@Article{info:doi/10.2196/67370,
author="Mancuso, Noah
and Michaels, Jenna
and Browne, N. Erica
and Maragh-Bass, C. Allysha
and Stocks, B. Jacob
and Soberano, R. Zachary
and Bond, Lily C.
and Yigit, Ibrahim
and Comello, G. Maria Leonora
and Larsen, Adams Margo
and Muessig, E. Kathryn
and Pettifor, Audrey
and Hightow-Weidman, B. Lisa
and Budhwani, Henna
and Stoner, D. Marie C.",
title="Greater Improvements in Vaccination Outcomes Among Black Young Adults With Vaccine-Resistant Attitudes in the United States South Following a Digital Health Intervention: Latent Profile Analysis of a Randomized Control Trial",
journal="JMIR Public Health Surveill",
year="2025",
month="Apr",
day="16",
volume="11",
pages="e67370",
keywords="COVID-19",
keywords="mHealth",
keywords="African American and Black",
keywords="young adults",
keywords="vaccination",
keywords="mobile health",
abstract="Background: Negative attitudes toward vaccines and suboptimal vaccination rates among African American and Black (Black) Americans have been well documented, due to a history of medical racism and human rights violations in the United States. However, digital health interventions (DHI) have been shown to address racial disparities in several health outcomes, such as cardiovascular disease, HIV, and maternal health. The Tough Talks COVID (TT-C) study was a randomized controlled trial of a DHI designed to empower Black young adults in the United States South to make informed, autonomous decisions about COVID-19 vaccine uptake by addressing structural barriers and misinformation about vaccines. Objective: Our objective was to identify subgroups of Black young adults with various vaccine attitudes at baseline and determine the subgroups for which the TT-C DHI was most impactful. Methods: Black young adults aged 18?29 years in Alabama, Georgia, and North Carolina who were unvaccinated or insufficiently vaccinated against COVID-19 completed three online surveys over three months (N=360). Latent profile analysis was used to identify subgroups based on general vaccine attitudes at baseline, including hesitancy, confidence, knowledge, conspiracy beliefs, and mistrust. Logistic regression was used to examine the associations between latent profiles and vaccine uptake, and linear regression was used to examine changes in vaccine attitudes at three months post-randomization. Modification of the TT-C DHI's effects was assessed by latent profiles. Results: Three latent profiles emerged: vaccine-receptive (n=124), vaccine-neutral (n=155), and vaccine-resistant (n=81). Political affiliation, income, social support, and recent flu vaccination differed significantly between the three subgroups (P<.05). Vaccine uptake was not significantly different by subgroup, and the TTC-DHI did not have differing effects on uptake across subgroups. However, the DHI had the strongest effect---with statistically significant measures of association (P<.05) and interaction P values (P<.10)---among the baseline vaccine-resistant and vaccine-neutral subgroups compared to the vaccine-receptive subgroups at three months in improving vaccine hesitancy, confidence, and conspiracy beliefs at three months: vaccine-resistant difference: ?0.40 (?0.76 to ?0.37), 0.39 (0.02 to 0.75), and ?0.47 (?0.86 to ?0.09); vaccine neutral difference: ?0.36 (?0.52 to ?0.19), 0.35 (0.18 to 0.51), and ?0.24 (?0.44 to ?0.03). The DHI had no effects on these outcomes among the vaccine-receptive subgroup. Conclusions: Our findings revealed subgroups of Black young adults in the United States South with different vaccination attitudes, for which the TT-C intervention had differing effects. Black young adults who are vaccine-resistant or vaccine-neutral may experience larger gains from a digital vaccine intervention. Future work aimed at improving vaccination outcomes could target these populations to maximize resource efficiency and drive the greatest improvements in vaccine outcomes. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/study/NCT05490329 ",
doi="10.2196/67370",
url="https://publichealth.jmir.org/2025/1/e67370"
}


@Article{info:doi/10.2196/65986,
author="Murray, M. Regan
and Chiang, C. Shawn
and Klassen, C. Ann
and Manganello, A. Jennifer
and Leader, E. Amy
and Lo, Wen-Juo
and Massey, M. Philip",
title="Developing an Online Community Advisory Board (CAB) of Parents From Social Media to Co-Design an Human Papillomavirus Vaccine Intervention: Participatory Research Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="16",
volume="9",
pages="e65986",
keywords="online community advisory boards",
keywords="community engagement",
keywords="social media",
keywords="digital health",
keywords="digital health intervention",
keywords="HPV vaccine",
keywords="human papillomavirus",
keywords="HPV",
keywords="parent health",
keywords="child health",
abstract="Background: Social media health interventions have grown significantly in recent years. However, researchers are still developing innovative methods to meaningfully engage online communities to inform research activities. Little has been documented describing this approach of using online community advisory boards (CABs) to co-create health communication interventions on social media. Objective: This study describes the formation, engagement, and maintenance of an online CAB focused on co-creating a health education intervention for parents regarding the human papillomavirus (HPV) vaccine. The study provides guiding principles for public health researchers implementing such CABs in future digital health interventions. Methods: In May 2020, Twitter was used to recruit parents of children aged 9?14 years, who were active users of the platform and were interested in serving on a CAB focused on child health and online programs. The recruitment campaign included Twitter (rebranded as X in 2023) advertising tools (eg, ``interests'' and ``audience look-a-likes''). A total of 17 parents completed a screening survey and 6 completed a follow-up phone interview. Following phone interviews, 6 parents were invited to join the CAB, where they committed to a 1-year involvement. The CAB participated in eleven 1-hour online meetings in the first year, contributing to monthly feedback through participatory workbooks. Long-term engagement was sustained through icebreakers and casual online interactions, as well as providing real-time updates to demonstrate CAB feedback integration. An anonymous midterm evaluation was conducted at the end of the project's first year to assess processes and identify future growth opportunities. Results: A total of 6 parents (5 females and 1 male) with children aged 9-14 years from diverse racial and ethnic backgrounds (African American, South Asian American, and White) across 6 states in the United States, representing urban, suburban, and rural areas, agreed to serve as CAB members. All 6 CAB members committed to 1 year of service beginning in July 2020 with 4 extending their participation into a second year (August 2021-August 2022). The CAB provided expert insights and feedback to co-develop the intervention, including character development, narrative content creation, study recruitment, survey development, and intervention delivery. The midterm evaluation showed 100\% (6/6) satisfaction among CAB members, who valued the connections with other parents and their contribution to research. While all members felt confident discussing HPV, 83\% (5/6) suggested diversifying the group and increasing informal bonding to enhance engagement and inclusivity, especially for differing vaccination views. Conclusions: This study demonstrates that online CABs are a highly effective model for co-creating and informing online health communication interventions. The engagement of parents from diverse backgrounds and the structured use of online tools (eg, interactive workbooks) creates a constructive and thoughtful environment for incorporating parent contributions to research. This study highlights guiding principles to forming, engaging, and maintaining an online CAB to enhance health research and practice. ",
doi="10.2196/65986",
url="https://formative.jmir.org/2025/1/e65986"
}


@Article{info:doi/10.2196/68855,
author="Feldman, G. Amy
and Beaty, L. Brenda
and Moore, L. Susan
and Bull, Sheana
and Wilson, Kumanan
and Atkinson, M. Katherine
and Bell, Cameron
and Denize, M. Kathryn
and Kempe, Allison",
title="Feasibility, Acceptability, and Effectiveness of a Smartphone App to Increase Pretransplant Vaccine Rates: Usability Study",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="15",
volume="9",
pages="e68855",
keywords="mobile app",
keywords="vaccines",
keywords="immunizations",
keywords="transplantation",
keywords="children",
keywords="beta test",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. Despite intensive medical care in the pretransplant period, less than 20\% of children are up to date for age-appropriate vaccines at the time of transplant. Mobile health apps have the potential to improve pretransplant vaccine rates. Objective: This paper aimed to perform phase 2 beta testing of the smartphone app, Immunize PediatricTransplant, to determine (1) if it was effective in achieving up-to-date vaccine status by the time of transplant in a cohort of children awaiting transplants and (2) if the app was feasible and acceptable to parent and transplant provider users. Methods: We recruited 25 dyads of parents and providers of a child awaiting a liver, kidney, or heart transplant at Children's Hospital Colorado, Ann and Robert H. Lurie Children's Hospital, and the Children's Hospital of Philadelphia. Parents and providers filled out an entry questionnaire before app use to gather baseline information. A research team member entered the child's vaccine records into the app. The parent and provider downloaded and used the app until the transplant to view vaccine records, read vaccine education, communicate with team members, and receive overdue vaccine reminders. After the transplant (or on April 1, 2024, the conclusion of the study), the parent and provider filled out an exit questionnaire to explore feasibility and acceptability of the app. The child's vaccine records were reviewed to determine if the child was up to date on vaccines at the time of transplant. Results: Twenty-five parent and provider dyads were enrolled; 56\% (14/25) had a child awaiting a liver transplant, 28\% (7/25) had a child awaiting a kidney transplant, and 16\% (4/25) had a child awaiting a heart transplant. At the conclusion of the study, 96\% (24/25) of the children were up to date on vaccines. Of the 36 parents and providers who filled out an exit questionnaire, 97\% (n=35) agreed or strongly agreed that they felt knowledgeable about pretransplant vaccine use and 86\% (n=31) agreed or strongly agreed that communication around vaccines was good after using the app. Further, 91\% (20/22) of parents and 79\% (11/14) of providers recommended the app to future parents and providers of transplant candidates. Parents and providers suggested that in the future the app should connect directly to the electronic medical record or state vaccine registries to obtain vaccine data. Conclusions: The overwhelming majority of children whose parents and providers used the Immunize PediatricTransplant app were up to date on vaccines at the time of transplant. The majority of app users felt the app was feasible and acceptable. In future iterations of the app and subsequent clinical trials, we will explore whether application programming interfaces might be used to extract vaccine data from the electronic medical record. If implemented broadly, this app has the potential to improve pretransplant vaccine rates, resulting in fewer posttransplant infections and improved posttransplant outcomes. ",
doi="10.2196/68855",
url="https://formative.jmir.org/2025/1/e68855"
}


@Article{info:doi/10.2196/68936,
author="Fundoiano-Hershcovitz, Yifat
and Lee, Felix
and Stanger, Catherine
and Breuer Asher, Inbar
and Horwitz, L. David
and Manejwala, Omar
and Liska, Jan
and Kerr, David",
title="Digital Health Intervention on Awareness of Vaccination Against Influenza Among Adults With Diabetes: Pragmatic Randomized Follow-Up Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="10",
volume="27",
pages="e68936",
keywords="digital health",
keywords="diabetes management",
keywords="influenza vaccination",
keywords="flu vaccination awareness",
keywords="mobile health",
abstract="Background: Diabetes mellitus significantly increases the risk of severe complications from influenza, necessitating targeted vaccination efforts. Despite vaccination being the most effective preventive measure, coverage remains below the World Health Organization's targets, partly due to limited awareness among patients. This study evaluated a digital health intervention aimed at improving influenza vaccination rates among adults with diabetes. Objective: This study aimed to demonstrate the effectiveness of digital health platforms in increasing vaccination rates among people with diabetes and to emphasize the impact of tailored messaging frequency on patient engagement and health behavior change. We hypothesized that digital tools providing empirical evidence of increased health risk awareness can effectively drive preventive actions. Methods: The study leveraged the Dario (Dario Health Corp) digital health platform to retrospectively analyze data from 64,904 users with diabetes assigned by the platform into three groups: (1) Group A received previously studied monthly flu nudge messages; (2) Group B received an adapted intervention with 2-3 monthly messages; (3) Group C served as the control with no intervention. Surveys were conducted at baseline, 3 months, and 6 months to assess vaccination status, awareness of influenza risks, and recollection of educational content. Statistical analyses, including logistic regression, chi-square tests, and t tests, were used to evaluate differences between groups. Results: Out of 64,904 users, 8431 completed the surveys. Vaccination rates were 71.0\% in group A, 71.9\% in group B, and 70.5\% in group C. Group B showed significantly higher awareness of influenza risks compared with the control group odds ratio (OR; OR 1.35, 95\% CI 1.12-1.63; P=.001), while group A did not (OR 1.10, 95\% CI 0.92-1.32; P=.27). Recollection of educational content was also higher in groups A (OR 1.29, 95\% CI 1.07-1.56; P=.008) and B (OR 1.92, 95\% CI 1.59-2.33; P<.001) compared with the control. In addition, a significant correlation between awareness and vaccination rates was found only in group B ($\chi$2(df=1)=6.12, P=.01). Conclusions: The adapted digital intervention (group B) effectively increased awareness of influenza risks and recollection of educational content, which correlated with the higher trend in vaccination rates. This study demonstrates the potential of digital health tools to enhance influenza vaccination among people with diabetes by improving risk awareness and education. Further research should focus on optimizing these interventions to achieve significant improvements in vaccination uptake and overall public health outcomes. Trial Registration: ClinicalTrials.gov NCT06840236; https://clinicaltrials.gov/study/NCT06840236 ",
doi="10.2196/68936",
url="https://www.jmir.org/2025/1/e68936",
url="http://www.ncbi.nlm.nih.gov/pubmed/40209214"
}


@Article{info:doi/10.2196/71865,
author="Kim, Minjin
and Kim, Ellie
and Lee, Hyeongsuk
and Piao, Meihua
and Rosen, Brittany
and Allison, J. Jeroan
and Zai, H. Adrian
and Nguyen, L. Hoa
and Shin, Dong-Soo
and Kahn, A. Jessica",
title="A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study",
journal="Asian Pac Isl Nurs J",
year="2025",
month="Apr",
day="7",
volume="9",
pages="e71865",
keywords="human papillomavirus",
keywords="HPV vaccination",
keywords="artificial intelligence",
keywords="AI",
keywords="chatbot intervention",
keywords="Korean Americans",
keywords="usability testing",
keywords="culturally tailored intervention",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)--powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville's usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1\%), second-generation individuals (n=13, 61.9\%), and single (n=20, 95.2\%). HPV awareness was high (n=19, 90.5\%), vaccine knowledge was also high (n=18, 81.8\%), but only 11 (52.4\%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. ",
doi="10.2196/71865",
url="https://apinj.jmir.org/2025/1/e71865"
}


@Article{info:doi/10.2196/69609,
author="Adegboyega, Adebola
and Wiggins, Amanda
and Wuni, Abubakari
and Ickes, Melinda",
title="The Impact of a Human Papillomavirus Facebook-Based Intervention (\#HPVVaxTalks) Among Young Black (African American and Sub-Saharan African Immigrants) Adults: Pilot Pre- and Poststudy",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="2",
volume="9",
pages="e69609",
keywords="human papillomavirus vaccination",
keywords="HPV vaccination",
keywords="Facebook-based intervention",
keywords="young Black adults",
keywords="social media",
abstract="Background: Despite the availability of prophylactic human papillomavirus (HPV) vaccines, uptake remains suboptimal among young Black adults. Social media is a platform for the dissemination of health information and can be used to promote HPV vaccination among young Black adults. Objective: This study aimed to assess the impact of a Facebook-based intervention (\#HPVVaxTalks), which consisted of 40 posts over 8 weeks in improving cognitive outcomes, reducing vaccine hesitancy, and increasing vaccine intention, and uptake among young Black adults aged 18-26 years. Methods: A pilot 1-group pre- and poststudy was conducted among 43 young Black adults who engaged in an 8-week Facebook intervention (\#HPVVaxTalks). \#HPVVaxTalks was developed in collaboration with a youth community advisory committee. Participants were actively recruited by research staff from community settings using flyers, and flyers were posted in public places in communities. Eligible participants were screened for eligibility and consented prior to study participation. Participants completed baseline surveys and were added to a Facebook page created for the study to receive intervention posts. Participants completed pre- and postdata on HPV knowledge, HPV vaccine knowledge, vaccine hesitancy, and vaccine uptake via REDCap (Research Electronic Data Capture) surveys distributed by email. Participants' satisfaction with the intervention was collected via individual interviews. Data were analyzed using 2-tailed paired t tests and repeated measures analysis Results: Overall, 32 of the 43 (74\%) participants completed the follow-up survey, and of the 23 participants who reported not having ever received the vaccine at baseline, 7 (30\%) reported receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge and receiving the vaccine at follow-up. Participants demonstrated significant improvements in HPV knowledge (pre: mean 7.3, SD 4.2 and post: mean 11.1, SD 4.3; P=.004) and HPV vaccine knowledge (pre: mean 2.8, SD 2.5 and post: mean 4.7, SD 2.2; P=.003) and reduction in vaccine hesitancy (pre: mean 28.3, SD 4.2 and post: mean 29.9, SD 3.6; P=.007) after the intervention. However, there were no significant changes in other outcomes. Feedback from open-ended questions and qualitative interviews highlighted participants' satisfaction with the intervention and its role in increasing HPV and HPV vaccine awareness. Conclusions: The findings from this study underscore the potential of social media platforms for health promotion among underrepresented populations and the importance of advocating for culturally appropriate interventions to improve HPV vaccination rates and reduce disparities. ",
doi="10.2196/69609",
url="https://formative.jmir.org/2025/1/e69609"
}


@Article{info:doi/10.2196/53849,
author="Aisyah, Nur Dewi
and Utami, Astri
and Rahman, Mauly Fauziah
and Adriani, Humaira Nathasya
and Fitransyah, Fiqi
and Endryantoro, Aziz M. Thoriqul
and Hutapea, Yosephine Prima
and Tandy, Gertrudis
and Manikam, Logan
and Kozlakidis, Zisis",
title="Using an Electronic Immunization Registry (Aplikasi Sehat IndonesiaKu) in Indonesia: Cross-Sectional Study",
journal="Interact J Med Res",
year="2025",
month="Mar",
day="27",
volume="14",
pages="e53849",
keywords="immunization",
keywords="registry",
keywords="digital",
keywords="puskesmas",
keywords="public health center",
keywords="mobile app",
abstract="Background: Electronic immunization registries (EIRs) are being increasingly used in low- and middle-income countries. In 2022, Indonesia's Ministry of Health introduced its first EIR, named Aplikasi Sehat IndonesiaKu (ASIK), as part of a comprehensive nationwide immunization program. This marked a conversion from traditional paper-based immunization reports to digital routine records encompassing a network of 10,000 primary health centers (puskesmas). Objective: This paper provides an overview of the use of ASIK as the first EIR in Indonesia. It describes the coverage of the nationwide immunization program (Bulan Imunisasi Anak Nasional) using ASIK data and assesses the implementation challenges associated with the adoption of the EIR in the context of Indonesia. Methods: Data were collected from primary care health workers' submitted reports using ASIK. The data were reported in real time, analyzed, and presented using a structured dashboard. Data on ASIK use were collected from the ASIK website. A quantitative assessment was conducted through a cross-sectional survey between September 2022 and October 2022. A set of questionnaires was used to collect feedback from ASIK users. Results: A total of 93.5\% (9708/10,382) of public health centers, 93.5\% (6478/6928) of subdistricts, and 97.5\% (501/514) of districts and cities in 34 provinces reported immunization data using ASIK. With >21 million data points recorded, the national coverage for immunization campaigns for measles-rubella; oral polio vaccine; inactivated polio vaccine; and diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type B vaccine were 50.1\% (18,301,057/36,497,694), 36.2\% (938,623/2,595,240), 30.7\% (1,276,668/4,158,289), and 40.2\% (1,371,104/3,407,900), respectively. The quantitative survey showed that, generally, users had a good understanding of ASIK as the EIR (650/809, 80.3\%), 61.7\% (489/793) of the users expressed that the user interface and user experience were overall good but could still be improved, 54\% (422/781) of users expressed that the ASIK variable fit their needs yet could be improved further, and 59.1\% (463/784) of users observed sporadic system interference. Challenges faced during the implementation of ASIK included a heavy workload burden for health workers, inadequate access to the internet at some places, system integration and readiness, and dual reporting using the paper-based format. Conclusions: The EIR is beneficial and helpful for monitoring vaccination coverage. Implementation and adoption of ASIK as Indonesia's first EIR still faces challenges related to human resources and digital infrastructure as the country transitions from paper-based reports to electronic or digital immunization reports. Continuous improvement, collaboration, and monitoring efforts are crucial to encourage the use of the EIR in Indonesia. ",
doi="10.2196/53849",
url="https://www.i-jmr.org/2025/1/e53849"
}


