%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67487 %T Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study %A Li,Mingyan %A Sun,Changxuan %A Ji,Chai %A Gao,Meiying %A Wang,Xia %A Yao,Dan %A Guo,Junxia %A Sun,Lidan %A Rafay,Abdul %A George,Antonita Shereen %A Muhandiramge,Sanduni Hasara Samararathna Samararathna %A Bai,Guannan %K COVID-19 %K caregivers %K children with special health care needs %K vaccination hesitancy %K decision-making %D 2025 %7 26.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers’ vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers’ attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers’ willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers’ willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers’ vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26%, n=3148, 57.4%, and n=3442, 62.7%, respectively) than those at other 2 stages. In comparison, caregivers’ hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6% and n=2045, 37.3%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children’s age and sex, parents’ educational level, comorbidities, and history of allergy, were significantly associated with caregivers’ attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers’ willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers’ willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. %R 10.2196/67487 %U https://publichealth.jmir.org/2025/1/e67487 %U https://doi.org/10.2196/67487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68881 %T Understanding Human Papillomavirus Vaccination Hesitancy in Japan Using Social Media: Content Analysis %A Liu,Junyu %A Niu,Qian %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ , Kyoto University, Yoshida-honmachi, Sakyo-Ku, Kyoto, 606-8501, Japan, 81 075 751 3952, aoyama.tomoki.4e@kyoto-u.ac.jp %K human papillomavirus %K HPV %K HPV vaccine %K vaccine confidence %K large language model %K stance analysis %K topic modeling %D 2025 %7 11.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the reinstatement of proactive human papillomavirus (HPV) vaccine recommendations in 2022, Japan continues to face persistently low HPV vaccination rates, which pose significant public health challenges. Misinformation, complacency, and accessibility issues have been identified as key factors undermining vaccine uptake. Objective: This study aims to examine the evolution of public attitudes toward HPV vaccination in Japan by analyzing social media content. Specifically, we investigate the role of misinformation, public health events, and cross-vaccine attitudes (eg, COVID-19 vaccines) in shaping vaccine hesitancy over time. Methods: We collected tweets related to the HPV vaccine from 2011 to 2021. Natural language processing techniques and large language models (LLMs) were used for stance analysis of the collected data. Time series analysis and latent Dirichlet allocation topic modeling were used to identify shifts in public sentiment and topic trends over the decade. Misinformation within opposed-stance tweets was detected using LLMs. Furthermore, we analyzed the relationship between attitudes toward HPV and COVID-19 vaccines through logic analysis. Results: Among the tested models, Gemini 1.0 pro (Google) achieved the highest accuracy (0.902) for stance analysis, improving to 0.968 with hyperparameter tuning. Time series analysis identified significant shifts in public stance in 2013, 2016, and 2020, corresponding to key public health events and policy changes. Topic modeling revealed that discussions around vaccine safety peaked in 2015 before declining, while topics concerning vaccine effectiveness exhibited an opposite trend. Misinformation in topic "Scientific Warnings and Public Health Risk" in the sopposed-stance tweets reached a peak of 2.84% (47/1656) in 2012 and stabilized at approximately 0.5% from 2014 onward. The volume of tweets using HPV vaccine experiences to argue stances on COVID-19 vaccines was significantly higher than the reverse. Conclusions: Based on observation on the public attitudes toward HPV vaccination from social media contents over 10 years, our findings highlight the need for targeted public health interventions to address vaccine hesitancy in Japan. Although vaccine confidence has increased slowly, sustained efforts are necessary to ensure long-term improvements. Addressing misinformation, reducing complacency, and enhancing vaccine accessibility are key strategies for improving vaccine uptake. Some evidence suggests that confidence in one vaccine may positively influence perceptions of other vaccines. This study also demonstrated the use of LLMs in providing a comprehensive understanding of public health attitudes. Future public health strategies can benefit from these insights by designing effective interventions to boost vaccine confidence and uptake. %M 39933163 %R 10.2196/68881 %U https://www.jmir.org/2025/1/e68881 %U https://doi.org/10.2196/68881 %U http://www.ncbi.nlm.nih.gov/pubmed/39933163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52871 %T The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation %A Béchard,Benoît %A Gramaccia,Julie A %A Gagnon,Dominique %A Laouan-Sidi,Elhadji Anassour %A Dubé,Ève %A Ouimet,Mathieu %A de Hemptinne,Delphine %A Tremblay,Sébastien %+ School of Psychology, Université Laval, 2325 Allée des Bibliothèques, Pavillon Félix-Antoine-Savard, Québec, QC, G1V 0A6, Canada, 1 4186565383, benoit.bechard.1@ulaval.ca %K attitude toward vaccination %K misinformation %K reinformation %K confidence %K perceived tentativeness %K vaccine hesitancy %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (χ21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual’s level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals’ perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one’s opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 %M 39413215 %R 10.2196/52871 %U https://formative.jmir.org/2024/1/e52871 %U https://doi.org/10.2196/52871 %U http://www.ncbi.nlm.nih.gov/pubmed/39413215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56559 %T Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment %A Staras,Stephanie A S %A Tauscher,Justin %A Vinson,Michelle %A Thompson,Lindsay A %A Gerend,Mary A %A Shenkman,Elizabeth A %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Road, Room 7005, Gainesville, FL, 32611, United States, 1 (352)294 8299, sstaras@ufl.edu %K participatory design %K think-aloud %K implementation science %K adolescent vaccination %K human papillomavirus vaccine %K usability %K eHealth %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents’ vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app’s usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child’s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents’ children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. %M 39298761 %R 10.2196/56559 %U https://formative.jmir.org/2024/1/e56559 %U https://doi.org/10.2196/56559 %U http://www.ncbi.nlm.nih.gov/pubmed/39298761 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e49366 %T Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study %A Kazi,Abdul Momin %A Ahsan,Nazia %A Jabeen,Rawshan %A Allana,Raheel %A Jamal,Saima %A Mughal,Muhammad Ayub Khan %A Hopkins,Kathryn L %A Malik,Fauzia Aman %+ Aga Khan University, Stadium Road, Karachi, Pakistan, 92 3002139610, momin.kazi@aku.edu %K infodemics %K mHealth %K social media %K electronic media %K Pakistan %K vaccination %K misinformation %K infodemiology %K mobile phone %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. Objective: We aimed to explore the effects of COVID-19–related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. Methods: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. Results: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media–driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. Conclusions: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale. %M 39231430 %R 10.2196/49366 %U https://infodemiology.jmir.org/2024/1/e49366 %U https://doi.org/10.2196/49366 %U http://www.ncbi.nlm.nih.gov/pubmed/39231430 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52926 %T Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies %A Fallucca,Alessandra %A Priano,Walter %A Carubia,Alessandro %A Ferro,Patrizia %A Pisciotta,Vincenzo %A Casuccio,Alessandra %A Restivo,Vincenzo %+ Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, Via del Vespro 129, Palermo, 90127, Italy, 39 3804703272, alessandra.fallucca@unipa.it %K vaccine strategies %K catch-up interventions %K recall intervention %K vaccination coverage %K multicomponent %K education %K remind %K reward %K vaccination %K vaccine %K adherence %K systematic review %K meta-analysis %K immunization %K health care based %K multidimensional intervention %K education based %K vaccine literacy %K PRISMA %D 2024 %7 23.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. Objective: This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. Methods: In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. Results: The analyses showed an overall efficacy of RR 1.22 (95% CI 1.19-1.26) for RCTs and RR 1.70 (95% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95% CI 0.12-0.95; before-after: coefficient 1.27, 95% CI 0.70-1.84). Conclusions: Community, family, and health care–based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases. %M 39042433 %R 10.2196/52926 %U https://publichealth.jmir.org/2024/1/e52926 %U https://doi.org/10.2196/52926 %U http://www.ncbi.nlm.nih.gov/pubmed/39042433 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57118 %T Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design %A Dionne,Maude %A Sauvageau,Chantal %A Etienne,Doriane %A Kiely,Marilou %A Witteman,Holly %A Dubé,Eve %+ Faculty of Social Sciences, Université Laval, 1030 avenue des Sciences-Humaines, Québec City, QC, G1V 0A6, Canada, 1 1 418 650 2131 ext 404062, Eve.Dube@ant.ulaval.ca %K immunization %K human papillomavirus %K HPV %K HPV vaccine %K school-based immunization program %K intervention %K strategies %K vaccination %K vaccine %K Quebec %K school-based %K vaccine coverage %K decision aid %K student %K students %K nurse %K nurses %K parent %K parents %K focus group %K descriptive analyses %K user-centered %K effectiveness %K data collection %K vaccine safety %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. Objective: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students’ parents in Quebec, Canada. Methods: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions’ relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses’ knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool’s relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Québec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). Results: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. Conclusions: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents’ knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale. %M 38976317 %R 10.2196/57118 %U https://formative.jmir.org/2024/1/e57118 %U https://doi.org/10.2196/57118 %U http://www.ncbi.nlm.nih.gov/pubmed/38976317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49695 %T Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis %A Xie,Yao Jie %A Liao,Xiaoli %A Lin,Meijuan %A Yang,Lin %A Cheung,Kin %A Zhang,Qingpeng %A Li,Yan %A Hao,Chun %A Wang,Harry HX %A Gao,Yang %A Zhang,Dexing %A Molassiotis,Alex %A Siu,Gilman Kit Hang %A Leung,Angela Yee Man %+ School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 34003798, grace.yj.xie@polyu.edu.hk %K community engagement %K community-based participatory research %K vaccination rate %K health promotion %K vaccine. %D 2024 %7 10.5.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. Objective: This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. Methods: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. Results: A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children’s immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95% CI 0.21-0.47, I2=99.9%, P<.001) and between-group comparison (RD 0.18, 95% CI 0.07-0.29, I2=98.4%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95% CI 0.36-0.67, I2=99.9%, P<.001), followed by intervention development (RD 0.36, 95% CI 0.23-0.50, I2=100.0%, P<.001), intervention implementation (RD 0.35, 95% CI 0.22-0.47, I2=99.8%, P<.001), and data collection (RD 0.34, 95% CI 0.19-0.50, I2=99.8%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95% CI 0.17-0.82, I2=100.0%, P<.001), followed by moderate community engagement extent (RD 0.45, 95% CI 0.33-0.58, I2=99.6%, P<.001) and low community engagement extent (RD 0.15, 95% CI 0.05-0.25, I2=99.2%, P<.001). The meta-analysis revealed that “health service support” demonstrated the largest effect sizes (RD 0.45, 95% CI 0.25-0.65, I2=99.9%, P<.001), followed by “health education and discussion” (RD 0.39, 95% CI 0.20-0.58, I2=99.7%, P<.001), “follow-up and reminder” (RD 0.33, 95% CI 0.23-0.42, I2=99.3%, P<.001), and “social marketing campaigns and community mobilization” (RD 0.24, 95% CI 0.06-0.41, I2=99.9%, P<.001). Conclusions: The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a “fit-for-purpose” approach rather than a “one-size-fits-all” approach to maximize the effectiveness of vaccine promotion. Trial Registration: PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339081 %M 38478914 %R 10.2196/49695 %U https://publichealth.jmir.org/2024/1/e49695 %U https://doi.org/10.2196/49695 %U http://www.ncbi.nlm.nih.gov/pubmed/38478914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38761 %T Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework %A Chadwick,Verity L %A Saich,Freya %A Freeman,Joseph %A Martiniuk,Alexandra %+ Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, 2006, Australia, 61 (02) 9351 2222, alexandra.martiniuk@sydney.edu.au %K COVID-19 %K SARS-CoV-2 %K vaccine %K mRNA %K Pfizer-BioNTech %K pediatric %K children %K media %K news %K web-based %K infodemic %K disinformation %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies’ media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8% in the United States, n=40, 10% in Australia, n=60, 15% in Canada, and n=13, 3% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries’ media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to “ending” the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the “infodemic” about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries—the United States, Australia, the United Kingdom, and Canada—used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine “boosters” as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. %M 36383344 %R 10.2196/38761 %U https://formative.jmir.org/2024/1/e38761 %U https://doi.org/10.2196/38761 %U http://www.ncbi.nlm.nih.gov/pubmed/36383344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50276 %T Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review %A Hansen,Rita-Kristin %A Baiju,Nikita %A Gabarron,Elia %+ Department of Education, ICT and Learning, Østfold University College, B R A veien 4, Remmen, Halden, 1783, Norway, 47 69608161, elia.gabarron@hiof.no %K social media %K vaccines %K vaccination %K randomized controlled trials %K information sources %D 2023 %7 26.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Vaccination programs are instrumental in prolonging and improving people’s lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs. Objective: This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children. Methods: The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. Results: This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non–general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12). Conclusions: The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions’ impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination. %M 38147375 %R 10.2196/50276 %U https://www.jmir.org/2023/1/e50276 %U https://doi.org/10.2196/50276 %U http://www.ncbi.nlm.nih.gov/pubmed/38147375 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47334 %T The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review %A Ou,Lihong %A Chen,Angela Chia-Chen %A Amresh,Ashish %+ Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 480 253 9098, lihongou@asu.edu %K human papillomavirus %K mobile health %K mHealth %K parents %K systematic review %K vaccination %K youth %K mobile phone %D 2023 %7 21.11.