A Protocol of a Pilot Experimental Study Using Social Network Interventions to Examine the Social Contagion of Attitudes Towards Childhood Vaccination in Parental Social Networks

The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy

Effective Approaches to Combat Vaccine Hesitancy.

BackgroundSocial network interventions targeted at children and adolescents can have a substantial effect on their health behaviors, including physical activity. However, designing successful social network interventions is a considerable research challenge. In this study, we rely on social network analysis and agent-based simulations to better understand and capitalize on the complex interplay of social networks and health behaviors. More specifically, we investigate criteria for selecting influence agents that can be expected to produce the most successful social network health interventions.ObjectiveThe aim of this study was to test which selection criterion to determine influence agents in a social network intervention resulted in the biggest increase in physical activity in the social network. To test the differences among the selection criteria, a computational model was used to simulate different social network interventions and observe the intervention’s effect on the physical activity of primary and secondary school children within their school classes. As a next step, this study relied on the outcomes of the simulated interventions to investigate whether social network interventions are more effective in some classes than others based on network characteristics.MethodsWe used a previously validated agent-based model to understand how physical activity spreads in social networks and who was influencing the spread of behavior. From the observed data of 460 participants collected in 26 school classes, we simulated multiple social network interventions with different selection criteria for the influence agents (ie, in-degree centrality, betweenness centrality, closeness centrality, and random influence agents) and a control condition (ie, no intervention). Subsequently, we investigated whether the detected variation of an intervention’s success within school classes could be explained by structural characteristics of the social networks (ie, network density and network centralization).ResultsThe 1-year simulations showed that social network interventions were more effective compared with the control condition (beta=.30; t100=3.23; P=.001). In addition, the social network interventions that used a measure of centrality to select influence agents outperformed the random influence agent intervention (beta=.46; t100=3.86; P<.001). Also, the closeness centrality condition outperformed the betweenness centrality condition (beta=.59; t100=2.02; P=.046). The anticipated interaction effects of the network characteristics were not observed.ConclusionsSocial network intervention can be considered as a viable and promising intervention method to promote physical activity. We demonstrated the usefulness of applying social network analysis and agent-based modeling as part of the social network interventions’ design process. We emphasize the importance of selecting the most successful influence agents and provide a better understanding of the role of network characteristics on the effectiveness of social network interventions.

Addressing personal parental values in decisions about childhood vaccination: Measure development

There is a need to stimulate physical activity among adolescents, but unfortunately, they are hard to reach with traditional mass media interventions. A promising alternative is to carry out social network interventions. In social network interventions, a small group of individuals (influence agents) is selected to promote health-related behaviors within their social network. This study investigates whether a social network intervention is more effective to promote physical activity, compared to a mass media intervention and no intervention. Adolescents (N = 446; Mage = 11.35, SDage = 1.34; 47% male) were randomly allocated by classroom (N = 26, in 11 schools) to one of three conditions: social network intervention, mass media intervention, or control condition. In the social network intervention, 15% of the participants (based on peer nominations) was approached to become an influence agent, who created vlogs about physical activity that were shown during the intervention. In the mass media intervention, participants were exposed to vlogs made by unfamiliar peers (i.e., vlogs of the social network intervention). The control condition did not receive vlogs about physical activity. All participants received a research smartphone to complete questionnaires and a wrist-worn accelerometer to measure physical activity. The trial was registered a priori in the Dutch Trial Registry (NTR6903). There were no differences in objectively measured physical activity between this social network intervention and the control condition in the short-term, but there was an unexpected increase in the control condition compared to the social network intervention in the long-term. No differences between the social network intervention and mass media intervention were observed. The current study does not provide evidence that this social network intervention is effective in increasing physical activity in adolescents. Exploratory analyses suggest that this social network intervention increased the perceived social norm toward physical activity and responses to the vlogs were more positive in the social network intervention than in the mass media intervention. These initial results warrant further research to investigate the role of the social norms and the added benefit of using influence agents for social network interventions.Clinical Trial Registration: https://www.trialregister.nl/, identifier NTR6903.

