Impact of the COVID-19 pandemic on social media utilization, influences related to parental vaccine decision making, and opinions on trustworthy social media vaccination campaigns: A qualitative analysis

Figures & data

Table 1. Sociodemographic characteristics of the sample (N = 64).

Sociodemographic Characteristic	N (%)
Age in years	Mean (SD)
	47.1 (7.9)
Gender
Female	54 (84.3)
Male	10 (15.6)
Race
White	46 (71.9)
Black	8 (12.5)
Asian	4 (6.3)
Other/Multiple	5(7.8)
Missing	1 (1.6)
Hispanic ethnicity
Yes	22 (34.4)
No	40 (62.5)
Missing	2 (3.1)
United States Region
Northeast	20 (31.2)
Midwest	7 (11.0)
Southeast	22 (34.3)
Southwest	7 (11.0)
West	8 (12.5)
Type of Insurance
Private	42 (65.6)
Public	19 (29.7)
None	2 (3.1)
Missing	1 (1.6)
Education
High School graduate	5 (7.8)
Some college	9 (14.1)
College graduate or higher	49 (76.6)
Missing	1 (1.6)
Employment status
Full time employed	46 (71.8)
Full time caregiver	8 (12.5)
Full time student	1 (1.6)
Part time employed	8 (12.5)
Retired	1 (1.6)
Relationship Status
Married/Partnered	54 (84.3)
Single/Divorced/Separated	9 (14.1)
Missing	1 (1.6)
How important is it your child (children) receive all recommended vaccines?
Very Important	39 (60.9)
Important	22 (34.4)
Not Important	2 (3.1)
Missing	1 (1.6)
Which vaccines has/have your child (children) age 11–17 received? Flu (every year or periodically)
Yes	42 (65.6)
No	22 (34.4)
≥ 1 HPV dose
Yes	32 (50.0)
No	32 (50.0)
MenACWY
Yes	38 (59.4)
No	26 (40.6)
Tdap
Yes	50 (78.1)
No	14 (21.9)
COVID-19
Yes	52 (81.3)
No	12 (18.8)
Social Media Use
Multiple times per day	33 (51.6)
Daily	23 (35.9)
Weekly	8 (12.5)
>Weekly or never	0 (0)

Figure 1. Frequency of social media use across platforms (N = 64).

Figure 2. Preferred sources for health care information ranked (N = 64).

HCP = health care provider.

Table 2. Illustrative quotes.