@Article{info:doi/10.2196/67487,
author="Li, Mingyan
and Sun, Changxuan
and Ji, Chai
and Gao, Meiying
and Wang, Xia
and Yao, Dan
and Guo, Junxia
and Sun, Lidan
and Rafay, Abdul
and George, Shereen Antonita
and Muhandiramge, Samararathna Sanduni Hasara Samararathna
and Bai, Guannan",
title="Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Mar",
day="26",
volume="11",
pages="e67487",
keywords="COVID-19",
keywords="caregivers",
keywords="children with special health care needs",
keywords="vaccination hesitancy",
keywords="decision-making",
abstract="Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers' vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers' attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children's Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers' willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers' willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers' vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26\%, n=3148, 57.4\%, and n=3442, 62.7\%, respectively) than those at other 2 stages. In comparison, caregivers' hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6\% and n=2045, 37.3\%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children's age and sex, parents' educational level, comorbidities, and history of allergy, were significantly associated with caregivers' attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers' willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers' willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. ",
doi="10.2196/67487",
url="https://publichealth.jmir.org/2025/1/e67487"
}


@Article{info:doi/10.2196/73062,
author="Flaherty, Thomas Gerard
and Mangan, Michael Ryan",
title="Impact of Social Media Influencers on Amplifying Positive Public Health Messages",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="21",
volume="27",
pages="e73062",
keywords="social media",
keywords="COVID-19",
keywords="vaccination",
keywords="personal brands",
keywords="public health",
keywords="wellness",
keywords="global health",
keywords="pandemic",
keywords="Twitter",
keywords="tweets",
keywords="vaccine",
keywords="longitudinal design",
keywords="wellness influencers",
keywords="hand annotation",
keywords="antivaccination",
keywords="infodemiology",
doi="10.2196/73062",
url="https://www.jmir.org/2025/1/e73062"
}


@Article{info:doi/10.2196/54921,
author="Zola Matuvanga, Tr{\'e}sor
and Paviotti, Antea
and Bikioli Bolombo, Freddy
and Lemey, Gwen
and Larivi{\`e}re, Ynke
and Salloum, Maha
and Isekah Osang'ir, Bernard
and Esanga Longomo, Emmanuel
and Milolo, Solange
and Matangila, Junior
and Maketa, Vivi
and Mitashi, Patrick
and Van Damme, Pierre
and Muhindo-Mavoko, Hypolite
and Van geertruyden, Jean-Pierre",
title="Long-Term Experiences of Health Care Providers Using Iris Scanning as an Identification Tool in a Vaccine Trial in the Democratic Republic of the Congo: Qualitative Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="6",
volume="9",
pages="e54921",
keywords="iris scan",
keywords="vaccine trial",
keywords="iris",
keywords="perception",
keywords="experience",
keywords="views",
keywords="biometric identification",
keywords="Democratic Republic of the Congo",
abstract="Background: Iris scanning has increasingly been used for biometric identification over the past decade, with continuous advancements and expanding applications. To better understand the acceptability of this technology, we report the long-term experiences of health care providers and frontline worker participants with iris scanning as an identification tool in the EBL2007 Ebola vaccine trial conducted in the Democratic Republic of the Congo. Objective: This study aims to document the long-term experiences of using iris scanning for identity verification throughout the vaccine trial. Methods: Two years after the start of the EBL2007 vaccine trial (February to March 2022), 69 trial participants---including nurses, first aid workers, midwives, and community health workers---were interviewed through focus group discussions. Additionally, 13 in-depth individual interviews were conducted with physicians involved in the trial, iris scan operators, trial staff physicians, and trial participants who declined iris scanning. Qualitative content analysis was used to identify key themes. Results: Initially, interviewees widely accepted the iris scan and viewed it as a distinctive tool for identifying participants in the EBL2007 vaccine trial. However, over time, perceptions became less favorable. Some participants expressed concerns that their vision had diminished shortly after using the tool and continued to decline until the end of the study. Others reported experiencing perceived vision loss long after the trial had concluded. However, no vision impairment was reported as an adverse event or assessed in the trial as being linked to the iris scan, which uses a previously certified safe infrared light for scanning. Conclusions: Our findings highlight the sustained acceptability and perceived high accuracy of the iris scan tool for uniquely identifying adult participants in a vaccine trial over time. Continued efforts to systematically disseminate and reinforce information about the function and safety of this technology are essential. Clearly presenting iris scanning as a safe procedure could help dispel misconceptions, concerns, and perceived risks among potential users in vaccine trials. ",
doi="10.2196/54921",
url="https://formative.jmir.org/2025/1/e54921",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053756"
}


@Article{info:doi/10.2196/63938,
author="Hansen, T. Bo
and Klungs{\o}yr, Ole
and Labberton, S. Angela
and S{\"a}{\"a}ksvuori, Lauri
and Rydland, M. Kjersti
and {\O}deskaug, E. Liz
and Wisl{\o}ff, Torbj{\o}rn
and Meijerink, Hinta",
title="Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="25",
volume="14",
pages="e63938",
keywords="influenza vaccination",
keywords="coverage",
keywords="uptake",
keywords="behavioral nudging",
keywords="vaccine hesitancy",
keywords="randomized controlled trial",
keywords="undervaccination",
keywords="migrant health",
keywords="mobile health",
keywords="mHealth",
keywords="smartphones",
keywords="eHealth",
keywords="SMS",
abstract="Background: The coverage of influenza vaccination among older adults in Norway is insufficient, especially in some immigrant groups. To improve public health, there is a need for an intervention that can increase influenza vaccination coverage. Further, interventions tailored to reduce potential barriers among immigrants can reduce health inequities. Objective: InfluSMS aims to determine if SMS nudging increases vaccination coverage among those aged 65 years or older (1) in Norway's general population; (2) among immigrants born in Poland; and (3) among immigrants born in Ukraine; and evaluate the impact of SMS nudging in Norwegian versus in the official language of the native country of immigrants born in Poland or Ukraine. Methods: InfluSMS is a pragmatic randomized controlled trial conducted among people aged 65 years or older residing in Norway. Influenza vaccination coverage is the main outcome, measured in control and intervention arms for each of the 3 populations listed earlier. In all 3 populations, the control arm is standard care, that is, no individual reminder for influenza vaccination. All populations have an intervention arm that will receive an SMS nudge in the Norwegian language. In addition, the Polish and Ukrainian immigrant populations include a second intervention arm that will receive an SMS nudge in Polish or Ukrainian, respectively. In the general population, at least 23,485 individuals will be randomized to the SMS intervention arm while the rest of the population constitutes the control arm. In each of the 2 immigrant populations, we will randomize all eligible individuals 1:1:1 into the 3 arms. The intervention will take place at the start of the 2025-2026 influenza season. All eligible individuals will be passively followed up through the National Immunisation Registry, SYSVAK, from which individual influenza vaccination status 3 months after the SMS nudge will be collected. Coverage rates between arms within each population and effect sizes between the populations will be compared. The cost-effectiveness of SMS nudging will also be assessed. Results: The inclusion of participants will start in the third quarter of 2025, and the registry data will be available in the first quarter of 2026. Coverage rates of each strategy and coverage differences between strategies will be presented. Conclusions: SMS nudging is a scalable, inexpensive, and nonintrusive intervention that could be integrated into the national influenza vaccination program if the trial shows it effectively increases influenza vaccination coverage among older adults. Further, the trial will establish whether language is a barrier to influenza vaccination uptake among recent immigrant groups that have low influenza vaccination coverage, and to what extent this potential barrier can be diminished by SMS nudging in the official language of their native country. Trial Registration: ClinicalTrials.gov NCT06486766; https://clinicaltrials.gov/study/NCT06486766 International Registered Report Identifier (IRRID): PRR1-10.2196/63938 ",
doi="10.2196/63938",
url="https://www.researchprotocols.org/2025/1/e63938",
url="http://www.ncbi.nlm.nih.gov/pubmed/39998878"
}


@Article{info:doi/10.2196/64653,
author="Atanasova, Sara
and Kamin, Tanja
and Perger, Nina",
title="Predictors of COVID-19 Vaccination Intention and Behavior Among Young People in a European Union Country With Low COVID-19 Vaccination Rates: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2025",
month="Feb",
day="21",
volume="11",
pages="e64653",
keywords="vaccine uptake",
keywords="young people",
keywords="COVID-19 vaccine",
keywords="health belief model",
keywords="theory of planned behavior",
abstract="Background: Vaccination against COVID-19 is a critical measure for managing the pandemic and achieving herd immunity. In 2021, Slovenia had a significantly lower COVID-19 vaccination rate compared to the average rate in the European Union, with individuals aged younger than 37 years showing the highest hesitancy. Previous studies primarily explored vaccination willingness before vaccines were available to young people, leaving a gap in understanding the factors influencing vaccination behavior and differences within the population of young people. Objective: This study aimed to investigate a wide set of predictors influencing COVID-19 vaccination intention and behavior among young people in Slovenia. Specifically, we aimed to compare vaccinated and unvaccinated young people, further categorizing the unvaccinated group into those who were hesitant, those who intended to vaccinate in the near future, and those who refused vaccination. Methods: An integrated model, based on the health belief model and theory of planned behavior, was developed, and it included additional contextual factors (such as trust in science, trust in vaccines, conspiracy theory tendencies, etc) and health-related and sociodemographic characteristics. Data were collected in August 2021 via the online access survey panel JazVem (Valicon), targeting individuals aged 15-30 years in Slovenia. Quotas ensured that the sample (n=507) was quasi-representative according to age, gender, education, and region. Bivariate analyses and multinomial logistic regression were performed to explore the determinants of vaccination intention and behavior. Results: Among respondents, 45.8\% (232/507) were vaccinated, 30.0\% (152/507) refused vaccination, 12.4\% (63/507) were hesitant, and 11.8\% (60/507) intended to undergo vaccination in the near future. Vaccinated individuals were predominantly aged 23-26 years, had higher education, and reported above-average material status. Refusers were more common among the youngest (15-18 years) and oldest (27-30 years) groups, had lower education, and showed higher conspiracy theory tendencies. Multinomial regression analysis revealed that unvaccinated respondents who perceived greater COVID-19--related health consequences were more likely to delay vaccination (adjusted odds ratio [aOR] 2.0, 95\% CI 1.2-3.3) or exhibit hesitancy (aOR 1.9, 95\% CI 1.1-3.2) compared with vaccinated respondents. Subjective norms were less influential among hesitant individuals (aOR 0.4, 95\% CI 0.2-0.7) and refusers (aOR 0.3, 95\% CI 0.2-0.7) than among vaccinated individuals. Self-efficacy in managing health problems was less evident among those who delayed vaccination to the near future (aOR 0.5, 95\% CI 0.3-0.9) than among vaccinated individuals. Conclusions: This study underscores the complexity of vaccination intentions and behaviors among young people, emphasizing the necessity for public health strategies promoting vaccination to be tailored to the specific reasons for nonvaccination within different subgroups. Interventions aimed at addressing vaccine hesitancy and delays should particularly focus on individuals with lower education and material disadvantages. By fostering trust and enhancing self-efficacy, these interventions could more effectively promote vaccine uptake. ",
doi="10.2196/64653",
url="https://publichealth.jmir.org/2025/1/e64653",
url="http://www.ncbi.nlm.nih.gov/pubmed/39983109"
}


@Article{info:doi/10.2196/68881,
author="Liu, Junyu
and Niu, Qian
and Nagai-Tanima, Momoko
and Aoyama, Tomoki",
title="Understanding Human Papillomavirus Vaccination Hesitancy in Japan Using Social Media: Content Analysis",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="11",
volume="27",
pages="e68881",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="vaccine confidence",
keywords="large language model",
keywords="stance analysis",
keywords="topic modeling",
abstract="Background: Despite the reinstatement of proactive human papillomavirus (HPV) vaccine recommendations in 2022, Japan continues to face persistently low HPV vaccination rates, which pose significant public health challenges. Misinformation, complacency, and accessibility issues have been identified as key factors undermining vaccine uptake. Objective: This study aims to examine the evolution of public attitudes toward HPV vaccination in Japan by analyzing social media content. Specifically, we investigate the role of misinformation, public health events, and cross-vaccine attitudes (eg, COVID-19 vaccines) in shaping vaccine hesitancy over time. Methods: We collected tweets related to the HPV vaccine from 2011 to 2021. Natural language processing techniques and large language models (LLMs) were used for stance analysis of the collected data. Time series analysis and latent Dirichlet allocation topic modeling were used to identify shifts in public sentiment and topic trends over the decade. Misinformation within opposed-stance tweets was detected using LLMs. Furthermore, we analyzed the relationship between attitudes toward HPV and COVID-19 vaccines through logic analysis. Results: Among the tested models, Gemini 1.0 pro (Google) achieved the highest accuracy (0.902) for stance analysis, improving to 0.968 with hyperparameter tuning. Time series analysis identified significant shifts in public stance in 2013, 2016, and 2020, corresponding to key public health events and policy changes. Topic modeling revealed that discussions around vaccine safety peaked in 2015 before declining, while topics concerning vaccine effectiveness exhibited an opposite trend. Misinformation in topic ``Scientific Warnings and Public Health Risk'' in the sopposed-stance tweets reached a peak of 2.84\% (47/1656) in 2012 and stabilized at approximately 0.5\% from 2014 onward. The volume of tweets using HPV vaccine experiences to argue stances on COVID-19 vaccines was significantly higher than the reverse. Conclusions: Based on observation on the public attitudes toward HPV vaccination from social media contents over 10 years, our findings highlight the need for targeted public health interventions to address vaccine hesitancy in Japan. Although vaccine confidence has increased slowly, sustained efforts are necessary to ensure long-term improvements. Addressing misinformation, reducing complacency, and enhancing vaccine accessibility are key strategies for improving vaccine uptake. Some evidence suggests that confidence in one vaccine may positively influence perceptions of other vaccines. This study also demonstrated the use of LLMs in providing a comprehensive understanding of public health attitudes. Future public health strategies can benefit from these insights by designing effective interventions to boost vaccine confidence and uptake. ",
doi="10.2196/68881",
url="https://www.jmir.org/2025/1/e68881"
}


@Article{info:doi/10.2196/66072,
author="Xiong, Xin
and Xiang, Linghui
and Chang, Litao
and Wu, XY Irene
and Deng, Shuzhen",
title="Forecasting the Incidence of Mumps Based on the Baidu Index and Environmental Data in Yunnan, China: Deep Learning Model Study",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="6",
volume="27",
pages="e66072",
keywords="mumps",
keywords="deep learning",
keywords="baidu index",
keywords="forecasting",
keywords="incidence prediction",
keywords="time series analysis",
keywords="Yunnan",
keywords="China",
abstract="Background: Mumps is a viral respiratory disease characterized by facial swelling and transmitted through respiratory secretions. Despite the availability of an effective vaccine, mumps outbreaks have reemerged globally, including in China, where it remains a significant public health issue. In Yunnan province, China, the incidence of mumps has fluctuated markedly and is higher than that in mainland China, underscoring the need for improved outbreak prediction methods. Traditional surveillance methods, however, may not be sufficient for timely and accurate outbreak prediction. Objective: Our study aims to leverage the Baidu search index, representing search volumes from China's most popular search engine, along with environmental data to develop a predictive model for mumps incidence in Yunnan province. Methods: We analyzed mumps incidence in Yunnan Province from 2014 to 2023, and used time series data, including mumps incidence, Baidu search index, and environmental factors, from 2016 to 2023, to develop predictive models based on long short-term memory networks. Feature selection was conducted using Pearson correlation analysis, and lag correlations were explored through a distributed nonlinear lag model (DNLM). We constructed four models with different combinations of predictors: (1) model BE, combining the Baidu index and environmental factors data; (2) model IB, combining mumps incidence and Baidu index data; (3) model IE, combining mumps incidence and environmental factors; and (4) model IBE, integrating all 3 data sources. Results: The incidence of mumps in Yunnan showed significant variability, peaking at 37.5 per 100,000 population in 2019. From 2014 to 2023, the proportion of female patients ranged from 41.3\% in 2015 to 45.7\% in 2020, consistently lower than that of male patients. After excluding variables with a Pearson correlation coefficient of <0.10 or P values of <.05, we included 3 Baidu index search term groups (disease name, symptoms, and treatment) and 6 environmental factors (maximum temperature, minimum temperature, sulfur dioxide, carbon monoxide, particulate matter with a diameter of 2.5 {\textmu}m or less, and particulate matter with a diameter of 10 {\textmu}m or less) for model development. DNLM analysis revealed that the relative risks consistently increased with rising Baidu index values, while nonlinear associations between temperature and mumps incidence were observed. Among the 4 models, model IBE exhibited the best performance, achieving the coefficient of determination of 0.72, with mean absolute error, mean absolute percentage error, and root-mean-square error values of 0.33, 15.9\%, and 0.43, respectively, in the test set. Conclusions: Our study developed model IBE to predict the incidence of mumps in Yunnan province, offering a potential tool for early detection of mumps outbreaks. The performance of model IBE underscores the potential of integrating search engine data and environmental factors to enhance mumps incidence forecasting. This approach offers a promising tool for improving public health surveillance and enabling rapid responses to mumps outbreaks. ",
doi="10.2196/66072",
url="https://www.jmir.org/2025/1/e66072"
}


@Article{info:doi/10.2196/58981,
author="Rowley, AK Elizabeth
and Mitchell, K. Patrick
and Yang, Duck-Hye
and Lewis, Ned
and Dixon, E. Brian
and Vazquez-Benitez, Gabriela
and Fadel, F. William
and Essien, J. Inih
and Naleway, L. Allison
and Stenehjem, Edward
and Ong, C. Toan
and Gaglani, Manjusha
and Natarajan, Karthik
and Embi, Peter
and Wiegand, E. Ryan
and Link-Gelles, Ruth
and Tenforde, W. Mark
and Fireman, Bruce",
title="Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="27",
volume="9",
pages="e58981",
keywords="disease risk score",
keywords="propensity score",
keywords="vaccine effectiveness",
keywords="COVID-19",
keywords="simulation study",
keywords="usefulness",
keywords="comorbidity",
keywords="assessment",
abstract="Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from --5.3\% to 6.1\% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95\% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7\% (95\% CI 92.2\%-95.2\%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3\% (95\% CI 94.0\%-96.6\%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from --2.2\% to 4.2\%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95\% level. The lowest coverage in the DRS scenarios was 87.8\% (95\% CI 85.8\%-89.8\%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8\% (95\% CI 93.4\%-96.2\%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. ",
doi="10.2196/58981",
url="https://formative.jmir.org/2025/1/e58981"
}


@Article{info:doi/10.2196/63314,
author="Zhang, Liuren
and Chu, Linchen
and Sundaram, E. Maria
and Zhou, Yi
and Sun, Xiu
and Wei, Zheng
and Fu, Chuanxi",
title="Identifying Preferred Features of Influenza Vaccination Programs Among Chinese Clinicians Practicing Traditional Chinese Medicine and Western Medicine: Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2025",
month="Jan",
day="20",
volume="11",
pages="e63314",
keywords="influenza vaccination program",
keywords="traditional Chinese medicine",
keywords="clinicians",
keywords="vaccine",
keywords="health care worker",
keywords="hospital-acquired",
keywords="effectiveness",
keywords="antiviral",
keywords="cross-sectional study",
abstract="Background: Achieving high vaccine coverage among clinicians is crucial to curb the spread of influenza. Traditional Chinese medicine (TCM), rooted in cultural symbols and concepts without direct parallels in modern Western medicine, may influence perspectives on vaccination. Therefore, understanding the preferences of TCM clinicians towards influenza vaccines is of great importance. Objective: To understand preferences for features of influenza vaccination programs and identify the optimal influenza vaccination program among clinicians practicing TCM and Western medicine. Methods: We conducted a discrete choice experiment with a national sample of 3085 Chinese clinicians from various hospital levels (n=1013 practicing TCM) from January to May 2022. Simulations from choice models using the experimental data generated the coefficients of preference and predicted the uptake rate of different influenza vaccination programs. Clinicians were grouped by vaccine preference classification through a latent class analysis. Results: All included attributes significantly influenced clinicians' preferences for choosing an influenza vaccination program. An approximate hypothetical 60\% increase of vaccine uptake could be obtained when the attitude of the workplace changed from ``no notice'' to ``encouraging of vaccination''; there was an approximate hypothetical 35\% increase of vaccine uptake when vaccination campaign strategies changed from ``individual appointment'' to ``vaccination in a workplace setting.'' In the entire sample, about 30\% (946/3085) of clinicians preferred free vaccinations, while 26.5\% (819/3085) comprehensively considered all attributes, except vaccination campaign strategies, when making a decision about choosing an influenza vaccination program. Clinicians who practiced TCM, worked in tertiary hospital, or had at least a postgraduate degree exhibited a lower preference for free vaccinations. Clinicians who practiced Western medicine, worked in primary hospital, or had at most a bachelor's degree had a higher preference for vaccinations in workplace settings. Conclusions: Offering a range of influenza vaccination programs targeting the preferred attributes of different clinician groups could potentially encourage more clinicians, including those practicing TCM, to participate in influenza vaccination programs. ",
doi="10.2196/63314",
url="https://publichealth.jmir.org/2025/1/e63314"
}