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine’s proven efficacy, the vaccination rate among US youth remains below the recommended 80% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. Objective: This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth’s vaccine uptake. Methods: We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. Results: Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82%), used a randomized controlled trial design (12/17, 71%), and adopted behavior change theories or a culture-centric approach (10/17, 59%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. Conclusions: This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations. %M 37988155 %R 10.2196/47334 %U https://pediatrics.jmir.org/2023/1/e47334 %U https://doi.org/10.2196/47334 %U http://www.ncbi.nlm.nih.gov/pubmed/37988155 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46951 %T Digital Storytelling Intervention to Promote Human Papillomavirus Vaccination Among At-Risk Asian Immigrant Populations: Pilot Intervention Study %A Chen,Angela Chia-Chen %A Kim,Sunny Wonsun %A Ou,Lihong %A Todd,Michael %A Larkey,Linda %+ College of Nursing, Michigan State University, 1355 Bogue Street, East Lansing, MI, 48824, United States, 1 5173555148, chenang6@msu.edu %K digital storytelling %K human papillomavirus %K immigrants %K Korean %K Vietnamese %K vaccination %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) calls for researchers to address this public health concern through HPV vaccination. Despite disparities in HPV-associated cancers in Korean Americans and Vietnamese Americans, their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Objective: The aim of this quasi-experimental single-group study was to assess the feasibility, acceptability, and preliminary effects of a culturally and linguistically congruent digital storytelling intervention on Korean American and Vietnamese American mothers’ attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by their child’s sex (boy vs girl) and by ethnicity (Korean American vs Vietnamese American). Methods: Participants were recruited via multiple avenues (eg, ethnic minority community organizations, social media, and flyers posted in local Asian supermarkets and nail salons). Web-based, valid, and reliable measures were administered to collect data preintervention and postintervention. Descriptive statistics, paired and independent sample t tests, the chi-square test, and the McNemar test were used to describe the distributions of variables and to examine the differences between subgroups and changes in key variables over time. Logistic regression models were used to examine associations of mothers’ HPV- and vaccine-related attitudes with vaccination intention and to explore if the association between attitudes and vaccination intention differed by the target children’s sex or ethnicity. Results: In our sample of 50 Korean American mothers (mean age 42.8, SD 4.8 years) and 114 Vietnamese American mothers (mean age 41.5, SD 5.4 years), 36% (18/50) of Korean American and 51% (58/114) of Vietnamese American mothers reported that their children received free or reduced-price lunches at school. After the intervention, mothers’ attitudes toward HPV and the vaccine (t163=2.49, P=.01) and intention to vaccinate their children improved significantly (X21=18.38, P<.001). The measure of mothers’ negative attitudes toward HPV and the vaccine was significantly associated with higher vaccination intention (odds ratio 0.27, 95% CI 0.14-0.51; P<.001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, and HPV communication with health care providers). Findings did not suggest that a child’s sex or ethnicity moderated the association between attitudes and vaccination intention. Conclusions: This remotely delivered intervention using digital stories was feasible and acceptable, and showed preliminary effects on promoting Korean American and Vietnamese American mothers’ intention to vaccinate their children against HPV. Future research that uses a randomized controlled trial design with a larger and more diverse sample and includes children’s vaccination status will help understand the effect of the intervention. %M 36877658 %R 10.2196/46951 %U https://formative.jmir.org/2023/1/e46951 %U https://doi.org/10.2196/46951 %U http://www.ncbi.nlm.nih.gov/pubmed/36877658 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42921 %T Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT %A Long,Millie D %A van Deen,Welmoed K %A Weisbein,Laura %A Khalil,Carine %A Appel,Keren L %A Zhang,Xian %A Chen,Wenli %A Zubrod,Lori %A Maris,Robbie %A Ghafari,Afsoon %A Dupuy,Taylor %A Ha,Christina Y %A Spiegel,Brennan M R %A Almario,Christopher V %A Melmed,Gil Y %+ Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, University of Chapel Hill, 130 Mason Farm Rd, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7080, United States, 1 919 962 2211, millie_long@med.unc.edu %K preventative %K education %K inflammatory bowel disease (IBD) %K education %K adults %K inflammation %K disease %K risk %K infections %K bone %K cancer %K development %K patient %K interview %K intervention %K prevention %K vaccination %K influenza %D 2023 %7 23.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. Objective: We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. Methods: Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. Results: Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55% (281/511) of the video group and 57% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75%, 231/307, for the video group and 72%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. Conclusions: The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. Trial Registration: ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537 %M 37610821 %R 10.2196/42921 %U https://www.jmir.org/2023/1/e42921 %U https://doi.org/10.2196/42921 %U http://www.ncbi.nlm.nih.gov/pubmed/37610821 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38388 %T Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study %A Lee,Hee Yun %A Xiong,Serena %A Sur,Aparajita %A Khang,Tounhia %A Vue,Bai %A Culhane-Pera,Kathleen A %A Pergament,Shannon %A Torres,M Beatriz %A Koopmeiners,Joseph S %A Desai,Jay %+ School of Social Work, The University of Alabama, 2024 Little Hall Box 870314, Tuscaloosa, AL, 35487, United States, 1 205 348 6553, hlee94@ua.edu %K human papillomavirus %K HPV %K HPV vaccine %K community-based participatory action research %K CBPAR %K eHealth %K website %K social cognitive theory %K Hmong %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website’s effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants’ HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents’ average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers’ self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website’s content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research–designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents’ and adolescents’ knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website’s impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). %M 37338961 %R 10.2196/38388 %U https://formative.jmir.org/2023/1/e38388 %U https://doi.org/10.2196/38388 %U http://www.ncbi.nlm.nih.gov/pubmed/37338961 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45696 %T Developing a Culturally and Linguistically Congruent Digital Storytelling Intervention in Vietnamese and Korean American Mothers of Human Papillomavirus–Vaccinated Children: Feasibility and Acceptability Study %A Kim,Sunny Wonsun %A Chen,Angela Chia-Chen %A Ou,Lihong %A Larkey,Linda %A Todd,Michael %A Han,Yooro %+ Edson College of Nursing and Health Innovation, Arizona State University, 500 N. 3rd St. MC. 3020, Phoenix, AZ, 85004, United States, 1 602 496 6789, Sunny.Kim@asu.edu %K Vietnamese %K Korean %K Asia %K cultural %K digital storytelling %K storytelling %K story %K stories %K HPV %K vaccine %K vaccination %K feasibility %K digital intervention %K mortality rate %K ratio %K odd %K rate %K deep analysis %K social media %K child %K immigrant %K mother %K immunization %K inoculation %K inoculate %K communication %K culture %K language %K human papillomavirus %K photo %K video %K digital %K microphone %K conversation %K dialogue %K Research Electronic Data Capture %K voiceover %K soundtrack %K writing %K write %K script %K health status %K health insurance %K survey %K questionnaire %K qualitative %K constructivist %K constructivism %D 2023 %7 14.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) call for researchers to address this public health concern through HPV vaccination. Disparities of HPV-associated cancers in Vietnamese and Korean Americans exist, yet their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve their HPV vaccination rates. We adopted digital storytelling (DST) that combines oral storytelling with computer-based technology (digital images, audio recording, and music) as a promising approach for facilitating the communication of culturally relevant health messages. Objective: This study aimed to (1) assess the feasibility and acceptability of intervention development through DST workshops, (2) conduct an in-depth analysis of the cultural experience that shapes HPV attitudes, and (3) explore aspects of the DST workshop experience that could inform future formative and intervention work. Methods: Through community partners, social media, and snowball sampling, we recruited 2 Vietnamese American and 6 Korean American mothers (mean age 41.4, SD 5.8 years) who had children vaccinated against HPV. Three virtual DST workshops were conducted between July 2021 and January 2022. Our team supported mothers to develop their own stories. Mothers completed web-based surveys before and after the workshop and provided feedback on each other’s story ideas and the workshop experience. We used descriptive statistics to summarize quantitative data and constant comparative analysis to analyze qualitative data collected in the workshop and field notes. Results: Eight digital stories were developed in the DST workshops. They were well accepted, and the mothers showed overall satisfaction and relevant indicators (eg, would recommend it to others, would attend a similar workshop, it was worth their time; mean 4.2-5, range 1-5). Mothers found the process rewarding and appreciated the opportunity to share their stories in group settings and learn from each other. The 6 major themes that emerged from the data reflect the mothers’ rich personal experiences, attitudes, and perceptions about their child’s HPV vaccination, which included (1) showing parents’ love and responsibility; (2) HPV and related knowledge, awareness, and attitudes; (3) factors influencing vaccine decision-making; (4) source of information and information sharing; (5) response to children's being vaccinated; and (6) cultural perspectives on health care and HPV vaccination. Conclusions: Our findings suggest that a virtual DST workshop is a highly feasible and acceptable approach to engaging Vietnamese American and Korean American immigrant mothers in developing culturally and linguistically congruent DST interventions. Further research is needed to test the efficacy and effectiveness of digital stories as an intervention for Vietnamese American and Korean American mothers of unvaccinated children. This process of developing an easy-to-deliver, culturally and linguistically aligned, and holistic web-based DST intervention can be implemented with other populations in other languages. %M 37314851 %R 10.2196/45696 %U https://formative.jmir.org/2023/1/e45696 %U https://doi.org/10.2196/45696 %U http://www.ncbi.nlm.nih.gov/pubmed/37314851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43873 %T The Initial Relationship Between the United States Department of Health and Human Services’ Digital COVID-19 Public Education Campaign and Vaccine Uptake: Campaign Effectiveness Evaluation %A Williams,Christopher J %A Kranzler,Elissa C %A Luchman,Joseph N %A Denison,Benjamin %A Fischer,Sean %A Wonder,Thomas %A Ostby,Ronne %A Vines,Monica %A Weinberg,Jessica %A Petrun Sayers,Elizabeth L %A Kurti,Allison N %A Trigger,Sarah %A Hoffman,Leah %A Peck,Joshua F A %+ Fors Marsh, 4250 Fairfax Dr, Office Suite 520, Arlington, VA, 22203, United States, 1 571 858 3800, chriswilliams@forsmarsh.com %K communication campaign %K COVID-19 %K COVID-19 pandemic %K COVID-19 vaccination %K public education campaign %K public health campaign %K social marketing %K marketing %K campaign %K vaccination %K patient education %K United States %K vaccine %K digital impression %K public education %D 2023 %7 3.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Over 1 million people in the United States have died of COVID-19. In response to this public health crisis, the US Department of Health and Human Services launched the We Can Do This public education campaign in April 2021 to increase vaccine confidence. The campaign uses a mix of digital, television, print, radio, and out-of-home channels to reach target audiences. However, the impact of this campaign on vaccine uptake has not yet been assessed. Objective: We aimed to address this gap by assessing the association between the We Can Do This COVID-19 public education campaign’s digital impressions and the likelihood of first-dose COVID-19 vaccination among US adults. Methods: A nationally representative sample of 3642 adults recruited from a US probability panel was surveyed over 3 waves (wave 1: January to February 2021; wave 2: May to June 2021; and wave 3: September to November 2021) regarding COVID-19 vaccination, vaccine confidence, and sociodemographics. Survey data were merged with weekly paid digital campaign impressions delivered to each respondent’s media market (designated market area [DMA]) during that period. The unit of analysis was the survey respondent–broadcast week, with respondents nested by DMA. Data were analyzed using a multilevel logit model with varying intercepts by DMA and time-fixed effects. Results: The We Can Do This digital campaign was successful in encouraging first-dose COVID-19 vaccination. The findings were robust to multiple modeling specifications, with the independent effect of the change in the campaign’s digital dose remaining practically unchanged across all models. Increases in DMA-level paid digital campaign impressions in a given week from –30,000 to 30,000 increased the likelihood of first-dose COVID-19 vaccination by 125%. Conclusions: Results from this study provide initial evidence of the We Can Do This campaign’s digital impact on vaccine uptake. The size and length of the Department of Health and Human Services We Can Do This public education campaign make it uniquely situated to examine the impact of a digital campaign on COVID-19 vaccination, which may help inform future vaccine communication efforts and broader public education efforts. These findings suggest that campaign digital dose is positively associated with COVID-19 vaccination uptake among US adults; future research assessing campaign impact on reduced COVID-19–attributed morbidity and mortality and other benefits is recommended. This study indicates that digital channels have played an important role in the COVID-19 pandemic response. Digital outreach may be integral in addressing future pandemics and could even play a role in addressing nonpandemic public health crises. %M 36939670 %R 10.2196/43873 %U https://www.jmir.org/2023/1/e43873 %U https://doi.org/10.2196/43873 %U http://www.ncbi.nlm.nih.gov/pubmed/36939670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43041 %T Development of a Tailored Mobile Phone–Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study %A Cunningham-Erves,Jennifer %A Wilkins,Consuelo H %A Dempsey,Amanda F %A Jones,Jessica L %A Thompson,Chris %A Edwards,Kathryn %A Davis,Megan %A Mayberry,Lindsay S %A Landsittal,Douglas %A Hull,Pamela C %+ Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States, 1 6153275692, jerves@mmc.edu %K human papillomavirus %K HPV %K vaccine %K hesitancy %K parent-child communication %K theory %K mobile health %K mHealth %K adolescents %K patient education %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers’ limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone–based, family-focused intervention guided by theory to address concerns of HPV vaccine–hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine–hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine–hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents’ corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87%) and shared decision-making in some cases (8/31, 26%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child’s physician, and an optional adolescents’ corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine–hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies). %M 37014680 %R 10.2196/43041 %U https://formative.jmir.org/2023/1/e43041 %U https://doi.org/10.2196/43041 %U http://www.ncbi.nlm.nih.gov/pubmed/37014680 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40269 %T Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study %A Siddiqi,Danya Arif %A Ali,Rozina Feroz %A Shah,Mubarak Taighoon %A Dharma,Vijay Kumar %A Khan,Anokhi Ali %A Roy,Tapash %A Chandir,Subhash %+ IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145, Singapore, 1 4109295557, subhash.chandir@ird.global %K missed opportunities for vaccination %K mobile-based immunization decision support system %K catch-up immunizations %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization–recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators’ understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. %M 36800221 %R 10.2196/40269 %U https://pediatrics.jmir.org/2023/1/e40269 %U https://doi.org/10.2196/40269 %U http://www.ncbi.nlm.nih.gov/pubmed/36800221 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44234 %T The Association Between Pediatric COVID-19 Vaccination and Socioeconomic Position: Nested Case-Control Study From the Pedianet Veneto Cohort %A Batzella,Erich %A Cantarutti,Anna %A Caranci,Nicola %A Giaquinto,Carlo %A Barbiellini Amidei,Claudio %A