Exploring parents’ views of the use of narratives to promote childhood vaccination online

PLOS ONE RESEARCH ARTICLE Exploring parents’ views of the use of narratives to promote childhood vaccination online Eve Dubé ID1,2*, Marie-Eve Trottier2, Dominique Gagnon2, Julie A. Bettinger3, Devon Greyson ID3, Janice Graham ID4, Noni E. MacDonald4, Shannon E. MacDonald5, Samantha B. Meyer6, Holly O. Witteman7, S. Michelle Driedger8 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Anthropology, Laval University, Quebec, Quebec, Canada, 2 Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada, 3 Department of Pediatrics, Vaccine Evaluation Center, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada, 4 Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada, 5 Faculty of Nursing, University, University of Alberta, Edmonton, Alberta, Canada, 6 School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada, 7 Department of Family Medicine, Laval University, Quebec, Quebec, Canada, 8 Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada * OPEN ACCESS Citation: Dubé E, Trottier M-E, Gagnon D, Bettinger JA, Greyson D, Graham J, et al. (2023) Exploring parents’ views of the use of narratives to promote childhood vaccination online. PLoS ONE 18(7): e0284107. https://doi.org/10.1371/journal. pone.0284107 Editor: Asrat Genet Amnie, City University of New York, UNITED STATES Received: August 30, 2022 Accepted: March 23, 2023 Published: July 19, 2023 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0284107 Copyright: © 2023 Dubé et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Abstract Background Negative information about vaccines that spreads online may contribute to parents’ vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents’ views regarding the use of positive narratives to promote childhood vaccination. Methods We identified three *4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician’s clinical experience with vaccinepreventable diseases (prevention of still existing diseases); and a mother’s experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention. Results Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider’s and parent’s narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed PLOS ONE | https://doi.org/10.1371/journal.pone.0284107 July 19, 2023 1 / 12 PLOS ONE Funding: This research was funded by the Canadian Institutes of Health Research Catalyst Grant. ED received the grant. https://cihr-irsc.gc.ca/ f/193.html The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Parents views of online narratives for childhood vaccination the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web. Conclusion While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention. Introduction In Canada and elsewhere, an increasing number of parents are choosing to delay or refuse some or all recommended vaccines for their children, leading to declining community protection and subsequent outbreaks of vaccine-preventable diseases [1–8]. The ubiquity of anti-vaccine discourse on the Internet, particularly on social media sites, is considered by many experts to be a key driver of vaccine hesitancy [9]. The Internet and social media have provided multiple avenues for parents to “talk” about their children’s health with other parents and medical experts, but also with pseudo-scientists and alternative care providers. Stories shared online are often powerful and can impact parents’ decision-making [10, 11]. Evidence suggests vaccine-related stories often present “anti-vaccine” views in more compelling ways than public health “pro-vaccine” messaging. It is also increasingly recognized that parental vaccination decisions can be affected by a small number of vaccination stories or narratives [10, 12–14]. A narrative is defined as “a representation of connected events and characters that has an identifiable structure, is bounded in space and time, and contains implicit or explicit messages about the topic being addressed” [15 p. 222]. Recent meta-analyses have concluded that narratives are more effective than traditional educational or informational messages at increasing the intention to adopt specific health behaviours [16–18]. Narrative messages are more persuasive because people become absorbed in the story and can identify with characters, reducing resistance to persuasion [18, 19]. However, little is known about how to optimally use stories as a public health strategy to promote vaccines [12, 20]. Two interventions using narratives about HPV and COVID-19 vaccinations have been recently evaluated and positively influenced vaccine attitudes and vaccine uptake [21, 22]. The aim of this project was to explore parents’ views on the use of narratives to promote childhood vaccination. Materials and methods This article presen (...truncated)