Abstract
Purpose
Whereas Romanian health officials have launched two national human papillomavirus (HPV) vaccination campaigns, the uptake rate remained insignificant. Understanding local perceptions of the vaccine is necessary, as they could inform future educational programmes. Given that social media provide new opportunities to communicate about vaccination, this paper sought to explore the public’s constructions of the HPV vaccine as they were expressed on Internet discussion forums.
Methods
Twenty discussion forums, with a total sample size of 2,240 comments (2007–2012), were included. We conducted a thematic analysis with a focus on language, informed by a discourse analytic approach.
Results
Positive discourses relying on evidence-based arguments or cancer-related experiences battled with negative discourses that focused mostly on pseudo-scientific information and affect-based testimonials. Both camps made use of appeals to authority in order to provide powerful messages. Critics expressed high levels of mistrust in the health system and perceived the vaccine as dangerous, as part of a conspiracy, as unnecessary or as a promoter of promiscuity. By contrast, supporters considered the HPV vaccine to be helpful and criticized the irrationality of opponents. Ambivalence and uncertainty also emerged, along with criticism toward the suboptimal organization of the vaccination programmes. Findings highlight ways in which views about the vaccine are embedded in broader perspectives about science, the national medical system, society development and economic inequality.
Conclusion
Online posts are likely to elicit fear and doubts around vaccination, which in turn may impair decisions. Findings indicate that targeted education campaigns are needed in order to address public concerns about vaccination.
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Dr. Diane M. Harper is a researcher who worked on the safety and efficacy trials for the HPV vaccines.
References
Baseman JG, Koutsky LA. The epidemiology of human papillomavirus infections. J Clin Virol. 2005;32S:S16–24.
Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine. 2006;24S1: 4–15.
Bosch FX, Lorincz A, Muñoz N, Meijer CJLM, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol. 2002;55:244–65.
Marur S, D’Souza G, Westra WH, Forastiere AA. HPV-associated head and neck cancer: a virus-related cancer epidemic. Lancet Oncol. 2010;11:781–9.
Psyrri A, DiMaio D. Human papillomavirus in cervical and head-and-neck cancer. Nat Clin Pract Oncol. 2008;5(1):24–31.
Muñoz N, Castellsague X, Berrington de Gonzalez A, Gissmann L. Chapter 1: HPV in the etiology of human cancer. Vaccine. 2006;24(S3):1–10.
GLOBOCAN database: IARC: International Agency for Research on Cancer. 2008. http://globocan.iarc.fr/. Accessed 10 Feb 2013.
World Health Organization (WHO). Health for All Database. 2012. http://data.euro.who.int/hfadb/ Accessed 10 Feb 2013.
Apostol I, Baban A, Nicula F, Suteu O, Coza D, Amati C, et al. Cervical cancer assessment in Romania under EUROCHIP-2. Tumori. 2010;96:545–52.
Băban A, Balázsi R, Bradley J, Rusu C, Szentágotai A, Tătaru R. Psychosocial and health system dimensions of cervical screening in Romania. Cluj-Napoca, Romania. Romanian Association of Health Psychology, Department of Psychology, Babes-Bolyai University, EngenderHealth. 2005.
Ministry of Health. 2009. http://www.informarehpv.ro/articole/52/Comunicat-de-presa–Ministerul-Sanatatii-demareaza-campania-de-informare-pentru-prevenirea-prin-vac.html. Accessed 11 Jul 2012.
European Centre for Disease Prevention and Control. Introduction of HPV vaccines in EU countries—an update. 2012. Stockholm: ECDC.
Fernandez ME, Allen JD, Mistry R, Kahn JA. Integrating clinical, community, and policy perspectives on human papillomavirus vaccination. Annu Rev Public Health. 2010;31:235–52.
Verhoeven V, Baay MF, Baay PE, Lardon F, Van Royen P, Vermorken JB. Everything you always wanted to know about HPV (but could not ask your doctor). Patient Educ Couns. 2010;81(1):101–5.
Hughes J, Cates JR, Liddon N, Smith JS, Gottlieb SL, Brewer NT. Disparities in how parents are learning about the human papillomavirus vaccine. Cancer Epid Biom Prev. 2009;18(2):363–72.
Witteman HO, Zikmund-Fisher BJ. The defining characteristics of Web 2.0 and their potential influence in the online vaccination debate. Vaccine. 2012;30:3734–40.
