Pregnant women who are skeptical of vaccines may be more likely to get their infants vaccinated on schedule after visiting an evidence-based valid website with a social media component compared with women provided with a website lacking a social media component or those given usual care, the authors of a new study report.
The findings suggest that adding a social media component to web-based vaccine information during pregnancy “can positively influence parental vaccine behaviors” and “improve vaccine acceptance,” Jason M. Glanz, PhD, and coauthors explain in an article published online today in Pediatrics.
It is estimated that 10% to 15% of parents delay or avoid one or more vaccines for their children, the authors explain. These “vaccine-hesitant” parents often mistrust physicians and other health experts and turn to the internet and social media for information, which is sometimes inaccurate.
However, social media can also convey accurate and important information and may improve immunization rates by alleviating parental concerns, they add. The true role of social media in promoting or discouraging vaccine acceptance among parents currently is unknown.
To study the influence of social media in this regard, Dr Glanz, a senior investigator at the Institute for Health Research at Kaiser Permanente Colorado in Denver and colleagues compared the influence of a website with a social media arm with that of a website alone and with usual care in a randomized controlled trial of pregnant women enrolled in the Kaiser Permanente Colorado in Denver health plan. The participants were recruited between September 2013 and October 2015, were at least 18 years of age, and were all in the third trimester of pregnancy.
In addition to a baseline survey to determine demographics and internet use, the volunteers completed the Parent Attitudes and Childhood Vaccines survey, a 15-item instrument that assesses vaccine hesitancy on a 100-point scale. Women with a score of 50 or more were considered “hesitant,” whereas those scoring below 50 were “nonhesitant.”
The investigators randomly assigned participants to one of three study groups. Those in the VSM group were given access to a vaccine website with information developed by the research team and included social media components that allowed the users to interact with the developers and with each other. Women in the VI group had access to the website but not the social media components, and women in the UC group had usual care only.
The women’s infants were followed for 200 days after birth. If they were vaccinated on schedule, their vaccination status was considered up-to-date, whereas those who were vaccinated late were classified as undervaccinated and ranked according to the age at which they were vaccinated, in days. The authors also conducted a subanalysis in which they assessed vaccination status for the measles-mumps-rubella vaccine among infants with at least 489 days of follow-up.
A total of 1093 women were enrolled in the study, including 542, 371, and 180 in the VSM, VI, and UC groups, respectively. Overall, 14.1% of the participants were classified as vaccine-hesitant, with respective median vaccine hesitancy scores of 13, 17, and 15 for the VSM, VI, and UC groups (P = .44). However, a lack of outcome data led to the exclusion of 205 infants and their mothers, leaving a total of 888 women in the final sample: 442 in the VSM group, 297 in the VI group, and 149 in the UC group.
Of the 739 participants given access to the website, 259 (35%) visited it at least once. Seventy-five (10%) of those participants were vaccine-hesitant, of whom 33 (44%) visited the website compared with 226 (34%) of the 664 nonhesitant participants. Among women in the VSM group who visited the social media component of the website, most interacted with members of the research team, rather than with other study participants.
“The proportion of infants up-to-date at the end of follow-up were 92.5, 91.3, and 86.6 for the VSM, VI, and UC arms, respectively,” the authors write. Similarly, infants in the VSM group were more likely to be up-to-date than infants in the UC group at 200 days (odds ratio, 1.92; 95% confidence interval, 1.07-3.47; P = .03). Infants in the VI group also were more likely to be up-to-date than those in the UC group, but the difference was not significant (P = .13), nor was there a significant difference between infants in the VSM and VI groups (P = .52).
In the measles-mumps-rubella subanalysis, conducted on 776 infants, up-to-date vaccine status was seen in 95.6%, 95.5%, and 91.8% in the VSM, VI, and UC groups, respectively. “Although none of the study arm comparisons were statistically significant, infants in the VSM and VI arms were ~2 times more likely to have received [measles-mumps-rubella] than infants in the UC arm,” the authors add.
Study limitations include the relatively low number of vaccine-hesitant participants and the relatively large proportion of infants (18.8%) lost to follow-up. The authors also acknowledge certain practical challenges, such as keeping abreast of evolving technologies and developing cost-effective web-based interventions, that can be accessed and maintained even by small practices or clinics. They are now conducting a cost-effectiveness analysis of the VSM intervention to help with implementation decisions.
Despite these challenges, online resources can have a positive effect on parental vaccine decisions, they conclude. “As a complement to routine well-child care, the information appears to be effective when presented to parents before their children are born.”
The authors have disclosed no relevant financial relationships.
Pediatrics. Published online November 6, 2017. Abstract
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