Public engagement with pictures and videos about COVID-19 vaccination on social media: A cross-sectional study in a developing country

ABSTRACT

Vaccination is a critical component of preventing infectious diseases and is one of the most effective public health interventions. While social media is an essential source of health and medical information, it is crucial to understand the link between social media involvement and vaccination engagement. This study examines the relationship between COVID-19 vaccination and social media in Iraq. A web-based questionnaire was administered through Google Forms to elicit responses from a total of 2088 Iraqi social media users aged 18 years and over. The findings suggested significant differences in vaccination engagement due to the level of use of social media and demographic backgrounds, particularly age, educational attainment, and income. Active users and young-aged groups with less educational level and income were more likely to have a positive attitude toward vaccination. Future studies should address demographics and the extent of using social media factors in public health studies. Our findings support the use of social media in raising health awareness.

KEYWORDS:

• COVID-19
• vaccine
• public engagement
• social media
• vaccination

Introduction

Vaccination is a critical component of preventing infectious diseases and is one of the most effective public health interventions [1]. Vaccinations are undoubtedly one of updated medicine's most outstanding achievements. As such, it is hoped that vaccines will help to put an end to the COVID-19 pandemic. The anti-vaccination movement, on the other hand, represented by disseminating incorrect information about vaccine safety on the internet and causing a dramatic decline in immunization rates around the world is on the rise [2]. The first mass vaccination campaign began in early December 2020. At least 13 different vaccines (distributed across four platforms) have been given out. There are now numerous vaccines in use, with daily updates on the number of immunization doses provided. The WHO has not yet approved any new vaccines for EUL until 1 June 2021[3]. A narrative form of communication can have a good effect on preventative and detecting health behaviors, and arguments and facts can also be employed to increase public participation [4]. Vaccines are one of modern medicine's most significant achievements. However, they are only partially accepted, with vaccination hesitation and rejection posing a severe health risk.

Social media is an essential source of health and medical information. It is crucial to understand the link between social media involvement and influenza vaccination since it might be applied to other vaccinations, such as those for COVID-19 [5]. The concepts of trust and engagement are inextricably linked. Citizens’ involvement is an excellent tool for understanding citizens’ demands and instilling trust in government. In contrast, the success of citizen engagement in a crisis is equally dependent on public trust that has been created over time. According to Civil Service College Singapore, citizens’ engagement offers a platform and voice to citizens to contribute to public decision-making and implementation. Community groups can play a pivotal role in citizen engagement, says WHO, with its working with governments across the world to improve access to information about the pandemic [6]. Community groups refer to organizations or associations of people who are united by a common interest or goal and work together to achieve shared objectives. These may include neighborhood associations, homeowners’ associations, political groups, religious organizations, advocacy groups, environmental groups, athletic teams, fan clubs, charities and many other types of groups. People often tend to make friends and form connections with people on social media who are from the same community group. This can be attributed to a sense of shared identity and a feeling of commonality with people who share similar experiences and values.

The way governments engage citizens during a pandemic may alter, but the core principles stay the same. To avoid misunderstandings, expectations should be stated explicitly and early. Public trust and confidence are in danger when engagement is solely viewed. This is especially important in a world where information is abundant and easy to obtain, individuals are more discerning, and citizens have high expectations of government. Intentional, people-centered, collaborative, transparent, and inclusive citizen participation is the key [7]. As stated by the Ministry of Communications and Information of Singapore, public messaging and citizen engagement has been critical in restoring public trust in Singapore during the COVID-19 outbreak. The Government has ensured that citizens are kept informed of the latest developments in COVID-19 instances, as well as the numerous safety management practices and measures adopted to restrict the spread of COVID-19 through a multi-pronged approach5. Aside from the public awareness campaign, the government has collaborated with residents to identify and address important public needs throughout the pandemic [8]. Three studies suggest that user answer to promotion is influenced by media content engagement. High transportation has been demonstrated to positively affect an ad if it is not intrusive due to its placement in a narrative. As a result of the increased ad conveyance, advertising effectiveness rises [9]. Social media has become a means of sharing information with the general population, and it may be a valuable source of information and a good way to keep up with the large quantity of medical knowledge available to the public [10]

