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Testing The Impact Of Social Media Messaging On COVID-19 Mitigation

Testing The Impact Of Social Media Messaging On COVID-19 Mitigation

Klein Buendel researchers and collaborators are launching a supplemental study to test the impact of social media messaging on COVID-19 mitigation, such as social distancing behaviors and vaccination, in a sample of mothers with daughters aged 14-17 years. The study, which is funded by the National Cancer Institute, will examine the impact of different sources frequently providing COVID-19 and vaccination information via Facebook.

The Internet, including social media, is a preferred channel for health information for many Americans (1,2). At their best, social media provide flexible, responsive, and accessible platforms for distributing information to the public from trusted voices such as Centers for Disease Control and Prevention (CDC) and National Institutes of Health to promote needed health behaviors (3,4). Social media can improve information dissemination and personal relevance (8-12), create social support and collective action (13,14), and detect and respond to emerging issues and trends such as the COVID-19 response (5,6). At their worst, social media circulate inaccurate, misleading, unsupported, and harmful information (5,7), which may be especially detrimental in this age of filter bubbles separating Americans into like-minded groups (5).

Following a pretest survey, mothers will be randomly assigned to one of three Facebook private groups varying in types of source in the COVID-19 social media posts – government health agencies, near-peer parents and family members, or news media. Social media platforms are directing users to health organizations (6) but other sources may be credible with users, as well. The private groups prevent experimental contamination while delivering the social media feed. Mothers will complete a posttest at 3-, 6-, and 9-weeks post-randomization. The primary outcomes, assessed at pretest and all posttests, will be social distancing behaviors by self and daughter and intention to vaccinate self and daughter for COVID-19 (if a vaccine becomes available). Secondary outcomes are mother-daughter communication about COVID-19 mitigation behaviors and vaccination, theoretic antecedents of mitigation behaviors and vaccination, media literacy, and COVID-19 misinformation. Individual differences among mothers and other covariates will be measured at baseline or obtained from the parent trial. Engagement with the social media feed will be recorded.

This research is funded by an administrative supplement to a grant from the National Cancer Institute (CA192652; Dr. David Buller, Klein Buendel, and Dr. Sherry Pagoto, University of Connecticut, Multiple Principal Investigators). Collaborators include Dr. Katie Baker, Dr. Joel Hillhouse, and Jessica Bibeau from East Tennessee State University; Dr. Kim Henry from Colorado State University; and Dr. Barbara Walkosz and Julia Berteletti from Klein Buendel.

References

1. Purcell K; Pew Research Center. The State Of Online Video. Available at: http://www.pewinternet.org/2010/06/03/the-state-of-online-video/. Published June 3 2010. Accessed May 22, 2020.

2. Majority of Adults Look Online for Health Informaiton. FactTank: News in the Numbers. February 1, 2013. http://www.pewresearch.org/fact-tank/2013/02/01/majority-of-adults-look-online-for-health-information/. Accessed May 22, 2020.

3. Veil SR, Buehner T, Palenchar MJ. A work-in-process literature review: incorporating social media in risk and crisis communication. J Contingencies Crisis Manage. 2011;19(2):110-122.

4. Breland JY, Quintiliani LM, Schneider KL, May CN, Pagoto S. Social media as a tool to increase the impact of public health research. Am J Public Health. 2017;107(12):1890-1891.

5. Sutton J. Health communication trolls and bots versus public health agencies’ trusted voices. Am J Public Health. 2018;108(10):1281-1282.

6. Merchant RM, Lurie N. Social media and emergency preparedness in response to novel coronavirus [published online ahead of print March 24, 2020]. JAMA. 2020 doi: 10.1001/jama.2020.4469

7. Broniatowski DA, Jamison AM, Qi S, et al. Weaponized health communication: Twitter bots and Russian trolls amplify the vaccine debate. Am J Public Health. 2018;108(10):1378-1384.

8. Valle CG, Tate DF, Mayer DK, Allicock M, Cai J. A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors. J Cancer Surviv. 2013;7(3):355-368.

9. Young SD, Cumberland WG, Lee SJ, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med. 2013;159(5):318-324.

10. Pagoto S, Baker K, Griffith J, et al. Engaging moms on teen indoor tanning through social media: protocol of a randomized controlled trial. JMIR Research Protocols. 2016;5:e228. doi: 10.2196/resprot.6624. PMCID: PMC5147712

11. Witte K. Putting the fear back in fear appeals: the extended parallel process model. Communication Monographs. 1992;59:329-349.