@Article{info:doi/10.2196/59352,
author="Taira, Kazuya
and Shiomi, Misa
and Nakabe, Takayo
and Imanaka, Yuichi",
title="The Association Between COVID-19 Vaccination Uptake and Information-Seeking Behaviors Using the Internet:  Nationwide Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="14",
volume="27",
pages="e59352",
keywords="COVID-19 vaccines",
keywords="internet use",
keywords="information seeking behavior",
keywords="Japan",
keywords="vaccine",
keywords="COVID-19",
keywords="behavior",
keywords="panel study",
keywords="longitudinal",
keywords="survey",
keywords="regression analysis",
keywords="chi-square test",
keywords="adult",
keywords="epidemiology",
keywords="health informatics",
abstract="Background: The COVID-19 pandemic, declared in March 2020, profoundly affected global health, societal, and economic frameworks. Vaccination became a crucial tactic in combating the virus. Simultaneously, the pandemic likely underscored the internet's role as a vital resource for seeking health information. The proliferation of misinformation on social media was observed, potentially influencing vaccination decisions and timing. Objective: This study aimed to explore the relationship between COVID-19 vaccination rates, including the timing of vaccination, and reliance on internet-based information sources in Japan. Methods: Using a cross-sectional study design using a subset of panel data, this nationwide survey was conducted in 7 waves. A total of 10,000 participants were randomly selected through an internet survey firm, narrowing down to 8724 after applying inclusion and exclusion criteria. The primary outcome was the COVID-19 vaccination date, divided into vaccinated versus unvaccinated and early versus late vaccination groups. The main exposure variable was the use of internet-based information sources. Control variables included gender, family structure, education level, employment status, household income, eligibility for priority COVID-19 vaccination due to pre-existing medical conditions, and a health literacy scale score. Two regression analyses using generalized estimating equations accounted for prefecture-specific correlations, focusing on vaccination status and timing. In addition, chi-square tests assessed the relationship between each information source and vaccination rates. Results: Representing a cross-section of the Japanese population, the regression analysis found a significant association between internet information seeking and higher vaccination rates (adjusted odds ratio [aOR] 1.42 for those younger than 65 years; aOR 1.66 for those aged 65 years and older). However, no significant link was found regarding vaccination timing. Chi-square tests showed positive associations with vaccination for television, government web pages, and web news, whereas blogs and some social networking sites were negatively correlated. Conclusions: Internet-based information seeking is positively linked to COVID-19 vaccination rates in Japan, underscoring the significant influence of online information on public health decisions. Nonetheless, certain online information sources, including blogs and some social networks, negatively affected vaccination rates, warranting caution in their use and recognition. The study highlights the critical role of credible online sources in public health communication and the challenge of combating misinformation on less regulated platforms. This research sheds light on how the digital information landscape influences health behaviors, stressing the importance of accurate and trustworthy health information amidst global health emergencies. ",
doi="10.2196/59352",
url="https://www.jmir.org/2025/1/e59352",
url="http://www.ncbi.nlm.nih.gov/pubmed/39808493"
}


@Article{info:doi/10.2196/52448,
author="Matthes, Nina
and Willem, Theresa
and Buyx, Alena
and Zimmermann, M. Bettina",
title="Social Media Recruitment as a Potential Trigger for Vulnerability: Multistakeholder Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="30",
volume="11",
pages="e52448",
keywords="vulnerability",
keywords="social media",
keywords="clinical study enrollment",
keywords="clinical study recruitment",
keywords="clinical trials",
keywords="stigma",
keywords="discrimination",
keywords="injustice",
keywords="recruitment",
keywords="clinical study",
keywords="hepatitis B",
keywords="TherVacB",
keywords="clinical research",
keywords="attitudes",
keywords="patient privacy",
keywords="utilization",
abstract="Background: More clinical studies use social media to increase recruitment accrual. However, empirical analyses focusing on the ethical aspects pertinent when targeting patients with vulnerable characteristics are lacking. Objective: This study aims to explore expert and patient perspectives on vulnerability in the context of social media recruitment and seeks to explore how social media can reduce or amplify vulnerabilities. Methods: As part of an international consortium that tests a therapeutic vaccine against hepatitis B (TherVacB), we conducted 30 qualitative interviews with multidisciplinary experts in social media recruitment (from the fields of clinical research, public relations, psychology, ethics, philosophy, law, and social sciences) about the ethical, legal, and social challenges of social media recruitment. We triangulated the expert assessments with the perceptions of 6 patients with hepatitis B regarding social media usage and attitudes relative to their diagnosis. Results: Experts perceived social media recruitment as beneficial for reaching hard-to-reach populations and preserving patient privacy. Features that may aggravate existing vulnerabilities are the acontextual point of contact, potential breaches of user privacy, biased algorithms disproportionately affecting disadvantaged groups, and technological barriers such as insufficient digital literacy skills and restricted access to relevant technology. We also report several practical recommendations from experts to navigate these triggering effects of social media recruitment, including transparent communication, addressing algorithm bias, privacy education, and multichannel recruitment. Conclusions: Using social media for clinical study recruitment can mitigate and aggravate potential study participants' vulnerabilities. Researchers should anticipate and address the outlined triggering effects within this study's design and proactively define strategies to overcome them. We suggest practical recommendations to achieve this. ",
doi="10.2196/52448",
url="https://humanfactors.jmir.org/2024/1/e52448"
}


@Article{info:doi/10.2196/54092,
author="Na, Kilhoe
and Zimdars, Melissa
and Cullinan, E. Megan",
title="Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="5",
volume="8",
pages="e54092",
keywords="alternative health",
keywords="social media",
keywords="misinformation",
keywords="vaccination",
keywords="COVID-19",
keywords="Coronavirus",
abstract="Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination--related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon's Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95\% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95\% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95\% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=--1.09, SE=.17; P<.001; OR .33, 95\% CI 0.23-0.47) and attitudes toward vaccination (B=-- 2.33, SE=.09; P=.02; OR 0.79, 95\% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95\% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=--.84, SE=.17; P<.001; OR 48, 95\% CI 0.32-0.62), and influenza vaccination practice (B=--1.14, SE=.17; P<.001; OR .31, 95\% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. ",
doi="10.2196/54092",
url="https://formative.jmir.org/2024/1/e54092"
}


@Article{info:doi/10.2196/52871,
author="B{\'e}chard, Beno{\^i}t
and Gramaccia, A. Julie
and Gagnon, Dominique
and Laouan-Sidi, Anassour Elhadji
and Dub{\'e}, {\`E}ve
and Ouimet, Mathieu
and de Hemptinne, Delphine
and Tremblay, S{\'e}bastien",
title="The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of  Misinformation",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="4",
volume="8",
pages="e52871",
keywords="attitude toward vaccination",
keywords="misinformation",
keywords="reinformation",
keywords="confidence",
keywords="perceived tentativeness",
keywords="vaccine hesitancy",
keywords="COVID-19",
abstract="Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article ($\chi$21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style ($\chi$21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23\% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 ",
doi="10.2196/52871",
url="https://formative.jmir.org/2024/1/e52871"
}


@Article{info:doi/10.2196/56651,
author="O'Brien, Gabrielle
and Ganjigunta, Ronith
and Dhillon, S. Paramveer",
title="Wellness Influencer Responses to COVID-19 Vaccines on Social Media: A Longitudinal Observational Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="27",
volume="26",
pages="e56651",
keywords="social media, COVID-19, vaccination",
keywords="personal brands",
keywords="public health",
keywords="wellness",
keywords="global health",
keywords="pandemic",
keywords="Twitter",
keywords="tweets",
keywords="vaccine",
keywords="longitudinal design",
keywords="wellness influencers",
keywords="hand-annotation",
keywords="anti-vaccination",
keywords="infodemiology",
abstract="Background: Online wellness influencers (individuals dispensing unregulated health and wellness advice over social media) may have incentives to oppose traditional medical authorities. Their messaging may decrease the overall effectiveness of public health campaigns during global health crises like the COVID-19 pandemic. Objective: This study aimed to probe how wellness influencers respond to a public health campaign; we examined how a sample of wellness influencers on Twitter (rebranded as X in 2023) identified before the COVID-19 pandemic on Twitter took stances on the COVID-19 vaccine during 2020-2022. We evaluated the prevalence of provaccination messaging among wellness influencers compared with a control group, as well as the rhetorical strategies these influencers used when supporting or opposing vaccination. Methods: Following a longitudinal design, wellness influencer accounts were identified on Twitter from a random sample of tweets posted in 2019. Accounts were identified using a combination of topic modeling and hand-annotation for adherence to influencer criteria. Their tweets from 2020-2022 containing vaccine keywords were collected and labeled as pro- or antivaccination stances using a language model. We compared their stances to a control group of noninfluencer accounts that discussed similar health topics before the pandemic using a generalized linear model with mixed effects and a nearest-neighbors classifier. We also used topic modeling to locate key themes in influencer's pro- and antivaccine messages. Results: Wellness influencers (n=161) had lower rates of provaccination stances in their on-topic tweets (20\%, 614/3045) compared with controls (n=242 accounts, with 42\% or 3201/7584 provaccination tweets). Using a generalized linear model of tweet stance with mixed effects to model tweets from the same account, the main effect of the group was significant ($\beta$1=--2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals ($\beta$=--0.9591, SE=0.2917; P=.001) but not social network position. A complementary modeling exercise of stance within user accounts showed a significant difference in the proportion of antivaccination users by group ($\chi$21[N=321]=36.1, P<.001). While nearly half of the influencer accounts were labeled by a K-nearest neighbor classifier as predominantly antivaccination (48\%, 58/120), only 16\% of control accounts were labeled this way (33/201). Topic modeling of influencer tweets showed that the most prevalent antivaccination themes were protecting children, guarding against government overreach, and the corruption of the pharmaceutical industry. Provaccination messaging tended to encourage followers to take action or emphasize the efficacy of the vaccine. Conclusions: Wellness influencers showed higher rates of vaccine opposition compared with other accounts that participated in health discourse before the pandemic. This pattern supports the theory that unregulated wellness influencers have incentives to resist messaging from establishment authorities such as public health agencies. ",
doi="10.2196/56651",
url="https://www.jmir.org/2024/1/e56651"
}


@Article{info:doi/10.2196/65740,
author="Barbosa da Silva J{\'u}nior, Jarbas
and Garcia-Saiso, Sebastian
and Marti, Myrna
and Salas, Daniel
and Contreras, Marcela
and Velandia-Gonzalez, Martha
and Luna, Daniel
and Nelson, Jennifer
and Fitzgerald, James
and Bascolo, Ernesto
and Talavera Romero, Lorena Ivy
and Chomali, May
and Curioso, H. Walter
and Plazzotta, Fernando
and Otero, Carlos
and Lopez Osornio, Alejandro
and Lennemann, Tessa
and Salinas, Karen
and D'Agostino, Marcelo",
title="Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="26",
volume="10",
pages="e65740",
keywords="medical informatics",
keywords="health systems",
keywords="immunizations",
keywords="public health",
keywords="viewpoint",
keywords="health challenges",
keywords="digital vaccine certificates",
keywords="outbreak management",
keywords="outbreak",
keywords="accuracy",
keywords="healthcare",
keywords="surveillance",
keywords="health outcomes",
keywords="global health",
keywords="mobile phone",
doi="10.2196/65740",
url="https://publichealth.jmir.org/2024/1/e65740"
}


@Article{info:doi/10.2196/57798,
author="Zhang, Lingli
and Li, Xin
and Chen, Jiali
and Wang, Xiaoye
and Sun, Yuyang",
title="Public Preference and Priorities for Including Vaccines in China's National Immunization Program: Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="14",
volume="10",
pages="e57798",
keywords="discrete choice experiment",
keywords="national immunization program",
keywords="vaccines",
keywords="vaccination",
keywords="immunization",
keywords="public preferences",
keywords="China",
keywords="mixed logit model",
keywords="heterogeneity",
keywords="varicella",
keywords="public health",
keywords="infectious diseases",
abstract="Background: Several important vaccines, such as the Haemophilus influenzae type b vaccine, rotavirus vaccine, pneumococcal conjugate vaccine, and influenza vaccine, have not been included in China's National Immunization Program (NIP) due to a prolonged absence of updates and limited resources. Public engagement could identify concerns that require attention and foster trust to ensure continuous support for immunization. Objective: This study aimed to identify public preferences for vaccine inclusion in the NIP and to determine the desired vaccine funding priorities in the Chinese population. Methods: A dual-response discrete choice experiment was utilized to estimate the relative importance of 6 attributes, including incidence of vaccine-preventable diseases, mortality of vaccine-preventable diseases, vaccine effectiveness, vaccine cost, vaccinated group, and vaccine coverage. Participants were recruited through the Wenjuanxing platform using a census-based quota sample of the nationwide population aged 18 years and older. A mixed logit model was used to estimate the coefficient of attribute preferences and predict the selection probability. Subgroups and interaction effects were analyzed to examine the heterogeneity in preferences. Results: In total, 1258 participants completed the survey, of which 880 were involved in the main analysis and 1166 in the sensitivity analysis. The relative importance and model estimates of 2 attributes, vaccine cost and vaccination group, varied between the unforced- and forced-choice settings. All 6 vaccine attributes significantly influenced the preferences for vaccine inclusion, with vaccine effectiveness and coverage as the most important factors, followed by the vaccinated group and mortality of vaccine-preventable diseases in the unforced-choice settings. The top vaccines recommended for China's NIP included the varicella vaccine, Haemophilus influenzae type b vaccine, enterovirus 71 vaccine, and influenza vaccine for preschoolers and school-aged children. The current analysis also revealed distinct preference patterns among different subgroups, such as gender, age, education, and income. The interaction analysis indicated that the region and health status of participants contribute to preference heterogeneity. Conclusions: Public preferences for including vaccines in the NIP were primarily influenced by vaccine effectiveness and coverage. The varicella vaccine should be prioritized for inclusion in the NIP. The public preferences could provide valuable insights when incorporating new vaccines in the NIP. ",
doi="10.2196/57798",
url="https://publichealth.jmir.org/2024/1/e57798"
}


@Article{info:doi/10.2196/52738,
author="Gong, Jie
and Gu, Dandan
and Dong, Suyun
and Shen, Wangqin
and Yan, Haiou
and Xie, Juan",
title="Effects of Message Framing on Human Papillomavirus Vaccination: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e52738",
keywords="message framing",
keywords="gain-loss framing",
keywords="human?papillomavirus",
keywords="vaccination",
keywords="attitude",
keywords="intention",
keywords="behavior",
keywords="systematic review",
keywords="PRISMA",
abstract="Background: With the advancement of cervical cancer elimination strategies, promoting human papillomavirus (HPV) vaccination is essential to achieving this goal. The issue of how to structure and develop message content to promote HPV vaccination is a debatable issue. Objective: The efficacy of gain-loss framing in vaccination contexts is disputed. Our study aimed to elucidate the consequences of message framing on attitudes, intentions, and behavioral tendencies toward HPV vaccination, with the objective of refining message framing strategies and their elements. Methods: This systematic review adhered strictly to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guideline reporting standards to comprehensively retrieve, extract, and integrate data. We searched databases, including PubMed, Embase, Scopus, and Web of Science, for literature published from database construction to August 15, 2023. Literature screening, data extraction, and quality evaluation were performed by 2 researchers. Intervention studies published in English, conducted with populations with children eligible for HPV vaccination, and involving message framing were included. Attitudes, intentions, and behaviors served as outcome evaluation criteria. Results: A total of 19 intervention studies were included. Gain-loss framing had no clear effect on vaccination attitudes nor intentions. Loss framing showed a weak advantage at improving HPV vaccination attitudes or intentions, but the evidence was not strong enough to draw definitive conclusions. The impact of gain-loss framing on HPV vaccination behaviors could not be determined due to the limited number of studies and the qualitative nature of the analysis. Conclusions: Combining gain-loss framing with other message framing approaches may be an effective way to enhance the effect of message framing. More high-quality message framing content and exploring alternative moderator or mediator variables are required to support the conclusion. Trial Registration: CRD42023451612; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=451612 ",
doi="10.2196/52738",
url="https://www.jmir.org/2024/1/e52738"
}


@Article{info:doi/10.2196/56989,
author="Hong, Seohyun
and Son, Yejun
and Lee, Myeongcheol
and Lee, Hyuk Jun
and Park, Jaeyu
and Lee, Hayeon
and Dragioti, Elena
and Fond, Guillaume
and Boyer, Laurent
and L{\'o}pez S{\'a}nchez, Felipe Guillermo
and Smith, Lee
and Tully, A. Mark
and Rahmati, Masoud
and Choi, Sung Yong
and Lee, Joo Young
and Yeo, Geun Seung
and Woo, Selin
and Yon, Keon Dong",
title="Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="1",
volume="10",
pages="e56989",
keywords="COVID-19",
keywords="influenza",
keywords="South Korea",
keywords="vaccination",
keywords="vaccinations",
keywords="COVID-19 vaccine",
keywords="COVID-19 vaccination",
keywords="SARS-CoV-2",
keywords="SARS-CoV-2 vaccine",
keywords="pandemic",
keywords="SARS-CoV-2 vaccination",
keywords="vaccine",
keywords="vaccine hesitancy",
abstract="Background: The imperative arises to study the impact of socioeconomic factors on the acceptance of SARS-CoV-2 and influenza vaccines amid changes in immunization policies during the COVID-19 pandemic. Objective: To enhance targeted public health strategies and improve age-specific policies based on identified risk factors, this study investigated the associations between sociodemographic factors and vaccination behaviors during the COVID-19 pandemic, with emphasis on age-specific vaccine cost policies. Methods: This study analyzed data from the Korean Community Health Survey 2019?2022 with 507,964 participants to investigate the impact of age-specific policies on vaccination behaviors during the pandemic period. Cohorts aged 19?64 years and 65 years or older were stratified based on age (years), sociodemographic factors, and health indicators. The cohorts were investigated to assess the influence of relevant risk factors on vaccine acceptance under the pandemic by using weighted odds ratio and ratio of odds ratio (ROR). Results: Among 507,964 participants, the acceptance of the SARS-CoV-2 vaccine (COVID-19 vaccine) was higher among individuals with factors possibly indicating higher socioeconomic status, such as higher education level (age 19?64 years: ROR 1.34; 95\% CI 1.27?1.40 and age ?65 years: ROR 1.19; 95\% CI 1.01?1.41) and higher income (age 19?64 years: ROR 1.67; 95\% CI 1.58?1.76 and age ?65 years: ROR 1.21; 95\% CI 1.06?1.38) for both age cohorts compared to influenza vaccine acceptance before the pandemic. In the context of influenza vaccination during the pandemic, the older cohort exhibited vaccine hesitancy associated with health care mobility factors such as lower general health status (ROR 0.89; 95\% CI 0.81?0.97). Conclusions: SARS-CoV-2 vaccination strategies should focus on reducing hesitancy among individuals with lower social participation. To improve influenza vaccine acceptance during the pandemic, strategies for the younger cohort should focus on individuals with lower social participation, while efforts for the older cohort should prioritize individuals with limited access to health care services. ",
doi="10.2196/56989",
url="https://publichealth.jmir.org/2024/1/e56989"
}