Betsch C, Brewer NT, Brocard P, et al. Opportunities and challenges of Web 2.0 for vaccination decisions. Vaccine. 2012;30:3727–33.
Nicholson MS, Leask J. Lessons from an online debate about measles-mumps-rubella (MMR) immunization. Vaccine. 2012;30(25):3806–12.
Betsch C, Renkewitz F, Betsch T, Ulshöfer C. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15(3):446–55.
Nan X, Madden K. HPV vaccine information in the blogosphere: how positive and negative blogs influence vaccine-related risk perceptions, attitudes, and behavioral intentions. Health Commun. 2012;27(8):829–36.
Betsch C, Renkewitz F, Haase N. Effect of narrative reports about vaccine adverse events and bias-awareness disclaimers on vaccine decisions: a simulation of an online patient social network. Med Decis Making. 2013;33(1):14–25.
Reyna VF. Risk perception and communication in vaccination decisions: a fuzzy-trace theory approach. Vaccine. 2012;30:3790–7.
Calloway C, Jorgensen CM, Saraiya M, Tsui J. A content analysis of news coverage of the HPV vaccine by U.S. newspapers, January 2002–June 2005. J Womens Health. 2006;15(7):803–9.
Fowler EF, Gollust SE, Dempsey AF, Lantz PM, Ubel PA. Issue emergence, evolution of controversy, and implications for competitive framing: the case of the HPV vaccine. Int J Press/Polit. 2012;17(2):169–89.
Habel MA, Liddon N, Stryker JE. The HPV vaccine: a content analysis of online news stories. J Womens Health. 2009;18(3):401–7.
Keelan J, Pavri V, Balakrishnan R, Wilson K. An analysis of the human papilloma virus vaccine debate on MySpace blogs. Vaccine. 2010;28:1535–40.
Krieger JL, Katz ML, Eisenberg D, Heaner S, Sarge M, Jain P. Media coverage of cervical cancer and the HPV vaccine: implications for geographic health inequities. Health Expect. 2011; [Epub ahead of print].
Madden K, Nan X, Briones R, Waks L. Sorting through search results: a content analysis of HPV vaccine information online. Vaccine. 2012;30(25):3741–6.
Quintero Johnson J, Sionean C, Scott AM. Exploring the presentation of news information about the HPV vaccine: a content analysis of a representative sample of U.S. newspaper articles. Health Commun. 2011;26(6):491–501.
Cooper Robbins SC, Pang C, Leask J. Australian Newspaper Coverage of Human Papillomavirus Vaccination, October 2006–December 2009. J Health Commun. 2012;17(2):149–59.
Abdelmutti N, Hoffman-Goetz L. Risk messages about HPV, cervical cancer, and the HPV vaccine Gardasil: a content analysis of Canadian and U.S. National Newspaper articles. Women Health. 2009;49(5):422–40.
Forster A, Wardle J, Stephenson J, Waller J. Passport to promiscuity or lifesaver: press coverage of HPV vaccination and risky sexual behavior. J Health Commun. 2010;15(2):205–17.
Hilton S, Hunt K, Langan M, Bedford H, Petticrew M. Newsprint media representations of the introduction of the HPV vaccination programme for cervical cancer prevention in the UK (2005–2008). Soc Sci Med. 2010;70(6):942–50.
Bodemer N, Müller SM, Okan Y, Garcia-Retamero R, Neumeyer-Gromen A. Do the media provide transparent health information? A cross-cultural comparison of public information about the HPV vaccine. Vaccine. 2012;30(25):3747–56.
Tozzi AE, Buonuomo PS, ML C d A, Carloni E, Menoli M, Gamba F. Comparison of quality of internet pages on human papillomavirus immunization in Italian and in English. J Adolesc Health. 2010;46(1):83–9.
Ache KA, Wallace LS. Human papillomavirus vaccination coverage on YouTube. Am J Prev Med. 2008;35:389–92.
Briones R, Nan X, Madden K, Waks L. When vaccines go viral: an analysis of HPV vaccine coverage on YouTube. Health Commun. 2012;27:478–85.
Penţa MA, Băban A. Mass media coverage of HPV vaccination in Romania: a content analysis. Under review.
Patton MQ. Qualitative evaluation and research methods, second edition. Sage. 1990.
Braun V, Clarke V. Using thematic analysis in psychology. Qualit Res Psych. 2006;3(2):77–101.