12. Rogers RW. A Protection Motivation Theory of fear appeals and attitude change1. J Psychol. 1975;91(1):93-114. doi: 10.1080/00223980.1975.9915803

13. Rogers RW. Cognitive and physiological processes in fear appeals and attitude change: a revised theory of protection motivation. In: Cacioppo, J, Petty, R, eds. Social Psychophysiology. New York, NY: Guilford Press; 1983:153-176.

14. Woodall GW, Starling R, Buller DB, Kong A, Wheeler C. Beta-test and randomized trial results for GoHealthyGirls: a website for HPV vaccine adoption. 29th Meeting of the International Papillomavirus Conference; August 20-25; Seattle, Washington.

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

COLLABORATOR SPOTLIGHT:
DR. GREGORY ZIMET

Dr. Gregory Zimet is a Clinical Psychologist and Professor in the Department of Pediatrics at the Indiana University School of Medicine. Since he arrived there in 1993, he has guided an extensive, multi-faceted research program focused on attitudes about, and acceptance of, vaccines for the prevention of sexually-transmitted infections, including the human papillomavirus (HPV) vaccine.

Currently, Dr. Zimet serves as a KB collaborating scientist with Dr. Gill Woodall and Dr. David Buller on a research project entitled “Web App Technology for Boys and Parents: Improving HPV Vaccine Uptake.” Other collaborating investigators include Dr. Alberta Kong and Dr. Randall Starling from the University of New Mexico. The four-year HPV project, funded by a grant from the National Cancer Institute (CA210125; G. Woodall, PI), is designed to produce a mobile web app to accurately inform parents and adolescent boys about the HPV vaccination and address unique concerns about its safety and effectiveness for boys. The mobile web app is being developed for personal computers, smartphones, and tablet computers.

Dr. Zimet’s research also has involved randomized clinical trials designed to evaluate the effects of brief health communication messages on hepatitis B virus and HPV vaccine uptake, and on acceptance of HIV testing. Through his involvement over the past five years in the Adolescent Medicine Trials Network for HIV/AIDS Interventions, Dr. Zimet has expanded his research focus to examine factors related to recruitment of adolescents into biomedical HIV prevention clinical trials. Biomedical trials that may involve the recruitment of adolescents are related to pre-exposure prophylaxis, HIV vaccine, and microbicides. Some of his recent publications address HPV vaccination, microbicide acceptability among adolescents, and attitudes about HIV and herpes simplex virus type 2 testing.

Dr. Zimet has served as a research mentor to five physician fellows, over 20 pre- and post-doctoral fellows in psychology, social work, health behavior, and nursing, and several junior faculty in the Department of Pediatrics and the School of Nursing at Indiana University.

Use of AFIX-based Strategies for HPV Vaccination in Florida

Use of AFIX-based Strategies for HPV Vaccination in Florida

Dr. Barbara Walkosz, a Senior Scientist at Klein Buendel (KB), is one of several authors on a recent publication reporting on Florida pediatricians’ use of AFIX-based strategies for human papillomavirus (HPV) vaccination of adolescents and young adults. The report is published in the journal Preventive Medicine. Research collaborators (coauthors) are from the Moffitt Cancer Center and Research Institute, the University of South Florida College of Medicine, Pediatric Partners, the Indiana University School of Medicine, and the Johns Hopkins University School of Public Health.

HPV vaccination is recommended by the U.S. Centers for Disease Control and Prevention (CDC) to significantly reduce the incidence of cervical, vaginal, oral, and other cancers caused by the sexually transmitted virus. A series of vaccinations are recommended for adolescents and young adults, preferably before the onset of sexual activity (9-26 years of age).

However, rates of HPV vaccination in Florida and the U.S. are disappointingly low – less than 50% for girls and less than 40% for boys. In an effort to increase HPV vaccination of pediatric patients, the CDC created and implements the AFIX quality improvement program with healthcare providers. AFIX stands for Assessment, Feedback, Incentives, and the exchange of information – the four key strategies of the program which is delivered to clinics by local health departments.

The Preventive Medicine paper reports on the results of a cross-sectional survey of a representative sample of 770 pediatric and family medicine physicians in Florida to assess the use of the AFIX strategies. Less than half of the physicians surveyed reported implementing any AFIX strategies, leaving room for program engagement, uptake, and improvement.

BeVaccinated Web App Usability Testing

BeVaccinated Web App Usability Testing

Dr. W. Gill Woodall from Klein Buendel and the University of New Mexico presented findings from the BeVaccinated project at the 68th Annual Conference of the International Communication Association in Prague, Czech Republic, May 24-28, 2018. The project tested the usability of a prototype web app for improving adolescent vaccination uptake.