@Article{info:doi/10.2196/57514,
author="Gustafson Hedov, Emelie
and Nyberg, Fredrik
and Gustafsson, Stefan
and Li, Huiqi
and Gissl{\'e}n, Magnus
and Sundstr{\"o}m, Johan",
title="Person-Centered Web-Based Mobile Health System (Symptoms) for Reporting Symptoms in COVID-19 Vaccinated Individuals: Observational Study of System, Users, and Symptoms",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e57514",
keywords="mHealth",
keywords="mobile health",
keywords="patient-reported outcomes",
keywords="apps",
keywords="COVID-19",
keywords="vaccination side effects",
keywords="web-based symptom reporting",
abstract="Background: The full spectrum of side effects from COVID-19 vaccinations and infections, including milder symptoms or health effects that do not lead to health care visits, remains unknown. Person-centered self-reporting of symptoms may offer a solution. Monitoring patient-reported outcomes over time will vary in importance for different patients. Individuals have unique needs and preferences, in terms of both communication methods and how the collected information is used to support care. Objective: This study aims to describe how Symptoms, a system for person-centered self-reporting of symptoms and health-related quality of life, was utilized in investigating COVID-19 vaccine side effects. We illustrate this by presenting data from the Symptoms system in newly vaccinated individuals from the RECOVAC (Register-based large-scale national population study to monitor COVID-19 vaccination effectiveness and safety) study. Methods: During the COVID-19 pandemic, newly vaccinated individuals were identified as the ideal population to query for milder symptoms related to COVID-19 vaccinations and infections. To this end, we used posters in observation areas at 150 vaccination sites across the V{\"a}stra G{\"o}taland region of Sweden, inviting newly vaccinated individuals to use a novel digital system, Symptoms. In the Symptoms system, users can track their symptoms, functioning, and quality of life as often as they wish, using evidence-based patient-reported outcome measures and short numeric rating scales. These scales cover a prespecified list of symptoms based on common COVID-19 symptoms and previously reported vaccine side effects. Participants could also use numeric rating scales for self-defined symptoms if their symptom was not included on the prespecified list. Results: A total of 731 people created user accounts and consented to share data for research between July 21, 2021, and September 27, 2022. The majority of users were female (444/731, 60.7\%), with a median age of 38 (IQR 30-47) years. Most participants (498/702, 70.9\%) did not report any of the comorbidities included in the questionnaire. Of the 731 participants, 563 (77.0\%) reported experiencing 1 or more symptoms. The most common symptom was pain at the injection site (486/563, 86.3\%), followed by fatigue (181/563, 32.1\%) and headache (169/563, 30.0\%). In total, 143 unique symptoms were reported. Of these, 29 were from the prespecified list, while the remaining 114 (79.7\%) were self-defined entries in the symptom field. This suggests that the flexibility of the self-directed system---allowing individuals to decide which symptoms they consider worth tracking---may be an important feature. Conclusions: Self-reported symptoms in the Symptoms system appeared to align with previously observed post--COVID-19 vaccination symptoms. The system was relatively easy to use and successfully captured broad, longitudinal data. Its person-centered and self-directed design seemed crucial in capturing the full burden of symptoms experienced by users. ",
doi="10.2196/57514",
url="https://formative.jmir.org/2024/1/e57514"
}


@Article{info:doi/10.2196/60939,
author="Joshi, Saubhagya
and Ha, Eunbin
and Amaya, Andee
and Mendoza, Melissa
and Rivera, Yonaira
and Singh, K. Vivek",
title="Ensuring Accuracy and Equity in Vaccination Information From ChatGPT and CDC: Mixed-Methods Cross-Language Evaluation",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e60939",
keywords="vaccination",
keywords="health equity",
keywords="multilingualism",
keywords="language equity",
keywords="health literacy",
keywords="online health information",
keywords="conversational agents",
keywords="artificial intelligence",
keywords="large language models",
keywords="health information",
keywords="public health",
abstract="Background: In the digital age, large language models (LLMs) like ChatGPT have emerged as important sources of health care information. Their interactive capabilities offer promise for enhancing health access, particularly for groups facing traditional barriers such as insurance and language constraints. Despite their growing public health use, with millions of medical queries processed weekly, the quality of LLM-provided information remains inconsistent. Previous studies have predominantly assessed ChatGPT's English responses, overlooking the needs of non--English speakers in the United States. This study addresses this gap by evaluating the quality and linguistic parity of vaccination information from ChatGPT and the Centers for Disease Control and Prevention (CDC), emphasizing health equity. Objective: This study aims to assess the quality and language equity of vaccination information provided by ChatGPT and the CDC in English and Spanish. It highlights the critical need for cross-language evaluation to ensure equitable health information access for all linguistic groups. Methods: We conducted a comparative analysis of ChatGPT's and CDC's responses to frequently asked vaccination-related questions in both languages. The evaluation encompassed quantitative and qualitative assessments of accuracy, readability, and understandability. Accuracy was gauged by the perceived level of misinformation; readability, by the Flesch-Kincaid grade level and readability score; and understandability, by items from the National Institutes of Health's Patient?Education?Materials Assessment Tool (PEMAT) instrument. Results: The study found that both ChatGPT and CDC provided mostly accurate and understandable (eg, scores over 95 out of 100) responses. However, Flesch-Kincaid grade levels often exceeded the American Medical Association's recommended levels, particularly in English (eg, average grade level in English for ChatGPT=12.84, Spanish=7.93, recommended=6). CDC responses outperformed ChatGPT in readability across both languages. Notably, some Spanish responses appeared to be direct translations from English, leading to unnatural phrasing. The findings underscore the potential and challenges of using ChatGPT for health care access. Conclusions: ChatGPT holds potential as a health information resource but requires improvements in readability and linguistic equity to be truly effective for diverse populations. Crucially, the default user experience with ChatGPT, typically encountered by those without advanced language and prompting skills, can significantly shape health perceptions. This is vital from a public health standpoint, as the majority of users will interact with LLMs in their most accessible form. Ensuring that default responses are accurate, understandable, and equitable is imperative for fostering informed health decisions across diverse communities. ",
doi="10.2196/60939",
url="https://formative.jmir.org/2024/1/e60939"
}


@Article{info:doi/10.2196/56390,
author="Preuhs, Katharina
and Bussink-Voorend, Daphne
and van Keulen, M. Hilde
and Wildeman, Ilona
and Hautvast, Jeannine
and Hulscher, Marlies
and van Empelen, Pepijn",
title="An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="30",
volume="8",
pages="e56390",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="informed decision-making",
keywords="user-centered design",
keywords="low literacy",
keywords="eHealth",
keywords="tailored decision aid",
abstract="Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one's attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. ",
doi="10.2196/56390",
url="https://formative.jmir.org/2024/1/e56390"
}


@Article{info:doi/10.2196/59087,
author="Kim, Youlim
and Lee, Hyeonkyeong
and Park, Jeongok
and Kim, Yong-Chan
and Kim, Hee Dong
and Lee, Young-Me",
title="eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="28",
volume="8",
pages="e59087",
keywords="cervical cancer",
keywords="human papillomavirus",
keywords="vaccines",
keywords="health communication",
keywords="chatbot",
keywords="artificial intelligence",
keywords="adolescent",
keywords="mobile phone",
abstract="Background: As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes ``cues to action'' that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. Objective: This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. Methods: The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. Results: A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts' chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Conclusions: Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention. ",
doi="10.2196/59087",
url="https://formative.jmir.org/2024/1/e59087",
url="http://www.ncbi.nlm.nih.gov/pubmed/39466304"
}


@Article{info:doi/10.2196/62657,
author="Brooks, J. Donald
and Kim, Inae Carolyn
and Mboussou, Fortune Franck
and Danovaro-Holliday, Carolina M.",
title="Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="25",
volume="10",
pages="e62657",
keywords="COVID-19",
keywords="COVID-19 vaccine",
keywords="immunization information system",
keywords="vaccination monitoring",
keywords="vaccine",
keywords="monitoring and evaluation",
abstract="Background: Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands---requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Objective: Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. Methods: We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. Results: In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85\% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, ``aggregate reporting system'' was the system most frequently reported as being in place (n=116, 98.3\%), while ``reminder system'' was the least (n=77, 89\%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6\%) of countries reported establishing at least one new system, ranging from 72\% (n=42) in high-income countries (HICs) to 62\% (n=16) in low-income countries. Concurrently, 55.3\% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62\% (n=36) of HICs reporting this compared to about 53\% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85\% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2\%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31\% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Conclusions: Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance. ",
doi="10.2196/62657",
url="https://publichealth.jmir.org/2024/1/e62657"
}


@Article{info:doi/10.2196/58257,
author="Oan?, Iulian
and H{\^a}ncean, Marian-Gabriel
and Perc, Matja?
and Lerner, J{\"u}rgen
and Mih?il?, Bianca-Elena
and Geant?, Marius
and Molina, Luis Jos{\'e}
and Tinc?, Isabela
and Espina, Carolina",
title="Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="25",
volume="26",
pages="e58257",
keywords="vaccine hesitancy",
keywords="online media",
keywords="social media",
keywords="assortative mixing",
keywords="personal network analysis",
keywords="social network analysis",
keywords="Romania",
keywords="vaccination",
keywords="health information",
keywords="COVID-19",
abstract="Background: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person's social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. Objective: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. Methods: We conducted 83 face-to-face interviews with participants from a living lab in Lere?ti, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73\% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents' preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. Results: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95\% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95\% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95\% CI 1.79-7.85; P<.001). Conclusions: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals' vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes. ",
doi="10.2196/58257",
url="https://www.jmir.org/2024/1/e58257"
}


@Article{info:doi/10.2196/55706,
author="Li, Lan
and Wood, E. Caroline
and Kostkova, Patty",
title="Evaluating a WeChat-Based Intervention to Enhance Influenza Vaccination Knowledge, Attitude, and Behavior Among Chinese University Students Residing in the United Kingdom: Controlled, Quasi-Experimental, Mixed Methods Study",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="24",
volume="8",
pages="e55706",
keywords="influenza vaccination",
keywords="intervention study",
keywords="social media",
keywords="students",
keywords="health promotion",
keywords="mixed methods",
abstract="Background: University students, who often live in close quarters and engage in frequent social interaction, face a heightened risk of influenza morbidity. Still, vaccination rates among this group, particularly Chinese students, remain consistently low due to limited awareness and insufficient access to vaccinations. Objective: This study examines the effectiveness of a cocreated WeChat-based intervention that targets mainland Chinese university students in the United Kingdom, aiming to improve their knowledge, attitude, and behavior (KAB) toward seasonal influenza vaccination. Methods: A quasi-experimental mixed methods design was used, incorporating an intervention and comparison group, with baseline and follow-up self-reported surveys. The study was conducted from December 19, 2022, to January 16, 2023. The primary outcome is the KAB score, which was measured before and after the intervention phases. System-recorded data and user feedback were included in the analysis as secondary outcomes. A series of hypothesis testing methods were applied to test the primary outcomes, and path analysis was used to explore the relationships. Results: Our study included 596 students, of which 303 (50.8\%) were in the intervention group and 293 (49.2\%) were in the control group. The intervention group showed significant improvements in knowledge, attitude, and intended behavior scores over time, whereas the control group had only a slight increase in intended behavior scores. When comparing changes between the 2 groups, the intervention group displayed significant differences in knowledge and attitude scores compared to the control group, while intended behavior scores did not significantly differ. After the intervention, the actual vaccination rate was slightly higher in the intervention group (63/303, 20.8\%) compared to the control group (54/293, 18.4\%). Path analysis found that the intervention had a significant direct impact on knowledge but not on attitudes; knowledge strongly influenced attitudes, and both knowledge and attitudes significantly influenced intended behavior; and there was a strong correlation between intended and actual behavior. In the intervention group, participants expressed a high level of satisfaction and positive review of the content and its use. Conclusions: This study demonstrates how a WeChat intervention effectively improves KAB related to seasonal influenza vaccination among Chinese students, highlighting the potential of social media interventions to drive vaccination behavior change. It contributes to the broader research on digital health intervention effectiveness and lays the groundwork for tailoring similar interventions to different health contexts and populations. ",
doi="10.2196/55706",
url="https://formative.jmir.org/2024/1/e55706"
}


@Article{info:doi/10.2196/51909,
author="Kolis, Jessica
and Brookmeyer, Kathryn
and Chuvileva, Yulia
and Voegeli, Christopher
and Juma, Sarina
and Ishizumi, Atsuyoshi
and Renfro, Katy
and Wilhelm, Elisabeth
and Tice, Hannah
and Fogarty, Hannah
and Kocer, Irma
and Helms, Jordan
and Verma, Anisha",
title="Infodemics and Vaccine Confidence: Protocol for Social Listening and Insight Generation to Inform Action",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="24",
volume="10",
pages="e51909",
keywords="infodemic",
keywords="infodemic management",
keywords="vaccine confidence",
keywords="vaccine demand",
keywords="misinformation",
keywords="disinformation",
keywords="infodemiology",
keywords="mixed methods",
keywords="thematic analysis",
keywords="COVID-19",
abstract="Background: In the fall of 2020, the COVID-19 infodemic began to affect public confidence in and demand for COVID-19 vaccines in the United States. While polls indicated what consumers felt regarding COVID-19 vaccines, they did not provide an understanding of why they felt that way or the social and informational influences that factored into vaccine confidence and uptake. It was essential for us to better understand how information ecosystems were affecting the confidence in and demand for COVID-19 vaccines in the United States. Objective: The US Centers for Disease Control and Prevention (CDC) established an Insights Unit within the COVID-19 Response's Vaccine Task Force in January 2021 to assist the agency in acting more swiftly to address the questions, concerns, perceptions, and misinformation that appeared to be affecting uptake of COVID-19 vaccines. We established a novel methodology to rapidly detect and report on trends in vaccine confidence and demand to guide communication efforts and improve programmatic quality in near real time. Methods: We identified and assessed data sources for inclusion through an informal landscape analysis using a snowball method. Selected data sources provided an expansive look at the information ecosystem of the United States regarding COVID-19 vaccines. The CDC's Vaccinate with Confidence framework and the World Health Organization's behavioral and social drivers for vaccine decision-making framework were selected as guiding principles for interpreting generated insights and their impact. We used qualitative thematic analysis methods and a consensus-building approach to identify prevailing and emerging themes, assess their potential threat to vaccine confidence, and propose actions to increase confidence and demand. Results: As of August 2022, we have produced and distributed 34 reports to >950 recipients within the CDC and externally. State and local health departments, nonprofit organizations, professional associations, and congressional committees have referenced and used the reports for learning about COVID-19 vaccine confidence and demand, developing communication strategies, and demonstrating how the CDC monitored and responded to misinformation. A survey of the reports' end users found that nearly 75\% (40/53) of respondents found them ``very'' or ``extremely'' relevant and 52\% (32/61) used the reports to inform communication strategies. In addition, our methodology underwent continuous process improvement to increase the rigor of the research process, the validity of the findings, and the usability of the reports. Conclusions: This methodology can serve as a diagnostic technique for rapidly identifying opportunities for public health interventions and prevention. As the methodology itself is adaptable, it could be leveraged and scaled for use in a variety of public health settings. Furthermore, it could be considered beyond acute public health crises to support adherence to guidance and recommendations and could be considered within routine monitoring and surveillance systems. ",
doi="10.2196/51909",
url="https://publichealth.jmir.org/2024/1/e51909"
}


@Article{info:doi/10.2196/53226,
author="Kuatsidzo, Ananda
and Wilson, Kumanan
and Ruller, Sydney
and Daly, Blake
and Halil, Roland
and Kobewka, Daniel",
title="Improving Vaccine Clinic Efficiency Through the CANImmunize Platform",
journal="Online J Public Health Inform",
year="2024",
month="Oct",
day="16",
volume="16",
pages="e53226",
keywords="digital solutions",
keywords="vaccine",
keywords="CANImmunize platform",
keywords="CANImmunize",
keywords="platform",
keywords="Canada",
keywords="Canadian",
keywords="workflow",
keywords="booking",
keywords="health care",
keywords="digital health",
keywords="hospital",
keywords="patient",
keywords="personnel",
doi="10.2196/53226",
url="https://ojphi.jmir.org/2024/1/e53226"
}


@Article{info:doi/10.2196/57242,
author="Salisbury, David
and Lazarus, V. Jeffrey
and Waite, Nancy
and Lehmann, Clara
and Sri Bhashyam, Sumitra
and de la Cruz, Marie
and Hahn, Beth
and Rousculp, D. Matthew
and Bonanni, Paolo",
title="COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2024",
month="Oct",
day="16",
volume="10",
pages="e57242",
keywords="COVID-19",
keywords="discrete choice experiment",
keywords="vaccine hesitancy",
keywords="vaccine side effects",
keywords="SARS-CoV-2",
keywords="COVID vaccination",
keywords="immunization",
keywords="preference elicitation",
keywords="informed decision-making",
keywords="antivaccine",
abstract="Background: Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers. Objective: We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines. Methods: Participants in the 2019nCoV-408 study were aged ?18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants' backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an ``opt-out'' option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non--high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options. Results: The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25\% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8\% vs 30.6\%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7\% vs 8.2\%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non--high-risk subgroups were protection against severe COVID-19 (38.2\% vs 31.5\%; P<.000), avoiding common vaccine side effects (12\% vs 20.5\%; P<.000), and avoiding serious vaccine side effects (9.7\% vs 7.5\%; P=.002). Conclusions: This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor. ",
doi="10.2196/57242",
url="https://publichealth.jmir.org/2024/1/e57242",
url="http://www.ncbi.nlm.nih.gov/pubmed/39412841"
}


@Article{info:doi/10.2196/52792,
author="Mechael, Patricia
and Gilani, Sara
and Ahmad, Ahsan
and LeFevre, Amnesty
and Mohan, Diwakar
and Memon, Asra
and Shah, Taighoon Mubarak
and Siddiqi, Arif Danya
and Chandir, Subhash
and Soundardjee, Riswana",
title="Evaluating the ``Zindagi Mehfooz'' Electronic Immunization Registry and Suite of Digital Health Interventions to Improve the Coverage and Timeliness of Immunization Services in Sindh, Pakistan: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="11",
volume="26",
pages="e52792",
keywords="electronic immunization registry",
keywords="registry",
keywords="Zindagi Mehfooz",
keywords="vaccination",
keywords="alert",
keywords="reminder",
keywords="dashboard",
keywords="survey",
keywords="cost",
keywords="economic",
keywords="digital health",
keywords="immunization",
keywords="children",
keywords="pediatrics",
keywords="equity",
keywords="accessibility",
keywords="text messages",
keywords="SMS",
keywords="zero dose",
abstract="Background: The Zindagi Mehfooz (safe life; ZM) electronic immunization registry (EIR) is a comprehensive suite of digital health interventions that aims to improve equitable access, timeliness, and coverage of child immunizations through a smartphone-based app for vaccinators, web-based dashboards for supervisors and managers, text message alerts and reminders for caregivers, and a call center. It has been implemented at scale in Sindh Province, Pakistan. Objective: This study aimed to present findings from an evaluation of the ZM-EIR suite of digital health interventions in order to improve data availability and use as a contribution, among other immunization program interventions, to enhanced immunization outcomes for children aged 12-23 months in Sindh Province. Methods: The mixed methods study included (1) analysis of ZM-EIR system data to identify high-, moderate-, and low-adoption and compliance sites; (2) in-depth interviews with caregivers, vaccinators, supervisors, and managers in the Expanded Program for Immunization (EPI); and (3) pre-post outcome evaluation using vaccine coverage from the Multiple Indicator Cluster Surveys (MICS) 2014 and 2018-2019. Key outcomes of interest were improved data availability, use and contribution to immunization outcomes, including receipt of individual antigens (Bacillus Calmette-Gu{\'e}rin [BCG], pentavalent [Penta] 1-3, measles), full immunization (all antigens), and zero-dose children defined as children aged 6-23 months who have not received the first dosage of the diphtheria-pertussis-tetanus 1/Penta vaccine. Results: By registering newborns, providing alerts and reminders, and tracking their immunization completion, the ZM-EIR improved data availability and use in the EPI. The ZM-EIR was well received by EPI administrators, supervisors, vaccinators, and caregivers. The key benefit highlighted by ZM-EIR users was a list of children who missed scheduled vaccines (defaulters). Through greater availability and use of data, the ZM-EIR implementation, as part of a broader package of immunization program--strengthening activities in Sindh Province, may have contributed to an increase in immunization coverage and timeliness for BCG vaccinations and a decrease in zero-dose children in 2018-2019 from 2014. Additional findings from the study included the dual burden of reporting on paper and gender-related considerations of female caregivers not wanting to provide their phone numbers to male vaccinators, creating barriers to greater uptake of the ZM-EIR. Conclusions: The ZM-EIR is a promising technology platform that has increased the availability and use of immunization data, which may have contributed, along with other intensive immunization program interventions, to improvements in immunization outcomes through systematic registration of children, alerts and reminders, and increased use of data for planning and monitoring by the EPI. Trial Registration: ISRCTN Registry ISRCTN23078223; https://doi.org/10.1186/ISRCTN23078223 ",
doi="10.2196/52792",
url="https://www.jmir.org/2024/1/e52792",
url="http://www.ncbi.nlm.nih.gov/pubmed/39162666"
}