Social media not only monitor public sentiments in real-time but can also examine how these beliefs are disseminated and how people respond to them [11]. During the COVID-19 pandemic, public engagement is critical since it demands collaboration and confidence from all walks of society. However, the definition of ‘engagement’ and its practical ramifications are complicated and confusing at times. The state owes it to the community to involve them in policymaking. Some of the COVID-19 response's requests for public participation underline the state’s duties to share data with the people [12]. Social media for policymakers could analyze and visualize ‘mentions’ of specific topics or keywords with the highest levels of engagement. Policy experts, through their manual reading of random subsets of social media posts, can identify common positive and negative themes surrounding vaccination issues [13]. According to CDC building, vaccine confidence requires trust in three areas, namely the vaccines themselves, healthcare personnel providing vaccines, and the system approving, distributing, and monitoring vaccines. Engaging individuals through media, face-to-face outreach, and online interactions to increase vaccine confidence [14]. The current study investigates the connection between COVID-19 vaccination and social media in Iraq, particularly Facebook which is the most widely used social media platform among Iraqi people irrespective of their demographic backgrounds.

Literature review

The literature review is divided into sections namely, Enhancing Public Health Communication in Crisis: Leveraging Social Media Insights, and Navigating Social Media for Public Health Success: Challenges and Strategies.

Enhancing public health communication in crisis: Leveraging social media insights

Public health authorities need to develop a communication strategy to improve their preparedness and reaction to public health crises [15]. The capacity to track how people use social media to spread misinformation could help better target and track the effects of public health measures [16,17]. The quantity of time people spent on each social media platform was associated with their contribution to three behavioral outcomes (social media behavior, offline communication behavior, and helping behavior) [18,19]. According to a prior study, there is a link between hashtag use and public participation on social media in terms of likes, shares, and comments [20]. To overcome skepticism and create faith in COVID-19 vaccinations, public engagement is essential. Public health practitioners may continue to develop community trust through building relationships, focusing on community perspectives, striving toward equity, and being candid about progress and setbacks [21]. To distribute the information related to COVID-19, several guidelines, posters, and recommendations for the public are available on the WHO formal website [22]. The problem of disinformation conveyed through news, and social media is shown by public perceptions of vaccines [23]. There is currently no way to keep up with new health-related stories as they emerge, given the velocity at which new information is made accessible and the resources required to evaluate it. The challenge of regulating information volume versus quality was articulated two decades ago. Approaches for managing rising misinformation in health-related news and media remain an unresolved public health concern [24]. Social media apps can be used strategically to promote open government and improve inhabitant – administration collaboration [25]. The use of government social media is critical for fostering citizen-government communication [26,27]. With government social media, several academics have recognized obstacles, hazards, organizational hurdles, and cultural differences [28,29]. When it comes to participating in local government issues, Facebook is preferred to other social media sites in some situations [30]. The most important result of our research is the creation of a decision tree based on our findings and supporting a multivariate and integrative perspective. Various interactive relationships between seasonal influenza vaccination and social media involvement, impact, and dependability in Israel during the COVID-19 pandemic are genuinely reasonable [31]. Public health campaigns must engage with traditional and social media platforms now to monitor, counter, and prevent the spread of fringe notions about a future COVID-19 vaccine. Public health officials should develop a robust vaccine educational campaign harnessing social influencers and targeting misinformation. Social media serves as a conduit for both factual and false information [32]. Negative tweets stating the absence of vaccine confidence and disinformation, or reports drew more attention and involved more online community interaction. People are increasingly using social media to connect with each other, and public participation can help determine how various messages about COVID-19 vaccinations circulate on social media [33]. Previous studies indicates that Misinformation spreads through social media data [34]. Within our family and friendship networks, as well as our larger communities, we can all be positive role models for vaccination, i.e. great engagement begins at home. There are numerous approaches to help educate the public about COVID-19 vaccination [35].