Canova,Cristina %+ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Via Loredan 18, Padua, 35131, Italy, 39 0498275391, cristina.canova@unipd.it %K SEP %K socioeconomic position %K quantile-g-computation %K nested case-control study %K COVID-19 vaccine %K children %K area deprivation index %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The success of pediatric COVID-19 vaccination strongly depends on parents' willingness to vaccinate their children. To date, the role of socioeconomic position (SEP) in pediatric COVID-19 vaccination has not been thoroughly examined. Objective: We evaluated the association between COVID-19 vaccination and SEP in a large pediatric cohort. Methods: A case-control study design nested into a pediatric cohort of children born between 2007 and 2017, living in the Veneto Region and followed up to at least January 1, 2022, was adopted. Data on children were collected from the Pedianet database and linked with the regional COVID-19 registry. Each child vaccinated with at least one dose of any COVID-19 vaccine between July 1, 2021, and March 31, 2022, was matched by sex, year of birth, and family pediatrician to up to 5 unvaccinated children. Unvaccinated children with a positive outcome on the swab test within 180 days before the index date were excluded from the analyses. Children were geo-referenced to determine their area deprivation index (ADI)—a social and material deprivation measure calculated at the census block level and consisting of 5 socioeconomic items. The index was then categorized in quintiles based on the regional ADI level. The association between ADI quintiles and vaccination status was measured using conditioned logistic regression models to estimate odds ratios and the corresponding 95% CIs. Quantile-g-computation regression models were applied to develop a weighted combination of the individual items to estimate how much each component influenced the likelihood of vaccination. All analyses were stratified by age at vaccination (5-11 and 12-14 years). Results: The study population consisted of 6475 vaccinated children, who were matched with 32,124 unvaccinated children. Increasing area deprivation was associated with a lower probability of being vaccinated, with approximately a linear dose-response relationship. Children in the highest deprivation quintile were 36% less likely to receive a COVID-19 vaccine than those with the lowest area deprivation (95% CI 0.59-0.70). The results were similar in the 2 age groups, with a slightly stronger association in 5-11–year-old children. When assessing the effects of the weighted combination of the individual items, a quintile increase was associated with a 17% decrease in the probability of being vaccinated (95% CI 0.80-0.86). The conditions that influenced the probability of vaccination the most were living on rent, being unemployed, and being born in single-parent families. Conclusions: This study has shown a significant reduction in the likelihood of receiving a COVID-19 vaccine among children living in areas characterized by a lower SEP. Findings were robust among multiple analyses and definitions of the deprivation index. These findings suggest that SEP plays an important role in vaccination coverage, emphasizing the need to promote targeted public health efforts to ensure global vaccine equity. %M 36645419 %R 10.2196/44234 %U https://publichealth.jmir.org/2023/1/e44234 %U https://doi.org/10.2196/44234 %U http://www.ncbi.nlm.nih.gov/pubmed/36645419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36827 %T Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey %A Abou-Arraj,Nadeem Elias %A Maddah,Diana %A Buhamdan,Vanessa %A Abbas,Roua %A Jawad,Nadine Kamel %A Karaki,Fatima %A Alami,Nael H %A Geldsetzer,Pascal %+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, United States, 1 510 643 0881, narraj@berkeley.edu %K Lebanon %K COVID-19 %K SARS-CoV-2 %K coronavirus %K vaccination %K vaccine hesitancy %K vaccine acceptance %K health care system %K misinformation %K public health %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is an additional burden on Lebanon’s fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study’s aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals’ motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience “snowball” sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one’s family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. %M 36383635 %R 10.2196/36827 %U https://formative.jmir.org/2022/12/e36827 %U https://doi.org/10.2196/36827 %U http://www.ncbi.nlm.nih.gov/pubmed/36383635 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e38297 %T Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey %A Thompson,Erika L %A Preston,Sharice M %A Francis,Jenny K R %A Rodriguez,Serena A %A Pruitt,Sandi L %A Blackwell,James-Michael %A Tiro,Jasmin A %+ Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States, 1 817 735 5162, Erika.Thompson@unthsc.edu %K HPV vaccination %K human papillomavirus %K social media %K decision-making %K vaccination %K teens %K adolescents %K parent %K USA %K United States %K misinformation %K internet %K survey %K unvaccinated %K child %K online %K health %K literacy %K decision %K health care %K decision %K teen %K vaccine %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents’ perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be “undecided/not wanting the vaccine” if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. %M 36103216 %R 10.2196/38297 %U https://pediatrics.jmir.org/2022/3/e38297 %U https://doi.org/10.2196/38297 %U http://www.ncbi.nlm.nih.gov/pubmed/36103216 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37656 %T Google Trends on Human Papillomavirus Vaccine Searches in the United States From 2010 to 2021: Infodemiology Study %A Bhagavathula,Akshaya Srikanth %A Massey,Philip M %+ Center for Public Health and Technology, Department of Health, Human Performance, and Recreation, College of Education and Health Professions, University of Arkansas, 346 West Ave., West Avenue Annex Building, Suite 317, Fayetteville, AR, 72701, United States, 1 479 575 8491, masseyp@uark.edu %K Google Trends %K HPV vaccine %K Google search %K attitude %K infodemiology %K searches %K United States of America %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The human papillomavirus (HPV) vaccine is recommended for adolescents and young adults to prevent HPV-related cancers and genital warts. However, HPV vaccine uptake among the target age groups is suboptimal. Objective: The aim of this infodemiology study was to examine public online searches in the United States related to the HPV vaccine from January 2010 to December 2021. Methods: Google Trends (GT) was used to explore online searches related to the HPV vaccine from January 1, 2010, to December 31, 2021. Online searches and queries on the HPV vaccine were investigated using relative search volumes (RSVs). Analysis of variance was performed to investigate quarterly differences in HPV vaccine searches in each year from 2010 to 2021. A joinpoint regression was used to identify statistically significant changes over time; the α level was set to .05. Results: The year-wise online search volume related to the HPV vaccine increased from 2010 to 2021, often following federal changes related to vaccine administration. Joinpoint regression analysis showed that HPV vaccine searches significantly increased on average by 8.6% (95% CI 5.9%-11.4%) across each year from 2010 to 2021. Moreover, HPV vaccine searches demonstrated a similar pattern across years, with search interest increasing through August nearly every year. At the state level, the highest 12-year mean RSV was observed in California (59.9, SD 14.3) and the lowest was observed in Wyoming (17.4, SD 8.5) during the period of 2010-2021. Conclusions: Online searches related to the HPV vaccine increased by an average of 8.6% across each year from 2010 to 2021, with noticeable spikes corresponding to key changes in vaccine recommendations. We identified patterns across years and differences at the state level in the online search interest related to the HPV vaccine. Public health organizations can use GT as a tool to characterize the public interest in and promote the HPV vaccine in the United States. %M 36036972 %R 10.2196/37656 %U https://publichealth.jmir.org/2022/8/e37656 %U https://doi.org/10.2196/37656 %U http://www.ncbi.nlm.nih.gov/pubmed/36036972 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32969 %T Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys %A Garrett,Paul M %A White,Joshua P %A Dennis,Simon %A Lewandowsky,Stephan %A Yang,Cheng-Ta %A Okan,Yasmina %A Perfors,Andrew %A Little,Daniel R %A Kozyreva,Anastasia %A Lorenz-Spreen,Philipp %A Kusumi,Takashi %A Kashima,Yoshihisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville Campus, Melbourne, 3010, Australia, 61 8344 6377 ext 03, paul.garrett@unimelb.edu.au %K COVID-19 %K immunity passport %K vaccination passport %K cross-cultural %K health policy %K digital certificates %K SARS-CoV-2 %K vaccine %K policy %K international %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. Objective: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. Methods: We collected 13,678 participants through online representative sampling across six countries—Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom—during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Results: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Conclusions: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world. %M 35377317 %R 10.2196/32969 %U https://publichealth.jmir.org/2022/7/e32969 %U https://doi.org/10.2196/32969 %U http://www.ncbi.nlm.nih.gov/pubmed/35377317 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e35695 %T Impact of a Papillomavirus Vaccination Promotion Program in Middle School: Study Protocol for a Cluster Controlled Trial %A Tran,Phuong Lien %A Chirpaz,Emmanuel %A Boukerrou,Malik %A Bertolotti,Antoine %+ Department of Gynecology and Obstetrics, University Hospital of St Pierre, 97 Avenue du Président Mitterrand, Saint Pierre, Réunion, 97410, France, 33 262262359135, phuong.tran@chu-reunion.fr %K HPV vaccine %K vaccination program %K middle school %K school %K student %K women's health %K sexual health %K cervical cancer %K vaccination %K papillomavirus %K vaccine %K public education %K patient education %K community education %K promotion %K program %K youth %K children %K protocol %K mortality %K uterine cervical cancer %K cancer %K HPV %K health promotion %K girls %K school %K intervention %K parent %K training %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: On Reunion Island, incidence and mortality for uterine cervical cancer is high, yet coverage rate for human papillomavirus (HPV) vaccination is low. Objective: The main objective of the study is to evaluate the impact of a health promotion program promoting HPV vaccination on the proportion of middle school girls who complete the full HPV vaccination schedule (2 or 3 doses) by the end of school year. Methods: This study is a cluster controlled intervention study using a superiority design. A combined health promotion program will be offered containing information to students and parents, training of general practitioners, and free school-based vaccination (in a “health bus”). Children who attend this program will constitute the intervention group and will be compared to children from another middle school who will not attend the program constituting the control group. Results: Recruitment began in October 2020. In the intervention school, of 780 students, 245 were randomly selected in the 12 classes. In the control school, 259 students out of 834 were randomly selected. Conclusions: In this study, we explore the impact of a health promotion program combining information toward students, parents, and general practitioners with free school-based vaccination. We expect a significantly higher HPV vaccination coverage in the intervention school as compared to the control school, whether it be among girls or boys. The final implication would be an extension of this program in all middle schools on the Island and thus an increase in HPV vaccination coverage. Trial Registration: ClinicalTrials.gov NCT04459221; https://clinicaltrials.gov/ct2/show/NCT04459221 International Registered Report Identifier (IRRID): DERR1-10.2196/35695 %M 35700023 %R 10.2196/35695 %U https://www.researchprotocols.org/2022/6/e35695 %U https://doi.org/10.2196/35695 %U http://www.ncbi.nlm.nih.gov/pubmed/35700023 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34715 %T The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Melamed,Alexander %A Wright,Jason D %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papilloma virus vaccination %K vaccination %K vaccine %K vaccine hesitancy %K cancer survivor %K narrative story %K web based %K randomized controlled trial %K RCT %K HPV %K human papilloma virus %K virus %K hesitancy %K cancer %K willingness %K behavior %K parent %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions: A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf %M 35421848 %R 10.2196/34715 %U https://publichealth.jmir.org/2022/5/e34715 %U https://doi.org/10.2196/34715 %U http://www.ncbi.nlm.nih.gov/pubmed/35421848 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e33235 %T Changes in Parental Attitudes Toward COVID-19 Vaccination and Routine Childhood Vaccination During the COVID-19 Pandemic: Repeated Cross-sectional Survey Study %A Wang,Qiang %A Xiu,Shixin %A Yang,Liuqing %A Han,Ying %A Cui,Tingting %A Shi,Naiyang %A Liu,Minqi %A Yi,Youqin %A Liu,Chang %A Wang,Xuwen %A Yang,Guoping %A Ji,Lili %A Zhou,Weijie %A Jin,Hui %A Zhen,Shiqi %A Lin,Leesa %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, China, 86 02583272572, jinhui_hld@163.com %K childhood vaccination %K COVID-19 vaccine %K vaccine hesitancy %K repeated cross-section survey %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic. Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China. Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness. Results: Overall, 2881, 1038, and 1183 participants were included in the survey’s three waves. Using the Vaccine Hesitancy Scale, 7.8% (225/2881), 15.1% (157/1038), and 5.5% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3% (1709/2881), 64.6% (671/1038), and 92% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, “concerns about vaccine safety and side effects” was the most common reason for refusal. Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety. %M 35486516 %R 10.2196/33235 %U https://publichealth.jmir.org/2022/5/e33235 %U https://doi.org/10.2196/33235 %U http://www.ncbi.nlm.nih.gov/pubmed/35486516 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e28676 %T Helping Children to Participate in Human Papillomavirus–Related Discussions: Mixed Methods Study of Multimedia Messages %A Occa,Aurora %A Stahl,Hayley M %A Julien-Bell,Sarah %+ Department of Communication, University of Kentucky, 272 Blazer Dining, 343 S. Martin Luther King Blvd, Lexington, KY, 40526, United States, 1 7865035997, aurora.occa@uky.edu %K animation %K game %K HPV %K child-parent communication %K child-physician communication %K pilot study %K children %K health communication %K communication technologies %K vaccination %K health education %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective: This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health—in particular when such conversations center around the HPV vaccination—and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children’s knowledge and perceptions of HPV prevention. Methods: A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children’s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results: Both the animated video and a web-based game increased children’s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions: This study shows that both materials were effective for improving children’s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns. %M 35404265 %R 10.2196/28676 %U https://formative.jmir.org/2022/4/e28676 %U https://doi.org/10.2196/28676 %U http://www.ncbi.nlm.nih.gov/pubmed/35404265 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30340 %T Parents’ Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Coan,Sharon P %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, 77030, United States, 1 (713) 500 9677, elisabethrbecker@gmail.com %K human papillomavirus %K vaccination %K user experience %K parent %K mHealth %K HPV %K vaccine %K HPV vaccine %K parenting %K pediatrics %K sexual health %K cervical cancer %K adolescents %K mHealth %K app %K application %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96%), 41 (5.67) years of age, college educated (n=55, 56%), and White and non-Hispanic (n=55, 56%) and had private health insurance for their children (n=75, 77%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88%), knowledge (84/95, 88%), and HPV vaccination intentions (64/95, 67%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73%-94%]). Parents also agreed that HPVCF is clear (86/95, 91%), accurate (86/95, 91%), and more helpful than other HPV vaccine information they had received (89/95, 94%) and that they would recommend it to others (81/95, 85%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. %M 35188469 %R 10.2196/30340 %U https://pediatrics.jmir.org/2022/1/e30340 %U https://doi.org/10.2196/30340 %U http://www.ncbi.nlm.nih.gov/pubmed/35188469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32273 %T A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study %A Feldman,Amy G %A Moore,Susan %A Bull,Sheana %A Morris,Megan A %A Wilson,Kumanan %A Bell,Cameron %A Collins,Margaret M %A Denize,Kathryn M %A Kempe,Allison %+ Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 720 777 5354, amy.feldman@childrenscolorado.org %K vaccinations %K transplantation %K mobile app %K agile development %K immunization %K mHealth %K mobile health %K children %K transplant recipients %K pediatric transplant recipients %K pediatrics %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. %M 35023840 %R 10.2196/32273 %U https://formative.jmir.org/2022/1/e32273 %U https://doi.org/10.2196/32273 %U http://www.ncbi.nlm.nih.gov/pubmed/35023840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33792 %T Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification %A Klein,Ari Z %A O'Connor,Karen %A Gonzalez-Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Fl., 423 Guardian Dr., Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K COVID-19 %K data mining %K COVID-19 vaccine %K pregnancy outcomes %D 2022 %7 6.1.