@Article{info:doi/10.2196/50364,
author="Zhang, Chenchen
and Guo, Xing
and Zhu, Rui
and Hou, Wenjie
and Wang, Lingmeng
and Wang, Fuzhi
and Zhang, Li
and Luo, Dan",
title="Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment",
journal="Online J Public Health Inform",
year="2024",
month="Oct",
day="3",
volume="16",
pages="e50364",
keywords="vaccination service app",
keywords="Mobile Application Rating Scale",
keywords="MARS",
keywords="quality evaluation",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="quality",
keywords="evaluation",
keywords="rating",
keywords="mHealth",
keywords="mobile health",
keywords="service",
keywords="services",
keywords="service content",
keywords="user evaluation",
keywords="vaccine",
keywords="vaccines",
keywords="public health",
abstract="Background: Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. Objective: Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. Methods: The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. Results: In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=--5.301; P<.001) and the subjective quality score (z=--4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=--2.55; P=.80) and the subjective quality score (z=--0.137; P=.89). There was good intragroup consistency among the raters. Conclusions: In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall. ",
doi="10.2196/50364",
url="https://ojphi.jmir.org/2024/1/e50364",
url="http://www.ncbi.nlm.nih.gov/pubmed/39361418"
}


@Article{info:doi/10.2196/56559,
author="Staras, S. Stephanie A.
and Tauscher, Justin
and Vinson, Michelle
and Thompson, A. Lindsay
and Gerend, A. Mary
and Shenkman, A. Elizabeth",
title="Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="19",
volume="8",
pages="e56559",
keywords="participatory design",
keywords="think-aloud",
keywords="implementation science",
keywords="adolescent vaccination",
keywords="human papillomavirus vaccine",
keywords="usability",
keywords="eHealth",
abstract="Background: In the United States, only 58\% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents' vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app's usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75\%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child's vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75\% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents' children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44\%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. ",
doi="10.2196/56559",
url="https://formative.jmir.org/2024/1/e56559"
}


@Article{info:doi/10.2196/56044,
author="Luchman, Joseph
and Bennett, Morgane
and Kranzler, Elissa
and Tuskeviciute, Rugile
and Vega, Ronald
and Denison, Benjamin
and Trigger, Sarah
and Nighbor, Tyler
and Vines, Monica
and Hoffman, Leah",
title="Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="10",
volume="10",
pages="e56044",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="vaccine",
keywords="United States",
keywords="segmentation",
keywords="latent class cluster analysis",
keywords="vaccines",
keywords="vaccination",
keywords="segmentation analysis",
keywords="estimation",
keywords="validation",
keywords="attitude",
keywords="attitudes",
keywords="belief",
keywords="beliefs",
keywords="behavior",
keywords="behaviors",
keywords="sociodemographic",
keywords="nonintender",
keywords="nonintenders",
keywords="waiter",
keywords="waiters",
keywords="confident",
keywords="confidents",
keywords="social distancing",
keywords="bivariate",
keywords="regression analysis",
keywords="survey",
keywords="respondent",
keywords="respondents",
abstract="Background: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services' COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death. Objective: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors. Methods: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago's national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves. Results: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents. Conclusions: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases. ",
doi="10.2196/56044",
url="https://publichealth.jmir.org/2024/1/e56044",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255032"
}


@Article{info:doi/10.2196/55613,
author="Lopes, Henrique
and Baptista-Leite, Ricardo
and Hermenegildo, Catarina
and Atun, Rifat",
title="Digital Gamification Tool (Let's Control Flu) to Increase Vaccination Coverage Rates: Proposal for Algorithm Development",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="10",
volume="13",
pages="e55613",
keywords="influenza",
keywords="gamification",
keywords="public health policies",
keywords="vaccination coverage rates",
keywords="health promotion",
abstract="Background: Influenza represents a critical public health challenge, disproportionately affecting at-risk populations, including older adults and those with chronic conditions, often compounded by socioeconomic factors. Innovative strategies, such as gamification, are essential for augmenting risk communication and community engagement efforts to address this threat. Objective: This study aims to introduce the ``Let's Control Flu'' (LCF) tool, a gamified, interactive platform aimed at simulating the impact of various public health policies (PHPs) on influenza vaccination coverage rates and health outcomes. The tool aligns with the World Health Organization's goal of achieving a 75\% influenza vaccination rate by 2030, facilitating strategic decision-making to enhance vaccination uptake. Methods: The LCF tool integrates a selection of 13 PHPs from an initial set proposed in another study, targeting specific population groups to evaluate 7 key health outcomes. A prioritization mechanism accounts for societal resistance and the synergistic effects of PHPs, projecting the potential policy impacts from 2022 to 2031. This methodology enables users to assess how PHPs could influence public health strategies within distinct target groups. Results: The LCF project began in February 2021 and is scheduled to end in December 2024. The model creation phase and its application to the pilot country, Sweden, took place between May 2021 and May 2023, with subsequent application to other European countries. The pilot phase demonstrated the tool's potential, indicating a promising increase in the national influenza vaccination coverage rate, with uniform improvements across all targeted demographic groups. These initial findings highlight the tool's capacity to model the effects of PHPs on improving vaccination rates and mitigating the health impact of influenza. Conclusions: By incorporating gamification into the analysis of PHPs, the LCF tool offers an innovative and accessible approach to supporting health decision makers and patient advocacy groups. It enhances the comprehension of policy impacts, promoting more effective influenza prevention and control strategies. This paper underscores the critical need for adaptable and engaging tools in PHP planning and implementation. International Registered Report Identifier (IRRID): RR1-10.2196/55613 ",
doi="10.2196/55613",
url="https://www.researchprotocols.org/2024/1/e55613",
url="http://www.ncbi.nlm.nih.gov/pubmed/39255031"
}


@Article{info:doi/10.2196/49366,
author="Kazi, Momin Abdul
and Ahsan, Nazia
and Jabeen, Rawshan
and Allana, Raheel
and Jamal, Saima
and Mughal, Khan Muhammad Ayub
and Hopkins, L. Kathryn
and Malik, Aman Fauzia",
title="Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study",
journal="JMIR Infodemiology",
year="2024",
month="Sep",
day="4",
volume="4",
pages="e49366",
keywords="infodemics",
keywords="mHealth",
keywords="social media",
keywords="electronic media",
keywords="Pakistan",
keywords="vaccination",
keywords="misinformation",
keywords="infodemiology",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. Objective: We aimed to explore the effects of COVID-19--related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. Methods: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. Results: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media--driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. Conclusions: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale. ",
doi="10.2196/49366",
url="https://infodemiology.jmir.org/2024/1/e49366"
}


@Article{info:doi/10.2196/60021,
author="Gu, Jie
and Xu, Yiyuan
and Yuan, Jiao
and Chen, Yuxiang
and Luo, Jingxia
and Guo, Cui
and Zhang, Guanbin",
title="Investigation of Mother-to-Child Transmission of Hepatitis B in Yinchuan, China: Cross-Sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="4",
volume="10",
pages="e60021",
keywords="hepatitis B virus",
keywords="mother-to-child transmission",
keywords="antiviral therapy",
keywords="immunization failure",
keywords="cord blood",
abstract="Background: Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally. Objective: This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan. Methods: From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood. Results: The prevalence of HBV among pregnant women was 2.5\% (947/37,557), with a declining trend every year ($\chi${\texttwosuperior}4=19.7; P=.001). From 2018 to 2020, only 33.0\% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [$\lambda$] reached a minimum value of --5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95\% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95\% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95\% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95\% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased. Conclusions: The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT. ",
doi="10.2196/60021",
url="https://publichealth.jmir.org/2024/1/e60021",
url="http://www.ncbi.nlm.nih.gov/pubmed/39230944"
}


@Article{info:doi/10.2196/51054,
author="Shea, Lindsay
and Cooper, Dylan
and Ventimiglia, Jonas
and Frisbie, Shelby
and Carlton, Conner
and Song, Wei
and Salzer, Mark
and Lee, Brian
and Hotez, Emily
and Vanness, J. David",
title="Self-Reported COVID-19 Vaccine and Booster Acceptance and Hesitancy Among Autistic Adults in Pennsylvania: Cross-Sectional Analysis of Survey Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="28",
volume="10",
pages="e51054",
keywords="autism",
keywords="COVID-19",
keywords="vaccination",
keywords="public health",
keywords="autism spectrum disorder",
keywords="autistic",
keywords="vaccine",
keywords="vaccines",
keywords="acceptance",
keywords="hesitancy",
keywords="immunize",
keywords="immunization",
keywords="immunizations",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="neurodevelopmental",
keywords="infectious",
keywords="respiratory",
keywords="survey",
keywords="surveys",
abstract="Background: The autistic population is rapidly increasing; meanwhile, autistic adults face disproportionate risks for adverse COVID-19 outcomes. Limited research indicates that autistic individuals have been accepting of initial vaccination, but research has yet to document this population's perceptions and acceptance of COVID-19 boosters. Objective: This study aims to identify person-level and community characteristics associated with COVID-19 vaccination and booster acceptance among autistic adults, along with self-reported reasons for their stated preferences. Understanding this information is crucial in supporting this vulnerable population given evolving booster guidelines and the ending of the public health emergency for the COVID-19 pandemic. Methods: Data are from a survey conducted in Pennsylvania from April 11 to September 12, 2022. Demographic characteristics, COVID-19 experiences, and COVID-19 vaccine decisions were compared across vaccination status groups. Chi-square analyses and 1-way ANOVA were conducted to test for significant differences. Vaccination reasons were ranked by frequency; co-occurrence was identified using phi coefficient correlation plots. Results: Most autistic adults (193/266, 72.6\%) intended to receive or received the vaccine and booster, 15\% (40/266) did not receive or intend to receive any vaccine, and 12.4\% (33/266) received or intended to receive the initial dose but were hesitant to accept booster doses. Reasons for vaccine acceptance or hesitancy varied by demographic factors and COVID-19 experiences. The most significant were previously contracting COVID-19, desire to access information about COVID-19, and discomfort with others not wearing a mask (all P=.001). County-level factors, including population density (P=.02) and percentage of the county that voted for President Biden (P=.001) were also significantly associated with differing vaccination acceptance levels. Reasons for accepting the initial COVID-19 vaccine differed among those who were or were not hesitant to accept a booster. Those who accepted a booster were more likely to endorse protecting others and trusting the vaccine as the basis for their acceptance, whereas those who were hesitant about the booster indicated that their initial vaccine acceptance came from encouragement from someone they trusted. Among the minority of those hesitant to any vaccination, believing that the vaccine was unsafe and would make them feel unwell were the most often reported reasons. Conclusions: Intention to receive or receiving the COVID-19 vaccination and booster was higher among autistic adults than the population that received vaccines in Pennsylvania. Autistic individuals who accepted vaccines prioritized protecting others, while autistic individuals who were vaccine hesitant had safety concerns about vaccines. These findings inform public health opportunities and strategies to further increase vaccination and booster rates among generally accepting autistic adults, to better support the already strained autism services and support system landscape. Vaccination uptake could be improved by leveraging passive information diffusion to combat vaccination misinformation among those not actively seeking COVID-19 information to better alleviate safety concerns. ",
doi="10.2196/51054",
url="https://publichealth.jmir.org/2024/1/e51054",
url="http://www.ncbi.nlm.nih.gov/pubmed/39196609"
}


@Article{info:doi/10.2196/52884,
author="Maar, Marion
and Bourdon, Caleigh
and Berti, Joahnna
and Bisaillon, Emma
and Boesch, Lisa
and Boston, Alicia
and Chapdelaine, Justin
and Humphrey, Alison
and Kumar, Sandeep
and Maar-Jackson, Benjamin
and Martell, Robert
and Naokwegijig, Bruce
and Preet Kaur, Davinder
and Rice, Sarah
and Rickaby, Barbara
and Sutherland, Mariette
and Reade, Maurianne",
title="Creating a Culturally Safe Online Data Collection Instrument to Measure Vaccine Confidence Among Indigenous Youth: Indigenous Consensus Method",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="12",
volume="8",
pages="e52884",
keywords="ATKC consensus method",
keywords="community-based participatory research",
keywords="COVID-19 vaccines",
keywords="cultural competency",
keywords="electronic survey development",
keywords="Indigenous Peoples",
keywords="vaccine confidence",
keywords="vaccine hesitancy",
keywords="youth",
abstract="Background: ?Participating in surveys can shape the perception of participants related to the study topic. Administering a vaccine hesitancy questionnaire can have negative impacts on participants' vaccine confidence. This is particularly true for online and cross-cultural data collection because culturally safe health education to correct misinformation is typically not provided after the administration of an electronic survey. Objective: ?To create a culturally safe, online, COVID-19 vaccine confidence survey for Indigenous youth designed to collect authentic, culturally relevant data of their vaccine experiences, with a low risk of contributing to further vaccine confusion among participants. Methods: ?Using the Aboriginal Telehealth Knowledge Circle consensus method, a team of academics, health care providers, policy makers, and community partners reviewed COVID-19 vaccine hesitancy surveys used in public health research, analyzed potential risks, and created a framework for electronic Indigenous vaccine confidence surveys as well as survey items. Results: ?The framework for safer online survey items is based on 2 principles, a first do-no-harm approach and applying a strengths-based lens. Relevant survey domains identified in the process include sociodemographic information, participants' connection to their community, preferred sources for health information, vaccination uptake among family members and peers, as well as personal attitudes toward vaccines. A total of 44 survey items were developed, including 5 open-ended items to improve the authenticity of the data and the analysis of the experiences of Indigenous youth. Conclusions: ?Using an Indigenous consensus method, we have developed an online COVID-19 vaccine confidence survey with culturally relevant domains and reduced the risk of amplifying misinformation and negative impacts on vaccine confidence among Indigenous participants. Our approach can be adapted to other online survey development in collaboration with Indigenous communities. ",
doi="10.2196/52884",
url="https://formative.jmir.org/2024/1/e52884"
}


@Article{info:doi/10.2196/51242,
author="Xia, Yiqi
and Wang, Ming
and Hu, Mingzheng
and Wang, Yanshang
and Yuan, Beibei
and Zhu, Dawei
and He, Ping",
title="Preferences and Willingness to Pay for Herpes Zoster Vaccination Among Chinese Adults: Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2024",
month="Aug",
day="9",
volume="10",
pages="e51242",
keywords="herpes zoster",
keywords="vaccine preference",
keywords="willingness to pay",
keywords="discrete choice experiment",
keywords="mixed logit model",
abstract="Background: The incidence of herpes zoster (HZ) is rapidly increasing, causing both clinical and economic burdens in China. Very little is known about Chinese residents' HZ vaccine preferences and willingness to pay (WTP) for each vaccination attribute. Objective: This study aims to elicit the preferences of Chinese urban adults (aged 25 years or older) regarding HZ vaccination programs and to calculate WTP for each vaccination attribute. Methods: In this study, we interviewed 2864 residents in 9 cities in China. A discrete choice experiment was conducted to investigate the residents' preferences for HZ vaccination and to predict the uptake rate for different vaccine scenarios. A mixed logit model was used to estimate the preferences and WTP for each attribute. Seven attributes with different levels were included in the experiment, and we divided the coefficients of other attributes by the coefficient of price to measure WTP. Results: Vaccine effectiveness, protection duration, risk of side effects, place of origin, and cost were proven to influence Chinese adults' preferences for HZ vaccination. The effectiveness of the HZ vaccine was the attribute that had the most predominant impact on residents' preferences, followed by protection duration. The residents were willing to pay CN {\textyen}974 (US \$145) to increase the vaccine effectiveness from 45\% to 90\%, and they would barely pay to exchange the vaccination schedule from 2 doses to 1 dose. It is suggested that the expected uptake could be promoted the most (by 20.84\%) with an increase in the protection rate from 45\% to 90\%. Conclusions: Chinese urban adults made trade-offs between vaccine effectiveness, protection duration, place of origin, side effects, and cost of HZ vaccination. Vaccine effectiveness was the most important characteristic. The residents have the highest WTP (CN {\textyen}974; US \$145) for enhancing the effectiveness of vaccines. To maximize HZ vaccine uptake, health authorities should promote vaccine effectiveness. ",
doi="10.2196/51242",
url="https://publichealth.jmir.org/2024/1/e51242"
}


@Article{info:doi/10.2196/51120,
author="Markovic, Andjela
and Kovacevic, Vladimir
and Brakenhoff, B. Timo
and Veen, Duco
and Klaver, Paul
and Mitratza, Marianna
and Downward, S. George
and Grobbee, E. Diederick
and Cronin, Maureen
and Goodale, M. Brianna
and ",
title="Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e51120",
keywords="wearable technology",
keywords="biosignals",
keywords="digital health",
keywords="SARS-CoV-2",
keywords="vaccine reactogenicity",
keywords="menstrual cycle",
keywords="vaccine",
keywords="wearables",
keywords="sex",
keywords="development",
keywords="implementation",
keywords="medical device",
keywords="breathing rate",
keywords="heart rate",
keywords="biological mechanism",
keywords="immune response",
keywords="vaccination",
abstract="Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine. Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases. Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination. Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8\% decrease in the duration of the menstrual phase following vaccination. Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05241-5 ",
doi="10.2196/51120",
url="https://www.jmir.org/2024/1/e51120"
}


@Article{info:doi/10.2196/47520,
author="Basu, Saurav
and Desai, Meghana
and Karan, Anup
and Bhardwaj, Surbhi
and Negandhi, Himanshu
and Jadhav, Nitin
and Maske, Amar
and Zodpey, Sanjay",
title="COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="29",
volume="10",
pages="e47520",
keywords="COVID-19",
keywords="community intervention",
keywords="COVID-19 vaccination",
keywords="COVID-appropriate behavior",
keywords="impact evaluation",
keywords="rural health",
keywords="community-based intervention",
keywords="rural population",
keywords="awareness",
keywords="disease prevention",
keywords="health literacy",
keywords="public health",
keywords="pandemic",
keywords="digital health",
keywords="community awareness",
keywords="effectiveness",
keywords="low- and middle-income countries",
keywords="vaccination",
keywords="infodemic",
abstract="Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs. Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community--based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India. Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods. Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95\% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23\% (95\% CI 3\%-45\%) and masking was 17\% (0\%-38\%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22\% (95\% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95\% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95\% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95\% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19--related stigma or discrimination in Pune was 68\% (95\% CI 0.133-0.191) lower than that in Satara. Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings. ",
doi="10.2196/47520",
url="https://publichealth.jmir.org/2024/1/e47520",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073851"
}


@Article{info:doi/10.2196/56546,
author="Huang, Yiting
and Feng, Shuaixin
and Zhao, Yuyan
and Wang, Haode
and Jiang, Hongbo",
title="Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="29",
volume="10",
pages="e56546",
keywords="systematic review",
keywords="discrete choice experiment",
keywords="preference",
keywords="COVID-19",
keywords="vaccine",
abstract="Background: Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. Objective: We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. Methods: A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. Results: The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40\%) and safety (7/53, 13\%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10\%), a higher proportion of low- and middle-income countries (4/24, 17\%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8\%) during the pandemic wave and COVID-19 mortality risk (5/25, 20\%) after the pandemic wave emerged as 2 of the most important attributes. Conclusions: Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. Trial Registration: PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7 ",
doi="10.2196/56546",
url="https://publichealth.jmir.org/2024/1/e56546",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073875"
}


@Article{info:doi/10.2196/55422,
author="Moffett, W. Kenneth
and Marshall, C. Michael
and Kim, C. Jae-Eun
and Dahlen, Heather
and Denison, Benjamin
and Kranzler, C. Elissa
and Meaney, Morgan
and Hoffman, Blake
and Pavisic, Ivica
and Hoffman, Leah",
title="Analyzing Google COVID-19 Vaccine Intent Search Trends and Vaccine Readiness in the United States: Panel Data Study",
journal="Online J Public Health Inform",
year="2024",
month="Jul",
day="29",
volume="16",
pages="e55422",
keywords="information-seeking behavior",
keywords="COVID-19",
keywords="internet use",
keywords="vaccination",
keywords="vaccine hesitancy",
abstract="Background: Factors such as anxiety, worry, and perceptions of insufficient knowledge about a topic motivate individuals to seek web-based health information to guide their health-related decision-making. These factors converged during the COVID-19 pandemic and were linked to COVID-19 vaccination decision-making. While research shows that web-based search relevant to COVID-19 was associated with subsequent vaccine uptake, less is known about COVID-19 vaccine intent search (which assesses vaccine availability, accessibility, and eligibility) as a signal of vaccine readiness. Objective: To increase knowledge about vaccine intent search as a signal of vaccine readiness, we investigated the relationship between COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume on Google. Methods: We compiled panel data from several data sources in all US counties between January 2021 and April 2023, a time during which those with primary COVID-19 vaccinations increased from <57,000 to >230 million adults. We estimated a random effects generalized least squares regression model with time-fixed effects to assess the relationship between county-level COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume. We controlled for health care capacity, per capita COVID-19 cases and vaccination doses administered, and sociodemographic indicators. Results: The county-level proportions of unvaccinated adults who reported that they would wait and see before getting a COVID-19 vaccine were positively associated with COVID-19 vaccine intent relative search volume ($\beta$=9.123; Z=3.59; P<.001). The county-level proportions of vaccine-enthusiast adults, adults who indicated they were either already vaccinated with a primary COVID-19 vaccine series or planned to complete the vaccine series soon, were negatively associated with COVID-19 vaccine intent relative search volume ($\beta$=--10.232; Z=--7.94; P<.001). However, vaccine intent search was higher in counties with high proportions of people who decided to wait and see and lower in counties with high proportions of vaccine enthusiasts. Conclusions: During this period of steep increase in COVID-19 vaccination, web-based search may have signaled differences in county-level COVID-19 vaccine readiness. More vaccine intent searches occurred in high wait-and-see counties, whereas fewer vaccine intent searches occurred in high vaccine-enthusiast counties. Considering previous research that identified a relationship between vaccine intent search and subsequent vaccine uptake, these findings suggest that vaccine intent search aligned with people's transition from the wait-and-see stage to the vaccine-enthusiast stage. The findings also suggest that web-based search trends may signal localized changes in information seeking and decision-making antecedent to vaccine uptake. Changes in web-based search trends illuminate opportunities for governments and other organizations to strategically allocate resources to increase vaccine uptake. Resource use is part of the larger public policy decisions that influence vaccine uptake, such as efforts to educate the public during evolving public health crises, including future pandemics. ",
doi="10.2196/55422",
url="https://ojphi.jmir.org/2024/1/e55422",
url="http://www.ncbi.nlm.nih.gov/pubmed/39073868"
}


