"To Each His Own": Discussions of Vaccine Decision-Making in Top Parenting Blogs

"To the extent that blogs can influence knowledge, attitudes, and behaviors related to vaccination, pediatricians and public health officiants should be aware of the potential for widespread misinformation."

Using both quantitative and qualitative methods, this study examines vaccination decision-making discussions on parenting blogs in the United States (US). It sought to understand first, what evidence and attitudes are used on blog posts and the corresponding discussions that ensue in the comments sections, and second, whether or not discussions of vaccination on parenting blogs had changed over the past decade.

The authors note that, "[a]lthough social media provides a way for people to congregate with like-minded others, it can also play a role in spreading misinformation about public health interventions. Previous research demonstrates that parents who use the Internet to gather information on vaccination are more likely to hold anti-vaccination beliefs."

Fourteen blogs, 46 blog articles, and 697 comments were included in the final data set and then were analysed using a mixed-method approach. Comments were analysed using a deductive coding scheme that examined whether content areas of interest were present or absent in vaccination discussions. Posts were coded inductively using a thematic analysis. Posts and comments were further coded as strongly vaccine-discouraging, vaccine-ambivalent, or strongly vaccine-encouraging. Finally, posts were grouped by year of publication (2006-2009, 2010-2012, and 2013-2015), and comments were analysed within each group to examine the evolution of vaccination decision-making discussions in the parenting blogosphere over the past decade.

Fifty-two percent of posts were categorised as strongly vaccine-discouraging and were most commonly associated with expressions of individual liberty. For example, a From Dates to Diapers, and Beyond! blogger writes that although she and her husband made their decision not to vaccinate their children after engaging in lengthy research and prayer, she does not criticise others parents for making different decisions. Blog posts that were classified as vaccine-ambivalent were most commonly associated with concerns that vaccines are not 100% effective and belief in alternative schedules in an attempt to avoid what parents believe to be an overloading of children's immune systems.

Comments were nearly 3 times as likely to strongly discourage vaccination (18.9%) than to strongly encourage it (7%). Similarly to the bloggers, the use of scientific evidence by readers either in favour of or against vaccination was uncommon, occurring in only 50 comments (7.2%). Seventy-four comments (10.6%) mentioned the signs or symptoms of adverse reactions. While 23.1% of comments on blog posts from 2006-2009 strongly discourage vaccination, the percentage decreased to just 12.0% for posts published from 2013-2015 (p = 0.008). Still, specific blogs have continued to publish anti-vaccination posts. Nature Moms Blog, the most highly ranked blog and the one with the greatest number of comments, published posts discouraging vaccination as recently as 2013.

These results suggest that some of the negative ideas about vaccines, such as efficacy and safety, can be directly addressed by the expertise of paediatricians. The American Academy of Pediatrics Committee on Bioethics advises that pediatricians take an understanding and respectful approach when addressing reasons for vaccine hesitancy with patients, as it is a complex topic. The present study's results demonstrating considerable anti-vaccination sentiments on parenting blogs support the idea that such a framework could be a helpful tool to be used by healthcare providers when talking to hesitant parents.

Furthermore, although anti-vaccination sentiments proliferate on the internet, it is noted here that social media can also be used to increase understanding of vaccines and disease prevention. The findings suggest that because individuals seek information about and advice regarding vaccination in the parenting blogosphere, this may be an important medium to use in developing public health interventions.

The authors reflect on the fact that, while much of the discussion in the parenting blogs and comments that were examined suggests that parents remain concerned about the safety and efficacy of vaccines, it is also clear that vaccination remains a highly charged issue in the US that reflects larger political tensions. There is an age-old debate regarding whether vaccination is a matter of personal choice and an individual liberty or is a matter of public health law best overseen by the government. The facts of community or herd immunity demonstrate that vaccination against infectious disease is never a solely personal decision within the context of public health. In this context, health care providers and the scientific community need organised efforts to fight vaccine hesitancy.

These findings suggest there is a need for public health professionals to understand the concerns being expressed in these forums and develop ways to dispel anti-vaccination myths.