Investigating Media Coverage and Public Perceptions of the HPV Vaccine in China - A Content Analysis of Weibo Posts

"...the significance of investigating the current stage of media coverage and public perception about the HPV vaccine, which can benefit the practice of tailoring health education on HPV vaccination..."

In China, the human papillomavirus (HPV) vaccine was not introduced until 2016, which makes it a relatively new entity for the public. On April 21 2020, China's domestically produced HPV vaccine was approved to be issued to the public, leading to increased attention and heated discourse initiated by governmental, media, and health organisations, as well as non-official discussions among ordinary netizens on China's social media platforms. Using the Health Belief Model (HBM) as a framework, this study investigates users' contribution to HPV vaccine-related public discussion on Weibo, a social media platform in China, to examine existing media narratives and the changes in public perception of the health behaviour brought on by the launch of domestic HPV vaccine.

As explained here, the HBM was derived from the attempt of several social psychologists in the 1950s to investigate the link between individuals' health beliefs and their preventative health behaviours. Six theoretical constructs in the HBM are postulated to constitute the motivation of individuals to practice health behaviours: perceived susceptibility, perceived seriousness, perceived benefits, perceived barriers, self-efficacy, and cues to action. Previous studies have used the HBM to examine the public perception and knowledge of health-related behaviour on social media platforms, finding that social media plays an important role in facilitating the exchange of information to promote community-level communication between healthcare institutions, non-profit organisations, and the general public.

On the one hand, studies have demonstrated the efficacy and success of the exchange of messages on Chinese social media, including Wechat and Weibo, in disseminating information about the HPV vaccine's usefulness (e.g., in preventing cervical cancer) and conveying messages in support of vaccination uptake. On the other hand, scholars have observed a lack of trust in the government's management of the production and distribution of vaccines - in part due to the 2018 Changchun Changsheng Biotechnology vaccine scandal. However, despite the active media environment and research showing a high willingness on the part of Chinese to get vaccinated against HPV, a nationwide survey has found that the public has limited knowledge of the HPV vaccine, and only a small proportion of the population has received the vaccination in mainland China.

For the study, conducted pilot data collection to locate the peak of Weibo posts after the release of the domestic HPV vaccine on April 21 2020, which suggested that the majority of HPV vaccine-related Weibo posts were published within the first week after launch. Accordingly, posts published in the first week after the event were collected. Then, to examine the changes in public discussion brought about by the event, a week of posts that were published a month after the event (from May 19-25 2020) were also collected. In addition, two weeks of posts published before the event were included to enable the comparison of Weibo discourses before and after the event. After eliminating duplicate and irrelevant posts, a total of 6,917 posts were included in the sample. The researchers then randomly selected 691 of the 6,917 posts to create a subsample for content analysis.

The majority of the sampled Weibo posts were created by ordinary users (n = 579, 83.8%), while the remaining Weibo discourse came from media organisations (n = 22, 3.2%), governmental accounts (n = 25, 3.6%), and health organisations (n = 65, 9.4%). Among the HBM components, cues to action (26.8%) and self-efficacy (18.8%) were mentioned the most frequently, followed by perceived susceptibility (13.3%), perceived barriers (12.4%), perceived benefits (11.1%), and perceived severity (8.1%).

Qualitative analysis of the posts illustrates the way that different author groups present HBM constructs and the distinct features in their narratives. (Excerpts in the paper are presented in Chinese and then translated into English.) For example, compared to the persuasive and informative narratives of organisational users, ordinary users tend to share their personal stories and worries more often on Weibo.

To understand changes in the proportion of HBM components included in Weibo posts before and after the launch of the domestic HPV vaccine, a cross-tabulation test was conducted in different time frames. The proportion of Weibo posts that mentioned cues to action and perceived benefits significantly increased after the launch of the domestic HPV vaccine. This finding indicates that more people were encouraged to take HPV vaccines and were informed about the efficacy of vaccination after the launch of the domestic HPV vaccine. Moreover, self-efficacy and perceived susceptibility were more frequently included in Weibo posts, indicating that Weibo users were more aware of the likelihood of HPV infection and had shared more information that might be helpful for vaccination.

However, there was no significant difference between the percentage of perceived severity and perceived barriers included in posts in the different time frames (pre- versus post-launch of the domestic vaccine). This finding could indicate lack of coverage on susceptibility and severity of HPV infections in the posts created by health professionals, which could limit the scope of the population that recognises the importance and urgency of being vaccinated against HPV. And the fact that the proportion of perceived barriers remained unchanged after the launch of the domestic vaccine indicates to the researchers that potential difficulty in accessing the HPV vaccine is not receiving enough attention from the government and other organisations.

The study also looked at which topics related to the HPV vaccine received the most attention on Weibo. Word cloud analysis revealed that topics related to the effect of the HPV vaccine and ways to get the vaccine had received special attention from Weibo users before the launch of the domestic HPV vaccine. Word cloud analysis based on posts collected in the week after the launch of the domestic HPV vaccine highlight that heated topics related to HPV vaccine started to connect with the policymaking process. Moreover, compared to the previous three weeks, the number of posts mentioning the keyword "female" in HPV vaccine discussions increased, which indicates the public had become more aware of the significance of the HPV vaccine in protecting women's health. Several posts perceived HPV vaccination also to be important for males.

In short, this study found that Weibo users in this investigation appear to be receptive to absorbing as much knowledge as possible about HPV vaccination, a relatively new public health endeavour in China, from different sources. The study indicates that Weibo users seem to be keen not to just to scan and seek information but also to engage in broader discussion on this issue on social media.

Though public awareness of HPV vaccination has improved along with increasingly active communication practices and enhanced public health services, the researchers suggest that more effort should be invested in tailoring and disseminating messages that communicate responsive and comprehensive HPV-vaccine-related information. They point to the fact that only a small proportion of ordinary users included the HBM constructs of perceived susceptibility and perceived severity in Weibo posts. As these two HBM constructs constitute the threat perception of a disease, it is likely that the public lacks a realistic perception of the likelihood and consequences of being infected by HPV. Moreover, the results of the word cloud analysis indicate that cervical cancer is frequently mentioned by the highly reposted posts, while other diseases caused by HPV infections are overlooked. There is, thus, a need to raise public awareness about the fact that HPV vaccination should be an important issue across genders.

In closing, the researchers suggest that media organisations and governmental departments cooperate with medical professionals to better tailor HPV-vaccine-related information, including the susceptibility and severity of HPV infections. The organisational accounts on Weibo should also pay more attention to the barriers to vaccination that are perceived by the ordinary users, thus providing the information that better meet the public's needs. Lastly, the potential of social media platforms in establishing a more active learning environment for health education should be taken advantage of so as to help reshape public perceptions and establish appropriate health beliefs.