Promoting vaccination and responding to misinformation in online environments: Insights from organisations and populations

Misinformation and other types of poor quality or biased information about vaccination are common in online environments such as social media. Exposure to this kind of information may contribute to negative sentiment, hesitancy or loss of confidence in vaccination, and negatively affect vaccine uptake. Organisations that promote vaccination can and do address poor quality information online, but there are relatively few studies investigating how they currently do this in digital spaces. Research insights could identify gaps in their efforts to support positive vaccination attitudes and behaviours and provide an evidence base to guide their practice. 

The aim of this thesis is to examine approaches to promoting vaccination and addressing misinformation and other poor quality or biased information in online environments, with a specific focus on social media. Four interconnected studies accomplished this aim, including a narrative review, two qualitative studies, and an online experiment.

The narrative review explored obstacles to communication about vaccination in the digital landscape by reviewing purposively selected literature. The first qualitative study examined approaches to promoting vaccination and responding to poor quality information on social media by analysing semi-structured, in-depth interviews with 17 Australian vaccination-promoting organisations. The second qualitative study, analysing responses from the same 17 organisations, examined approaches to using social media as a communications tool. The online experiment compared different text-based debunking strategies used by vaccination-promoting organisations by exposing 454 parents of young children to a debunking intervention and measuring changes in their agreement with vaccination myths and intention to vaccinate. 

This thesis found that various factors facilitate the flow of misinformation and other poor quality information in digital spaces like social media. Vaccination-promoting organisations perceive misinformation and other poor quality information as a threat to public trust in vaccination. They respond with a range of sophisticated strategies, like creating safe spaces for audiences to talk about vaccination, but lack capacity and confidence when detecting misinformation and addressing it, including when to respond and how. They experience difficulties exploiting the full potential of social media to reach broad audiences and monitor the information landscape via social media listening. This thesis found that text-based debunking strategies used by vaccination-promoting organisations, such as repeating misinformation alongside corrective text, can decrease belief in misinformation. 

Findings from this thesis suggest vaccination-promoting organisations could enhance their communication practice by increasing the scale and sophistication of their social media listening activities to better understand audiences, tailor messages, and identify opportunities to respond to emerging misinformation. They could reach broader audiences on social media by building a strong and trusted voice, increasing collaboration and coordination with like-minded organisations, and making proactive efforts to connect with audiences. They could increase their confidence responding to misinformation by using research insights to develop evidence-based debunking approaches. 

Innovations, such as guidance for manual social media listening and a publicly accessible misinformation database, would address gaps in listening capacity and help vaccination-promoting organisations better understand audiences and the poor quality information they may be exposed to. Research examining misinformation effects on vaccination attitudes and behaviours could provide insight into whether and how much debunking activities should be prioritised over other activities. Research on debunking novel vaccination misinformation could provide guidance on whether to respond to emerging myths. Research ascertaining what constitutes meaningful exposure could help establish thresholds for responding to particular myths.