Navigating social media for public health success: Challenges and strategies

The latest advancements of the COVID-19 infodemic could be a reason for the internet media. Which has become a fertile platform for many people to spread false information, instigate uncivil disputes, and urge reckless acts [36]. For teens and adults, social media platforms such as Twitter provide a ubiquitous and increasingly handy source of information about current events. Consuming this content critically needs a greater level of digital literacy-defined as ‘the ability to access, analyze, and evaluate all types of information and communication’ [37]. The quantity of likes on a photo is related to the level of engagement on a post. Photos with no Zika content received more engagement than photos with Zika content. Unrelated photos had 23.6 likes per week on average, compared to 5.8 likes per week for Zika-related photos [38]. Twitter is used by the main health establishments to spread health data, create associations, and inspire people to take action to improve their health. The sampled organizations were the American Heart Association, the American Cancer Society, and the American Diabetes Association. The most utilized interactive tools were hashtags and hyperlinks [39]. State leaders have been creative in communicating about vaccine availability and education through TV ads, social media platforms, radio stations, signs, posters, billboards, and educational videos. The Minnesota Department of Health has created a statewide tool to connect patients with vaccinators. West Virginia has developed vaccine safety and available resources specifically for health care providers [40]. During the current COVID-19 pandemic, people may increase their use of social media due to social distancing. Social media is awash with virus conspiracies and misinformation. The findings of this study could directly help researchers and policymakers to develop more targeted implementation strategies [41]. COVID-19 vaccines provide the possibility of restoration to some semblance of normalcy. Vaccine-based protection requires a large enough population and good governance. Only community engagement and increased local vaccination acceptability and confidence will result in a successful vaccine roll-out. To connect with and influence perceptions about vaccines and the wider government's response to the COVID-19 pandemic, a new approach is required. Macao's planned bottom-up method, which is backed up by evidence syntheses, gives local actors the capacity to design and implement communication initiatives [42]. The case study shows how social media engagement might be used in the later phases of a pandemic. This knowledge will be useful in the future for Macao and other countries dealing with public health disasters. Also, the World Health Organization has released a report on the use of social media in fighting outbreaks of disease [43]. This could indicate that Facebook is an important instrument for successful communication among the community and administrations throughout public health disasters. Users might be enticed to share and promote public health messaging by visiting government Facebook sites [44]. The public health response to the SARS-CoV-2 vaccine needs to shift from working on behalf of affected communities to working with them [45]. Within the COVID-19 context, the limitations of community engagement must be addressed. Innovative techniques to adapt traditional society engagement methods, as well as digital resources such as social media platforms, may be required [46].

COVID-19 cases and vaccinations in Iraq

From 3 January 2020–23 August 2021, the World Health Organization reported 1,819,455 confirmed cases of COVID-19 in Iraq, with 20,110 deaths. As of July 4, 2021, a total of 1,087,866 vaccination doses had been delivered. A total of 388,541 people were fully vaccinated, with 699,325 receiving at least one dose [47]. On March 25, 2021, Iraq received 336 000 doses of the AstraZeneca COVID-19 vaccine. Over the next few weeks, another 1.1 million doses were sent to Iraq. By the end of 2021, the goal was to cover 20% of the population. This is the first batch of vaccinations sent to Iraq [48]. According to a survey conducted by local academics, Iraq, like other Arab countries, has a high level of vaccination apprehension. Nearly all the 1,069 persons polled said they would eventually get the vaccine in Iraq. However, almost two-thirds of those surveyed (64%) stated they would hold off on getting a shot [49].

Based on this literature review and the aims of the research, two research questions and two hypotheses have been set.

Research questions

RQ1. What are the public attitudes toward those who posted pictures and videos about COVID – 19 vaccinations on social media?

RQ2. How does the public engage with pictures and videos posted on social media?

Hypothesis

Along with the research questions presented, this study tests two hypotheses based on the collected data in the survey of the public during the quarantine. These hypotheses shed light on the study’s underlying arguments.

H1. There is a correlation between the levels of social media usage (LSMU) and Vaccination Engagement (VE).

H2. There is a correlation between the socio-demographic factors (S-DF) and Vaccination Engaging (VE).