Categories	Illustrative Quotations
Theme 1: Pandemic’s impact on parents’ general patterns of social media use
Types of posts	Most pics of me, my family, cats, or food :). (F, 53) I post humorous things. The world needs some happiness and good news right now. Pretty food I don’t post health information on social media. I post pictures of family, events, vacations. Inspirational quotes. (M, 49) Factual information from the CDC. Recommendations to protect against serious illnesses. (M, 55) I post information I find that talks about the pros and cons of vaccines. I want to give the correct information I find. There are a lot of things I find that are totally not true. (M, 55) I post about major lifetime events such as graduations. I try not to be political. (F, 53) Lighthearted things and family, I don’t want to be part of ugliness. I avoid engagement since nobody knows how to act right anymore. (F, 43)
Motivations to post or repost	Important issues that have fact and meaning (F, 55) If it’s something that’s worth repeating, something informative, or humorous (M, 39) Things that inspire people. Things that bring joy. (M, 49) If I feel passionate about the topic or want to share information with others (F, 51) If I feel I can contribute to a discussion, I will post. If I have a question and want advice, I will post. (F, 59) I want to help my Facebook friends. I want to share any important or helpful info. (F, 52)
Pandemic effect on level of engagement
Same	[in terms of engaging more] No, I post in waves and always have. (F, 45) Remained about the same as before (F, 43)
More	I would say more because of being stuck inside so much. (F, 55) More, it was a way to stay connected with others when we couldn’t do so in person. (F, 48) Well, I had more time to be on social media, so I would say it increased. I was also trying to stay connected with friends. (F, 54)
Less	My contact on FB [Facebook] became less and less. Initially I took to social media more to lessen the isolation of the pandemic. I found myself agitated with much of the ignorance. (F, 49) Less on most days. I get fed up with the ignorance. (F, 43) Less. Too much negativity now. (M, 49) Yes. A lot less engagement. People are just so opinionated (F, 53) Oddly less. Groups have fractured. (M, 63) Much less. I’m done with the constant panic and fear, my anxiety. Not just the pandemic but EVERYTHING is negative. (F, 43)
Passive engagement	Less interaction, more observing (F, 34) I’m more on social media but posting less. Nowadays you seriously have to watch what you post. (F, 39) More engagement due to more free time and WFH … Def don’t post as much about anything. Just scrolling and liking. (F, 43) I read more than I advise in health matters. (M, 42)
Engagement with health or vaccine discussions	I do not. It can lead to fights. (M, 39) No, I don’t. It’s an individual’s choice when it comes to health. (M, 49) With friends and family. COVID vaccines are important. (M, 55) I was unintelligent and post only once in my life on my views on healthcare and was instantly sent hostile messages for a week or so. I stay away from anything with my personal opinion of any merit anymore. (F, 42) Yes, I engage a lot about health on social media. (M, 55) No. I don’t trust the “Facebook” doctors. Everyone seems to have become experts on infectious diseases on social media. … I read, but I only use information that makes sense to me. So I take everything with a grain of salt. (F, 41) Not anymore [discuss health]. I feel face to face conversations are best. (F, 43) YES. I discuss health especially when I disagree with someone. I only respond to those I know. (F, 54)
Theme 2: Pandemic’s impact on parental engagement about vaccines on social media and off-line behaviors related to vaccination
Type of information seen about vaccines
Mixed/neutral	Lots of things. Some say you shouldn’t get them and that they don’t work. Others think they are the best thing that was ever invented. Mainly regarding COVID vaccine. I generally see a mix of both negative and positive. (F, 38) A mixed bag of positive and negative. It seems to be aligned with political beliefs. (F, 53) Very polarized opinions. There are a group of hard-core believer and then there are groups of people that are hard core nonbelievers of vaccines. And then arguments ensue. (F, 41)
Negative	About how healthy young people are suddenly dying of heart problems. mostly in fb [Facebook] groups of people that are anti-vaccine. (F, 53) They inject you with microchips. Will mutate your body. Will turn you into zombies. It depends on political affiliation. (M, 49) I always see studies trying to prove vaccines cause autism. (F, 48) That you can’t spread the virus [in reference to COVID]. [Getting a vaccine] It’s a way to see who will do as the government TELLS them. (F, 39) That they are putting things into them to track you. (F, 34) Individuals expressing concern about particular vaccines (side effects, lack of research, bizarre mutations, etc.). (F, 59)
Positive	I see mostly positive information about vaccines, and believe in that. Do not do further research. (F, 52) That the vaccines were helping to lower the COVID cases. (F, 43) Mom groups that say their kids suffered no side effects. (F, 53) News from CDC or WHO. (F, 34) Prevents long term dangerous illnesses such as HPV vaccine prevents cancer. I am afraid of cancer so I listened more. (F, 53) It helps save lives and protects you and the health of others around you. (F,41)