@Article{info:doi/10.2196/52926,
author="Fallucca, Alessandra
and Priano, Walter
and Carubia, Alessandro
and Ferro, Patrizia
and Pisciotta, Vincenzo
and Casuccio, Alessandra
and Restivo, Vincenzo",
title="Effectiveness of Catch-Up Vaccination Interventions Versus Standard or Usual Care Procedures in Increasing Adherence to Recommended Vaccinations Among Different Age Groups: Systematic Review and Meta-Analysis of Randomized Controlled Trials and Before-After Studies",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="23",
volume="10",
pages="e52926",
keywords="vaccine strategies",
keywords="catch-up interventions",
keywords="recall intervention",
keywords="vaccination coverage",
keywords="multicomponent",
keywords="education",
keywords="remind",
keywords="reward",
keywords="vaccination",
keywords="vaccine",
keywords="adherence",
keywords="systematic review",
keywords="meta-analysis",
keywords="immunization",
keywords="health care based",
keywords="multidimensional intervention",
keywords="education based",
keywords="vaccine literacy",
keywords="PRISMA",
abstract="Background: To address the global challenge of vaccine hesitancy, the Strategic Advisory Group of Experts on Immunization strongly promotes vaccination reminder and recall interventions. Coupled with the new opportunities presented by scientific advancements, these measures are crucial for successfully immunizing target population groups. Objective: This systematic review and meta-analysis aims to assess the effectiveness of various interventions in increasing vaccination coverage compared with standard or usual care. The review will cover all vaccinations recommended for different age groups. Methods: In February 2022, 2 databases were consulted, retrieving 1850 studies. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 79 manuscripts were included after the assessment phase. These comprised 46 trials/randomized controlled trials (RCTs) and 33 before-after studies. A meta-analysis using a random-effects model was performed with STATA software (version 14.1.2). The selected outcome was the risk ratio (RR) of vaccination coverage improvement effectiveness. Additionally, meta-regression analyses were conducted for the included manuscripts. Results: The analyses showed an overall efficacy of RR 1.22 (95\% CI 1.19-1.26) for RCTs and RR 1.70 (95\% CI 1.54-1.87) for before-after studies when considering all interventions cumulatively. Subgroup analyses identified multicomponent interventions (RR 1.58, 95\% CI 1.36-1.85) and recall clinical interventions (RR 1.24, 95\% CI 1.17-1.32) as the most effective in increasing vaccination coverage for RCTs. By contrast, educational interventions (RR 2.13, 95\% CI 1.60-2.83) and multicomponent interventions (RR 1.61, 95\% CI 1.43-1.82) achieved the highest increases for before-after studies. Meta-regression analyses indicated that the middle-aged adult population was associated with a higher increase in vaccination coverage (RCT: coefficient 0.54, 95\% CI 0.12-0.95; before-after: coefficient 1.27, 95\% CI 0.70-1.84). Conclusions: Community, family, and health care--based multidimensional interventions, as well as education-based catch-up strategies, effectively improve vaccination coverage. Therefore, their systematic implementation is highly relevant for targeting undervaccinated population groups. This approach aligns with national vaccination schedules and aims to eliminate or eradicate vaccine-preventable diseases. ",
doi="10.2196/52926",
url="https://publichealth.jmir.org/2024/1/e52926"
}


@Article{info:doi/10.2196/51007,
author="Li, Yiming
and Li, Jianfu
and Dang, Yifang
and Chen, Yong
and Tao, Cui",
title="Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="15",
volume="10",
pages="e51007",
keywords="COVID-19",
keywords="vaccine",
keywords="COVID-19 vaccine",
keywords="adverse drug event",
keywords="ADE",
keywords="Vaccine Adverse Event Reporting System",
keywords="VAERS",
keywords="adverse event following immunization",
keywords="AEFI",
abstract="Background: The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. Objective: This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. Methods: We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Results: Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68\%), pyrexia (n=122,120, 13.56\%), and fatigue (n=121,910, 13.54\%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32\%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. Conclusions: This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns. ",
doi="10.2196/51007",
url="https://publichealth.jmir.org/2024/1/e51007",
url="http://www.ncbi.nlm.nih.gov/pubmed/39008362"
}


@Article{info:doi/10.2196/49812,
author="Du, Zhanwei
and Liu, Caifen
and Bai, Yuan
and Wang, Lin
and Lim, Wen Wey
and Lau, Y. Eric H.
and Cowling, J. Benjamin",
title="Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="12",
volume="10",
pages="e49812",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="dose fractionation",
keywords="neutralizing antibody level",
keywords="vaccination",
keywords="review",
keywords="vaccine",
abstract="Background: With the emergence of SARS-CoV-2 variants that have eluded immunity from vaccines and prior infections, vaccine shortages and vaccine effectiveness pose unprecedented challenges for governments in expanding booster vaccination programs. The fractionation of vaccine doses might be an effective strategy for helping society to face these challenges, as fractional doses may have efficacies comparable with those of the standard doses. Objective: This study aims to investigate the relationship between vaccine immunogenicity and protection and to project efficacies of fractional doses of vaccines for COVID-19 by using neutralizing antibody levels. Methods: In this study, we analyzed the relationship between in vitro neutralization levels and the observed efficacies against both asymptomatic infection and symptomatic infection, using data from 13 studies of 10 COVID-19 vaccines and from convalescent cohorts. We further projected efficacies for fractional doses, using neutralization as an intermediate variable, based on immunogenicity data from 51 studies included in our systematic review. Results: In comparisons with the convalescent level, vaccine efficacy against asymptomatic infection and symptomatic infection increased from 8.8\% (95\% CI 1.4\%-16.1\%) to 71.8\% (95\% CI 63\%-80.7\%) and from 33.6\% (95\% CI 23.6\%-43.6\%) to 98.6\% (95\% CI 97.6\%-99.7\%), respectively, as the mean neutralization level increased from 0.1 to 10 folds of the convalescent level. Additionally, mRNA vaccines provided the strongest protection, which decreased slowly for fractional dosing with dosages between 50\% and 100\% of the standard dose. We also observed that although vaccine efficacy increased with the mean neutralization level, the rate of this increase was slower for vaccine efficacy against asymptomatic infection than for vaccine efficacy against symptomatic infection. Conclusions: Our results are consistent with studies on immune protection from SARS-CoV-2 infection. Based on our study, we expect that fractional-dose vaccination could provide partial immunity against SARS-CoV-2 and its variants. Our findings provide a theoretical basis for the efficacy of fractional-dose vaccines, serving as reference evidence for implementing fractional dosing vaccine policies in areas facing vaccine shortages and thereby mitigating disease burden. Fractional-dose vaccination could be a viable vaccination strategy comparable to full-dose vaccination and deserves further exploration. ",
doi="10.2196/49812",
url="https://publichealth.jmir.org/2024/1/e49812"
}


@Article{info:doi/10.2196/57118,
author="Dionne, Maude
and Sauvageau, Chantal
and Etienne, Doriane
and Kiely, Marilou
and Witteman, Holly
and Dub{\'e}, Eve",
title="Development of Promising Interventions to Improve Human Papillomavirus Vaccination in a School-Based Program in Quebec, Canada: Results From a Formative Evaluation Using a Mixed Methods Design",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="8",
volume="8",
pages="e57118",
keywords="immunization",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="school-based immunization program",
keywords="intervention",
keywords="strategies",
keywords="vaccination",
keywords="vaccine",
keywords="Quebec",
keywords="school-based",
keywords="vaccine coverage",
keywords="decision aid",
keywords="student",
keywords="students",
keywords="nurse",
keywords="nurses",
keywords="parent",
keywords="parents",
keywords="focus group",
keywords="descriptive analyses",
keywords="user-centered",
keywords="effectiveness",
keywords="data collection",
keywords="vaccine safety",
abstract="Background: Despite the availability of school-based human papillomavirus (HPV) vaccination programs, disparities in vaccine coverage persist. Barriers to HPV vaccine acceptance and uptake include parental attitudes, knowledge, beliefs, and system-level barriers. A total of 3 interventions were developed to address these barriers: an in-person presentation by school nurses, an email reminder with a web-based information and decision aid tool, and a telephone reminder using motivational interviewing (MI) techniques. Objective: Here we report on the development and formative evaluation of interventions to improve HPV vaccine acceptance and uptake among grade 4 students' parents in Quebec, Canada. Methods: In the summer of 2019, we conducted a formative evaluation of the interventions to assess the interventions' relevance, content, and format and to identify any unmet needs. We conducted 3 focus group discussions with parents of grade 3 students and nurses. Interviews were recorded, transcribed, and analyzed for thematic content using NVivo software (Lumivero). Nurses received training on MI techniques and we evaluated the effect on nurses' knowledge and skills using a pre-post questionnaire. Descriptive quantitative analyses were carried out on data from questionnaires relating to the training. Comparisons were made using the proportions of the results. Finally, we developed a patient decision aid using an iterative, user-centered design process. The iterative refinement process involved feedback from parents, nurses, and experts to ensure the tool's relevance and effectiveness. The evaluation protocol and data collection tools were approved by the CHU (Centre Hospitalier Universitaire) de Qu{\'e}bec Research Ethics Committee (MP-20-2019-4655, May 16, 2019). Results: The data collection was conducted from April 2019 to March 2021. Following feedback (n=28) from the 3 focus group discussions in June 2019, several changes were made to the in-person presentation intervention. Experts (n=27) and school nurses (n=29) recruited for the project appreciated the visual and simplified information on vaccination in it. The results of the MI training for school nurses conducted in August 2019 demonstrated an increase in the skills and knowledge of nurses (n=29). School nurses who took the web-based course (n=24) filled out a pretest and posttest questionnaire to evaluate their learning. The rating increased by 19\% between the pretest and posttest questionnaires. Several changes were made between the first draft of the web-based decision-aid tool and the final version during the summer of 2019 after an expert consultation of experts (n=3), focus group participants (n=28), and parents in the iterative process (n=5). More information about HPV and vaccines was added, and users could click if more detail is desired. Conclusions: We developed and pilot-tested 3 interventions using an iterative process. The interventions were perceived as potentially effective to increase parents' knowledge and positive attitudes toward HPV vaccination, and ultimately, vaccine acceptance. Future research will assess the effectiveness of these interventions on a larger scale. ",
doi="10.2196/57118",
url="https://formative.jmir.org/2024/1/e57118",
url="http://www.ncbi.nlm.nih.gov/pubmed/38976317"
}


@Article{info:doi/10.2196/57164,
author="Huang, Liang-Chin
and Eiden, L. Amanda
and He, Long
and Annan, Augustine
and Wang, Siwei
and Wang, Jingqi
and Manion, J. Frank
and Wang, Xiaoyan
and Du, Jingcheng
and Yao, Lixia",
title="Natural Language Processing--Powered Real-Time Monitoring Solution for Vaccine Sentiments and Hesitancy on Social Media: System Development and Validation",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="21",
volume="12",
pages="e57164",
keywords="vaccine sentiment",
keywords="vaccine hesitancy",
keywords="natural language processing",
keywords="NLP",
keywords="social media",
keywords="social media platforms",
keywords="real-time tracking",
keywords="vaccine",
keywords="vaccines",
keywords="sentiment",
keywords="sentiments",
keywords="vaccination",
keywords="vaccinations",
keywords="hesitancy",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="machine learning",
keywords="uptake",
keywords="willing",
keywords="willingness",
keywords="classification",
abstract="Background: Vaccines serve as a crucial public health tool, although vaccine hesitancy continues to pose a significant threat to full vaccine uptake and, consequently, community health. Understanding and tracking vaccine hesitancy is essential for effective public health interventions; however, traditional survey methods present various limitations. Objective: This study aimed to create a real-time, natural language processing (NLP)--based tool to assess vaccine sentiment and hesitancy across 3 prominent social media platforms. Methods: We mined and curated discussions in English from Twitter (subsequently rebranded as X), Reddit, and YouTube social media platforms posted between January 1, 2011, and October 31, 2021, concerning human papillomavirus; measles, mumps, and rubella; and unspecified vaccines. We tested multiple NLP algorithms to classify vaccine sentiment into positive, neutral, or negative and to classify vaccine hesitancy using the World Health Organization's (WHO) 3Cs (confidence, complacency, and convenience) hesitancy model, conceptualizing an online dashboard to illustrate and contextualize trends. Results: We compiled over 86 million discussions. Our top-performing NLP models displayed accuracies ranging from 0.51 to 0.78 for sentiment classification and from 0.69 to 0.91 for hesitancy classification. Explorative analysis on our platform highlighted variations in online activity about vaccine sentiment and hesitancy, suggesting unique patterns for different vaccines. Conclusions: Our innovative system performs real-time analysis of sentiment and hesitancy on 3 vaccine topics across major social networks, providing crucial trend insights to assist campaigns aimed at enhancing vaccine uptake and public health. ",
doi="10.2196/57164",
url="https://medinform.jmir.org/2024/1/e57164",
url="http://www.ncbi.nlm.nih.gov/pubmed/38904984"
}


@Article{info:doi/10.2196/56064,
author="Wang, Qiang
and Yang, Liuqing
and Xiu, Shixin
and Shen, Yuan
and Jin, Hui
and Lin, Leesa",
title="A Prediction Model for Identifying Seasonal Influenza Vaccination Uptake Among Children in Wuxi, China: Prospective Observational Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="17",
volume="10",
pages="e56064",
keywords="influenza",
keywords="vaccination",
keywords="children",
keywords="prediction model",
keywords="China",
keywords="vaccine",
keywords="behaviors",
keywords="health care professional",
keywords="intervention",
keywords="sociodemographics",
keywords="vaccine hesitancy",
keywords="clinic",
keywords="Bayesian network",
keywords="logistic regression",
keywords="accuracy",
keywords="Cohen $\kappa$",
keywords="prediction",
keywords="public health",
keywords="immunization",
keywords="digital age",
abstract="Background: Predicting vaccination behaviors accurately could provide insights for health care professionals to develop targeted interventions. Objective: The aim of this study was to develop predictive models for influenza vaccination behavior among children in China. Methods: We obtained data from a prospective observational study in Wuxi, eastern China. The predicted outcome was individual-level vaccine uptake and covariates included sociodemographics of the child and parent, parental vaccine hesitancy, perceptions of convenience to the clinic, satisfaction with clinic services, and willingness to vaccinate. Bayesian networks, logistic regression, least absolute shrinkage and selection operator (LASSO) regression, support vector machine (SVM), naive Bayes (NB), random forest (RF), and decision tree classifiers were used to construct prediction models. Various performance metrics, including area under the receiver operating characteristic curve (AUC), were used to evaluate the predictive performance of the different models. Receiver operating characteristic curves and calibration plots were used to assess model performance. Results: A total of 2383 participants were included in the study; 83.2\% of these children (n=1982) were <5 years old and 6.6\% (n=158) had previously received an influenza vaccine. More than half (1356/2383, 56.9\%) the parents indicated a willingness to vaccinate their child against influenza. Among the 2383 children, 26.3\% (n=627) received influenza vaccination during the 2020-2021 season. Within the training set, the RF model showed the best performance across all metrics. In the validation set, the logistic regression model and NB model had the highest AUC values; the SVM model had the highest precision; the NB model had the highest recall; and the logistic regression model had the highest accuracy, F1 score, and Cohen $\kappa$ value. The LASSO and logistic regression models were well-calibrated. Conclusions: The developed prediction model can be used to quantify the uptake of seasonal influenza vaccination for children in China. The stepwise logistic regression model may be better suited for prediction purposes. ",
doi="10.2196/56064",
url="https://publichealth.jmir.org/2024/1/e56064",
url="http://www.ncbi.nlm.nih.gov/pubmed/38885032"
}


@Article{info:doi/10.2196/47070,
author="Lang, Anna-Lena
and Hohmuth, Nils
and Vi{\vs}kovi{\'c}, Vuka{\vs}in
and Konigorski, Stefan
and Scholz, Stefan
and Balzer, Felix
and Remschmidt, Cornelius
and Leistner, Rasmus",
title="COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application--Based Prospective Observational Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="4",
volume="26",
pages="e47070",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="COVID-19 vaccines",
keywords="BNT162b2",
keywords="vaccine effectiveness",
keywords="participatory disease surveillance",
keywords="web application",
keywords="digital public health",
keywords="vaccination",
keywords="Germany",
keywords="effectiveness",
keywords="data collection",
keywords="disease surveillance",
keywords="tool",
abstract="Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ?16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2\% (95\% CI 70.4\%-97.4\%) at week 4 to 37.2\% (95\% CI 23.5\%-48.5\%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6\% (95\% CI 50.3\%-78.8\%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. ",
doi="10.2196/47070",
url="https://www.jmir.org/2024/1/e47070",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833299"
}


@Article{info:doi/10.2196/53071,
author="Uwera, Thaoussi
and Venkateswaran, Mahima
and Bhutada, Kiran
and Papadopoulou, Eleni
and Rukundo, Enock
and K Tumusiime, David
and Fr{\o}en, Frederik J.",
title="Electronic Immunization Registry in Rwanda: Qualitative Study of Health Worker Experiences",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="28",
volume="11",
pages="e53071",
keywords="childhood immunization",
keywords="electronic immunization registry",
keywords="digital health interventions",
abstract="Background: Monitoring childhood immunization programs is essential for health systems. Despite the introduction of an electronic immunization registry called e-Tracker in Rwanda, challenges such as lacking population denominators persist, leading to implausible reports of coverage rates of more than 100\%. Objective: This study aimed to assess the extent to which the immunization e-Tracker responds to stakeholders' needs and identify key areas for improvement. Methods: In-depth interviews were conducted with all levels of e-Tracker users including immunization nurses, data managers, and supervisors from health facilities in 5 districts of Rwanda. We used an interview guide based on the constructs of the Human, Organization, and Technology--Fit (HOT-Fit) framework, and we analyzed and summarized our findings using the framework. Results: Immunization nurses reported using the e-Tracker as a secondary data entry tool in addition to paper-based forms, which resulted in considerable dissatisfaction among nurses. While users acknowledged the potential of a digital tool compared to paper-based systems, they also reported the need for improvement of functionalities to support their work, such as digital client appointment lists, lists of defaulters, search and register functions, automated monthly reports, and linkages to birth notifications and the national identity system. Conclusions: Reducing dual documentation for users can improve e-Tracker use and user satisfaction. Our findings can help identify additional digital health interventions to support and strengthen the health information system for the immunization program. ",
doi="10.2196/53071",
url="https://humanfactors.jmir.org/2024/1/e53071",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805254"
}