Methods

Study design and participants

Ethical approval was obtained from the University of Raparin Institutional Review Board. This study represents an empirical survey to investigate the public engagement of the COVID-19 vaccine on social media in Iraq. It has used a web-based questionnaire administered through Google Forms (n = 2088) to elicit responses from Iraqi social media users aged 18 years and over (Table 1). Participants who missed answering any questions/ questions were excluded. The random sampling method is considered one of the most valid and reliable methods since everyone in the research context had the opportunity to participate [50,51]. On this basis, the results are viewed as representing the whole population [52]. Data collection was carried out during the second week of May through mid-June 2021. The participants in the survey were divided into two gender groups, male (1338/2088, 64.1%); female (750/2088, 35.9%). The participants were also categorized into three age groups: 18–35 years (1398/2088, 64.1%); 36–50 (504/2088, 34.1%); and ≥51 years (186/2088, 809%). The 18–35 – year-old participants comprised the largest group because a noticeable number of them were mainly college students, a cohort that actively uses social media. The participants had different educational attainment: ≤ high school (174/2088, 8.3%), diploma (180/2088, 8.6%), bachelor (1068 / 2088, 51.1%), master (420/2088, 20.1%), PhD (234/2088, 11.2). Also, the income level of participants was considered and they were categorized according to the Iraqi life economic situation: less than 100$ (558/2088,28%), which comprised the largest group with a high percentage of students who were relying on their families; 200$ to 400$ (342/2088, 17.2%); 401$ to 600$ (270 /2088,13.6%); 601$ to 800$ (234 /20881, 11.7%); 801$ to 1000$ (246 / 2088, 12.3%); and ≥1001$ (342/2088, 17.2%).

Table 1. Demographic background of participants.

Characteristics	Respondents, n 2088 (%)
Gender
Male	1338 (64.1)
Female	750 (35.9)
Age (years)
18–35	1398 (64)
19–35	504 (24.1)
≥ 51	186 (8.9)
Educational Level
≤ High school	174 (8.3)
Diploma	180 (8.6)
Bachelor's degree	1068 (51.1)
Master's degree	420 (20.1)
≥ PhD degree	234 (11.2)
Income
less than 100$	558 (28)
200$ to 400$	342 (17.2)
401$ to 600$	270 (13.6)
601$ to 800$	234 (11.7)
801$ to 1000$	246 (12.3)
≥1001$	342 (17.2)

The measures

Public engagement with vaccination pictures and videos on social media

To measure the participants’ attitudes towards posting photos and videos on COVID – 19 vaccinations, five phrases were stated with response options ranging from ‘ 1 strongly disagree’ to ‘strongly agree’. Also, the ways of engagement were measured by providing options ranging from 1 no comment, 2 negative emoji, 3 like, 4 positive emojis, and 5 comments.

Level of social media usage (LSMU)

To access the active/ non-active social media users’, the participants were asked questions with ordinal options that were rated on a 7 point scale ranging from 1’ less than 1hour’ to 7 ‘ more than 5 h’.

Socio-demographic factors (S-DF).

Here, the participants’ gender, male vs. female educational attainment on the basis of a 6-point scale ranging from1 ‘ ≤ High school’ to 7 ‘≥ Ph.D. degree’, age according to a 3 point scale ranging from 1’ 18- 35’ to 4 ‘ ≥ 51’, and income rated on a 7 point scale ranging from 1 ‘ less than 100US$’ to 7 ‘≥1001 US$’ were considered. The socio-demographic factors are summarized in Table 1.

Statistical mean

The Spearman correlation model was used to test the three hypotheses: Level of social media usage (LSMU) and Socio-demographic factors (S-DF) vaccination engagement (VE). The Mann–Whitney U test was used to assess gender variance. In addition, descriptive analysis including Standard Deviation, Mean, and Mean Rank was used to arrive at the descriptive results. The data were analyzed using SPSS (version 22, IBM Corp).

