Elsevier

Vaccine

Volume 33, Issue 39, 22 September 2015, Pages 5051-5056
Vaccine

On pins and needles: How vaccines are portrayed on Pinterest

https://doi.org/10.1016/j.vaccine.2015.08.064Get rights and content

Highlights

  • This study analyzed 800 vaccine-related Pinterest posts.

  • The majority of the pins were anti-vaccine.

  • Concerns about vaccine safety and side effects were oft-repeated themes.

  • Perceived barriers appeared in more than half of the pins.

Abstract

Vaccination is an effective public health tool for reducing morbidity and mortality caused by infectious diseases. However, increasing numbers of parents question the safety of vaccines or refuse to vaccinate their children outright. The Internet is playing a significant role in the growing voice of the anti-vaccination movement as a growing number of people use the Internet to obtain health information, including information about vaccines. Given the role the Internet plays in providing vaccination-related communication, coupled with limited research in this area, this study focused on the social media platform Pinterest, analyzing 800 vaccine-related pins through a quantitative content analysis. The majority of the pins were anti-vaccine, and most were original posts as opposed to repins. Concerns about vaccine safety and side effects were oft-repeated themes, as was the concept of conspiracy theory. Pro-vaccine pins elicited consistently more engagement than anti-vaccine pins. Health educators and public health organizations should be aware of these dynamics, since a successful health communication campaign should start with an understanding of what and how publics communicate about the topic at hand.

Introduction

Public voicing of anti-vaccination sentiment has been increasing [1]. Common themes are that vaccines are ineffective, useless, or dangerous [1]; children receive too many vaccines at once [2]; and mandatory vaccination infringes on civil liberties and parental rights [3], [4]. Additionally, many parents believe that vaccine-preventable diseases no longer present a serious health risk because they lack personal experience with these diseases [5], [6]. Given the significant public health implications of vaccine rejection (e.g., [7]), it is important to understand the content of vaccine-related information the public is using to make these decisions.

Many people search for health information on the Internet and, although Internet searches lead to public health versus anti-vaccination websites with about equal likelihood [8], [9], anti-vaccination messages are more commonly found on the Internet than in print or broadcast media [1]. Visiting anti-vaccination websites for 5–10 min can increase perceptions of vaccination risks and decrease intentions to vaccinate [23]. Parents who do not vaccinate their children are more likely to have searched for vaccination information online and from more sources in general than parents who fully vaccinate their children [8], [10], [11]. Anti-vaccination websites are likely to use narrative appeals, including personal stories accompanied by photos, which can increased risk perceptions and decrease vaccination intentions [12].

Across the few studies of vaccination representation on social media to date, results have been mixed. Briones and co-workers [4] found that most HPV-vaccine focused videos on YouTube were negative in tone and ‘liked’ more often by viewers than positive or neutral videos. An earlier study focused on general vaccination-themed videos on YouTube found a higher percentage of positive videos (48% positive, 32% negative, and 20% ambiguous), although the negative videos in their study received more ratings and ‘likes’, and the content often included unsubstantiated medical claims [13]. Another study about the HPV vaccine among MySpace blog posts found a similar ratio of positive versus negative (52% positive, 43% negative, and 6% ambiguous). Finally, the sole Twitter study available indicated that the majority of tweets about vaccination promoted substantiated medical information [7]. These studies address more established social media platforms, whereas Pinterest is a newer visual social media platform that has not received much academic attention.

There is a paucity of available research on the portrayal of vaccines and vaccinations on social media channels in general, and no studies to date have been published on Pinterest and vaccination representations. Visually focused social media platforms are widely seen as an area of continued growth, and users spend significantly more time per visit on Pinterest (14.2 min) than on most other social media platforms. With a third of online women in the US using Pinterest as of 2013 [14], and a majority of Americans searching for health information online, it is important to understand what vaccination information is available on such a popular social media platform. This study, therefore, addresses the following research questions:

RQ1

How are vaccinations portrayed on Pinterest?

RQ2

How do Pinterest users engage with vaccination content on the platform?