Pediatric Vaccine Hesitancy and COVID-19

Immunisation is one of public health's greatest success stories, yet, annually, 20 million children miss out entirely or partially on routine immunisation. National immunisation estimates have the United Arab Emirates (UAE) lagging behind with 4% of children under the age of 1 not having received any vaccines. Vaccine hesitancy is considered one of the biggest barriers to vaccination. This study aims to evaluate the UAE's parents' vaccination attitudes and practices as well as estimate vaccine hesitancy's prevalence and determinants. This cross-sectional, descriptive study collected data from parents across the UAE during the months of March and April 2024. The 60-item questionnaire included the Parental Attitudes towards Childhood Vaccines scale (PACV), the Vaccine Hesitancy Scale, and the Digital Vaccine Literacy (DVL) scale. Univariate, bivariate (chi-squared test), and multivariate (logistic regression) analyses were conducted. A total of 550 responses were retained. 84.55% of participants were female (n = 465/550), half were middle-aged (31-45 years old), and 21.09% (n = 116/550) were healthcare workers. 94.36% (n = 519/550) had their child/children receive all mandated vaccines. Only 39.82% (n = 219/550) found their level of knowledge about childhood vaccinations to be good/excellent. 70.11% (n = 386/550) of participants had high digital vaccine literacy. More than 95% had positive attitudes towards measles, meningitis, and pertussis vaccines. 14.00% (n = 77/550) were identified as vaccine-hesitant according to the PACV. Overall, using general practitioner/ paediatrician as a knowledge source, digital vaccine literacy, perceived children's vaccine knowledge, and nationality were associated with lower vaccine hesitancy status. Vaccine hesitancy exists and is prevalent in the UAE; however, the majority of participants reported high trust in vaccines, the local healthcare systems and physicians. Vaccine hesitancy can be tackled but will require tailored solutions and proactive healthcare workers.

This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

BackgroundVaccination constitutes one of the most efficacious public health interventions, preventing millions of fatalities annually. Nevertheless, vaccine hesitancy persists as a significant challenge, particularly among parents. The dissemination of misinformation via the internet, notably through social media platforms, has contributed to the escalation of vaccine hesitancy. E-health literacy, defined as the capacity to locate and utilize online health information, possesses the potential to influence vaccine attitudes. This study aimed to investigate the relationships among education level, e-health literacy and childhood vaccination attitude among parents.MethodsThe cross-sectional study design was used. This study was guided by STROBE. Convenience sampling recruited 699 parents in Türkiye with an online survey. The data tools used in the study were the parental information form, Public Attitudes Towards Vaccination - Health Belief Model Scale (PAV-HBM) and E-health Literacy Scale. The collected data were analyzed using SPSS version 25.0, and the PROCESS macro in SPSS was employed to estimate path coefficients and assess the adequacy of the model. The mediating effects of e-health literacy on the pathway in which education level of the parents affects childhood vaccination were verified using model 4 of the SPSS PROCESS macro proposed by Hayes.ResultsThe E-Health literacy had significantly mediate the relationship between educational level and the PAVS-HBM sub-dimensions of perceived susceptibility (B = 0.044, 95% CI= [0.023–0.071]), severity (B = 0.045, 95% CI= [0.023–0.070]), benefits (B = 0.054, 95% CI= [0.029–0.086]), and health motivation (B = 0.045, 95% CI= [0.023–0.071]). However, e-health literacy did not mediate the relationship between education level and perceived barriers (B = − 0.013, 95% CI= [− 0.049- −0.023]).ConclusionThe results revealed that education level among parents affect all vaccine attitudes without perceived barriers and the level of e-health literacy mediates this relationship. Therefore, health communication strategies, such as the development of e-health literacy by health authorities and the provision of reliable information about vaccination on digital platforms, including social media, may have potential benefits in promoting positive vaccination attitudes in the community.Clinical trial numberNot applicable.