Results

Public attitude toward posting pictures and videos on COVID – 19 vaccinations

The most significant number 672(32.3) tends to agree with posting photos and videos of COVID – 19 vaccinations on social media, and only 300 (14.14) strongly agree (Table 2). However, the majority of samples were distributed on strongly disagree 216(10.4), tend to disagree 366(17.6), and a quarter of sample 528(25.4) did not know to agree or disagree. In general, the total sample, to some extent, agreed because the (mean was = 3.22) which ranged from 2.61–3.40 represents (true to some extent).

Table 2. Public attitudes towards posting pictures and videos on COVID – 19 vaccinations on social media with consideration of the gender variance (N = 2088).

Variables		Public attitudes toward posting pictures and videos of COVID – 19 vaccinations on social media
Variables	Mean	Mean Rank	Chi2	P	Strongly disagree	Tend to disagree	Do not know	Tends to agree	Strongly agree	df
Gender			131.533a	.000						4
Male	3.131	1003.27		.	180(13.5)	282(21.2)	246(18.5)	432(32.4)	192(14.4)
Female	3.400	1109.40			36(4.8)	84(11.2)	282(37.6)	240(32)	108(14.4)
Age			524.656a	.000						8
18–35	3.457	1148.00			90(6.5)	156(11.2)	414(29.7)	492(35.3)	240(17.2)
36–50	3.143	1006.46			66(13.1)	90(17.9)	114(29.7)	174(34.5)	60(11.9)
51 and	1.742	339.40			60(32.3)	120(64.5)	–	6(3.2)	–
Education			321.492^a	.000						16
High school	3.207	1008.19			12(6.9)	30(17.2)	66(37.9)	42(24.1)	24(13.8)
Diploma	3.533	1173.20			6(3.3)	24(13.3)	54(30)	60(33.3)	36(20)
Bachelor's degree	3.418	1121.52			66(6.2)	144(13.6)	312(29.4)	360(33.9)	180(16.9)
Master	3.129	994.83			48(11.4)	96(22.9)	72(17.1)	162(38.6)	42(10)
PhD	2.308	632.50			84(35.9)	72(30.8)	18(7.7)	42(17.9)	18(7.7)
Total	3.22				216(10.4)	366(17.6)	528(25.4)	672(32.3)	300(14.4)

Table 2 indicates variance between male and female attitudes toward posting pictures and videos. Also, the chi-square test suggests significant differences at (x2 = 131.533a, p < .000). Though both genders agreed to some extent with posting pictures and videos because the meaning of the male was (3.131) and the female was (3.400), the female had more positive attitudes because the mean rank of the female was (1109.40), whereas the males was (1003.27). According to Table 2, a small percentage of females strongly disagreed and tended to disagree but more than a third of them (37.4) did not know to agree or disagree with posting pictures and videos.

Table 2 indicates varied attitudes of different age groups toward posting pictures and videos on COVID – 19 vaccinations. The chi-square test suggests significant differences at (x² = 524.656a, p < .000). The value of the mean rank of the youngest age group (18–35) was the highest (1148.00). This means that young age groups were more likely to post and support posting pictures and videos of people vaccinated on social media compared to the other age groups. Furthermore, only young age groups tended to agree to post photo and video because the mean of (36-50) was 3.14, while for (51 and above was 1.742), which did not reach 3:41. Also, the mean of 51 and above represented a strong disagreement because it is in the range of (1–1.80). Table 2 indicates varied attitudes of the sample, on the basis of their educational attainment, toward posting pictures and videos on vaccination; which is significant at (x² = 321.492a, p < .000) The value of means of Diploma was (3.533 and) Bachelor's degree (3.418) which represented agreement, while the other educational attainments represented disagreements.

Public engagement with vaccination pictures and videos on social media

Table 3 indicates that 42.4% of the sample received COVID-19 vaccines, and 15.2% of them posted pictures or videos of the third vaccination. In fact, 15.2% is not a small percentage for posting pictures and obviously seen on social media, which has become a new trend among social media users to share their vaccination. 53.2% of the respondents did not react with related posts and a third group of the participants, 32.4% reacted with those posts by clicking likes. 5.8% engaged with showing positive emoji and 7.8% wrote positive comments. Only 0.9% showed negative emojis which indicated criticism to those who posted their vaccination on social media.

