The Growing Vaccine Hesitancy: Exploring the Influence of the Internet

"To communicate vaccination effectively, we must find out what the target groups know about vaccination and what they would like to find out about it..."

Opponents of vaccination use the internet, among other tools, to increase their presence in public debates. As people increasingly seek health information online, the question becomes how to communicate about vaccination to parents in order to prevent a drop in vaccination coverage among children. Research shows that women use the internet to search for information on medical topics more often than men and have the highest influence on the decision whether to vaccinate their children or not. Thus, from the perspective of communication planning, it makes sense to segment mothers in order to research their profiles and standpoints, knowledge, and attitudes towards vaccination.

The present study uses the Situational Theory of Publics (STOP) to segment Slovenian mothers to subpublics, and to prescribe a clearly defined form of communication for each of the segmented groups. The goal is to determine: (i) the amount and nature of communicative behaviour related to vaccination among mothers of young children in Slovenia, (ii) the effects of communicative cognitions, attitudes, standpoints, and behaviour, and (iii) the likelihood that publics will participate collectively to pressure organisations responsible for vaccination. The study provides practical implications for improved healthcare communication, focused on vaccination, not only from the Slovenian but also from an international perspective.

STOP consists of 2 dependent variables and 3 independent variables. Dependent variables include active communicative behaviour (information seeking about a certain topic based on planned examination of the environment) and passive communicative behaviour (information processing, which means unplanned (coincidental) discovery of a message, followed by its constant processing). Independent variables present the recognition of the issue, its limitations, and level of involvement. According to the relations between dependent and independent variables, STOP distinguishes 4 types of publics: non-public, latent, aware, and active; all of them partake in active and passive communication. If it is presumed that each of the independent variables has a low and high value, it is possible to split publics into 8 different groups, which are detailed in the article.

In the survey, 1,704 mothers participated who gave birth in 2014 and 2015 in Slovenia. Most mothers (34.4%) belong to the "aware public" group, with a characteristically high level of problem and constraint recognition, and a high level of involvement. Mothers who belong to this group are quite determined that it makes no sense to discuss professional matters with doctors, a noticeable deviation from the other groups and the overall average. The same goes for their support for alternative approaches, which differs greatly from the overall average. The aware public favours the statement that science offers no benefits over common sense, which also presents a clear deviation from the entire sample and a substantial deviation from the other 3 public groups. Their trust in people is somewhere between cautious and trustful, which is the lowest of all and a notable deviation towards higher cautiousness compared to the overall average.

The study also showed that mothers react passively to information on vaccination no matter whether they come across it coincidentally or intentionally. Most often, they seek information about vaccination from friends or online. The more concerned they are about the safety of vaccines, the more they search for information about vaccination, and their communication is consequently more active. (As the researchers explain, this finding suggests that doctors should discuss with mothers openly their fear of vaccines and vaccination. It would also make sense to implement educational programmes for parents on credible web health sources, especially regarding vaccination.) The mothers who problematise the safety of vaccines more and are afraid of their adverse events tend to be in favour of alternative options. Groups that oppose vaccination advocate a healthy lifestyle, which could be a connecting point with parents who still show vaccine hesitancy. In communication with them, vaccination could be conveyed as part of a holistic medical child treatment, alongside breastfeeding and consumption of healthy food.

In the discussion section of the paper, the researchers make several suggestions based on the findings. For example, mothers who support vaccination but are often reserved could be an important contact point. Research has shown that the more mothers are in favour of vaccination, the more they are likely to stay out of communicative actions. Practitioners could focus on communicating the benefits of vaccination intensively to future parents who may not yet have a negative attitude towards vaccination. Furthermore, mothers in the latent public group who communicate actively could become ambassadors of vaccination, as they are less critical about the safety of vaccines but still fear their side effects and wish to see comprehensive information about the adverse events of vaccination. They do not have negative attitudes towards doctors, and they trust science and reject alternative approaches.

In conclusion: "There is a huge need for intensive professional communication about vaccination on the internet and social media. The improvement of the communicational competences of doctors and healthcare workers is essential to achieve better communication with parents and the media, and needs to be focused on mothers and pregnant women."