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. %M 34870607 %R 10.2196/33792 %U https://formative.jmir.org/2022/1/e33792 %U https://doi.org/10.2196/33792 %U http://www.ncbi.nlm.nih.gov/pubmed/34870607 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29872 %T COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey %A Tsai,Richard %A Hervey,John %A Hoffman,Kathleen %A Wood,Jessica %A Johnson,Jennifer %A Deighton,Dana %A Clermont,Donald %A Loew,Brian %A Goldberg,Stuart L %+ Inspire, 3101 Wilson Boulevard, Suite 220, Arlington, VA, 22201, United States, 1 800 945 0381, richard@inspire.com %K COVID-19 %K vaccine %K hesitancy %K cancer %K autoimmune diseases %K vaccination %K comorbidities %K SARS-CoV-2 %K survey %K cross-sectional %K survey %K incidence %K safety %K vulnerable %K perception %K attitude %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3% (5459/19,980); autoimmune diseases, 23.2% (4946/21,294); chronic lung diseases: 35.4% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6% (3960/21,294), with 10.3% (2190/21,294) declaring that they would not, 3.5% (742/21,294) stating that they probably would not, and 4.8% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4% (731/5459); autoimmune diseases, 19.4% (962/4947); chronic lung diseases: 17.8% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8%) had received at least one COVID-19 vaccine injection, and 6.5% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0% (3796/5501) self-reported local reactions, and 40.0% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0% (1070/1390) and 67.0% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual’s underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care–related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. %M 34709184 %R 10.2196/29872 %U https://publichealth.jmir.org/2022/1/e29872 %U https://doi.org/10.2196/29872 %U http://www.ncbi.nlm.nih.gov/pubmed/34709184 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32814 %T Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study %A Zhang,Jueman %A Wang,Yi %A Shi,Molu %A Wang,Xiuli %+ School of New Media, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 10 6276 6689, xiuli.wang@pku.edu.cn %K COVID-19 %K vaccine %K topic modeling %K LDA %K valence %K share %K viral %K Twitter %K social media %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective: The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods: We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results: Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people’s views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people’s views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions: This study suggests the public interest in and demand for information about vaccine development and people’s views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter. %M 34665761 %R 10.2196/32814 %U https://publichealth.jmir.org/2021/12/e32814 %U https://doi.org/10.2196/32814 %U http://www.ncbi.nlm.nih.gov/pubmed/34665761 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28846 %T Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study %A Becker,Elisabeth RB %A Shegog,Ross %A Savas,Lara S %A Frost,Erica L %A Healy,C Mary %A Spinner,Stanley W %A Vernon,Sally W %+ The University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States, 1 713 500 4472, elisabeth.becker@uth.tmc.edu %K human papillomavirus %K vaccination %K qualitative %K focus groups %K sexually transmitted infection %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective: This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods: We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results: The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86%). Approximately half (8/17, 47%) of parents expressed no preference for the focus group format, whereas 47% (8/17) requested a text-only chat format and 6% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions: Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child’s pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents. %M 34806991 %R 10.2196/28846 %U https://formative.jmir.org/2021/11/e28846 %U https://doi.org/10.2196/28846 %U http://www.ncbi.nlm.nih.gov/pubmed/34806991 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30642 %T COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies %A Muric,Goran %A Wu,Yusong %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Suite 1001, Marina del Rey, CA, 90292, United States, 1 213 740 2467, gmuric@isi.edu %K vaccine hesitancy %K COVID-19 vaccines %K dataset %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K hesitancy %K vaccine %K Twitter %K misinformation %K conspiracy %K trust %K public health %K utilization %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword–centered data collection with more than 1.8 million tweets, and (2) a historical account–level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. %M 34653016 %R 10.2196/30642 %U https://publichealth.jmir.org/2021/11/e30642 %U https://doi.org/10.2196/30642 %U http://www.ncbi.nlm.nih.gov/pubmed/34653016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29789 %T Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts %A Liew,Tau Ming %A Lee,Cia Sin %+ Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, 65 62223322, liew.tau.ming@singhealth.com.sg %K social media %K COVID-19 %K vaccine hesitancy %K natural language processing %K machine learning %K infodemiology %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to “COVID-19” and “vaccine” over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model. Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133). Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3%), (2) public concerns related to COVID-19 vaccines (19.6%), (3) discussions about news items related to COVID-19 vaccines (13.3%), (4) public health communications about COVID-19 vaccines (10.3%), (5) discussions about approaches to COVID-19 vaccination drives (17.1%), and (6) discussions about the distribution of COVID-19 vaccines (20.3%). Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines. Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks. The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. %M 34583316 %R 10.2196/29789 %U https://publichealth.jmir.org/2021/11/e29789 %U https://doi.org/10.2196/29789 %U http://www.ncbi.nlm.nih.gov/pubmed/34583316 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28355 %T Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papillomavirus %K human papillomavirus vaccination %K behavioral insights %K behavioral change %K web-based randomized controlled trial %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events. Objective: This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons. Methods: We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format. Results: Only 484 (29.2%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95% CI 0.83-1.73). Conclusions: This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049745 %M 34569941 %R 10.2196/28355 %U https://www.jmir.org/2021/9/e28355 %U https://doi.org/10.2196/28355 %U http://www.ncbi.nlm.nih.gov/pubmed/34569941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30451 %T Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models %A Tomaszewski,Tre %A Morales,Alex %A Lourentzou,Ismini %A Caskey,Rachel %A Liu,Bing %A Schwartz,Alan %A Chin,Jessie %+ School of Information Sciences, University of Illinois at Urbana-Champaign, 501 E Daniel St, Champaign, IL, 61820, United States, 1 217 333 0125, chin5@illinois.edu %K misinformation %K disinformation %K social media %K HPV %K human papillomavirus vaccination %K vaccination %K causality mining %K cause %K effect %K risk perceptions %K vaccine %K perception %K risk %K Twitter %K machine learning %K natural language processing %K cervical cancer %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine–related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine–related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. %M 34499043 %R 10.2196/30451 %U https://www.jmir.org/2021/9/e30451 %U https://doi.org/10.2196/30451 %U http://www.ncbi.nlm.nih.gov/pubmed/34499043 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31409 %T COVID-19 Vaccine Perception in South Korea: Web Crawling Approach %A Lee,Hocheol %A Noh,Eun Bi %A Park,Sung Jong %A Nam,Hae Kweun %A Lee,Tae Ho %A Lee,Ga Ram %A Nam,Eun Woo %+ Department of Health Administration, Yonsei University Graduate School, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K COVID-19 vaccine %K COVID-19 %K instagram %K social media %K infodemiology %K sentiment analysis %K vaccine perception %K South Korea %K web crawling %K AstraZeneca %K Pfizer %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens’ perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens’ perception of COVID-19 vaccines. The keywords searched were “vaccine,” “AstraZeneca,” and “Pfizer.” In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0% (476/670) and for Pfizer was 56.3% (498/885). Among words crawled with “vaccine,” “good” ranked first, with a frequency of 13.43% (312/2323). Meanwhile, “side effect” ranked highest, with a frequency of 29.2% (163/559) for “AstraZeneca,” but 0.6% (4/673) for “Pfizer.” With “vaccine,” positive words were more frequently used, whereas with “AstraZeneca” and “Pfizer” negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. %M 34348890 %R 10.2196/31409 %U https://publichealth.jmir.org/2021/9/e31409 %U https://doi.org/10.2196/31409 %U http://www.ncbi.nlm.nih.gov/pubmed/34348890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29329 %T Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study %A Chen,Hao %A Li,Xiaomei %A Gao,Junling %A Liu,Xiaoxi %A Mao,Yimeng %A Wang,Ruru %A Zheng,Pinpin %A Xiao,Qianyi %A Jia,Yingnan %A Fu,Hua %A Dai,Junming %+ Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, No.138# Yixueyuan Road, Xuhui District, Shanghai, 200032, China, 86 021 54237358, jmdai@fudan.edu.cn %K COVID-19 pandemic %K vaccination behavior %K vaccine hesitancy %K health belief model %D 2021 %7 6.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=−0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=−0.45, P<.001) via vaccine hesitancy (SSC=−0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function. %M 34280115 %R 10.2196/29329 %U https://www.jmir.org/2021/9/e29329 %U https://doi.org/10.2196/29329 %U http://www.ncbi.nlm.nih.gov/pubmed/34280115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30715 %T Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach %A Luo,Chen %A Ji,Kaiyuan %A Tang,Yulong %A Du,Zhiyuan %+ Institute of Communication Studies, Communication University of China, No 1 Dingfuzhuang East Street, Chaoyang District, Beijing, 100024, China, 86 13217810927, longbao0927@163.com %K COVID-19 %K vaccine %K Zhihu %K structural topic modeling %K medical professional %K laypeople %K adverse reactions %K vaccination %K vaccine effectiveness %K vaccine development %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine–related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the “safety of Chinese-made vaccine” topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as “qualitatively different” in perspective rather than “quantitatively different” in scientific knowledge. Among those questions closely associated with medical expertise, the “qualitatively different” characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. %M 34346885 %R 10.2196/30715 %U https://www.jmir.org/2021/8/e30715 %U https://doi.org/10.2196/30715 %U http://www.ncbi.nlm.nih.gov/pubmed/34346885 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e28800 %T Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study %A Boucher,Jean-Christophe %A Cornelson,Kirsten %A Benham,Jamie L %A Fullerton,Madison M %A Tang,Theresa %A Constantinescu,Cora %A Mourali,Mehdi %A Oxoby,Robert J %A Marshall,Deborah A %A Hemmati,Hadi %A Badami,Abbas %A Hu,Jia %A Lang,Raynell %+ School of Public Policy and Department of Political Science, University of Calgary, 906 8 Ave SW 5th Floor, Calgary, AB, Canada, 1 403 220 8565, jc.boucher@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K social media %K Twitter %K behavior %K risk reduction %K attitudes %K social network analysis %K machine learning %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. %M 34447924 %R 10.2196/28800 %U https://infodemiology.jmir.org/2021/1/e28800 %U https://doi.org/10.2196/28800 %U http://www.ncbi.nlm.nih.gov/pubmed/34447924 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29942 %T The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study %A Chan,Calvin %A Sounderajah,Viknesh %A Daniels,Elisabeth %A Acharya,Amish %A Clarke,Jonathan %A Yalamanchili,Seema %A Normahani,Pasha %A Markar,Sheraz %A Ashrafian,Hutan %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, 10th floor, Queen Elizabeth Queen Mother Building, St. Mary's Hospital, South Wharf Road, London, W2 1NY, United Kingdom, 44 02033126666, vs1108@imperial.ac.uk %K COVID-19 %K infodemiology %K public health %K quality %K reliability %K social media %K vaccination %K vaccine %K video %K web-based health information %K YouTube %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases “coronavirus vaccine” and “COVID-19 vaccine” were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58%), vaccine trials (n=28, 58%), side effects (n=23, 48%), efficacy (n=17, 35%), and manufacturing (n=8, 17%). Ten (21%) videos encouraged continued public health measures. Only 2 (4.2%) videos made nonfactual claims. The content of 47 (98%) videos was scored to have low (n=27, 56%) or moderate (n=20, 42%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. %M 34081599 %R 10.2196/29942 %U https://publichealth.jmir.org/2021/7/e29942 %U https://doi.org/10.2196/29942 %U http://www.ncbi.nlm.nih.gov/pubmed/34081599 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e23105 %T Using Machine Learning to Compare Provaccine and Antivaccine Discourse Among the Public on Social Media: Algorithm Development Study %A Argyris,Young Anna %A Monu,Kafui %A Tan,Pang-Ning %A Aarts,Colton %A Jiang,Fan %A Wiseley,Kaleigh Anne %+ Michigan State University, 404 Wilson Road, East Lansing, MI, 48823, United States, 1 517 353 2198, argyris@msu.edu %K antivaccination movement %K Twitter messaging %K public health informatics %K supervised machine learning algorithm %K unsupervised machine learning algorithm %K qualitative content analysis %K data visualization %K infodemiology %K infodemic %K health misinformation %K infoveillance %K social listening %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite numerous counteracting efforts, antivaccine content linked to delays and refusals to vaccinate has grown persistently on social media, while only a few provaccine campaigns have succeeded in engaging with or persuading the public to accept immunization. Many prior studies have associated the diversity of topics discussed by antivaccine advocates with the public’s higher engagement with such content. Nonetheless, a comprehensive comparison of discursive topics in pro- and antivaccine content in the engagement-persuasion spectrum remains unexplored. Objective: We aimed to compare discursive topics chosen by pro- and antivaccine advocates in their attempts to influence the public to accept or reject immunization in the engagement-persuasion spectrum. Our overall objective was pursued through three specific aims as follows: (1) we classified vaccine-related tweets into provaccine, antivaccine, and neutral categories; (2) we extracted and visualized discursive topics from these tweets to explain disparities in engagement between pro- and antivaccine content; and (3) we identified how those topics frame vaccines using Entman’s four framing dimensions. Methods: We adopted a multimethod approach to analyze discursive topics in the vaccine debate on public social media sites. Our approach combined (1) large-scale balanced data collection from a public social media site (ie, 39,962 tweets from Twitter); (2) the development of a supervised classification algorithm for categorizing tweets into provaccine, antivaccine, and neutral groups; (3) the application of an unsupervised clustering algorithm for identifying prominent topics discussed on both sides; and (4) a multistep qualitative content analysis for identifying the prominent discursive topics and how vaccines are framed in these topics. In so doing, we alleviated methodological challenges that have hindered previous analyses of pro- and antivaccine discursive topics. Results: Our results indicated that antivaccine topics have greater intertopic distinctiveness (ie, the degree to which discursive topics are distinct from one another) than their provaccine counterparts (t122=2.30, P=.02). In addition, while antivaccine advocates use all four message frames known to make narratives persuasive and influential, provaccine advocates have neglected having a clear problem statement. Conclusions: Based on our results, we attribute higher engagement among antivaccine advocates to the distinctiveness of the topics they discuss, and we ascribe the influence of the vaccine debate on uptake rates to the comprehensiveness of the message frames. These results show the urgency of developing clear problem statements for provaccine content to counteract the negative impact of antivaccine content on uptake rates. %M 34185004 %R 10.2196/23105 %U https://publichealth.jmir.org/2021/6/e23105/ %U https://doi.org/10.2196/23105 %U http://www.ncbi.nlm.nih.gov/pubmed/34185004 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27603 %T Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia %A Mekonnen,Zeleke Abebaw %A Gelaye,Kassahun Alemu %A Were,Martin %A Tilahun,Binyam %+ Department of Health Informatics, Institute of Public Health, University of Gondar, Chechela Street, Gondar, 196, Ethiopia, 251 913747092, zelekeabebaw7@gmail.com %K mHealth %K eHealth %K mobile phone %K text message %K short message service %K reminder %K immunization %K vaccination %K Ethiopia %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 %M 34128813 %R 10.2196/27603 %U https://mhealth.jmir.org/2021/6/e27603 %U https://doi.org/10.2196/27603 %U http://www.ncbi.nlm.nih.gov/pubmed/34128813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24564 %T Characteristics of Antivaccine Messages on Social Media: Systematic Review %A Wawrzuta,Dominik %A Jaworski,Mariusz %A Gotlib,Joanna %A Panczyk,Mariusz %+ Department of Education and Research in Health Sciences, Faculty of Health Sciences, Medical University of Warsaw, ul Żwirki i Wigury 81, Warsaw, 02-091, Poland, 48 225720490, dwawrzuta@wum.edu.pl %K vaccination %K social media %K antivaccination movement %K vaccination refusal %K health communication %K public health %K vaccines %D 2021 %7 4.6.2021 %9 Review %J J Med Internet Res %G English %X Background: Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines. Objective: This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users’ web-based activities. Methods: We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies. Results: The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media. Conclusions: Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users. %M 34085943 %R 10.2196/24564 %U https://www.jmir.org/2021/6/e24564 %U https://doi.org/10.2196/24564 %U http://www.ncbi.nlm.nih.gov/pubmed/34085943 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e26372 %T The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study %A Hou,Zhiyuan %A Song,Suhang %A Du,Fanxing %A Shi,Lu %A Zhang,Donglan %A Lin,Leesa %A Yu,Hongjie %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K prevention %K vaccination %K behavior %K children %K China %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children’s and adolescents’ prevention and vaccination behaviors amid China’s COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children’s and adolescents’ prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents’ characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2% (638/776) of children or adolescents always wore masks when going out compared with 31.5% (521/1655) before the epidemic; in addition, 25.0% (414/1655) and 79.8% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9% (776/1655) went out during the epidemic. Meanwhile, 56.1% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8% (468/626) delaying scheduled vaccinations and 80.9% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. %M 33882450 %R 10.2196/26372 %U https://publichealth.jmir.org/2021/5/e26372 %U https://doi.org/10.2196/26372 %U http://www.ncbi.nlm.nih.gov/pubmed/33882450 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28352 %T YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Zagnit,Emily A %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K vaccination %K COVID-19 %K social media %K communication %K misinformation %K disinformation %K adverse reactions %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords “coronavirus vaccination,” we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. %M 33886487 %R 10.2196/28352 %U https://publichealth.jmir.org/2021/5/e28352 %U https://doi.org/10.2196/28352 %U http://www.ncbi.nlm.nih.gov/pubmed/33886487 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e17262 %T Evaluating a Mobile Phone–Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial %A Ehlman,Daniel C %A Magoola,Joseph %A Tanifum,Patricia %A Wallace,Aaron S %A Behumbiize,Prosper %A Mayanja,Robert %A Luzze,Henry %A Yukich,Joshua %A Daniels,Danni %A Mugenyi,Kevin %A Baryarama,Fulgentius %A Ayebazibwe,Nicholas %A Conklin,Laura %+ Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, United States, 1 4046398224, dehlman@cdc.gov %K immunization %K vaccination %K reminder system %K mHealth %K short message service %K text messages %K cell phone %K mobile phone %K vaccination dropout %K vaccination timeliness %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective: This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods: A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results: Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions: Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration: ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID): DERR1-10.2196/17262 %M 33625372 %R 10.2196/17262 %U https://www.researchprotocols.org/2021/2/e17262 %U https://doi.org/10.2196/17262 %U http://www.ncbi.nlm.nih.gov/pubmed/33625372 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22222 %T Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis in US Mothers and Children Aged 0-2: PREVAIL Cohort Study %A Morrow,Ardythe L %A Staat,Mary A %A DeFranco,Emily A %A McNeal,Monica M %A Cline,Allison R %A Conrey,Shannon C %A Schlaudecker,Elizabeth P %A Piasecki,Alexandra M %A Burke,Rachel M %A Niu,Liang %A Hall,Aron J %A Bowen,Michael D %A Gerber,Susan I %A Langley,Gayle E %A Thornburg,Natalie J %A Campbell,Angela P %A Vinjé,Jan %A Parashar,Umesh D %A Payne,Daniel C %+ Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH, 45220, United States, 1 513 505 1994, morrowa@ucmail.uc.edu %K birth cohort %K RSV %K influenza %K rotavirus %K norovirus %K vaccines %K vaccine effectiveness %K immunology %K pediatrics %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Acute gastroenteritis (AGE) and acute respiratory infections (ARIs) cause significant pediatric morbidity and mortality. Developing childhood vaccines against major enteric and respiratory pathogens should be guided by the natural history of infection and acquired immunity. The United States currently lacks contemporary birth cohort data to guide vaccine development. Objective: The PREVAIL (Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal) Cohort study was undertaken to define the natural history of infection and immune response to major pathogens causing AGE and ARI in US children. Methods: Mothers in Cincinnati, Ohio, were enrolled in their third trimester of pregnancy, with intensive child follow-up to 2 years. Blood samples were obtained from children at birth (cord), 6 weeks, and 6, 12, 18, and 24 months. Whole stool specimens and midturbinate nasal swabs were collected weekly and tested by multipathogen molecular assays. Saliva, meconium, maternal blood, and milk samples were also collected. AGE (≥3 loose or watery stools or ≥1 vomiting episode within 24 hours) and ARI (cough or fever) cases were documented by weekly cell phone surveys to mothers via automated SMS text messaging and review of medical records. Immunization records were obtained from registries and providers. follow-up ended in October 2020. Pathogen-specific infections are defined by a PCR-positive sample or rise in serum antibody. Results: Of the 245 enrolled mother–child pairs, 51.8% (n=127) were White, 43.3% (n=106) Black, 55.9% (n=137) publicly insured, and 86.5% (n=212) initiated breastfeeding. Blood collection was 100.0% for mothers (n=245) and 85.7% for umbilical cord (n=210). A total of 194/245 (79.2%) mother–child pairs were compliant based on participation in at least 70% (≥71/102 study weeks) of child-weeks and providing 70% or more of weekly samples during that time, or blood samples at 18 or 24 months. Compliant participants (n=194) had 71.0% median nasal swab collection (IQR 30.0%-90.5%), with 98.5% (191/194) providing either an 18- or 24-month blood sample; median response to weekly SMS text message surveys was 95.1% (IQR 76.5%-100%). Compliant mothers reported 2.0 AGE and 4.5 ARI cases per child-year, of which 25.5% (160/627) and 38.06% (486/1277) of cases, respectively, were medically attended; 0.5% of AGE (3/627) and 0.55% of ARI (7/1277) cases were hospitalized. Conclusions: The PREVAIL Cohort demonstrates intensive follow-up to document the natural history of enteric and respiratory infections and immunity in children 0-2 years of age in the United States and will contribute unique data to guide vaccine recommendations. Testing for pathogens and antibodies is ongoing. International Registered Report Identifier (IRRID): RR1-10.2196/22222 %M 33576746 %R 10.2196/22222 %U http://www.researchprotocols.org/2021/2/e22222/ %U https://doi.org/10.2196/22222 %U http://www.ncbi.nlm.nih.gov/pubmed/33576746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21734 %T Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial %A Ateudjieu,Jérôme %A Yakum,Ndinakie Martin %A Goura,André Pascal %A Guenou,Etienne %A Beyala,Landry Bita’a %A Amada,Lapia %A Ngoche,Isabelle %A Kiadjieu,Frank Forex %A Nangue,Charlette %A Djosseu,Elvis Briand Soukep %A Kenfack,Bruno %+ Meilleur Accès aux soins de Santé (MA SANTE), Mvolye Street, Yaoundé, 33490, Cameroon, 237 679336464, pgoura@masante-cam.org %K immunization status %K coverage: completeness %K timeliness %K EPI vaccines %K children under five %K Foumban %K Cameroon %K vaccines %K infectious %K immunization %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. Objective: This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. Methods: Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. Results: Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. Conclusions: This trial is expecting to test an innovative approach to improving children’s immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. Trial Registration: Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse International Registered Report Identifier (IRRID): DERR1-10.2196/21734 %M 33555269 %R 10.2196/21734 %U https://www.researchprotocols.org/2021/2/e21734 %U https://doi.org/10.2196/21734 %U http://www.ncbi.nlm.nih.gov/pubmed/33555269 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e17149 %T Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review %A Karafillakis,Emilie %A Martin,Sam %A Simas,Clarissa %A Olsson,Kate %A Takacs,Judit %A Dada,Sara %A Larson,Heidi Jane %+ London School of Hygiene & Tropical Medicine, Vaccine Confidence Project, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2079272831 ext 2831, emilie.karafillakis@lshtm.ac.uk %K vaccination %K antivaccination movement %K vaccination refusal %K social media %K internet %K research design %K review %K media monitoring %K social listening %K infodemiology %K infoveillance %D 2021 %7 8.2.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring. Objective: The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations. Methods: A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles’ titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses. Results: This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes). Conclusions: Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design. %M 33555267 %R 10.2196/17149 %U http://publichealth.jmir.org/2021/2/e17149/ %U https://doi.org/10.2196/17149 %U http://www.ncbi.nlm.nih.gov/pubmed/33555267 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e21303 %T Utilizing Theories and Evaluation in Digital Gaming Interventions to Increase Human Papillomavirus Vaccination Among Young Males: Qualitative Study %A Darville,Gabrielle %A Burns,Jade %A Chavanduka,Tanaka %A Anderson-Lewis,Charkarra %+ Department of Public Health, College of Health Professions, Mercer University, 1501 Mercer University Drive, Macon, GA, 31207, United States, 1 478 301 5129, darville_gc@mercer.edu %K digital games %K behavior change %K theory %K evaluation %K game design %K health care providers %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV attributes to most cancers including anal, oral, cervical, and penile. Despite infection rates in the United States, recommendations and communication campaigns have traditionally focused on females. Because of this, males lack knowledge about reasons for vaccination, the benefits of being vaccinated, and their HPV risk, overall. Gaming as a health education strategy can be beneficial as mechanism that can promote behavior change for this key demographic because of the popularity of gaming. Objective: We sought to explore the relationship between gamification and HPV vaccine uptake. Methods: Interviews were conducted with experts (n=22) in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology, and health communication on how a game should be developed to increase HPV vaccination rates among males. Results: Overwhelmingly, theoretical models such as the health belief model were identified with key constructs such as self-efficacy and risk perception. Experts also suggested using intervention mapping and logic models as planning tools for health promotion interventions utilizing a digital game as a medium. In game and out of game measures were discussed as assessments for quality and impact by our expert panel. Conclusions: This study shows that interventions should focus on whether greater utilization of serious games, and the incorporation of theory and standardized methods, can encourage young men to get vaccinated and to complete the series of HPV vaccinations. %M 33480856 %R 10.2196/21303 %U http://games.jmir.org/2021/1/e21303/ %U https://doi.org/10.2196/21303 %U http://www.ncbi.nlm.nih.gov/pubmed/33480856 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e24827 %T Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Ya Qi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K parental acceptability %K COVID-19 vaccination %K children under the age of 18 years %K theory of planned behavior %K social media influence %K China %D 2020 %7 30.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children’s vaccination. Objective: The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods: This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020. Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. Results: The prevalence of parents’ acceptability of COVID-19 vaccination for their children was 72.6% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95% CI 0.74-0.99). Conclusions: Parents’ acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner. %M 33326406 %R 10.2196/24827 %U http://pediatrics.jmir.org/2020/2/e24827/ %U https://doi.org/10.2196/24827 %U http://www.ncbi.nlm.nih.gov/pubmed/33326406 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22996 %T An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial %A Kazi,Abdul Momin %A Qazi,Saad Ahmed %A Khawaja,Sadori %A Ahsan,Nazia %A Ahmed,Rao Moueed %A Sameen,Fareeha %A Khan Mughal,Muhammad Ayub %A Saqib,Muhammad %A Ali,Sikander %A Kaleemuddin,Hussain %A Rauf,Yasir %A Raza,Mehreen %A Jamal,Saima %A Abbasi,Munir %A Stergioulas,Lampros K %+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan, 92 2134864232, momin.kazi@aku.edu %K artificial intelligence %K AI %K routine childhood immunization %K EPI %K LMICs %K mHealth %K Pakistan %K personalized messages %K routine immunization %K smartphone apps %K vaccine-preventable illnesses %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective: The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement. Methods: A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage. Results: Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions: This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs. Trial Registration: ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107 International Registered Report Identifier (IRRID): DERR1-10.2196/22996 %M 33274726 %R 10.2196/22996 %U https://www.researchprotocols.org/2020/12/e22996 %U https://doi.org/10.2196/22996 %U http://www.ncbi.nlm.nih.gov/pubmed/33274726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21451 %T Dimensions of Misinformation About the HPV Vaccine on Instagram: Content and Network Analysis of Social Media Characteristics %A Massey,Philip M %A Kearney,Matthew D %A Hauer,Michael K %A Selvan,Preethi %A Koku,Emmanuel %A Leader,Amy E %+ Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA, 19104, United States, 1 267 359 6067, pmm85@drexel.edu %K social media %K cancer %K vaccination %K health communication %K public health %K HPV, human papillomavirus %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The human papillomavirus (HPV) vaccine is a major advancement in cancer prevention and this primary prevention tool has the potential to reduce and eliminate HPV-associated cancers; however, the safety and efficacy of vaccines in general and the HPV vaccine specifically have come under attack, particularly through the spread of misinformation on social media. The popular social media platform Instagram represents a significant source of exposure to health (mis)information; 1 in 3 US adults use Instagram. Objective: The objective of this analysis was to characterize pro- and anti-HPV vaccine networks on Instagram, and to describe misinformation within the anti-HPV vaccine network. Methods: From April 2018 to December 2018, we collected publicly available English-language Instagram posts containing hashtags #HPV, #HPVVaccine, or #Gardasil using Netlytic software (n=16,607). We randomly selected 10% of the sample and content analyzed relevant posts (n=580) for text, image, and social media features as well as holistic attributes (eg, sentiments, personal stories). Among antivaccine posts, we organized elements of misinformation within four broad dimensions: 1) misinformation theoretical domains, 2) vaccine debate topics, 3) evidence base, and 4) health beliefs. We conducted univariate, bivariate, and network analyses on the subsample of posts to quantify the role and position of individual posts in the network. Results: Compared to provaccine posts (324/580, 55.9%), antivaccine posts (256/580, 44.1%) were more likely to originate from individuals (64.1% antivaccine vs 25.0% provaccine; P<.001) and include personal narratives (37.1% vs 25.6%; P=.003). In the antivaccine network, core misinformation characteristics included mentioning #Gardasil, purporting to reveal a lie (ie, concealment), conspiracy theories, unsubstantiated claims, and risk of vaccine injury. Information/resource posts clustered around misinformation domains including falsification, nanopublications, and vaccine-preventable disease, whereas personal narrative posts clustered around different domains of misinformation, including concealment, injury, and conspiracy theories. The most liked post (6634 likes) in our full subsample was a positive personal narrative post, created by a non-health individual; the most liked post (5604 likes) in our antivaccine subsample was an informational post created by a health individual. Conclusions: Identifying characteristics of misinformation related to HPV vaccine on social media will inform targeted interventions (eg, network opinion leaders) and help sow corrective information and stories tailored to different falsehoods. %M 33270038 %R 10.2196/21451 %U https://www.jmir.org/2020/12/e21451 %U https://doi.org/10.2196/21451 %U http://www.ncbi.nlm.nih.gov/pubmed/33270038 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e16883 %T Evaluation of a Serious Video Game to Facilitate Conversations About Human Papillomavirus Vaccination for Preteens: Pilot Randomized Controlled Trial %A Cates,Joan R %A Fuemmeler,Bernard F %A Stockton,Laurie L %A Diehl,Sandra J %A Crandell,Jamie L %A Coyne-Beasley,Tamera %+ Massey Cancer Center, Virginia Commonwealth University, 830 E. Main St., Rm 4-128, P.O. Box 980149, Richmond, VA, 23219, United States, 1 804 828 8892, Bernard.Fuemmeler@vcuhealth.org %K video games %K papillomavirus vaccines %K adolescent health %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, the most common sexually transmitted infection, human papillomavirus (HPV), causes genital warts and is associated with an estimated 33,700 newly diagnosed cancer cases annually. HPV vaccination, especially for preteens aged 11 to 12 years, is effective in preventing the acquisition of HPV and HPV-associated cancers. However, as of 2018, completion of the 2- or 3-dose HPV vaccination series increased only from 48.6% to 51.1% in teens aged 13 to 17 years, and this increase was observed only in boys. By comparison, 88.7% of teens had more than one dose of the recommended vaccine against tetanus, diphtheria, and acellular pertussis (Tdap), and 85.1% of teens had more than one dose of meningococcal vaccine. Immunizations for Tdap, meningococcal disease, and HPV can occur at the same clinical visit but often do not. Objective: Vaccination against HPV is recommended for routine use in those aged 11 to 12 years in the United States, yet it is underutilized. We aimed to develop an educational video game to engage preteens in the decision to vaccinate. Methods: Land of Secret Gardens is a metaphor for protecting seedlings (body) with a potion (vaccine). We screened 131 dyads of parents and preteens from 18 primary practices in North Carolina who had not initiated HPV vaccination. We measured vaccination intentions, story immersion, and game play and documented HPV vaccination rates. A total of 55 dyads were enrolled, and we randomly assigned 28 (21 completed) to play the game and 27 (26 completed) to the comparison group. Results: In total, 18 preteens reported playing the game. The vaccination self-efficacy score was higher in the comparison group than the intervention group (1.65 vs 1.45; P=.05). The overall mean decisional balance score trended toward greater support of vaccination, although differences between the groups were not significant.. Vaccine initiation and completion rates were higher in the intervention group (22% vs 15%; P=.31) than in the comparison group (9% vs 2%; P=.10), although the difference was not significant. Conclusions: Video games help preteens in the decision to pursue HPV vaccination. A serious video game on HPV vaccination is acceptable to parents and preteens and can be played as intended. Gamification is effective in increasing preteen interest in HPV vaccination, as game features support decision making for HPV vaccination. Trial Registration: ClinicalTrials.gov NCT04627298; https://www.clinicaltrials.gov/ct2/show/NCT04627298 %M 33270028 %R 10.2196/16883 %U https://games.jmir.org/2020/4/e16883 %U https://doi.org/10.2196/16883 %U http://www.ncbi.nlm.nih.gov/pubmed/33270028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20113 %T A Web Application About Herd Immunity Using Personalized Avatars: Development Study %A Hakim,Hina %A Bettinger,Julie A %A Chambers,Christine T %A Driedger,S Michelle %A Dubé,Eve %A Gavaruzzi,Teresa %A Giguere,Anik M C %A Kavanagh,Éric %A Leask,Julie %A MacDonald,Shannon E %A Orji,Rita %A Parent,Elizabeth %A Paquette,Jean-Sébastien %A Roberge,Jacynthe %A Sander,Beate %A Scherer,Aaron M %A Tremblay-Breault,Martin %A Wilson,Kumanan %A Reinharz,Daniel %A Witteman,Holly O %+ Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry 2881, Université Laval, Quebec City, QC, G1V 0A6, Canada, 1 418 656 2131 ext 3981, holly.witteman@fmed.ulaval.ca %K community immunity %K herd immunity %K vaccination %K vaccine hesitancy %K avatar %K web application %D 2020 %7 30.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. Objective: This study aims to design a web application about community immunity and optimize it based on users’ cognitive and emotional responses. Methods: Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants’ cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization’s content and messaging. Results: Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users’ emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. Conclusions: Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity. %M 33124994 %R 10.2196/20113 %U https://www.jmir.org/2020/10/e20113 %U https://doi.org/10.2196/20113 %U http://www.ncbi.nlm.nih.gov/pubmed/33124994 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e19503 %T Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study %A Teitelman,Anne M %A Gregory,Emily F %A Jayasinghe,Joshua %A Wermers,Zara %A Koo,Ja H %A Morone,Jennifer F %A Leri,Damien C %A Davis,Annet %A Feemster,Kristen A %+ University of Pennsylvania, School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2158981910, teitelm@nursing.upenn.edu %K cervical cancer %K prevention %K mobile health %K parents %K adolescent health %K vaccine %K human papillomavirus %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: More than 90% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods: Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results: Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75% (15/20) of adolescents and 88% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88% (30/34) of parents and 75% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82% (28/34) of parents and 85% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95% CI –2.15 to 0.15). Conclusions: mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines. %M 34345789 %R 10.2196/19503 %U https://nursing.jmir.org/2020/1/e19503/ %U https://doi.org/10.2196/19503 %U http://www.ncbi.nlm.nih.gov/pubmed/34345789 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e18878 %T Antivaccine Messages on Facebook: Preliminary Audit %A Dhaliwal,Dhamanpreet %A Mannion,Cynthia %+ University of Calgary, 2500 University Dr NW, Calgary, AB, , Canada, 1 403 210 3848, cmannion@ucalgary.ca %K antivaccine %K vaccines %K vaccination %K immunization %K communicable disease %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization lists vaccine hesitancy as one of 10 threats to global health. The antivaccine movement uses Facebook to promote messages on the alleged dangers and consequences of vaccinating, leading to a reluctance to immunize against preventable communicable diseases. Objective: We would like to know more about the messages these websites are sharing via social media that can influence readers and consumers. What messages is the public receiving on Facebook about immunization? What content (news articles, testimonials, videos, scientific studies) is being promoted? Methods: We proposed using a social media audit tool and 3 categorical lists to capture information on websites and posts, respectively. The keywords “vaccine,” “vaccine truth,” and “anti-vax” were entered in the Facebook search bar. A Facebook page was examined if it had between 2500 and 150,000 likes. Data about beliefs, calls to action, and testimonials were recorded from posts and listed under the categories Myths, Truths, and Consequences. Website data were entered in a social media audit template. Results: Users’ posts reflected fear and vaccine hesitancy resulting from the alleged dangers of immunization featured on the website links. Vaccines were blamed for afflictions such as autism, cancer, and infertility. Mothers shared testimonies on alleged consequences their children suffered due to immunization, which have influenced other parents to not vaccinate their children. Users denied the current measles outbreaks in the United States to be true, retaliating against the government in protests for fabricating news. Conclusions: Some Facebook messages encourage prevailing myths about the safety and consequences of vaccines and likely contribute to parents’ vaccine hesitancy. Deeply concerning is the mistrust social media has the potential to cast upon the relationship between health care providers and the public. A grasp of common misconceptions can help support health care provider practice. %M 33079072 %R 10.2196/18878 %U http://publichealth.jmir.org/2020/4/e18878/ %U https://doi.org/10.2196/18878 %U http://www.ncbi.nlm.nih.gov/pubmed/33079072 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17371 %T Use of Apps to Promote Childhood Vaccination: Systematic Review %A de Cock,Caroline %A van Velthoven,Michelle %A Milne-Ives,Madison %A Mooney,Mary %A Meinert,Edward %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K vaccination %K vaccination coverage %K mobile apps %K infant %K childhood vaccination %K immunization %K smartphone technology %K mobile phone %D 2020 %7 18.5.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. Objective: This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. Methods: PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. Results: A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P≤.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. Conclusions: There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. International Registered Report Identifier (IRRID): RR2-10.2196/16929 %M 32421684 %R 10.2196/17371 %U https://mhealth.jmir.org/2020/5/e17371 %U https://doi.org/10.2196/17371 %U http://www.ncbi.nlm.nih.gov/pubmed/32421684 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16983 %T Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review %A Montagni,Ilaria %A Mabchour,Inass %A Tzourio,Christophe %+ Bordeaux Population Health U1219, Inserm-University of Bordeaux, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 0547304281, ilaria.montagni@u-bordeaux.fr %K gamification %K vaccination %K vaccine hesitancy %K digital tools %K scoping review %D 2020 %7 18.5.2020 %9 Review %J JMIR Serious Games %G English %X Background: Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective: The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods: We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results: A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions: Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage. %M 32348271 %R 10.2196/16983 %U http://games.jmir.org/2020/2/e16983/ %U https://doi.org/10.2196/16983 %U http://www.ncbi.nlm.nih.gov/pubmed/32348271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15800 %T A Values-Tailored Web-Based Intervention for New Mothers to Increase Infant Vaccine Uptake: Development and Qualitative Study %A Dempsey,Amanda %A Kwan,Bethany M %A Wagner,Nicole M %A Pyrzanowski,Jennifer %A Brewer,Sarah E %A Sevick,Carter %A Narwaney,Komal %A Resnicow,Kenneth %A Glanz,Jason %+ University of Colorado, Denver, 13199 East Montview Blvd, Suite 300, Aurora, CO, 80045, United States, 1 3037246679, amanda.dempsey@ucdenver.edu %K immunization %K parents %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccine hesitancy among parents leads to childhood undervaccination and outbreaks of vaccine-preventable disease. As the reasons for vaccine hesitancy are diverse, there is often not enough time during regular clinical visits for medical providers to adequately address all the concerns that parents have. Providing individually tailored vaccine information via the internet before a clinical visit may be a good mechanism for effectively allaying parents’ vaccination concerns while also being time efficient. Including tailoring based on values is a promising, but untested, approach to message creation. Objective: This study aimed to describe the process by which we developed a Web-based intervention that is being used in an ongoing randomized controlled trial aimed at improving the timeliness of infant vaccination by reducing parental vaccine hesitancy. Methods: Development of the intervention incorporated evidence-based health behavior theories. A series of interviews, surveys, and feedback sessions were used to iteratively develop the intervention in collaboration with vaccination experts and potential end users. Results: In all, 41 specific content areas were identified to be included in the intervention. User feedback elucidated preferences for specific design elements to be incorporated throughout the website. The tile-based architecture chosen for the website was perceived as easy to use. Creating messages that were two-sided was generally preferred over other message formats. Quantitative surveys identified associations between specific vaccine values and vaccination beliefs, suggesting that values tailoring should vary, depending on the specific belief being endorsed. Conclusions: Using health behavior theories, qualitative and quantitative data, and significant expert and end user input, we created a novel, Web-based intervention to improve infant vaccination timeliness. The intervention is based on tailoring messages according to each individual’s values and beliefs. This intervention is currently being tested in a controlled randomized clinical trial. %M 32134394 %R 10.2196/15800 %U https://www.jmir.org/2020/3/e15800 %U https://doi.org/10.2196/15800 %U http://www.ncbi.nlm.nih.gov/pubmed/32134394 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e13552 %T Implementation Effectiveness of a Parent-Directed YouTube Video (“It Doesn’t Have To Hurt”) on Evidence-Based Strategies to Manage Needle Pain: Descriptive Survey Study %A Chambers,Christine T %A Dol,Justine %A Parker,Jennifer A %A Caes,Line %A Birnie,Kathryn A %A Taddio,Anna %A Campbell-Yeo,Marsha %A Halperin,Scott A %A Langille,Jennifer %+ Department of Psychology and Neuroscience, Dalhousie University, 5850/5980 University Ave, Halifax, NS, Canada, 1 9024708877, christine.chambers@dal.ca %K pain management %K child %K knowledge translation %K social media %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the availability of high-quality evidence and clinical practice guidelines for the effective management of pediatric pain, this evidence is rarely used in practice for managing children’s pain from needle procedures such as vaccinations. Parents are generally unaware of pain management strategies they can use with their children. Objective: This study aimed to develop, implement, and evaluate the implementation effectiveness of a parent-directed YouTube video on evidence-based strategies to manage needle pain in children. Methods: This was a descriptive study. Analytics were extracted from YouTube to describe video reach. A Web-based survey was used to seek parent and health care professional (HCP) feedback about the video. The 2-minute 18-second video was launched on YouTube on November 4, 2013. In the video, a 4-year-old girl tells parents what they should and should not do to help needles hurt less. The key evidence-based messages shared in the video were distraction, deep breathing, and topical anesthetic creams. A group of parents (n=163) and HCPs (n=278) completed the Web-based survey. Measures of reach included number of unique views, country where the video was viewed, sex of the viewer, and length of watch time. The Web-based survey assessed implementation outcomes of the video, such as acceptability, appropriateness, penetration, and adoption. Results: As of November 4, 2018 (5 years after launch), the video had 237,132 unique views from 182 countries, with most viewers watching an average of 55.1% (76/138 seconds) of the video. Overall, both parents and HCPs reported strong acceptance of the video (ie, they liked the video, found it helpful, and felt more confident) and reported significant improvements in plans to use distraction, deep breathing, and topical anesthetic creams. Conclusions: This parent-directed YouTube video was an acceptable and appropriate way to disseminate evidence about the procedure of pain management to a large number of parents. %M 32130190 %R 10.2196/13552 %U http://pediatrics.jmir.org/2020/1/e13552/ %U https://doi.org/10.2196/13552 %U http://www.ncbi.nlm.nih.gov/pubmed/32130190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16427 %T Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial %A Liao,Qiuyan %A Fielding,Richard %A Cheung,Yee Tak Derek %A Lian,Jinxiao %A Yuan,Jiehu %A Lam,Wendy Wing Tak %+ University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 3917 9289, qyliao11@hku.hk %K influenza vaccination %K social media %K intervention %K children %D 2020 %7 28.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Seasonal influenza vaccination (SIV) coverage among young children remains low worldwide. Mobile social networking apps such as WhatsApp Messenger are promising tools for health interventions. Objective: This was a preliminary study to test the effectiveness and parental acceptability of a social networking intervention that sends weekly vaccination reminders and encourages exchange of SIV-related views and experiences among mothers via WhatsApp discussion groups for promoting childhood SIV. The second objective was to examine the effect of introducing time pressure on mothers’ decision making for childhood SIV for vaccination decision making. This was done using countdowns of the recommended vaccination timing. Methods: Mothers of child(ren) aged 6 to 72 months were randomly allocated to control or to one of two social networking intervention groups receiving vaccination reminders with (SNI+TP) or without (SNI–TP) a time pressure component via WhatsApp discussion groups at a ratio of 5:2:2. All participants first completed a baseline assessment. Both the SNI–TP and SNI+TP groups subsequently received weekly vaccination reminders from October to December 2017 and participated in WhatsApp discussions about SIV moderated by a health professional. All participants completed a follow-up assessment from April to May 2018. Results: A total of 84.9% (174/205), 71% (57/80), and 75% (60/80) who were allocated to the control, SNI–TP, and SNI+TP groups, respectively, completed the outcome assessment. The social networking intervention significantly promoted mothers’ self-efficacy for taking children for SIV (SNI–TP: odds ratio [OR] 2.69 [1.07-6.79]; SNI+TP: OR 2.50 [1.13-5.55]), but did not result in significantly improved children’s SIV uptake. Moreover, after adjusting for mothers’ working status, introducing additional time pressure reduced the overall SIV uptake in children of working mothers (OR 0.27 [0.10-0.77]) but significantly increased the SIV uptake among children of mothers without a full-time job (OR 6.53 [1.87-22.82]). Most participants’ WhatsApp posts were about sharing experience or views (226/434, 52.1%) of which 44.7% (101/226) were categorized as negative, such as their concerns over vaccine safety, side effects and effectiveness. Although participants shared predominantly negative experience or views about SIV at the beginning of the discussion, the moderator was able to encourage the discussion of more positive experience or views and more knowledge and information. Most intervention group participants indicated willingness to receive the same interventions (110/117, 94.0%) and recommend the interventions to other mothers (102/117, 87.2%) in future Conclusions: Online information support can effectively promote mothers’ self-efficacy for taking children for SIV but alone it may not sufficient to address maternal concerns over SIV to achieve a positive vaccination decision. However, the active involvement of health professionals in online discussions can shape positive discussions about vaccination. Time pressure on decision making interacts with maternal work status, facilitating vaccination uptake among mothers who may have more free time, but having the opposite effect among busier working mothers. Trial Registration: Hong Kong University Clinical Trials Registry HKUCTR-2250; https://tinyurl.com/vejv276 %M 32130136 %R 10.2196/16427 %U http://www.jmir.org/2020/2/e16427/ %U https://doi.org/10.2196/16427 %U http://www.ncbi.nlm.nih.gov/pubmed/32130136 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16929 %T Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review %A Van Velthoven,Michelle Helena %A Milne-Ives,Madison %A de Cock,Caroline %A Mooney,Mary %A Meinert,Edward %+ Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K app %K smartphone technology %K vaccination %K vaccines %K immunization %K children %K mobile phone %D 2020 %7 5.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective: The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods: We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results: This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions: This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID): PRR1-10.2196/16929 %M 32022694 %R 10.2196/16929 %U https://www.researchprotocols.org/2020/2/e16929 %U https://doi.org/10.2196/16929 %U http://www.ncbi.nlm.nih.gov/pubmed/32022694 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13832 %T Providers’ Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study %A Cunningham-Erves,Jennifer %A Koyama,Tatsuki %A Huang,Yi %A Jones,Jessica %A Wilkins,Consuelo H %A Harnack,Lora %A McAfee,Caree %A Hull,Pamela C %+ Department of Internal Medicine, Meharry Medical College, 1005 Dr DB Todd Jr Blvd, Nashville, TN, 37208, United States, 1 6153275692, jerves@mmc.edu %K neoplasms %K papillomavirus infections %K papillomavirus vaccines %K primary prevention %K health care provider %K vaccine hesitancy %K provider barriers to HPV vaccination %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Human papillomavirus (HPV) vaccine hesitancy among parents contributes to low vaccination coverage in adolescents. To improve health care provider communication and vaccine recommendation practices with hesitant parents, it is important to understand how providers perceive parental HPV vaccine hesitancy. Objective: This study aimed to characterize perceived reasons for parental HPV vaccine hesitancy and identify factors associated with perceived parental hesitancy among providers at community-based pediatric clinics. Methods: In 2018, providers in 23 community-based pediatric clinics in Tennessee were invited to complete a Web-based baseline survey as part of a larger quality improvement study focused on HPV vaccine uptake. These survey data were used for a cross-sectional, secondary data analysis. Scale scores ranging from 0 to 100 were calculated for provider self-efficacy (confidence in ability to recommend HPV vaccine), provider outcome expectations (expectations that recommendation will influence parents’ decisions), and perceived parental HPV vaccine hesitancy. Provider confidence in HPV vaccine safety and effectiveness were categorized as high versus low. Clinic-level exposures examined were clinic size and rural-urban location. Descriptive analyses were used to characterize perceived parental barriers by provider type. Mixed-effects linear regression models were fit taking one exposure variable at a time, whereas controlling for provider type, age, gender, and race to identify provider- and clinic-level factors associated with perceived parental barriers to HPV vaccination. Results: Of the 187 providers located in the 23 clinics, 137 completed the survey. The majority of physician providers were white and female, with a higher percentage of females among nurse practitioners (NPs) and physician assistants (PAs). The most common parental barriers to HPV vaccination perceived by providers were concerns about HPV vaccine safety (88%), child being too young (78%), low risk of HPV infection for child through sexual activity (70%), and mistrust in vaccines (59%). In adjusted mixed models, perceived parental HPV vaccine hesitancy was significantly associated with several provider-level factors: self-efficacy (P=.001), outcome expectations (P<.001), and confidence in HPV vaccine safety (P=.009). No significant associations were observed between perceived parental HPV vaccine hesitancy and clinic-level factors clinic size nor location. Conclusions: Researchers developing provider-focused interventions to reduce parental HPV vaccine hesitancy should consider addressing providers’ self-efficacy, outcome expectations, and confidence in HPV vaccine safety to help providers communicate more effectively with HPV vaccine hesitant parents. %M 31267976 %R 10.2196/13832 %U https://cancer.jmir.org/2019/2/e13832/ %U https://doi.org/10.2196/13832 %U http://www.ncbi.nlm.nih.gov/pubmed/31267976 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13456 %T Sentiment Analysis of Social Media on Childhood Vaccination: Development of an Ontology %A On,Jeongah %A Park,Hyeoun-Ae %A Song,Tae-Min %+ College of Nursing, Seoul National University, 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 27408827, hapark@snu.ac.kr %K social media %K vaccination %K health information interoperability %K semantics %D 2019 %7 7.6.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although vaccination rates are above the threshold for herd immunity in South Korea, a growing number of parents have expressed concerns about the safety of vaccines. It is important to understand these concerns so that we can maintain high vaccination rates. Objective: The aim of this study was to develop a childhood vaccination ontology to serve as a framework for collecting and analyzing social data on childhood vaccination and to use this ontology for identifying concerns about and sentiments toward childhood vaccination from social data. Methods: The domain and scope of the ontology were determined by developing competency questions. We checked if existing ontologies and conceptual frameworks related to vaccination can be reused for the childhood vaccination ontology. Terms were collected from clinical practice guidelines, research papers, and posts on social media platforms. Class concepts were extracted from these terms. A class hierarchy was developed using a top-down approach. The ontology was evaluated in terms of description logics, face and content validity, and coverage. In total, 40,359 Korean posts on childhood vaccination were collected from 27 social media channels between January and December 2015. Vaccination issues were identified and classified using the second-level class concepts of the ontology. The sentiments were classified in 3 ways: positive, negative or neutral. Posts were analyzed using frequency, trend, logistic regression, and association rules. Results: Our childhood vaccination ontology comprised 9 superclasses with 137 subclasses and 431 synonyms for class, attribute, and value concepts. Parent’s health belief appeared in 53.21% (15,709/29,521) of posts and positive sentiments appeared in 64.08% (17,454/27,236) of posts. Trends in sentiments toward vaccination were affected by news about vaccinations. Posts with parents’ health belief, vaccination availability, and vaccination policy were associated with positive sentiments, whereas posts with experience of vaccine adverse events were associated with negative sentiments. Conclusions: The childhood vaccination ontology developed in this study was useful for collecting and analyzing social data on childhood vaccination. We expect that practitioners and researchers in the field of childhood vaccination could use our ontology to identify concerns about and sentiments toward childhood vaccination from social data. %M 31199290 %R 10.2196/13456 %U http://www.jmir.org/2019/6/e13456/ %U https://doi.org/10.2196/13456 %U http://www.ncbi.nlm.nih.gov/pubmed/31199290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13256 %T Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach %A Lee,Hee Yun %A Lee,Mi Hwa %A Sharratt,Monica %A Lee,Sohye %A Blaes,Anne %+ School of Social Work, The University of Alabama, 1022 Little Hall Box 870314, Tuscaloosa, AL, 35401, United States, 1 205 348 6553, hlee94@ua.edu %K uterine cervical cancer %K papanicolaou test %K papillomavirus infections %K papillomavirus vaccines %K text messaging %K Asian American %K immigrants %D 2019 %7 6.6.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke’s thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population’s perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. %M 31199340 %R 10.2196/13256 %U https://mhealth.jmir.org/2019/6/e13256/ %U https://doi.org/10.2196/13256 %U http://www.ncbi.nlm.nih.gov/pubmed/31199340 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e12851 %T Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial %A Kazi,Abdul Momin %A Ahsan,Nazia %A Khan,Ayub %A Jamal,Saima %A Kalimuddin,Hussain %A Ghulamhussain,Naveera %A Wajidali,Zabin %A Muqeet,Abdul %A Zaidi,Fabiha %A Subzlani,Meraj %A McKellin,William %A Ali,Asad %A Collet,Jean-Paul %+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi,, Pakistan, 92 2134864232, momin.kazi@aku.edu %K routine immunization %K SMS messages %K automated call messages %K cluster randomized clinical trial %K vaccine barriers %K personalized intervention %K cell phones %K vaccination coverage %K mobile health %K text messaging %K developing countries %K parents %D 2019 %7 30.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)–based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call–based messages and interventions to improve routine immunization (RI) coverage. Objective: The primary objective of this study is to evaluate whether automated mobile phone–based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. Methods: This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family’s vaccination experience and related factors. Results: All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. Conclusions: The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone–based communication to improve RI coverage and timelines. Moreover, information regarding families’ perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. Trial Registration: ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo) International Registered Report Identifier (IRRID): DERR1-10.2196/12851 %M 31148544 %R 10.2196/12851 %U http://www.researchprotocols.org/2019/5/e12851/ %U https://doi.org/10.2196/12851 %U http://www.ncbi.nlm.nih.gov/pubmed/31148544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13373 %T Case of Paradoxical Cultural Sensitivity: Mixed Method Study of Web-Based Health Informational Materials About the Human Papillomavirus Vaccine in Israel %A Abed Elhadi Shahbari,Nour %A Gesser-Edelsburg,Anat %A Mesch,Gustavo S %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 504847217, nabede01@campus.haifa.ac.il %K web-based health informational materials %K HPV vaccine %K Israel %K cultural sensitivity %K transparency %K sexuality %K quantitative analysis %K qualitative content analysis %K Hebrew and Arabic %D 2019 %7 17.