Table 3. Receiving vaccine and public engagement with posting pictures during vaccination on social media.

Receiving vaccination	N 2088(%)
Yes	886 (42.4)
No	1202 (57.6)
Posting pictures during vaccination
Yes	318 (15.2)
No	1770 (84.8)
Ways of engagement
Like	672 (32.4)
Positive emoji	120 (5.8)
Comment	162 (7.8)
Negative emoji	18 (0.9)
No reaction	1104 (53.2)

The participants claimed they posted pictures and videos for several reasons. ‘Encouraging people to receive vaccines was the first reason by (54.3%) and ‘building public trust’ was the second reason by (21%) (Table 4). The participants realized that the vaccination rate was too low, and more than half of the people were not willing to receive vaccines. Another reason was ‘ethical/national/ humanities responsibility’ (15.7%). Although the latter reason records the third, it looks interesting because it represents personal responsibility and a logical reason.

Table 4. Reasons for posting pictures of vaccination on social media.

Reasons	N 2088 (%)
An ethical/national/ humanities responsibility	54 (15.7)
Building public trust	72 (21)
Just to imitate others	24 (7)
Make me happy	6 (1.7)
Encourage people to receive vaccines	186 (54.3)

The use of social media and vaccination engagement (VE)

The first hypothesis predicts a positive correlation between the levels of using social media (non-active users to active users) with vaccination engagement. As previously mentioned in the methodology section, two concepts, namely ‘attitude toward picture during vaccination’, and ‘reaction with posting pictures on vaccination’ have been utilized to COVID-19 vaccine engagement on social media. As Table 5 indicates, there is a positive correlation between (LSMU) and attitudes toward vaccination picture, which was significant at (Rs = .168**; P = .000), and (LSMU) and the reaction with vaccination pictures posted on social media was significant at (Rs = .060**; P = .000).

Table 5. The Spearman correlation model of the correlations between level of social media usage (LSMU) and socio-demographic factors (S-DF) vaccination engagement (VE), (N 2088 = 088).

(LSMU) and (S-DF)	Vaccination Engagement	Rs	p
(LSMU)	Attitude toward pictures during vaccination	.168**	.000
	Reaction by posting picture on vaccination	.060**	.000
(S-DF) (Age, Education, Income)
Age	Attitude toward pictures during vaccination	−.307**	.000
	Reaction by posting picture on vaccination	−.025	.249
Education	Attitude toward pictures during vaccination	−.189**	.000
	Reaction by posting picture on vaccination	.054*	.014
Income	Attitude toward pictures during vaccination	−.134**	.000
	Reaction by posting picture on vaccination	.077**	.001

**Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level (2-tailed).

The third hypothesis which is set to validate the correlation between socio-demographic factors and vaccination engagement. Regarding age, Table 5 indicates a negative correlation between the ages of the sample members and attitudes toward posting pictures on vaccination (−.307**; P < .000). This means that the young participants are more likely to have positive attitudes toward posting a photo on vaccination. Regarding the correlation between age and reaction with posting pictures on vaccination, Table 5 indicates no correlation because the Spearman test was (-.025; P < .225). Table 5 shows that the people with high educational attainment were more likely to have negative attitudes toward vaccination engagement (−.189**; P < .000). This means that highly educated people do not encourage posting a picture on vaccination. Whereas the participants with higher education attainment were more likely to react to posting pictures on vaccination via social media (.054*; P < .014). Table 5 indicates the negative correlations between people’s income and their attitudes toward posting pictures on vaccination. This hypothesis has been confirmed by the Superman test at (−.189**; P < .000) level of significance. As such, it means that lower or poor people are more likely to have positive attitudes towards posting a picture on vaccination.