Willig C. A discourse dynamic approach to the study of subjectivity in health psychology. Theory Psychol. 2000;10:547–70.
Robinson KM. Unsolicited narratives from the Internet: a rich source of qualitative data. Qual Health Res. 2001;11(5):706–14.
Rodham K, Gavin J. The ethics of using the Internet to collect qualitative research data. Res ethics Rev. 2006;2:92–7.
Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet. 2011;378:526–35.
Betsch C. Innovations in communication: the Internet and the psychology of vaccination decisions. Euro Surveill. 2011;16(17):1–6.
Callaghan J, Lazard L. ‘Please don’t put the whole dang thing out there!’: a discursive analysis of internet discussions around infant feeding. Psych Health. 2012;27(8):938–55.
Craciun C, Baban A. “Who will take the blame?”: Understanding the reasons why Romanian mothers decline HPV vaccination for their daughters. Vaccine. 2012;30(48):6789–93.
Slovic P, Peters E, Finucane ML, MacGregor DG. Affect, risk, and decision making. Health Psych. 2005;24(S4):S35–40.
Slovic P, Finucane M, Peters E, MacGregor DG. The affect heuristic. In: Gilovich T, Griffin D, Kahneman D, editors. Heuristics and biases: the psychology of intuitive judgment. NewYork: Cambridge University Press; 2002. p. 397–20.
Loewenstein G, Weber EU, Hsee CK, Welch N. Risk as feelings. Psych Bull. 2001;127(2):267–86.
Ziarnowski KL, Brewer NT, Weber B. Present choices, future outcomes: anticipated regret and HPV vaccination. Prev Med. 2009;48:411–4.
Chapman GB, Coups EJ. Emotions and preventive health behavior: worry, regret, and influenza vaccination. Health Psychol. 2006;25(1):82–90.
Betsch C, Ulshöfer C, Renkewitz F, Betsch T. The influence of narrative v statistical information on perceiving vaccination risks. Med Decis Mak. 2011;31:742–53.
Ritov I, Baron J. Reluctance to vaccinate: omission bias and ambiguity. J Behav Decis Mak. 1990;3:263–77.
Ritov I, Baron J. Outcome knowledge, regret, and omission bias. Organ Behav Hum Decis Proc. 1995;64:119–27.
Baron J, Ritov I. Omission bias, individual differences and normality. Organ Behav Hum Decis Process. 2004;94:74–85.
Brown KF, Kroll JS, Hudson MJ, et al. Omission bias and vaccine rejection by parents of healthy children: implications for the influenza A/H1N1 vaccination programme. Vaccine. 2010;28:4181–5.
Henrich N, Holmes B. What the public was saying about the H1N1 vaccine: perceptions and issues discussed in on-line comments during the 2009 H1N1 pandemic. PLoS ONE. 2011;6(4):e18479.
Bean SJ. Emerging and continuing trends in vaccine opposition Website content. Vaccine. 2011;29(10):1874–80.
Zimmerman RK, Wolfe RM, Fox DE, Fox JR, Nowalk MP, Troy JA, et al. Vaccine criticism on the World Wide Web. J Med Internet Res. 2005;7(2):e17.
Kata A. A postmodern Pandora’s box: anti-vaccination misinformation on the Internet. Vaccine. 2010;28:1709–16.
Graffigna G, Bosio AC. The influence of setting on findings produced in qualitative health research: a comparison between face-to-face and online discussion groups about HIV/AIDS. Int J Qual Methods. 2006;5(3):55–76.
Connoly T, Reb J. Towards interactive, internet-based decision aid for vaccination decisions: better information alone is not enough. Vaccine. 2012;30:3813–8.
Acknowledgments
We are grateful to Dr. Irina Todorova for her helpful comments on the manuscript.
This study was supported by the National Council for Eurasian and East European Research (NCEEER). The funding source had no role in the design, data collection, analysis and interpretation, writing of the paper or decision to publish.
Conflict of Interest Statement
Authors Marcela Penţa and Adriana Băban declare that they have no conflict of interest.
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Penţa, M.A., Băban, A. Dangerous Agent or Saviour? HPV Vaccine Representations on Online Discussion Forums in Romania. Int.J. Behav. Med. 21, 20–28 (2014). https://doi.org/10.1007/s12529-013-9340-z
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DOI: https://doi.org/10.1007/s12529-013-9340-z