The design of social and behavioral health interventions (such as a campaign to increase vaccinations) can best be done with a clear understanding of theories of behavior change [15, pp. 25–26]. The Health Belief Model (HBM), developed in the 1950s as a framework to explain health behaviors, is one of the most common theories used to study health-related behavior and has been used to predict several types of vaccine uptakes [15], [16]. The HBM's main constructs, as applied to vaccinations, are perceived susceptibility (what is the likelihood of contracting the disease), perceived severity (how serious is the disease, if contracted), perceived benefits (how effective is the vaccine in protecting against the disease), perceived barriers (what are the perceived costs of receiving the vaccine, such as vaccine safety and potential or feared side effects), and self-efficacy (belief that one can successfully take the steps to get vaccinated or get their kids vaccinated) [16], [17]. Gerend and Shepherd [16], for example, found that perceived susceptibility and perceived barriers were significant predictors of HPV vaccine uptake among young adult women. Since no data is available on how HBM constructs are expressed in vaccine-focused Pinterest pins, research is needed to determine what the prevalent expressed constructs are, providing a baseline for communications and medical professionals who endeavor to address the issue of vaccinations on Pinterest. The third research question, therefore, is:

RQ3

How are HBM constructs represented in vaccination-focused Pinterest pins?

Kata [3] described two prominent content themes in the online anti-vaccination environment: conspiracy theories and the concept of violation of civil liberties. The majority of anti-vaccination websites frame the fight against vaccines as a struggle against government and pharmaceutical cover-ups as well as an exclusive pursuit of profits [18]. In the abovementioned study of HPV-vaccine-focused YouTube videos by Briones et al. [17], researchers found that 20% of the videos addressed the concept of civil liberties, while a small percentage mentioned conspiracy theories. More broadly, there is a growing part of the population that mistrusts both government, the pharmaceutical industry, and public health officials with regard to vaccines and their safety [9]. In order to find out if either content theme is prevalent on Pinterest, the fourth research question is:

RQ4

To what extent do vaccination-related Pinterest pins mention issues related to conspiracy theories and civil liberties?

The available literature highlights the use of narratives in anti-vaccination materials [12]. Pinterest, with its visual focus, lends itself to the use of narratives. Since narratives are perceived as a potential strategy to communicate pro-vaccination messages, it is important to discover if anti-vaccine pins use narratives more frequently than statistical information on this social media channel, as well [8]. The hypothesis, therefore, is:

H1

Anti-vaccine messages on Pinterest will use narrative vaccination information more frequently, whereas pro-vaccine messages will use statistical representations more frequently.

Section snippets

Methodology

This study analyzed information relating to vaccinations on Pinterest. Drawing upon existing literature, we used four keywords to select the Pinterest posts (hereafter identified as “pins”) for the sample: “vaccination,” “vaccine,” “vaccines,” and “vaccinate” [7], [13], [17], [19]. Pins were sampled by choosing every fifth applicable pin for analysis. On March 19, 20, and 21 of 2014, each fifth pin for each keyword search was selected by scrolling down the page with search results. Each pin

Results

The data collected through content analyses of 800 Pinterest pins was imported into and analyzed using Statistical Package for the Social Sciences version 22.

Research question one asked how vaccinations are portrayed on Pinterest. The overarching stance of the pins was decidedly anti-vaccine: 74.0% (n = 592) fell in this category; 18% (n = 144) represented a pro-vaccine stance; 6.9% (n = 55) were neutral in tone; 1.1% (n = 9) undetermined (see Table 2 for complete results, and see Fig. 1, Fig. 2, Fig. 3

Discussion

This study is among the first to analyze the portrayal of vaccinations on the social media platform Pinterest. A quantitative content analysis of 800 pins showed that the majority of pins portray vaccinations in a negative light. Importantly, vaccination portrayals on YouTube were 74.7% pro-vaccine in Ache et al.’s [19] HPV vaccine study, 32% pro-vaccine in Briones et al.’s [17] HPV vaccine study, and now only 24.0% pro-vaccine in this general vaccine study. Although these studies vary in their

Conflict of interest

The authors have no conflict of interest to disclose.

References (25)

  • A. Kitta

    Vaccinations and public concern in history: legend, rumor, and risk perception

    (2012)
  • D.E. Sugerman et al.

    Measles outbreak in a highly vaccinated population, San 351 Diego, 2008: role of the intentionally undervaccinated

    Pediatrics

    (2010)
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