge the perceptions of the emotional disadvantages and increase perceptions of emotional advantages of COVID-19 vaccinations, such as reducing feelings of regret, and increasing feelings of freedom and reassurance.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry

In response to the COVID-19 pandemic, scientists coordinated a complex immunization effort that developed and distributed vaccines by December 2020. This study aimed to explain COVID-19 vaccination decision-making process to inform vaccine communication with patients and the public. Building on quantitative research on COVID-19 vaccine hesitancy, we conducted a grounded theory study, collecting 30 qualitative interviews with employees at a U.S. university that provided vaccine eligibility in December 2020. Analysis followed the Sort and Sift, Think and Shift method. Participants who had chosen to receive the vaccine and those who had not both described five factors that impacted their decision-making: emotional response, understanding, personal values, culture, and social norms. Across these factors, we identified three cross-cutting themes: time, trust, and communication tactics. In a time of emerging science and changing answers, the constant introduction of new information created information overload for participants. COVID-19 vaccine development was a "grand experiment globally," which required trust, not only knowledge, to overcome hesitancy. The complex information environment surrounding COVID-19 vaccination requires multi-level intervention that cannot rely on knowledge translation alone. We need to help patients build trusting relationships with experts that can create scaffolding for future information processing.

eHealth literacy of patients attending a primary care clinic in Malaysia and its associated factors: A cross-sectional study

BACKGROUND

People are overloaded with online health information (OHI) of variable quality. eHealth literacy is important for people to acquire and appraise reliable information to make health-related decisions. While eHealth literacy is widely studied in developed countries, few studies have been conducted among patients in low- and middle-income countries (LMICs).

OBJECTIVE

We aimed to determine the level of eHealth literacy in patients attending a primary care clinic in Malaysia and its associated factors.

METHODS

A cross-sectional study using a self-administered questionnaire was conducted in an urban primary care clinic. We used a systematic random sampling method to select patients aged 18 years and above who attended the clinic. The eHealth literacy scale (eHEALS) was used to measure eHealth literacy.

RESULTS

A total of 381 participants were included. The mean eHEALS was 24.4 ± 7.6. The eHEALS statements related to skills in appraising OHI were scored lower than statements related to looking for online resources. Higher education level of attending upper secondary school (AOR 2.53, 95% CI 1.05-6.11), tertiary education (AOR 4.05, 95% CI 1.60-10.25), higher monthly household income of >US$470 (AOR 1.95, 95% CI 1.07-3.56), and those who had sought OHI in the past month (AOR 1.95, 95% CI 1.13-3.36) were associated with a higher eHealth literacy level.

CONCLUSIONS

This study found a low eHealth literacy level among primary care patients in Malaysia. While the patients were confident in searching for OHI, they lacked skills in appraising them. Our findings inform the interventions for improving eHealth literacy in LMICs, especially educating the public about OHI appraisal.

A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends

Objective: To sort out the research focuses in the field of e-health literacy, analyze its research topics and development trends, and provide a reference for relevant research in this field in the future. Methods: The literature search yielded a total of 431 articles retrieved from the core dataset of Web of Science using the keywords “ehealth literacy”, “E-health literacy” and “electronic health literacy”. A bibliometric analysis was performed by using CiteSpace to explore the development history, hot themes, and trends of future research in the field of e-health literacy. Results: The thematic evolution path in e-health literacy was divided into three stages. The research focuses were inspected from four aspects: evaluation, correlation with health-promotion behaviors, influencing factors, and intervention measures for improvement. Conclusion: E-health literacy research faces challenges such as the development of the connotation of the term, the objectivity of evaluation methods, and the long-term impact of interventions. Future research themes in e-health literacy will include the standardization of evaluation instruments and the individualization of therapeutic strategies.

A Framework of AI-Based Approaches to Improving eHealth Literacy and Combating Infodemic

The global COVID-19 pandemic has put everyone in an urgent need of accessing and comprehending health information online. Meanwhile, there has been vast amount of information/misinformation/disinformation generated over the Internet, particularly social media platforms, resulting in an infodemic. This public health crisis of COVID-19 pandemic has put each individual and the entire society in a test: what is the level of eHealth literacy is needed to seek accurate health information from online resources and to combat infodemic during a pandemic? This article aims to summarize the significances and challenges of improving eHealth literacy in both communicable (e.g., COVID-19) and non-communicable diseases [e.g., cancer, Alzheimer's disease, and cardiovascular diseases (CVDs)]. Also, this article will make our recommendations of a general framework of AI-based approaches to improving eHealth literacy and combating infodemic, including AI-augmented lifelong learning, AI-assisted translation, simplification, and summarization, and AI-based content filtering. This general framework of AI-based approaches to improving eHealth literacy and combating infodemic has the general advantage of matching the right online health information to the right people.