Views on negative information’s credibility/trustworthiness	I felt as though most of the information may have been disinformation and not credible. (F, 38) I didn’t necessarily believe the [negative] information was credible, but I was concerned enough about it – because it involved my child – to ask her pediatrician. The doctor said there is no medical proof and that the benefits were great. That was enough. (F, 57) I ignored most of it. (F, 51) No I did not view the negative information as trustworthy. It was based on opinions and not facts. (F, 51) I can’t think of a single negative comment that I would consider credible. (F, 45) I didn’t view negative as trustworthy or not, because I didn’t know the facts. It was more food for thought. (F, 34)
Views on positive information’s credibility/trustworthiness	Yes [positive information] viewed as trustworthy. Because based on trials and statistics. (F, 53) Yes, credible because it came from the CDC. (F, 38) If it came from a proven and reliable source. (F, 41) I mean, I’m biased toward it because I agree with it. But, I still always check sources, and think about motivations behind the publications. (F, 42) Positive information seems to be more transparent and fact-checked. Negative seems to be more conspiracy and other theories. (M, 63) I felt the positive information was trustworthy because it was based on scientific research. (F, 51)
Perceived impact on vaccine behaviors for children
No change	No change in getting vaccines, I always did get them for my family (F, 52) No, I still feel that routine vaccinations are important. I want to do everything I can to prevent my family from getting any disease or illness. (F, 48) No. I have always believed in vaccines all along. My kids are all up to date with recommended immunizations. COVID or no COVID, we stand with vaccines. (F, 41)
More likely to seek vaccines	Yes. I actually also made sure my son got the flu and HPV vaccines. (F, 48) Yes, and rightly so. We are moving down the line in terms of who is next and that is also the children. (F, 39) Yeah for the flu vaccine it did. Before I was not a fan of them getting the flu vax. How? I saw how COVID was ravaging through people so quickly. (F, 47)
Less likely to seek vaccines	Somewhat. I never had any doubts prior. Some doubts have creeped in. people always say they know someone who has had complications or side effects. (M, 49) Yes, I don’t trust the government at all now. If you don’t go along with the vaccine and mask mandate, you are targeted. (M, 55)
Theme 3: Perspectives for developing a credible and trustworthy social media intervention regarding vaccination in the wake of COVID-19 pandemic
Sources for trustworthy/credible information	It would have to come from an official government source. Like a post from the CDC. (M, 49) I would say the WHO, FDA, some doctors. I don’t know what to think about the CDC at this moment. (F, 38) If it is a credible article such as the CDC or FDA published article, then I think it is trustworthy. (F, 51) If it’s from a place like the CDC, I would consider it trustworthy, but more often than that, I don’t trust things I see on social media. (F, 45) I usually don’t trust anything on social media, because a lot of people repost things without thinking about how true they are. (F, 34) Endorsements from public health authorities (R91. Diane. G1)
Validation, wanting links to reputable resources to learn more	I will google it and see what else I find to either validate or invalidate it. (F, 53) Referenced data that I can interpret myself. (F, 45) Proven facts and where I can verify them (M, 42) If it’s somewhat in layman’s terms. Relatable. Also, if they can point us toward more information that supports their claims or statements. (F, 42) I always encourage people to do RESEARCH, numbers talk. (F, 39) I doubt all and research its credibility on my own. (F, 45) I went into the sources and read the information, then cross-referenced them with my research. (F, 51)
Influence of message delivery type Storytelling/narrative messages Data driven messages	Seeing other parents, I know, like myself, also made the decision to vaccinate their children made me feel good about my decision to do so with my own child. (F, 51) Seeing how many people (plural) have a vaccine and it didn’t help them. (F, 39) It influences me when it is from someone I trust. (M, 55) A social media post has the best chance of influencing me if it’s just facts. I don’t appreciate people or companies trying to scare me into doing something. (F, 45) I think that infographic, images, and videos can assist with information distribution, but I still look at the source. Anyone can create an infographic and spread misinformation. (F, 38) No, they’re probably good for clarifying information or giving more insight, but I wouldn’t say it affects my decision. (F, 51) All of that helps me understand the information, but I would still consider the source to determine credibility. (F, 59)
Posts by personal healthcare providers	I would trust it for sure coming from my health care provider. That’s my first source. (F, 38) My child’s doctor is on social media and I don’t follow them or engage in any way. (F, 48) I would rather engage with my health care provider in a private setting. Everything that is said on social media is not private. (M, 55) MMMM, I don’t know. I feel like healthcare still needs to be tailored to the individual. So posts by my doctor about what’s good for everyone may not be great. I’d rather have a one on one. I’d still maybe follow them just to see what their visit specials and things are, new staff, etc. (F, 51) If our pediatrician started posting on social media. I would think it was a bit weird (F, 45)

M = Male; F = Female (Gender, Age in Years).