@Article{info:doi/10.2196/39297,
author="Hoang, Uy
and Delanerolle, Gayathri
and Fan, Xuejuan
and Aspden, Carole
and Byford, Rachel
and Ashraf, Mansoor
and Haag, Mendel
and Elson, William
and Leston, Meredith
and Anand, Sneha
and Ferreira, Filipa
and Joy, Mark
and Hobbs, Richard
and de Lusignan, Simon",
title="A Profile of Influenza Vaccine Coverage for 2019-2020: Database Study of the English Primary Care Sentinel Cohort",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="24",
volume="10",
pages="e39297",
keywords="medical records systems",
keywords="computerize",
keywords="influenza",
keywords="influenza vaccines",
keywords="sentinel surveillance",
keywords="vocabulary controlled",
keywords="general practitioners",
keywords="general practice",
keywords="primary health care",
keywords="vaccine",
keywords="public health",
keywords="surveillance",
keywords="uptake",
abstract="Background: Innovation in seasonal influenza vaccine development has resulted in a wider range of formulations becoming available. Understanding vaccine coverage across populations including the timing of administration is important when evaluating vaccine benefits and risks. Objective: This study aims to report the representativeness, uptake of influenza vaccines, different formulations of influenza vaccines, and timing of administration within the English Primary Care Sentinel Cohort (PCSC). Methods: We used the PCSC of the Oxford-Royal College of General Practitioners Research and Surveillance Centre. We included patients of all ages registered with PCSC member general practices, reporting influenza vaccine coverage between September 1, 2019, and January 29, 2020. We identified influenza vaccination recipients and characterized them by age, clinical risk groups, and vaccine type. We reported the date of influenza vaccination within the PCSC by International Standard Organization (ISO) week. The representativeness of the PCSC population was compared with population data provided by the Office for National Statistics. PCSC influenza vaccine coverage was compared with published UK Health Security Agency's national data. We used paired t tests to compare populations, reported with 95\% CI. Results: The PCSC comprised 7,010,627 people from 693 general practices. The study population included a greater proportion of people aged 18-49 years (2,982,390/7,010,627, 42.5\%; 95\% CI 42.5\%-42.6\%) compared with the Office for National Statistics 2019 midyear population estimates (23,219,730/56,286,961, 41.3\%; 95\% CI 4.12\%-41.3\%; P<.001). People who are more deprived were underrepresented and those in the least deprived quintile were overrepresented. Within the study population, 24.7\% (1,731,062/7,010,627; 95\% CI 24.7\%-24.7\%) of people of all ages received an influenza vaccine compared with 24.2\% (14,468,665/59,764,928; 95\% CI 24.2\%-24.2\%; P<.001) in national data. The highest coverage was in people aged ?65 years (913,695/1,264,700, 72.3\%; 95\% CI 72.2\%-72.3\%). The proportion of people in risk groups who received an influenza vaccine was also higher; for example, 69.8\% (284,280/407,228; 95\% CI 69.7\%-70\%) of people with diabetes in the PCSC received an influenza vaccine compared with 61.2\% (983,727/1,607,996; 95\% CI 61.1\%-61.3\%; P<.001) in national data. In the PCSC, vaccine type and brand information were available for 71.8\% (358,365/498,923; 95\% CI 71.7\%-72\%) of people aged 16-64 years and 81.9\% (748,312/913,695; 95\% CI 81.8\%-82\%) of people aged ?65 years, compared with 23.6\% (696,880/2,900,000) and 17.8\% (1,385,888/7,700,000), respectively, of the same age groups in national data. Vaccination commenced during ISO week 35, continued until ISO week 3, and peaked during ISO week 41. The in-week peak in vaccination administration was on Saturdays. Conclusions: The PCSC's sociodemographic profile was similar to the national population and captured more data about risk groups, vaccine brands, and batches. This may reflect higher data quality. Its capabilities included reporting precise dates of administration. The PCSC is suitable for undertaking studies of influenza vaccine coverage. ",
doi="10.2196/39297",
url="https://publichealth.jmir.org/2024/1/e39297",
url="http://www.ncbi.nlm.nih.gov/pubmed/38787605"
}


@Article{info:doi/10.2196/49695,
author="Xie, Jie Yao
and Liao, Xiaoli
and Lin, Meijuan
and Yang, Lin
and Cheung, Kin
and Zhang, Qingpeng
and Li, Yan
and Hao, Chun
and Wang, HX Harry
and Gao, Yang
and Zhang, Dexing
and Molassiotis, Alex
and Siu, Hang Gilman Kit
and Leung, Man Angela Yee",
title="Community Engagement in Vaccination Promotion: Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="10",
volume="10",
pages="e49695",
keywords="community engagement",
keywords="community-based participatory research",
keywords="vaccination rate",
keywords="health promotion",
keywords="vaccine.",
abstract="Background: Community engagement plays a vital role in global immunization strategies, offering the potential to overcome vaccination hesitancy and enhance vaccination confidence. Although there is significant backing for community engagement in health promotion, the evidence supporting its effectiveness in vaccination promotion is fragmented and of uncertain quality. Objective: This review aims to systematically examine the effectiveness of different contents and extent of community engagement for promoting vaccination rates. Methods: This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive and exhaustive literature search was performed in 4 English databases (PubMed, Embase, Web of Science, and Cochrane Library) and 2 Chinese databases (CNKI and Wan Fang) to identify all possible articles. Original research articles applying an experimental study design that investigated the effectiveness of community engagement in vaccination promotion were eligible for inclusion. Two reviewers independently performed the literature search, study selection, quality assessment, and data extraction. Discrepancies were resolved through discussion, with the arbitration of a third reviewer where necessary. Results: A total of 20 articles out of 11,404 records from 2006 to 2021 were retrieved. The studies used various designs: 12 applied single-group pre-post study designs, 5 were cluster randomized controlled trials (RCTs), and 3 were non-RCTs. These studies targeted multiple vaccines, with 8 focusing on children's immunization, 8 on human papillomavirus vaccine, 3 on hepatitis B virus vaccine, and 1 on COVID-19 vaccine. The meta-analysis revealed significant increases in vaccination rates both in pre-post comparison (rate difference [RD] 0.34, 95\% CI 0.21-0.47, I2=99.9\%, P<.001) and between-group comparison (RD 0.18, 95\% CI 0.07-0.29, I2=98.4\%, P<.001). The meta-analysis revealed that participant recruitment had the largest effect size (RD 0.51, 95\% CI 0.36-0.67, I2=99.9\%, P<.001), followed by intervention development (RD 0.36, 95\% CI 0.23-0.50, I2=100.0\%, P<.001), intervention implementation (RD 0.35, 95\% CI 0.22-0.47, I2=99.8\%, P<.001), and data collection (RD 0.34, 95\% CI 0.19-0.50, I2=99.8\%, P<.001). The meta-analysis indicated that high community engagement extent yielded the largest effect size (RD 0.49, 95\% CI 0.17-0.82, I2=100.0\%, P<.001), followed by moderate community engagement extent (RD 0.45, 95\% CI 0.33-0.58, I2=99.6\%, P<.001) and low community engagement extent (RD 0.15, 95\% CI 0.05-0.25, I2=99.2\%, P<.001). The meta-analysis revealed that ``health service support'' demonstrated the largest effect sizes (RD 0.45, 95\% CI 0.25-0.65, I2=99.9\%, P<.001), followed by ``health education and discussion'' (RD 0.39, 95\% CI 0.20-0.58, I2=99.7\%, P<.001), ``follow-up and reminder'' (RD 0.33, 95\% CI 0.23-0.42, I2=99.3\%, P<.001), and ``social marketing campaigns and community mobilization'' (RD 0.24, 95\% CI 0.06-0.41, I2=99.9\%, P<.001). Conclusions: The results of this meta-analysis supported the effectiveness of community engagement in vaccination promotion with variations in terms of engagement contents and extent. Community engagement required a ``fit-for-purpose'' approach rather than a ``one-size-fits-all'' approach to maximize the effectiveness of vaccine promotion. Trial Registration: PROSPERO CRD42022339081; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=339081 ",
doi="10.2196/49695",
url="https://publichealth.jmir.org/2024/1/e49695",
url="http://www.ncbi.nlm.nih.gov/pubmed/38478914"
}


@Article{info:doi/10.2196/50551,
author="Jessiman-Perreault, Genevi{\`e}ve
and Boucher, Jean-Christophe
and Kim, Youn So
and Frenette, Nicole
and Badami, Abbas
and Smith, M. Henry
and Allen Scott, K. Lisa",
title="The Role of Scientific Research in Human Papillomavirus Vaccine Discussions on Twitter: Social Network Analysis",
journal="JMIR Infodemiology",
year="2024",
month="May",
day="9",
volume="4",
pages="e50551",
keywords="human papillomavirus",
keywords="HPV",
keywords="vaccine",
keywords="immunization",
keywords="social media",
keywords="misinformation",
keywords="social network analysis",
abstract="Background: Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy. Objective: In this study, we aimed to better understand the type and quality of scientific research shared on Twitter (recently rebranded as X) by vaccine-hesitant and vaccine-confident communities. Methods: To analyze the use of scientific research on social media, we collected tweets and retweets using a list of keywords associated with HPV and HPV vaccines using the Academic Research Product Track application programming interface from January 2019 to May 2021. From this data set, we identified tweets referring to or sharing scientific literature through a Boolean search for any tweets with embedded links, hashtags, or keywords associated with scientific papers. First, we used social network analysis to build a retweet or reply network to identify the clusters of users belonging to either the vaccine-confident or vaccine-hesitant communities. Second, we thematically assessed all shared papers based on typology of evidence. Finally, we compared the quality of research evidence and bibliometrics between the shared papers in the vaccine-confident and vaccine-hesitant communities. Results: We extracted 250 unique scientific papers (including peer-reviewed papers, preprints, and gray literature) from approximately 1 million English-language tweets. Social network maps were generated for the vaccine-confident and vaccine-hesitant communities sharing scientific research on Twitter. Vaccine-hesitant communities share fewer scientific papers; yet, these are more broadly disseminated despite being published in less prestigious journals compared to those shared by the vaccine-confident community. Conclusions: Vaccine-hesitant communities have adopted communication tools traditionally wielded by health promotion communities. Vaccine-confident communities would benefit from a more cohesive communication strategy to communicate their messages more widely and effectively. ",
doi="10.2196/50551",
url="https://infodemiology.jmir.org/2024/1/e50551",
url="http://www.ncbi.nlm.nih.gov/pubmed/38722678"
}


@Article{info:doi/10.2196/45837,
author="Khoury, Georges
and Ward, K. Jeremy
and Mancini, Julien
and Gagneux-Brunon, Amandine
and Luong Nguyen, Binh Liem",
title="Health Literacy and Health Care System Confidence as Determinants of Attitudes to Vaccines in France: Representative Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="7",
volume="10",
pages="e45837",
keywords="vaccine hesitancy",
keywords="health literacy",
keywords="trust",
keywords="attitude toward vaccines",
keywords="public health",
keywords="vaccination",
keywords="COVID-19",
keywords="adult",
keywords="sociodemographic factor",
abstract="Background: Health literacy involves individuals' knowledge, personal skills, and confidence to take action to evaluate and appraise health-related information and improve their health or that of their community. Objective: This study aimed to analyze the association between health literacy and attitude toward vaccines, adjusted with other factors. Methods: We used the SLAVACO Wave 3, a survey conducted in December 2021 among a sample of 2022 individuals, representative of the French adult population. We investigated factors associated with the attitude toward vaccines using respondents' different sociodemographic data, health literacy levels, and the health care system confidence levels using a multinomial logistic regression analysis. Results: Among the participants, 440.4 (21.8\%) were classified as ``distrustful of vaccines in general,'' 729.2 (36.1\%) were ``selectively hesitant,'' and 852.4 (42.2\%) were ``nonhesitant.'' In our model, the level of health literacy was not statistically different between the ``distrustful of vaccines in general'' and the ``selectively hesitant'' (P=.48), but it was associated with being a ``nonhesitant'' (adjusted odds ratio [aOR] 1.86, 95\% CI 1.25-2.76). The confidence in the health care system was a strong predictor for a ``nonhesitant'' attitude toward vaccines (aOR 12.4, 95\% CI 7.97-19.2). We found a positive correlation of 0.34 (P<.001) between health literacy and confidence in the health care system, but the interaction term between health literacy and health care system confidence was not significant in our model. Conclusions: Health literacy was associated with a ``nonhesitant'' attitude toward vaccines. The findings demonstrated that health literacy and confidence in the health care system are modestly correlated. Therefore, to tackle the subject of vaccine hesitancy, the main focus should be on increasing the population's confidence and on increasing their health literacy levels or providing vaccine information addressing the needs of less literate citizens. ",
doi="10.2196/45837",
url="https://publichealth.jmir.org/2024/1/e45837",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713494"
}


@Article{info:doi/10.2196/54769,
author="Rahbeni, Al Tahani
and Satapathy, Prakasini
and Itumalla, Ramaiah
and Marzo, Rillera Roy
and Mugheed, L. Khalid A.
and Khatib, Nazli Mahalaqua
and Gaidhane, Shilpa
and Zahiruddin, Syed Quazi
and Rabaan, A. Ali
and Alrasheed, A. Hayam
and Al-Subaie, F. Maha
and Al Kaabil, A. Nawal
and Alissa, Mohammed
and Ibrahim, L. Amani Ahmed A.
and Alsaif, Abdulkhaliq Hussain
and Naser, Habeeb Israa
and Rustagi, Sarvesh
and Kukreti, Neelima
and Dziedzic, Arkadiusz",
title="COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="30",
volume="10",
pages="e54769",
keywords="COVID-19",
keywords="vaccine acceptance",
keywords="vaccine hesitancy",
keywords="umbrella review",
keywords="systematic review",
keywords="meta-analysis",
keywords="vaccine",
keywords="hesitancy",
keywords="global perceptions",
keywords="perception",
keywords="random effect model",
keywords="synthesis",
keywords="healthcare workers",
keywords="patients",
keywords="patient",
keywords="chronic disease",
keywords="pregnant women",
keywords="parents",
keywords="child",
keywords="children",
abstract="Background: The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization. Objective: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions. Methods: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative. Results: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63\% (95\% CI 0.60\%-0.67\%) in the general population, with significant heterogeneity (I2 = 97.59\%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64\% (95\% CI 0.57\%-0.71\%) and 69\% (95\% CI 0.61\%-0.76\%), respectively. However, lower acceptance was noted among pregnant women, at 48\% (95\% CI 0.42\%-0.53\%), and parents consenting for their children, at 61.29\% (95\% CI 0.56\%-0.67\%). The pooled vaccine hesitancy rate was 32\% (95\% CI 0.25\%-0.39\%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses. Conclusions: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies. Trial Registration: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr ",
doi="10.2196/54769",
url="https://publichealth.jmir.org/2024/1/e54769",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687992"
}


@Article{info:doi/10.2196/38761,
author="Chadwick, L. Verity
and Saich, Freya
and Freeman, Joseph
and Martiniuk, Alexandra",
title="Media Discourse Regarding COVID-19 Vaccinations for Children Aged 5 to 11 Years in Australia, Canada, the United Kingdom, and the United States: Comparative Analysis Using the Narrative Policy Framework",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="29",
volume="8",
pages="e38761",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="mRNA",
keywords="Pfizer-BioNTech",
keywords="pediatric",
keywords="children",
keywords="media",
keywords="news",
keywords="web-based",
keywords="infodemic",
keywords="disinformation",
abstract="Background: Media narratives can shape public opinion and actions, influencing the uptake of pediatric COVID-19 vaccines. The COVID-19 pandemic has occurred at a time where infodemics, misinformation, and disinformation are present, impacting the COVID-19 response. Objective: This study aims to investigate how narratives about pediatric COVID-19 vaccines in the media of 4 English-speaking countries: the United States, Australia, Canada, and the United Kingdom. Methods: The Narrative Policy Framework was used to guide the comparative analyses of the major print and web-based news agencies' media regarding COVID-19 vaccines for children aged 5 to 11 years. Data were sought using systematic searching on Factiva (Dow Jones) of 4 key phases of pediatric vaccine approval and rollout. Results: A total of 400 articles (n=287, 71.8\% in the United States, n=40, 10\% in Australia, n=60, 15\% in Canada, and n=13, 3\% in the United Kingdom) met the search criteria and were included. Using the Narrative Policy Framework, the following were identified in each article: hero, villain, survivor, and plot. The United States was the earliest country to vaccinate children, and other countries' media often lauded the United States for this. Australian and Canadian media narratives about vaccines for children aged 5 to 11 years were commonly about protecting susceptible people in society, whereas the US and the UK narratives focused more on the vaccine helping children return to school. All 4 countries focused on the vaccines for children aged 5 to 11 years as being key to ``ending'' the pandemic. Australian and Canadian narratives frequently compared vaccine rollouts across states or provinces and bemoaned local progress in vaccine delivery compared with other countries globally. Canadian and US narratives highlighted the ``infodemic'' about the COVID-19 pandemic and disinformation regarding child vaccines as impeding uptake. All 4 countries---the United States, Australia, the United Kingdom, and Canada---used war imagery in reporting about COVID-19 vaccines for children. The advent of the Omicron variant demonstrated that populations were fatigued by the COVID-19 pandemic, and the media reporting increasingly blamed the unvaccinated. The UK media narrative was unique in describing vaccinating children as a distraction from adult COVID-19 vaccination efforts. The United States and Canada had narratives expressing anger about potential vaccine passports for children. In Australia, general practitioners were labelled as heroes. Finally, the Canadian narrative suggested altruistic forgoing of COVID-19 vaccine ``boosters'' as well as pediatric COVID-19 vaccines to benefit those in poorer nations. Conclusions: Public health emergencies require clear; compelling and accurate communication. The stories told during this pandemic are compelling because they contain the classic elements of a narrative; however, they can be reductive and inaccurate. ",
doi="10.2196/38761",
url="https://formative.jmir.org/2024/1/e38761",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383344"
}


@Article{info:doi/10.2196/50958,
author="Liao, Qiuyan
and Yuan, Jiehu
and Wong, Ling Irene Oi
and Ni, Yuxuan Michael
and Cowling, John Benjamin
and Lam, Tak Wendy Wing",
title="Motivators and Demotivators for COVID-19 Vaccination Based on Co-Occurrence Networks of Verbal Reasons for Vaccination Acceptance and Resistance: Repetitive Cross-Sectional Surveys and Network Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="22",
volume="10",
pages="e50958",
keywords="COVID-19",
keywords="vaccination acceptance",
keywords="vaccine hesitancy",
keywords="motivators",
keywords="co-occurrence network analysis",
abstract="Background: Vaccine hesitancy is complex and multifaced. People may accept or reject a vaccine due to multiple and interconnected reasons, with some reasons being more salient in influencing vaccine acceptance or resistance and hence the most important intervention targets for addressing vaccine hesitancy. Objective: This study was aimed at assessing the connections and relative importance of motivators and demotivators for COVID-19 vaccination in Hong Kong based on co-occurrence networks of verbal reasons for vaccination acceptance and resistance from repetitive cross-sectional surveys. Methods: We conducted a series of random digit dialing telephone surveys to examine COVID-19 vaccine hesitancy among general Hong Kong adults between March 2021 and July 2022. A total of 5559 and 982 participants provided verbal reasons for accepting and resisting (rejecting or hesitating) a COVID-19 vaccine, respectively. The verbal reasons were initially coded to generate categories of motivators and demotivators for COVID-19 vaccination using a bottom-up approach. Then, all the generated codes were mapped onto the 5C model of vaccine hesitancy. On the basis of the identified reasons, we conducted a co-occurrence network analysis to understand how motivating or demotivating reasons were comentioned to shape people's vaccination decisions. Each reason's eigenvector centrality was calculated to quantify their relative importance in the network. Analyses were also stratified by age group. Results: The co-occurrence network analysis found that the perception of personal risk to the disease (egicentrality=0.80) and the social responsibility to protect others (egicentrality=0.58) were the most important comentioned reasons that motivate COVID-19 vaccination, while lack of vaccine confidence (egicentrality=0.89) and complacency (perceived low disease risk and low importance of vaccination; egicentrality=0.45) were the most important comentioned reasons that demotivate COVID-19 vaccination. For older people aged ?65 years, protecting others was a more important motivator (egicentrality=0.57), while the concern about poor health status was a more important demotivator (egicentrality=0.42); for young people aged 18 to 24 years, recovering life normalcy (egicentrality=0.20) and vaccine mandates (egicentrality=0.26) were the more important motivators, while complacency (egicentrality=0.77) was a more important demotivator for COVID-19 vaccination uptake. Conclusions: When disease risk is perceived to be high, promoting social responsibility to protect others is more important for boosting vaccination acceptance. However, when disease risk is perceived to be low and complacency exists, fostering confidence in vaccines to address vaccine hesitancy becomes more important. Interventions for promoting vaccination acceptance and reducing vaccine hesitancy should be tailored by age. ",
doi="10.2196/50958",
url="https://publichealth.jmir.org/2024/1/e50958",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648099"
}