While vaccination rates for young children in the U.S. currently meet recommended standards, the CDC reports adolescent vaccines uptake (Gardasil 9 for HPV, MCV4 for meningococcal infection, Tdap for Tetanus, Diptheria and Pertussis protection, and Varicella vaccine for Chickenpox protection) to be less than optimal. In the case of the Human Papillomavirus (HPV) vaccine, rates are seriously below desired uptake levels. Despite established safety and effectiveness information about these vaccinations, and a wide variety of medical organizations recommending them, parents continue to have concerns about them, particularly the HPV vaccine.

For health communication researchers focused on Diffusion of Innovations, this is a classic difficulty of lack of effective messaging to prompt the uptake of an innovation by closing a knowledge gap among parents, in this case, on effective adolescent vaccines. The CDC and the Presidents Cancer Panel call for the development of effective and accessible messaging to improve vaccine decision-making as well as uptake. Because parents drive the decision to, and action for, vaccine uptake, messaging should be focused on them, but not exclusively, as there are benefits from parents and adolescents communicating about vaccines specifically and health issues generally. Approaching the vaccines as a recommended adolescent vaccine panel instead of each vaccine singularly may provide adoption benefit, as a vaccine panel approach builds the normative expectation for getting all adolescent vaccines as a group.

To address this vaccine uptake deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via a smartphone. The majority of adults of parenting age own smartphones and use them to access online information, especially minority adults, and use mobile apps for information acquisition and decision support, making them a potentially efficacious channel for delivering vaccine information and tools. The prototype app was developed via formative research with focus group participants and guided by an Expert Advisory Board (EAB) comprised of vaccination experts and clinicians. Usability testing was conducted iteratively with nine parent and teen pairs in New Mexico and seven parent and teen pairs in Colorado. Pairs were comprised of one teen, ages 13-17, and their accompanying parent or guardian.

Usability testing was conducted individually with the parent and teen by trained research staff. Parents and teens reported that the prototype app was easy to use. Users reported that they could learn to use it quickly and that they were confident using it. With feasibility established, the full version of the app will be designed to improve dissemination of vaccine information, improve parent/teen communication around health behavior choices, and ultimately, improve the uptake of vaccinations.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R41HD082901; Dr. W. Gill Woodall, Principal Investigator). Collaborators included Julia Berteletti from KB; Dr. Randall Starling, Dr. Alberta Kong, and Dr. Lance Chilton from the University of New Mexico; Dr. Greg Zimet from Indiana University; and Dr. Nathan Stupiansky from the University of Arizona.

Designing a Web App to Promote Teen Vaccination Uptake

Designing a Web App to Promote Teen Vaccination Uptake

Ms. Julia Berteletti, KB Research Program Manager, is presenting a poster on formative research from the BeVaccinated Project at the 39th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine, April 11-14, 2018 in New Orleans, Louisiana.

While vaccination rates for young children in the United States currently meet recommended standards, the Centers for Disease Control and Prevention reports adolescent vaccines uptake to be less than optimal, and in the case of the Human Papillomavirus (HPV) vaccine, seriously below desired uptake levels. To address this deficit, a web-browser application prototype, BeVaccinated, was developed to test reactions to and feasibility of delivering adolescent vaccine information via smartphone. The BeVaccinated app prototype was developed from formative research with 26 focus group participants and guided by an Expert Advisory Board comprised of vaccination experts and clinicians.

Usability testing on one module, about deciding to vaccinate, was conducted iteratively with nine parent and teen pairs in New Mexico and seven parent and teen pairs in Colorado. Pairs were comprised of one teen (ages 13-17) and their accompanying parent or guardian. Usability testing was conducted individually with the parent and teen by trained research staff. During the testing, participants used the app prototype, answering questions as prompted. At the conclusion of testing, participants completed the 10-item Bangor System Usability Scale (SUS). Parents and teens rated the app as very easy to use. SUS data also indicated that participants could quickly learn to use the app and that they would be confident using it.

A Specifications Document outlines the planned design of the full-scale app based on testing results. Findings included in the specifications document are: 1) provide tailored learning experiences to teens (i.e., game-based) and parents (i.e., didactic) within the same app; 2) integrate individualized information (e.g., clinic preferences); and 3) provide a vaccination record tracking feature. The planned app could improve dissemination of vaccine information, enhance parent/teen communication around health behavior choices, and ultimately, improve the uptake of vaccinations.

This research was funded by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R41HD082901; Dr. Gill Woodall, KB Senior Scientist, PI) Research collaborators included Dr. Randall Starling and Dr. Lance Chilton from the University of New Mexico, Dr. Gregory Zimet from Indiana University, Dr. Nathan Stupiansky from the University of Arizona, and Sophia Strickfaden from KB.