BackgroundThere has been a growing interest in understanding the effects of social networks on health-related behaviour, with a particular backdrop being the emerging prominence of complexity or systems science in public health. Social network interventions specifically use or alter the characteristics of social networks to generate, accelerate, or maintain health behaviours. We conducted a systematic review and meta-analysis to investigate health behaviour outcomes of social network interventions.Methods and findingsWe searched eight databases and two trial registries from 1990 to May 28, 2019, for English-language reports of randomised controlled trials (RCTs) and before-and-after studies investigating social network interventions for health behaviours and outcomes. Trials that did not specifically use social networks or that did not include a comparator group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of health behaviours or outcomes at ≤6 months was assessed by random-effects meta-analysis. Secondary outcomes included those measures at >6–12 months and >12 months. This study is registered with the International Prospective Register of Systematic Reviews, PROSPERO: CRD42015023541. We identified 26,503 reports; after exclusion, 37 studies, conducted between 1996 and 2018 from 11 countries, were eligible for analysis, with a total of 53,891 participants (mean age 32.4 years [SD 12.7]; 45.5% females). A range of study designs were included: 27 used RCT/cluster RCT designs, and 10 used other study designs. Eligible studies addressed a variety of health outcomes, in particular sexual health and substance use. Social network interventions showed a significant intervention effect compared with comparator groups for sexual health outcomes. The pooled odds ratio (OR) was 1.46 (95% confidence interval [CI] 1.01–2.11; I2 = 76%) for sexual health outcomes at ≤6 months and OR 1.51 (95% CI 1.27–1.81; I2 = 40%) for sexual health outcomes at >6–12 months. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in haemoglobin A1c (HbA1c), and smoking cessation. Because of clinical and measurement heterogeneity, it was not appropriate to pool data on these other behaviours in a meta-analysis. For sexual health outcomes, prespecified subgroup analyses were significant for intervention approach (p < 0.001), mean age of participants (p = 0.002), and intervention length (p = 0.05). Overall, 22 of the 37 studies demonstrated a high risk of bias, as measured by the Cochrane Risk of Bias tool. The main study limitations identified were the inclusion of studies of variable quality; difficulty in isolating the effects of specific social network intervention components on health outcomes, as interventions included other active components; and reliance on self-reported outcomes, which have inherent recall and desirability biases.ConclusionsOur findings suggest that social network interventions can be effective in the short term (<6 months) and longer term (>6 months) for sexual health outcomes. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in HbA1c, and smoking cessation.

Introduction Prison population is particularly vulnerable to communicable diseases, including vaccine-preventable infections [1], due to various factors such as low social distancing, high turnover rates, and a high proportion of migrants [2]. However, vaccination coverage among people living in prison (PLP) remains low, largely due to limited access to healthcare services, low levels of vaccine literacy and general health literacy [3]. Additional challenges include persistent vaccine hesitancy and widespread distrust in institutions. Objectives As part of the RISE-Vac project—co-funded by the 3rd EU Health Program—we developed and implemented an evidence-based educational program aimed at boosting vaccination rates in both PLP and prison staff (PS) and evaluated the effect of the intervention on vaccine hesitancy, vaccine literacy and vaccine attitude. Methods We conducted a cross-sectional non-randomised study in 24 prisons of 6 European countries. The sample included 782 PLP and 717 PS members. In participant prisons, an educational program about vaccination for preventable infection diseases was implemented; for PLP, the program consisted in the distribution of educational material (leaflet and a short video) and/or an educational event; for PS, it consisted in a 4-hours online course. Within the study sample, 387 from PLP (49%) and 285 from PS (40%) undertook the intervention. Vaccine hesitancy was measured through a scale previously validated in a sub-cohort of participants – in the following referred to as pre-test [4]. A structured questionnaire was administered to measure vaccine literacy, general health literacy and socio-demographic characteristics of participants. Vaccine attitude was determined as the willingness to accept a vaccine if offered. Linear regression model was applied to assess the effect of the intervention and pre-test on vaccine and general health literacy and vaccine hesitancy. Logistic regression was applied to assess the association between the intervention and pre-test on vaccine attitude. All analyses were stratified by group (PLP and PS) and adjusted for socio-demographic variables. Mediation analysis was conducted to quantify the proportion of the effect of the intervention on vaccine attitude mediated by vaccine hesitancy, adjusting for pre-test and socio-demographic variables. Results In both PLP and PS, the intervention was associated with higher levels of vaccine literacy and stronger associations were observed among those who undertook the pre-test (PLP: interaction between pre-test and intervention, p=0.03; intervention, p=0.005 and p&lt;0.001 in the non-pre-test and pre-test group respectively; PS: interaction, p&lt;0.001; intervention, p=0.02 and p&lt;0.001 in the non-pre-test and pre-test group respectively). In PLP, the intervention was inversely associated with vaccine hesitancy only in those who did not take part of the pre-test but not in the others (interaction, p=0.02; intervention, p&lt;0.001 and p=0.22 in the non-pre-test and pre-test group respectively). In PS, no significant interaction was observed between the intervention and pre-test (p=0.11); the intervention was significantly associated with lower vaccine hesitancy (p=0.002). In both PLP and PS, the intervention was significantly associated with a positive vaccine attitude toward vaccination with no significant interaction with pre-test: in PLP, OR=5.21 (95% CI: 2.74 to 9.91); in PS OR=2.52 (95% CI: 1.54 to 4.13). Finally, mediation analysis showed that less than 30% of the effect of the intervention on vaccination attitude was mediated by a reduction in vaccine hesitancy (24% with p&lt;0.001 and 28% with p=0.002 in PLP and PS respectively). Conclusion Evidence-based educational interventions are effective in improving vaccine hesitancy and vaccine literacy among PLP and PS. Also, they enhance the willingness of participants to be vaccinated, through a mechanism that is only partially explained by their effect on vaccine hesitancy. Further research should be conducted to quantify the real impact of this kind of intervention on vaccine uptake in prison population.