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Designing web-based informational materials regarding the human papillomavirus (HPV) vaccine has become a challenge for designers and decision makers in the health authorities because of the scientific and public controversy regarding the vaccine’s safety and effectiveness and the sexual and moral concerns related to its use. Objective: The study aimed to investigate how cultural sensitivity (CS) is articulated in the explanatory informational materials on the HPV vaccine that are posted on the websites of the Israeli health authorities. In addition, the study examined the effect of transparency on the expression of CS in the informational materials. Methods: The study employed a quantitative and qualitative content analysis of the texts of explanatory informational materials published on the Arabic and Hebrew websites of the Israel Ministry of Health and the Clalit health maintenance organization (HMO). Results: The findings revealed the differences in the dimensions of CS (based on the CS model by Resnicow) between the informational materials targeting the majority Jewish population and those targeting the minority Arab population. Indeed, the research findings point to a paradox. On the one hand, the materials appealing to the conservative Arab population exhibited CS, in that the sexual context of the vaccine was missing. On the other hand, analysis of Resnicow's deep dimensions showed that disregarding the sexual context does not allow the relevant target audience to reflect on the barriers and concerns. In addition, the way the information was provided exhibited a lack of transparency regarding the CS dimensions (surface and deep). Conclusions: The public health authorities have 2 main objectives in the context of vaccinations. One is to raise the vaccination rates and the other is to provide full and culturally sensitive information to give the public the tools to make intelligent decisions. The findings of this study indicated that despite the high uptake rate for HPV vaccination in the Arab population, the health authorities did not exercise full transparency and CS in transmitting the association between engaging in sexual relations and the necessity of the vaccination. Thus, the major challenge for the health authorities is to find ways to implement the objective of communicating information about the vaccination in a way that is transparent and culturally sensitive, even if this raises questions and fears among the public deriving from their culture. %M 31102371 %R 10.2196/13373 %U http://www.jmir.org/2019/5/e13373/ %U https://doi.org/10.2196/13373 %U http://www.ncbi.nlm.nih.gov/pubmed/31102371 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e8540 %T FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer %A Ruiz-López,Tomás %A Sen,Sagar %A Jakobsen,Elisabeth %A Tropé,Ameli %A Castle,Philip E %A Hansen,Bo Terning %A Nygård,Mari %+ HPV Research Group, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway, Oslo,, Norway, 47 95181886, mari.nygard@kreftregisteret.no %K papillomavirus vaccines %K educational technology %K uterine cervical neoplasms %K papillomavirus infections %K primary prevention %K secondary prevention %K early detection of cancer %K mobile applications %K health education %K learning %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. %M 30958271 %R 10.2196/games.8540 %U https://games.jmir.org/2019/2/e8540/ %U https://doi.org/10.2196/games.8540 %U http://www.ncbi.nlm.nih.gov/pubmed/30958271 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e10915 %T Young People’s Knowledge of Antibiotics and Vaccinations and Increasing This Knowledge Through Gaming: Mixed-Methods Study Using e-Bug %A Eley,Charlotte Victoria %A Young,Vicki Louise %A Hayes,Catherine Victoria %A Verlander,Neville Q %A McNulty,Cliodna Ann Miriam %+ Primary Care Unit, Public Health England, Microbiology Department, Gloucester Royal Hospital, Gloucester, GL1 3NN, United Kingdom, 44 02084953253, charlotte.eley@phe.gov.uk %K education %K children %K knowledge %K antibiotics %K vaccines %D 2019 %7 01.02.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: e-Bug, led by Public Health England, educates young people about important topics: microbes, infection prevention, and antibiotics. Body Busters and Stop the Spread are 2 new e-Bug educational games. Objective: This study aimed to determine students’ baseline knowledge, views on the games, and knowledge improvement. Methods: Students in 5 UK educational provisions were observed playing 2 e-Bug games. Before and after knowledge and evaluation questionnaires were completed, and student focus groups were conducted. Results: A total of 123 junior and 350 senior students completed the questionnaires. Vaccination baseline knowledge was high. Knowledge increased significantly about antibiotic use, appropriate sneezing behaviors, and vaccinations. In total, 26 student focus groups were conducted. Body Busters was engaging and enjoyable, whereas Stop the Spread was fast-paced and challenging but increased vaccination and health behavior intentions. Conclusions: e-Bug games are an effective learning tool for students to enhance knowledge about microbes, infection prevention, and antibiotics. Game-suggested improvements should help increase enjoyment. %M 30707096 %R 10.2196/10915 %U https://games.jmir.org/2019/1/e10915/ %U https://doi.org/10.2196/10915 %U http://www.ncbi.nlm.nih.gov/pubmed/30707096 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 1 %P e9544 %T Relationship Between Media Coverage and Measles-Mumps-Rubella (MMR) Vaccination Uptake in Denmark: Retrospective Study %A Hansen,Niels Dalum %A Mølbak,Kåre %A Cox,Ingemar Johansson %A Lioma,Christina %+ Statens Serum Institut, Artillerivej 5, Copenhagen, 2300, Denmark, 45 32683268, niels.dalum.hansen@gmail.com %K online news media %K vaccination uptake %K media influence on vaccination uptake %K MMR %K autism %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the influence of media coverage upon vaccination activity is valuable when designing outreach campaigns to increase vaccination uptake. Objective: To study the relationship between media coverage and vaccination activity of the measles-mumps-rubella (MMR) vaccine in Denmark. Methods: We retrieved data on media coverage (1622 articles), vaccination activity (2 million individual registrations), and incidence of measles for the period 1997-2014. All 1622 news media articles were annotated as being provaccination, antivaccination, or neutral. Seasonal and serial dependencies were removed from the data, after which cross-correlations were analyzed to determine the relationship between the different signals. Results: Most (65%) of the anti-vaccination media coverage was observed in the period 1997-2004, immediately before and following the 1998 publication of the falsely claimed link between autism and the MMR vaccine. There was a statistically significant positive correlation between the first MMR vaccine (targeting children aged 15 months) and provaccination media coverage (r=.49, P=.004) in the period 1998-2004. In this period the first MMR vaccine and neutral media coverage also correlated (r=.45, P=.003). However, looking at the whole period, 1997-2014, we found no significant correlations between vaccination activity and media coverage. Conclusions: Following the falsely claimed link between autism and the MMR vaccine, provaccination and neutral media coverage correlated with vaccination activity. This correlation was only observed during a period of controversy which indicates that the population is more susceptible to media influence when presented with diverging opinions. Additionally, our findings suggest that the influence of media is stronger on parents when they are deciding on the first vaccine of their children, than on the subsequent vaccine because correlations were only found for the first MMR vaccine. %M 30672743 %R 10.2196/publichealth.9544 %U https://publichealth.jmir.org/2019/1/e9544/ %U https://doi.org/10.2196/publichealth.9544 %U http://www.ncbi.nlm.nih.gov/pubmed/30672743 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e63 %T Using Predictive Analytics to Identify Children at High Risk of Defaulting From a Routine Immunization Program: Feasibility Study %A Chandir,Subhash %A Siddiqi,Danya Arif %A Hussain,Owais Ahmed %A Niazi,Tahira %A Shah,Mubarak Taighoon %A Dharma,Vijay Kumar %A Habib,Ali %A Khan,Aamir Javed %+ Harvard Medical School Center for Global Health Delivery–Dubai, Building 14,, Dubai Healthcare City,, United Arab Emirates, 971 44221742, subhash.chandir@ird.global %K machine learning %K artificial intelligence %K immunizations %K dropouts %K predictive analytics %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the availability of free routine immunizations in low- and middle-income countries, many children are not completely vaccinated, vaccinated late for age, or drop out from the course of the immunization schedule. Without the technology to model and visualize risk of large datasets, vaccinators and policy makers are unable to identify target groups and individuals at high risk of dropping out; thus default rates remain high, preventing universal immunization coverage. Predictive analytics algorithm leverages artificial intelligence and uses statistical modeling, machine learning, and multidimensional data mining to accurately identify children who are most likely to delay or miss their follow-up immunization visits. Objective: This study aimed to conduct feasibility testing and validation of a predictive analytics algorithm to identify the children who are likely to default on subsequent immunization visits for any vaccine included in the routine immunization schedule. Methods: The algorithm was developed using 47,554 longitudinal immunization records, which were classified into the training and validation cohorts. Four machine learning models (random forest; recursive partitioning; support vector machines, SVMs; and C-forest) were used to generate the algorithm that predicts the likelihood of each child defaulting from the follow-up immunization visit. The following variables were used in the models as predictors of defaulting: gender of the child, language spoken at the child’s house, place of residence of the child (town or city), enrollment vaccine, timeliness of vaccination, enrolling staff (vaccinator or others), date of birth (accurate or estimated), and age group of the child. The models were encapsulated in the predictive engine, which identified the most appropriate method to use in a given case. Each of the models was assessed in terms of accuracy, precision (positive predictive value), sensitivity, specificity and negative predictive value, and area under the curve (AUC). Results: Out of 11,889 cases in the validation dataset, the random forest model correctly predicted 8994 cases, yielding 94.9% sensitivity and 54.9% specificity. The C-forest model, SVMs, and recursive partitioning models improved prediction by achieving 352, 376, and 389 correctly predicted cases, respectively, above the predictions made by the random forest model. All models had a C-statistic of 0.750 or above, whereas the highest statistic (AUC 0.791, 95% CI 0.784-0.798) was observed in the recursive partitioning algorithm. Conclusions: This feasibility study demonstrates that predictive analytics can accurately identify children who are at a higher risk for defaulting on follow-up immunization visits. Correct identification of potential defaulters opens a window for evidence-based targeted interventions in resource limited settings to achieve optimal immunization coverage and timeliness. %M 30181112 %R 10.2196/publichealth.9681 %U http://publichealth.jmir.org/2018/3/e63/ %U https://doi.org/10.2196/publichealth.9681 %U http://www.ncbi.nlm.nih.gov/pubmed/30181112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e130 %T Vaccine Images on Twitter: Analysis of What Images are Shared %A Chen,Tao %A Dredze,Mark %+ Center for Language and Speech Processing, Johns Hopkins University, Hackerman Hall 226, 3400 North Charles Street, Baltimore, MD, 21218, United States, 1 410 516 4237, tchen77@jhu.edu %K vaccine %K visual communication %K image tweet %K Twitter %K retweet prediction %K social media %D 2018 %7 03.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Visual imagery plays a key role in health communication; however, there is little understanding of what aspects of vaccine-related images make them effective communication aids. Twitter, a popular venue for discussions related to vaccination, provides numerous images that are shared with tweets. Objective: The objectives of this study were to understand how images are used in vaccine-related tweets and provide guidance with respect to the characteristics of vaccine-related images that correlate with the higher likelihood of being retweeted. Methods: We collected more than one million vaccine image messages from Twitter and characterized various properties of these images using automated image analytics. We fit a logistic regression model to predict whether or not a vaccine image tweet was retweeted, thus identifying characteristics that correlate with a higher likelihood of being shared. For comparison, we built similar models for the sharing of vaccine news on Facebook and for general image tweets. Results: Most vaccine-related images are duplicates (125,916/237,478; 53.02%) or taken from other sources, not necessarily created by the author of the tweet. Almost half of the images contain embedded text, and many include images of people and syringes. The visual content is highly correlated with a tweet’s textual topics. Vaccine image tweets are twice as likely to be shared as nonimage tweets. The sentiment of an image and the objects shown in the image were the predictive factors in determining whether an image was retweeted. Conclusions: We are the first to study vaccine images on Twitter. Our findings suggest future directions for the study and use of vaccine imagery and may inform communication strategies around vaccination. Furthermore, our study demonstrates an effective study methodology for image analysis. %M 29615386 %R 10.2196/jmir.8221 %U http://www.jmir.org/2018/4/e130/ %U https://doi.org/10.2196/jmir.8221 %U http://www.ncbi.nlm.nih.gov/pubmed/29615386 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e20 %T Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial %A Kazi,Abdul Momin %A Ali,Murtaza %A Zubair,Khurram %A Kalimuddin,Hussain %A Kazi,Abdul Nafey %A Iqbal,Saleem Perwaiz %A Collet,Jean-Paul %A Ali,Syed Asad %+ Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 34864232, momin.kazi@aku.edu %K SMS %K mobile phone %K reminders %K low- and middle-income countries %K routine immunization %K children %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) %M 29514773 %R 10.2196/publichealth.7026 %U http://publichealth.jmir.org/2018/1/e20/ %U https://doi.org/10.2196/publichealth.7026 %U http://www.ncbi.nlm.nih.gov/pubmed/29514773 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e59 %T Evaluation of a Mobile Phone–Based Intervention to Increase Parents’ Knowledge About the Measles-Mumps-Rubella Vaccination and Their Psychological Empowerment: Mixed-Method Approach %A Fadda,Marta %A Galimberti,Elisa %A Fiordelli,Maddalena %A Schulz,Peter Johannes %+ Health Ethics and Policy Lab, Department of Health Sciences and Technology, ETH Zurich, Auf der Mauer 17, Zurich, 8092, Switzerland, 41 4463 ext 24187, marta.fadda@hest.ethz.ch %K qualitative research %K measles-mumps-rubella vaccine %K surveys and questionnaires %K mobile applications %K knowledge %K patient participation %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most intervention studies is that they do not apply randomized controlled trials (RCTs), the method that, over the last 2 decades, has increasingly been considered as the only method to provide proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. This study, however, holds that methods other than RCTs also can produce meaningful results. Objective: The aim of this study was to evaluate 2 mobile phone–based interventions aimed at increasing parents’ knowledge of the measles-mumps-rubella (MMR) vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The 2 interventions were part of an RCT. Methods: We conducted 2 studies with the RCT participants: a Web-based survey aimed at assessing their rating of the tool regarding a number of qualities such as usability and usefulness (N=140), and qualitative telephonic interviews to explore participants’ experiences with the app (N=60). Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment intervention) liked the app significantly better compared with the group that only received the empowerment intervention (F2,137=15.335; P<.001). Parents who were exposed to the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that efforts to empower patients should always be accompanied by the provision of factual information. Using a narrative format that promotes parents’ identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time. Trial Registration: International Standard Randomized Controlled Trial Number 30768813; http://www.isrctn.com/ ISRCTN30768813 (Archived by WebCite at http://www.webcitation.org/6xOQSJ3w8) %M 29514772 %R 10.2196/mhealth.8263 %U http://mhealth.jmir.org/2018/3/e59/ %U https://doi.org/10.2196/mhealth.8263 %U http://www.ncbi.nlm.nih.gov/pubmed/29514772