"Until I Know It's Safe for Me": The Role of Timing in COVID-19 Vaccine Decision-Making and Vaccine Hesitancy

Managing the COVID-19 pandemic-and other communicable diseases-involves broad societal uptake of vaccines. As has been demonstrated, however, vaccine uptake is often uneven and incomplete across populations. This is a substantial challenge that must be addressed by public health efforts. To this point, significant research has focused on demographic and attitudinal correlates with vaccine hesitancy to understand uptake patterns. In this study, however, we advance understandings of individual decision-making processes involved in vaccine uptake through a mixed-methods investigation of the role of timing in COVID-19 vaccine choices. In the first step, a survey experiment, we find the timing of vaccine rollout (i.e., when a vaccine becomes available to the respondent) has a significant impact on public decision-making. Not only is there a higher level of acceptance when the vaccine becomes available at a later time, but delayed availability is correlated with both lower levels of 'desire to wait' and 'total rejection' of the vaccine. In a second step, we explore associated qualitative data, finding that temporal expressions (i.e., professing a desire to wait) can serve as a proxy for underlying non-temporal rationales, like concerns around safety, efficacy, personal situations, or altruism. By identifying these patterns, as well as the complexities of underlying factors, through a mixed-methods investigation, we can inform better vaccine-related policy and public messaging, as well as enhance our understanding of how individuals make decisions about vaccines in the context of COVID-19.

Changes in Behaviors and Attitudes in Response to COVID-19 Pandemic and Vaccination in Healthcare Workers and University Students in Italy

The objectives of the cross-sectional study were to measure how behaviors and attitudes about preventive measures toward COVID-19 changed over time among Italian vaccinated healthcare workers and university students, and the associated characteristics. The study was carried out between February and March 2021 in the city of Naples, Campania region, Southern Italy. The perceived personal risk of being infected by SARS-CoV-2 after the vaccination was significantly higher among males, in those having a higher perceived personal risk of being infected by SARS-CoV-2 before the vaccination, and in those who were more concerned about the efficacy of the vaccination. The fear of getting the disease as reason to have the COVID-19 vaccination was reported more frequently in younger participants, in those with at least one chronic medical condition, in those with a higher concern about the severity of COVID-19, in those with a higher level of trust in the information received, and in those who acquired information from scientific journals. Overall, 21.3% were willing to engage the three main public health measures (wearing a mask, careful hand washing, physical distancing) after receiving the second dose of the vaccination compared to the behavior before the pandemic began. This willingness was predicted by a higher level of trust in the information received and by a lower self-rated health status. Only 0.1% of participants were willing to engage all three measures after receiving the second dose of the vaccination compared to the behavior before receiving the first dose. These findings are useful in order to develop information strategies regarding vaccine safety and efficacy and the importance of public health measures against COVID-19.

The effects of misinformation on COVID-19 vaccine hesitancy in Bangladesh

Purpose

The main purpose of this study is to assess the prevalence of COVID-19 vaccine hesitancy among the general population in Bangladesh and the role of misinformation in this process.

Design/methodology/approach

An online survey was conducted to assess COVID-19 vaccine hesitancy among ordinary citizens. In addition to demographic and vaccine-related information, a five-point Likert scale was used to measure vaccine-related misinformation beliefs and how to counter them. Chi-square tests were used to examine the relationship between demographic variables and vaccine acceptance. A binary logistic regression analysis was conducted to identify vaccine hesitancy by different demographic groups. Nonparametric Mann–Whitney and Kruskal–Wallis tests were performed to determine the significance of difference between demographic groups in terms of their vaccine-related misinformation beliefs. Finally, the total misinformation score was computed to examine the correlation between vaccine hesitancy and the total score.