Socio-demographic factors (S-DF) and vaccination engagement (VE)

Discussion

Public attitude and COVID – 19 vaccinations

The Iraqi government received COVID-19 vaccines on 25 March 2021 and started to vaccinate people [48]. The government did not initially adopt a robust vaccination process through a comprehensive campaign to encourage people to be vaccinated, perhaps due to the lack of doses and the lack of enough personnel. The process was supposed to be taken through online registration and the vaccination was undertaken after some weeks. The goal is to cover 20% of the population by the end of 2021[48]. Hence, this slow start has created vaccination hesitation among people, particularly young people who are dominating social media. This means that the social media has not been invested purposefully and thoughtfully in vaccination campaigns. Iraqi people have a high level of vaccination apprehension, and the previous study identified that (64%) of the sample preferred to receive vaccines at the end of 2021 [49]. In response to RQ1, this study has identified that the engagement was viewed low on social media. For instance, 53.2% of the respondents did not react to the related posts and one third of the participants, 32.4% reacted to those posts by clicking likes only without writing comments. However, 15.2% of the sample who received vaccines posted pictures or/and videos of the third vaccination. In fact, 15.2% is not a small percentage for posting pictures and is obviously seen on social media, and hence has become a new trend among social media users to share their vaccination. This result indicates the imbalance between the rate of posting pictures and videos and engagement with the posted. Added to that, the active social media users were more likely to engage positively because (LSMU) and attitudes toward vaccination pictures were significant at (Rs = .168**; P = .000), and (LSMU) and reaction to vaccination pictures posted on social media was significant at (Rs = .060**; P = .000) (Table 4). This indicates that active social media users tend to act positively with vaccination engagement. It is also assumed that social media plays a crucial role if the social media activists tend to support posting pictures on vaccination. On this basis, it can be assumed that the vaccination campaign across social media in the Iraqi context tends to come with good results.

Socio-demographic factors and vaccination engagement

The demographic backgrounds of the participants should be taken into consideration as there were significant differences among them. The negative correlation between age and attitudes toward posting pictures on vaccination (-.307**; P < .000) Table 5, means that the young age group had more positive attitudes. Similarly, there was a negative correlation between attitudes, based on educational attainment, toward vaccination engagement (-.189**; P < .000). The income factor was negative as well, at (-.189**; P < .000). This indicates that Young, less educated, and low-income people have more positive vaccination attitudes.

Hence, the focus should be on social media as it tends to disseminate information on vaccination that forms the source of public engagement. At times, all demographic factors should be considered. To avoid public health being at risk, it is required to control and adequately handle the erroneous and dangerous media content, communicate trustworthy information that aims at increasing the uptake of a potential COVID-19 vaccine to stop the epidemic, and reinforce media collaboration.

Conclusion

This research is the first in Iraq to investigate public engagement with COVID-19 vaccination across social media. The study on the use of social media to disseminate COVID-19 material and boost public participation in it is meager [53,54]. COVID-19’s national/ global existence, and social transmission pathways require social and community engagement and response. The public in countries worldwide is encouraged to engage in rising health awareness, which collaborates with policy makers’ orientation to have an acceptable and appropriate COVID-19 and other pandemic prevention and control measures. Social media represents an active and vital platform to engage the public with prevention and control measures. Our research has empirically proved the existence of a low level of vaccination engagement across social media. Furthermore, the findings show significant differences in terms of public engagement due to the level of use of social media and the role of demographic backgrounds, particularly age, educational level, and income. It has also been found that active users and young-aged groups with less educational attainment and low income are more likely to have positive attitudes toward vaccination engagement. Theoretically speaking, this group is less powerful and influential in society compared to the group who are more aged and have higher educational degrees and income. Based on this, future studies should focus on demographic and social media factors to support health awareness. To learn more about the varied causes and motivations behind different populations’ resistance to vaccination, qualitative study might be conducted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Ahmed Omar Bali

Dr. Ahmed Omar Bali is an assistant professor in the field of communication and PR, at the University of Human Development, in the Kurdistan Region of Iraq.

Araz Ramazan Ahmad

Dr. Araz Ramazan Ahmad is an assistant professor in the field of digital media, at the University of Raparin, in the Kurdistan Region of Iraq.

Emad Omer

Dr. Emad Omer is an associate professor at Mass Communication College Ajman University – UAE.

Ka Yiu Lee

Dr. Ka Yiu Lee is an assistant professor at the Department of Health Sciences, Mid Sweden University: Sundsvall, SE.