Abstract
Human papillomavirus (HPV) vaccine hesitancy or refusal is common among parents of adolescents. An understanding of public perceptions from the perspective of behavior change theories can facilitate effective and targeted vaccine promotion strategies. To develop and validate deep learning models for understanding public perceptions of HPV vaccines from the perspective of behavior change theories using data from social media. This retrospective cohort study, conducted from April to August 2019, included longitudinal and geographic analyses of public perceptions regarding HPV vaccines, using sampled HPV vaccine-related Twitter discussions collected from January 2014 to October 2018. The prevalence of social media discussions related to the construct of health belief model (HBM) and theory of planned behavior (TPB), categorized by deep learning algorithms. Locally estimated scatterplot smoothing (LOESS) revealed trends of constructs. Social media users' US state-level home location information was extracted from their profiles, and geographic analyses were performed to identify the clustering of public perceptions of the HPV vaccine. A total of 1 431 463 English-language posts from 486 116 unique usernames were collected. Deep learning algorithms achieved F-1 scores ranging from 0.6805 (95% CI, 0.6516-0.7094) to 0.9421 (95% CI, 0.9380-0.9462) in mapping discussions to the constructs of behavior change theories. LOESS revealed trends in constructs; for example, prevalence of perceived barriers, a construct of HBM, deceased from its apex in July 2015 (56.2%) to its lowest prevalence in October 2018 (28.4%; difference, 27.8%; P < .001); Positive attitudes toward the HPV vaccine, a construct of TPB, increased from early 2017 (30.7%) to 41.9% at the end of the study (difference, 11.2%; P < .001), while negative attitudes decreased from 42.3% to 31.3% (difference, 11.0%; P < .001) during the same period. Interstate variations in public perceptions of the HPV vaccine were also identified; for example, the states of Ohio and Maine showed a relatively high prevalence of perceived barriers (11 531 of 17 106 [67.4%] and 1157 of 1684 [68.7%]) and negative attitudes (9655 of 17 197 [56.1%] and 1080 of 1793 [60.2%]). This cohort study provided a good understanding of public perceptions on social media and evolving trends in terms of multiple dimensions. The interstate variations of public perceptions could be associated with the rise of local antivaccine sentiment. The methods described in this study represent an early contribution to using existing empirically and theoretically based frameworks that describe human decision-making in conjunction with more intelligent deep learning algorithms. Furthermore, these data demonstrate the ability to collect large-scale HPV vaccine perception and intention data that can inform public health communication and education programs designed to improve immunization rates at the community, state, or even national level.
Highlights
Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States.[1]
Locally estimated scatterplot smoothing (LOESS) revealed trends in constructs; for example, prevalence of perceived barriers, a construct of health belief model (HBM), deceased from its apex in July 2015 (56.2%) to its lowest prevalence in October 2018 (28.4%; difference, 27.8%; P < .001); Positive attitudes toward the HPV vaccine, a construct of theory of planned behavior (TPB), increased from early 2017 (30.7%) to 41.9% at the end of the study, while negative attitudes decreased from 42.3% to 31.3% during the same period
Interstate variations in public perceptions of the HPV vaccine were identified; for example, the states of Ohio and Maine showed a relatively high prevalence of perceived barriers (11 531 of 17 106 [67.4%] and 1157 of 1684 [68.7%]) and negative attitudes (9655 of 17 197 [56.1%] and 1080 of 1793 [60.2%]). This cohort study provided a good understanding of public perceptions on social media and evolving trends in terms of multiple dimensions
Summary
Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States.[1] HPV infections cause approximately 33 700 cases of cancer every year in the United States, including cervical, vaginal, vulvar, penile, and anal cancers.[2,3] The HPV vaccine has been available since 2006 to protect against HPV-associated cancers and is recommended for adolescents starting at age 9 years through age 26 years if not vaccinated, and, for some people, up to age 45 years.[4] compared with other adolescent vaccines (eg, tetanus, diphtheria, pertussis [Tdap] and meningococcal B [MenB]), HPV vaccine rates remain low, with approximately 51% of adolescents not completing the HPV vaccination series.[5] The most common reasons for parental declination of HPV vaccine include safety concerns, perceived lack of necessity, and lack of knowledge about the vaccine and HPV.[6] For this reason, knowledge about the prevalence of these concerns can inform tailored strategies to mitigate them and improve immunization rates
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