Findings

This study found that nearly half of the respondents were willing to receive COVID-19 vaccine, whereas more than one third of the participants were unsure about taking the vaccine. Demographic variables (e.g., gender, age and education) were found to be significantly related to COVID-19 vaccine acceptance. The results of binary logistic regression analysis showed that respondents who were below 40 years of age, females and those who had lower education attainments had significantly higher odds of vaccine hesitancy. There were significant differences in participants’ vaccine-related misinformation beliefs based on their demographic characteristics, particularly in the case of educational accomplishments. A highly significant negative correlation was found between total misinformation score and vaccine acceptance.

Research limitations/implications

The survey was conducted online, and therefore, it automatically precluded non-internet users from completing the survey. Further, the number of participants from villages was relatively low. Overall, the results may not be representative of the entire population in Bangladesh.

Practical implications

The findings of this paper could guide government agencies and policymakers in devising appropriate strategies to counter COVID-related misinformation to reduce the level of vaccine hesitancy in Bangladesh.

Originality/value

To the authors’ best knowledge, this study is the first to measure the level of COVID-19 vaccine hesitancy and the influence of misinformation in this process among the general public in Bangladesh.

Likelihood of COVID-19 vaccination by subgroups across the US: post-election trends and disparities

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted older individuals, those with lower educational attainment, and Black and Hispanic populations, yet vaccine hesitancy remains prevalent. Because widespread uptake of COVID-19 vaccines is critical to end the pandemic, addressing vaccine hesitancy is an important public health priority. Between April 1, 2020 and March 16, 2021, we have repeatedly surveyed a nationally representative online panel of adults and have tracked their stated likelihood of getting COVID-19 vaccinations. We present new evidence that in recent months disparities in self-reported likelihood of COVID-19 vaccination have narrowed by race/ethnicity, with an increasing proportion of Black individuals and Hispanic individuals indicating that they are likely to get a vaccine. At the same time, younger adults have progressively become less likely than older adults to state they will get a COVID-19 vaccine. Most vaccine-hesitant individuals are concerned about both vaccine efficacy and safety and do not trust the vaccine development or vaccine approval process. We conclude that outreach efforts to minority populations may be achieving their objectives in raising confidence in COVID-19 vaccines, but special outreach efforts are needed to address both vaccine hesitancy among younger adults and mistrust in the vaccine development and approval process.

COVID-19 vaccine hesitancy among women leaving jails: A qualitative study

In many correctional facilities across the United States, COVID-19 vaccine refusal rates are as high as 50%. Most women leaving jails have low SES, health literacy, and mistrust of governmental institutions, thus exacerbating existing health disparities and making women leaving jail vulnerable. Data from 25 interviews with recently released women suggest that interventions to promote vaccines to this population will have to address health education and mitigate mistrust, misinformation, and conspiracy theories.

Effect of Internet use for searching information on vaccination on the uptake of human papillomavirus vaccine in France: A path-analysis approach

Internet is a popular source of information regarding vaccination. This study aimed to determine whether there is a negative association between Internet use among French vaccine-hesitant mothers and HPV vaccine uptake by their daughters, and to gain insight into the pathways that would link Internet use to the lack of HPV vaccine uptake. We conducted a pooled cross-sectional analysis across the 2015, 2016, 2017 and 2018 Vaccinoscopie® Survey. Multivariate logistic regression and path models were used in the analysis. The study sample included a total of 2038 respondent mothers. Of those, 89 (4.4%) declared having never been in the situation of searching for information regarding a vaccination they had hesitated about, leaving 1949 mothers for the present analysis. Approximately 24% (466/1949) of the mothers declared using the Internet as a source of vaccine information. In multivariate logistic regression adjusted for physician recommendation of HPV vaccination, attitudes towards vaccines in general, perception of HPV vaccine usefulness, maternal level of education, region of residence, and the survey year, the use of Internet by the mothers was significantly associated with a lower HPV vaccination among their daughters (adjusted odds ratio (aOR), 0.66; 95% confidence interval (CI), 0.47-0.91). Path analysis further confirmed the negative effect of Internet use (β = -0.10, standard error (SE) = 0.02, P < 0.0001), highlighting how the Internet plays a detrimental role in HPV vaccine uptake through a lower perceived level of HPV vaccine usefulness, a lower perceived level of information on childhood vaccination, and unfavorable attitudes towards vaccination in general.