(S)pin the Flu Vaccine: Recipes for Concern

"The prevalence of vaccine misinformation on social media is increasing, but the visual platform Pinterest is understudied in this area."

Vaccine myths are prevalent on the internet and social networking sites, which allow for individuals to disseminate false information to their peer networks. Photo-sharing platform Pinterest was an early actor among social media platforms in responding to misinformation, first disabling searches for pins with vaccine-related information, then announcing they would only show vaccine information from public health organisations. Pinterest's visual nature is of particular interest, since messages that include visuals tend to be more memorable, engaging, and motivating than text alone. Furthermore, Pinterest has a primarily female user base, and women often play a central role in their families' healthcare decisions. This study explores the content and nature of influenza vaccine information that is shared on Pinterest.

The study involved an analysis of 500 flu-vaccine-related Pinterest posts collected on October 9 2018 through manual systematic random sampling, using keywords "flu vaccine" and "flu vaccination". In addition to assessing what percentage of posts on Pinterest describe influenza vaccination positively versus negatively, the researchers analysed the messages for how individuals discussed the severity, susceptibility, and efficacy of obtaining an influenza vaccine, using concepts from the Health Belief Model (HBM). The researchers also considered the source of the vaccine message and the presence of exemplars in the posts, such as visual fear appeals, as well as the characteristics of any individuals appearing in the message.

Overall, 70.8% (n = 359) of pins expressed either a positive or negative attitude toward the flu vaccine; of these, 52.5% were pro-flu vaccine, while 47.5% were anti-flu vaccine. With regard to HBM constructs, roughly equal numbers of pins mentioned the perceived benefits of the flu vaccine (25.0%, n = 125) or perceived barriers to the flu vaccine (25.8%, n = 129), and cues to action to get the vaccine were present in 23.0% (n = 115) of the posts, with cues to actions to refuse the vaccine were present in 11.8% (n = 59) of the pins. (The other HBM constructs were not frequently present.) Turning to the sources of flu vaccination pins, most pins 65.8%, (n = 329) originated with individuals, while only about 5% were published by government entities such as public health departments and official medical entities such as hospitals. Of the pins shared from Pinterest influencer accounts, 72.3% (n = 86) were pro-flu vaccine, while 27.7% (n = 33) were anti-flu vaccine; of the pins shared from sources external to Pinterest, only 42.6% (n = 100) were pro-flu vaccine, and 57.4% (n = 135) were anti-flu vaccine.

With regard to exemplars within the post, the majority of persons portrayed in pin visuals were White (84.7%, n = 171); this may leave out people who could be positively influenced or who should be persuaded to get the vaccine. Medical professionals appeared in 36.6% (n = 74) of the pins with people; 11.6% (n = 58) showed healthcare professionals promoting the flu vaccine, whereas 7.0% (n = 35) showed them opposing the vaccine. Moreover, close to half of the sample (47.6%, n = 238) used a fear visual - e.g., a needle (79.8%, n = 190) or a large needle (49.6%, n = 118). Overall, pins that are negative about the flu vaccine - for example, discussing side effects, fear visuals, or self-efficacy to decline the flu vaccine - tended to result in higher engagement with those pins than posts with positive elements about the flu vaccine.

This study suggests that a search for the flu vaccine on Pinterest provides a more balanced picture than anticipated, with a roughly equal percentage of posts supporting and posts critiquing the flu vaccine. Similarly, perceived benefits of the flu vaccines and perceived barriers to the vaccine were each present in approximately one-quarter of the total sample. Finally, posts originating with Pinterest influencers, which may be more likely to be spread on the platform, were more likely to be pro-flu vaccine.

However, the presence of many vaccine-hesitant posts is still an area of concern, and pins associated with higher engagement appeared to be primarily associated with anti-vaccine variables and constructs. Also, the fact that only 5% of all posts were confirmed to originate with public health agencies is worrisome, as this voice is often likely to be one to provide trustworthy and reliable information. Another concern related to the study's results is that the construct of perceived threat (how serious the flu is perceived to be, and how susceptible people think they themselves are) was barely present, meaning that even correct posts about the flu in this sample may not have made a Pinterest user more likely to decide to get the flu shot. Furthermore, few posts contained self-efficacy claims. Because self-efficacy is a strong predictor of vaccine uptake, the researchers suggest that content on social media should aim to increase this determinant, especially if simultaneously discussing the threat of the flu.

Although social media platforms are increasingly taking steps to correct or block false information and to promote reliable information, these measures alone likely will not be enough. "Once misinformation has taken hold, it is notoriously hard to correct," the study's lead author said in an interview. "We need more research in how to communicate about these issues on social media, and how to truly address fears and concerns people may have, as well as continue to build trust in, particularly, the future COVID-19 vaccine."