Exploring Parents' Views of the Use of Narratives to Promote Childhood Vaccination Online

"With the public's growing use of social media to inform health decisions, it is vital for public health experts to understand these platforms and how they could be mobilized for vaccine promotion interventions..."

Many experts have cited the ubiquity of anti-vaccine discourse on the internet, particularly on social media sites, as a key driver of vaccine hesitancy. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination.

The researchers identified three approximately 4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination:

• Narrative #1: Parents' informed decision making: A mother and a father share that they did not get their first child vaccinated because others in their social network shared negative comments about vaccines, which made them hesitant. The parents note that, as they became better informed about childhood vaccinations, they made an informed decision and decided to have both their sons immunised as the best way to protect their health. The video ends with the parents recommending looking for evidence-based information about vaccination and warning other parents about online misinformation.
• Narrative #2: A paediatrician's story: A doctor recounts difficult cases he had to handle with young children suffering and eventually dying of vaccine-preventable diseases (VPDs). The video ends with the him reminding viewers of the importance of vaccinating children. (See video below.)
• Narrative #3: A mother's story: A mother recounts the story of her son's illness and hospitalisation due to a meningococcal disease, describing the challenges of living with a child with severe disabilities. The video ends with a call to vaccinate by the mother.

The researchers then held virtual focus group discussions with 15 parents of children aged 0 to 5 years, who considered themselves somewhat or very hesitant towards vaccination and who lived in Québec, Canada. The goal was to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention.

In general, parents trusted both healthcare providers' and parents' narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with VPDs were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned they generally are not watching such videos while navigating the Web. Some parents suggested presenting such narratives in waiting rooms of medical clinics to prompt further discussion about vaccination with healthcare providers. Others noted that these narratives could complement written information on governmental or hospital websites.

In short: "While invoking negative emotions, guilt or fear in vaccine promotion interventions could create a backfire effect and be counter productive, most participants thought it was a good strategy to counterbalance vaccine critical stories that are shared online..." One specific recommendation: Because messages focused only on benefits of vaccination tend to be deemed less credible and trustworthy, narratives should not overemphasise the benefits of vaccines (e.g., no vaccine is 100% effective and 100% safe) and should include information about the potential risks of vaccines (e.g., mild and common adverse events after immunisation, rare risk of severe adverse events).

In conclusion: "Although recent studies have shown positive impact of debunking myths on vaccination acceptance, these approaches can backfire for the highly hesitant....By promoting messages on the importance of vaccination to prevent disease instead of focusing on specific myths, the use of narratives is a promising approach....As some participants suggested, it could be beneficial for online narratives in a video format to feature on governmental pages about vaccine information to make a decision....Larger quantitative studies are needed to assess the reach and impact of such an intervention."