Although previous studies have demonstrated an association between vaccine attitudes and cognitive biases, often resulting in vaccination hesitancy, the exact contribution of rationality has not been fully clarified. We tested two hypotheses regarding the impact of rationality on vaccine attitudes stemming from bounded and expressive rationality. We focused on parental vaccine attitudes operationalized by the affective, behavioral, and cognitive attitude components and investigated how these are influenced by disillusionment toward authorities and ability to engage in rational thinking operationalized using cognitive reflection and heuristics and biases tasks. The study was of a cross‐sectional correlational design with a non‐probabilistic sample of 823 volunteer participants surveyed online in April and May 2018 in Croatia. The results identified disillusionment toward authorities as a predictor of all components. Furthermore, performance on heuristics and biases tasks also predicted the affective and cognitive, but not the behavioral component, whereas cognitive reflection had no impact on vaccine attitudes. Next, a moderation effect of disillusionment toward authorities on the association between the omission bias task and all attitude components was identified. Parents with low disillusionment demonstrated positive vaccine attitudes regardless of their rationality, whereas for parents with high disillusionment a significant positive correlation between performance on the omission bias task as assessed with a vaccination vignette and attitudes was identified. This suggests that the ability to resist vaccine specific omission bias, that is, higher rationality, can decrease the negative effects of disillusionment, which supports the bounded rationality hypothesis.

Introduction: Vaccination is an effective public health intervention; however, coverage of vaccination is declining in states like Tamil Nadu which have good health indicators. Objective: To evaluate the presence of vaccine hesitancy among parents of children between 1 and 5 years of age attending the paediatric out patient department of a tertiary care hospital in Chennai and to assess its relationship with attitudes towards vaccines. Material & Methods: A cross sectional questionnaire-based survey was conducted among 100 consecutively sampled parents of children between 1 and 5 years of age attending a tertiary care paediatric out-patient department. The Parental Attitude towards Childhood Vaccines scale of vaccine hesitancy and the Beliefs and Attitudes towards Childhood Vaccines scale were used to measure vaccine hesitancy and beliefs and attitudes towards vaccination respectively. The data were analysed descriptively and statistical correlation between vaccination attitudes and vaccination hesitancy were studied. Results: In the predominantly urban, educated, working class population, the prevalence of vaccine hesitancy was 21%. But all the children had received complete vaccination appropriate for age. The major drivers for vaccine hesitancy were suspicions about newer vaccines, concerns about adverse effects of vaccines and the perception that there is no need for vaccines against uncommon diseases. The vaccine hesitancy scores were negatively correlated with the vaccine attitude scores (R = -0.266; p = 0.007). Conclusion: Vaccine hesitancy is present among the sampled mothers and is influenced mainly by concerns regarding safety of newer vaccines. Vaccine hesitancy needs to be clearly addressed for strengthening the Universal Immunization Program.

Public willingness to vaccinate has become an important public health issue given the vaccine hesitancy observed worldwide in recent decades. And social media is the main way of information dissemination, and will bring a great impact on people in public health events. The present paper analyzes the relationship between vaccinated Chinese people’s vaccine attitudes and social media information networks. This study aims to explore the impact of social media use on vaccine hesitancy by generating a descriptive statistical and structural model analysis of vaccine hesitancy-relevant content. In this study, the influence model between social media use behavior and vaccination willingness was constructed from three perspectives, including contact intensity, social media trust, and social media information satisfaction. Questionnaires were distributed online, and relevant data analysis software was used. In China, public enthusiasm for the covid-19 vaccine is generally high, and news on social media may have an impact on the willingness to receive the vaccine. Additionally, the Chinese government’s COVID-19 control policies make people who are not willing to actively vaccinate will be vaccinated for their daily life and work reasons. All these reflect the low correlation between vaccination and media publicity. Therefore, social media has a certain impact on COVID-19 vaccination behavior, but it is not the main factor affecting public vaccination.

Measles, the media, and MMR: Impact of the 2014–15 measles outbreak