@Article{info:doi/10.2196/47241,
author="Themistocleous, Sophia
and Argyropoulos, D. Christos
and Vogazianos, Paris
and Shiamakkides, George
and Noula, Evgenia
and Nearchou, Andria
and Yiallouris, Andreas
and Filippou, Charalampos
and Stewart, A. Fiona
and Koniordou, Markela
and Kopsidas, Ioannis
and Askling, H. Helena
and Vene, Sirkka
and Gagneux-Brunon, Amandine
and Prellezo, Baranda Jana
and {\'A}lvarez-Barco, Elena
and Salmanton-Garc{\'i}a, Jon
and Leckler, Janina
and Macken, J. Alan
and Davis, Joanna Ruth
and Azzini, Maria Anna
and Armeftis, Charis
and Hellemans, Margot
and Di Marzo, Romina
and Luis, Catarina
and Olesen, F. Ole
and Valdenmaiier, Olena
and Jakobsen, Finne Stine
and Naucl{\'e}r, Pontus
and Launay, Odile
and Mallon, Patrick
and Ochando, Jordi
and van Damme, Pierre
and Tacconelli, Evelina
and Zaoutis, Theoklis
and Cornely, A. Oliver
and Pana, Dorothea Zoi",
title="Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Apr",
day="4",
volume="10",
pages="e47241",
keywords="patient advocacy groups",
keywords="clinical trials",
keywords="volunteer registry",
keywords="vaccines",
keywords="public health",
keywords="healthcare",
keywords="COVID-19",
keywords="vaccine trial",
keywords="VACCELERATE",
keywords="health promotion",
keywords="health advocate",
keywords="clinical trial",
abstract="Background: The VACCELERATE Pan-European Scientific network aims to strengthen the foundation of vaccine trial research across Europe by following the principles of equity, inclusion, and diversity. The VACCELERATE Volunteer Registry network provides access to vaccine trial sites across the European region and supports a sustainable volunteer platform for identifying potential participants for forthcoming vaccine clinical research. Objective: The aim of this study was to approach members of patient advocacy groups (PAGs) across Europe to assess their willingness to register for the VACCELERATE Volunteer Registry and their perspectives related to participating in vaccine trials. Methods: In an effort to understand how to increase recruitment for the VACCELERATE Volunteer Registry, a standardized survey was developed in English and translated into 8 different languages (Dutch, English, French, German, Greek, Italian, Spanish, and Swedish) by the respective National Coordinator team. The online, anonymous survey was circulated, from March 2022 to May 2022, to PAGs across 10 European countries (Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Spain, and Sweden) to share with their members. The questionnaire constituted of multiple choice and open-ended questions evaluating information regarding participants' perceptions on participating in vaccine trials and their willingness to become involved in the VACCELERATE Volunteer Registry. Results: In total, 520 responses were collected and analyzed. The PAG members reported that the principal criteria influencing their decision to participate in clinical trials overall are (1) the risks involved, (2) the benefits that will be gained from their potential participation, and (3) the quality and quantity of information provided regarding the trial. The survey revealed that, out of the 520 respondents, 133 individuals across all age groups were ``positive'' toward registering in the VACCELERATE Volunteer Registry, with an additional 47 individuals reporting being ``very positive.'' Respondents from Northern European countries were 1.725 (95\% CI 1.206-2.468) times more likely to be willing to participate in the VACCELERATE Volunteer Registry than respondents from Southern European countries. Conclusions: Factors discouraging participants from joining vaccine trial registries or clinical trials primarily include concerns of the safety of novel vaccines and a lack of trust in those involved in vaccine development. These outcomes aid in identifying issues and setbacks in present registries, providing the VACCELERATE network with feedback on how to potentially increase participation and enrollment in trials across Europe. Development of European health communication strategies among diverse public communities, especially via PAGs, is the key for increasing patients' willingness to participate in clinical studies. ",
doi="10.2196/47241",
url="https://publichealth.jmir.org/2024/1/e47241",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573762"
}


@Article{info:doi/10.2196/53375,
author="Zhang, M. Jueman
and Wang, Yi
and Mouton, Magali
and Zhang, Jixuan
and Shi, Molu",
title="Public Discourse, User Reactions, and Conspiracy Theories on the X Platform About HIV Vaccines: Data Mining and Content Analysis",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="3",
volume="26",
pages="e53375",
keywords="HIV",
keywords="vaccine",
keywords="Twitter",
keywords="X platform",
keywords="infodemiology",
keywords="machine learning",
keywords="topic modeling",
keywords="sentiment",
keywords="conspiracy theory",
keywords="COVID-19",
abstract="Background: The initiation of clinical trials for messenger RNA (mRNA) HIV vaccines in early 2022 revived public discussion on HIV vaccines after 3 decades of unsuccessful research. These trials followed the success of mRNA technology in COVID-19 vaccines but unfolded amid intense vaccine debates during the COVID-19 pandemic. It is crucial to gain insights into public discourse and reactions about potential new vaccines, and social media platforms such as X (formerly known as Twitter) provide important channels. Objective: Drawing from infodemiology and infoveillance research, this study investigated the patterns of public discourse and message-level drivers of user reactions on X regarding HIV vaccines by analyzing posts using machine learning algorithms. We examined how users used different post types to contribute to topics and valence and how these topics and valence influenced like and repost counts. In addition, the study identified salient aspects of HIV vaccines related to COVID-19 and prominent anti--HIV vaccine conspiracy theories through manual coding. Methods: We collected 36,424 English-language original posts about HIV vaccines on the X platform from January 1, 2022, to December 31, 2022. We used topic modeling and sentiment analysis to uncover latent topics and valence, which were subsequently analyzed across post types in cross-tabulation analyses and integrated into linear regression models to predict user reactions, specifically likes and reposts. Furthermore, we manually coded the 1000 most engaged posts about HIV and COVID-19 to uncover salient aspects of HIV vaccines related to COVID-19 and the 1000 most engaged negative posts to identify prominent anti--HIV vaccine conspiracy theories. Results: Topic modeling revealed 3 topics: HIV and COVID-19, mRNA HIV vaccine trials, and HIV vaccine and immunity. HIV and COVID-19 underscored the connections between HIV vaccines and COVID-19 vaccines, as evidenced by subtopics about their reciprocal impact on development and various comparisons. The overall valence of the posts was marginally positive. Compared to self-composed posts initiating new conversations, there was a higher proportion of HIV and COVID-19--related and negative posts among quote posts and replies, which contribute to existing conversations. The topic of mRNA HIV vaccine trials, most evident in self-composed posts, increased repost counts. Positive valence increased like and repost counts. Prominent anti--HIV vaccine conspiracy theories often falsely linked HIV vaccines to concurrent COVID-19 and other HIV-related events. Conclusions: The results highlight COVID-19 as a significant context for public discourse and reactions regarding HIV vaccines from both positive and negative perspectives. The success of mRNA COVID-19 vaccines shed a positive light on HIV vaccines. However, COVID-19 also situated HIV vaccines in a negative context, as observed in some anti--HIV vaccine conspiracy theories misleadingly connecting HIV vaccines with COVID-19. These findings have implications for public health communication strategies concerning HIV vaccines. ",
doi="10.2196/53375",
url="https://www.jmir.org/2024/1/e53375",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568723"
}


@Article{info:doi/10.2196/41559,
author="Mishra, Vishala
and Dexter, P. Joseph",
title="Response of Unvaccinated US Adults to Official Information About the Pause in Use of the Johnson \& Johnson--Janssen COVID-19 Vaccine: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="1",
volume="26",
pages="e41559",
keywords="Centers for Disease Control and Prevention",
keywords="CDC",
keywords="COVID-19",
keywords="health communication",
keywords="health information",
keywords="health literacy",
keywords="public health",
keywords="risk perception",
keywords="SARS-CoV-2",
keywords="vaccine hesitancy",
keywords="web-based surveys",
doi="10.2196/41559",
url="https://www.jmir.org/2024/1/e41559",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557597"
}


@Article{info:doi/10.2196/45508,
author="Malkin, Jennifer
and Jessiman-Perreault, Genevi{\`e}ve
and Alberga Machado, Amanda
and Teare, Gary
and Snider, Joanne
and Tirmizi, Farhan Syed
and Youngson, Erik
and Wang, Ting
and Law, Jessica
and Bandara, Thilina
and Rathwell, Mika
and Neudorf, Cordell
and Allen Scott, Lisa",
title="Individual and Geospatial Determinants of Health Associated With School-Based Human Papillomavirus Immunization in Alberta: Population-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="27",
volume="10",
pages="e45508",
keywords="co-design",
keywords="geospatial",
keywords="human papillomavirus",
keywords="immunization",
keywords="population-based",
keywords="vaccine",
abstract="Background: Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden on marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions. Objective: The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. Methods: Health administrative data for male and female individuals born in 2004 in Alberta were used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors were assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t tests. A multidisciplinary team comprising researchers and knowledge users formed a co-design team to design the study protocol and review the study results. Results: The cohort consisted of 45,207 youths. In the adjusted model, the odds of those who did not see their general practitioner (GP) within 3 years before turning 10 years old and not being fully immunized were 1.965 times higher (95\% CI 1.855-2.080) than those who did see their GP. The odds of health system users with health conditions and health system nonusers not being fully immunized were 1.092 (95\% CI 1.006-1.185) and 1.831 (95\% CI 1.678-1.998) times higher, respectively, than health system users without health conditions. The odds of those who lived in areas with the most material and social deprivation not being fully immunized were 1.287 (95\% CI 1.200-1.381) and 1.099 (95\% CI 1.029-1.174) times higher, respectively, than those who lived in areas with the least deprivation. The odds of those who lived in rural areas not being fully immunized were 1.428 times higher (95\% CI 1.359-1.501) than those who lived in urban areas. Significant hot spot clusters of individuals without full HPV immunization exist in rural locations on the northern and eastern regions of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) than cold spots. Conclusions: Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions. ",
doi="10.2196/45508",
url="https://publichealth.jmir.org/2024/1/e45508",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536211"
}


@Article{info:doi/10.2196/51152,
author="Ullah, Nazifa
and Martin, Sam
and Poduval, Shoba",
title="A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="26",
volume="8",
pages="e51152",
keywords="COVID-19",
keywords="ethnic minorities",
keywords="vaccine",
keywords="hesitancy",
keywords="social media",
keywords="discourse",
keywords="minority groups",
abstract="Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a ``snapshot'' of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. ",
doi="10.2196/51152",
url="https://formative.jmir.org/2024/1/e51152",
url="http://www.ncbi.nlm.nih.gov/pubmed/38530334"
}


@Article{info:doi/10.2196/54680,
author="Kanan, Mohammed
and Abdulrahman, Samar
and Alshehri, Abdulaziz
and AlSuhaibani, Renad
and Alotaibi, M. Nawaf
and Alsaleh, Azhar
and Nasser, Bushra
and Baowaydhan, Rana
and Alredaini, Ibrahim
and Khalid, Taif
and Almukhtar, Fatima
and Altoaimi, Nourah
and Alhneshel, Almaha
and Alanazi, Shouq
and Algmaizi, Shahad",
title="Factors Underlying Vaccine Hesitancy and Their Mitigations in Saudi Arabia: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="22",
volume="13",
pages="e54680",
keywords="acceptance",
keywords="campaigns",
keywords="effectiveness",
keywords="factors",
keywords="hesitancy",
keywords="immunization rates",
keywords="immunization",
keywords="intervention",
keywords="literature analysis",
keywords="misinformation",
keywords="mitigations",
keywords="prevention",
keywords="protocol",
keywords="public health",
keywords="review methodology",
keywords="review methods",
keywords="Saudi Arabia",
keywords="search",
keywords="searching",
keywords="syntheses",
keywords="synthesis",
keywords="systematic review",
keywords="systematic",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="vaccine",
abstract="Background: Vaccine hesitancy is a growing concern in Saudi Arabia, impacting even well-educated parents. The decision-making process involves various factors such as accessibility, trustworthy information, and the influence of social networks, reflecting a complex interplay of emotional, cultural, social, spiritual, and political dimensions. Objective: This review seeks to evaluate the prevalence and trends of vaccine hesitancy, identify contributing factors, and explore potential solutions to enhance immunization rates. This review aligns with global concerns, as the World Health Organization has identified vaccine hesitancy as a top global health threat. Methods: Our systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PICOS (Population, Intervention, Comparison, Outcomes, and Study) criteria for comprehensive assessment. We will conduct a thorough search across various databases, encompassing a wide range of vaccines, and pay special attention to vaccination campaigns and refusals. Inclusion criteria involve descriptive, observational, and analytical studies focusing on factors influencing vaccine acceptance or hesitancy. The study will use the Crowe Critical Appraisal Tool for quality assessment and perform a narrative synthesis to summarize findings thematically. Results: This systematic review is expected to unveil the prevalence and trends of vaccine hesitancy in diverse populations in Saudi Arabia, shedding light on cultural, religious, and social factors contributing to hesitancy. It aims to assess the effectiveness of implemented strategies, enable regional and global comparisons, and provide implications for tailored vaccination policies. Additionally, the review may pinpoint research gaps, guiding future investigations to address and mitigate vaccine hesitancy effectively. Conclusions: The findings are expected to have direct policy implications and guide interventions to strengthen vaccination programs and improve public health outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/54680 ",
doi="10.2196/54680",
url="https://www.researchprotocols.org/2024/1/e54680",
url="http://www.ncbi.nlm.nih.gov/pubmed/38517463"
}


@Article{info:doi/10.2196/47165,
author="Luo, Sitong
and Jiao, Kedi
and Zhang, Yuhang
and Xu, Yutong
and Zhou, Jingtao
and Huang, Siwen
and Li, Yan
and Xiao, Yongkang
and Ma, Wei
and He, Lin
and Ren, Xianlong
and Dai, Zhen
and Sun, Jiaruo
and Li, Qingyu
and Cheng, Feng
and Liang, Wannian",
title="Behavioral Intention of Receiving Monkeypox Vaccination and Undergoing Monkeypox Testing and the Associated Factors Among Young Men Who Have Sex With Men in China: Large Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="19",
volume="10",
pages="e47165",
keywords="mpox",
keywords="monkeypox",
keywords="young men who have sex with men",
keywords="vaccination",
keywords="testing",
keywords="China",
keywords="men",
keywords="sex",
keywords="cross-sectional study",
keywords="infection",
keywords="restrictions",
keywords="feasibility",
keywords="barrier",
keywords="distress",
keywords="emotional distress",
keywords="men who have sex with men",
abstract="Background: The worldwide human monkeypox (mpox) outbreak in 2022 mainly affected men who have sex with men (MSM). In China, young men who have sex with men (YMSM) were at a potential high risk of mpox infection due to their sexual activeness and the eased COVID-19 restrictions at the end of 2022. Objective: This study aimed to investigate the behavioral intention of receiving mpox vaccination and undergoing mpox testing in 4 different scenarios and explore their associations with background and behavioral theory--related factors among Chinese YMSM. Methods: An online cross-sectional survey was conducted among YMSM aged 18-29 years from 6 representative provinces of China in September 2022. Participants recruited (recruitment rate=2918/4342, 67.2\%) were asked to self-administer an anonymous questionnaire designed based on prior knowledge about mpox and classic health behavior theories. Data on the participants' background, mpox knowledge and cognition, mpox vaccination and testing cognition, and the behavioral intention of receiving mpox vaccination and undergoing mpox testing were collected. Descriptive analysis and univariate and multivariate linear regressions were performed. Geodetector was used to measure the stratified heterogeneity of behavioral intention. Results: A total of 2493 YMSM with a mean age of 24.6 (SD 2.9) years were included. The prevalence of having a behavioral intention of receiving mpox vaccination ranged from 66.2\% to 88.4\% by scenario, varying in epidemic status and cost. The prevalence of having an mpox testing intention was above 90\% in all scenarios regardless of the presence of symptoms and the cost. The positive factors related to vaccination intention included mpox knowledge (ba=0.060, 95\% CI 0.016-0.103), perceived susceptibility of mpox (ba=0.091, 95\% CI 0.035-0.146), perceived severity of mpox (ba=0.230, 95\% CI 0.164-0.296), emotional distress caused by mpox (ba=0.270, 95\% CI 0.160-0.380), perceived benefits of mpox vaccination (ba=0.455, 95\% CI 0.411-0.498), self-efficacy of mpox vaccination (ba=0.586, 95\% CI 0.504-0.668), and having 1 male sex partner (ba=0.452, 95\% CI 0.098-0.806), while the negative factor was perceived barriers to vaccination (ba=--0.056, 95\% CI --0.090 to --0.022). The positive factors related to testing intention were perceived severity of mpox (ba=0.283, 95\% CI 0.241-0.325), perceived benefits of mpox testing (ba=0.679, 95\% CI 0.636-0.721), self-efficacy of mpox testing (ba=0.195, 95\% CI 0.146-0.245), having 1 male sex partner (ba=0.290, 95\% CI 0.070-0.510), and having in-person gatherings with MSM (ba=0.219, 95\% CI 0.072-0.366), while the negative factor was emotional distress caused by mpox (ba=--0.069, 95\% CI --0.137 to --0.001). Conclusions: Among Chinese YMSM, the intention of undergoing mpox testing is optimal, while the mpox vaccination intention has room for improvement. A future national response should raise YMSM's mpox knowledge, disseminate updated information about mpox and preventive measures, improve preventive service accessibility and privacy, and provide advice on positively coping with the associated emotional distress. ",
doi="10.2196/47165",
url="https://publichealth.jmir.org/2024/1/e47165",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502181"
}


@Article{info:doi/10.2196/51113,
author="Xian, Xuechang
and Neuwirth, J. Rostam
and Chang, Angela",
title="Government-Nongovernmental Organization (NGO) Collaboration in Macao's COVID-19 Vaccine Promotion: Social Media Case Study",
journal="JMIR Infodemiology",
year="2024",
month="Mar",
day="19",
volume="4",
pages="e51113",
keywords="COVID-19",
keywords="government",
keywords="vaccine",
keywords="automated content analysis",
keywords="Granger causality test",
keywords="network agenda setting",
keywords="QAP",
keywords="social media",
abstract="Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao's COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ``Vaccine importance'' and ``COVID-19 risk'' were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ``COVID-19 risk'' and ``vaccine effectiveness,'' while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. ",
doi="10.2196/51113",
url="https://infodemiology.jmir.org/2024/1/e51113",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502184"
}


@Article{info:doi/10.2196/50181,
author="Blazek, Susanne E.
and Bucher, Amy",
title="Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="19",
volume="8",
pages="e50181",
keywords="behavioral barriers",
keywords="benefits",
keywords="COVID-19",
keywords="Marine Corps",
keywords="military",
keywords="vaccine reluctance",
abstract="Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines' self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines' written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good ($\kappa$=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45\%), low estimates of risk (33/235, 14\%), and fear of physical discomfort (29/235, 12\%). Resulting interventions directly targeted Marines' self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. ",
doi="10.2196/50181",
url="https://formative.jmir.org/2024/1/e50181",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502179"
}


@Article{info:doi/10.2196/45070,
author="Dang, Huyen Thi Thanh
and Carnahan, Emily
and Nguyen, Linh
and Mvundura, Mercy
and Dao, Sang
and Duong, Hong Thi
and Nguyen, Trung
and Nguyen, Doan
and Nguyen, Tu
and Werner, Laurie
and Ryman, K. Tove
and Nguyen, Nga",
title="Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="18",
volume="26",
pages="e45070",
keywords="eHealth",
keywords="digital health",
keywords="immunization information system",
keywords="electronic immunization registry",
keywords="immunization",
keywords="data quality",
keywords="data use",
keywords="costing",
abstract="Background: The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits. Objective: This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system. Methods: This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective. Results: NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100\% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8\% (202/580) in Hanoi and 29.4\% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US \$0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS. Conclusions: The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs. ",
doi="10.2196/45070",
url="https://www.jmir.org/2024/1/e45070",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498020"
}


@Article{info:doi/10.2196/53040,
author="Zhan, Siyi
and Lin, Hongbo
and Yang, Yingying
and Chen, Tao
and Mao, Sheng
and Fu, Chuanxi",
title="Investigating Nonspecific Effects of the Live-Attenuated Japanese Encephalitis Vaccine on Lower Respiratory Tract Infections in Children Aged 25-35 Months:  Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="18",
volume="10",
pages="e53040",
keywords="nonspecific effect of vaccines",
keywords="Japanese encephalitis vaccine",
keywords="lower respiratory tract infectious diseases",
keywords="trained immunity",
keywords="Anderson Gill model",
abstract="Background: Live attenuated vaccines may be used to prevent nontargeted diseases such as lower respiratory tract infections (LRTIs) due to their nonspecific effects (NSEs). Objective: We aimed to analyze the NSEs of the Japanese encephalitis vaccine on pediatric LRTIs in children aged 25 months to 35 months. Methods: A retrospective cohort study was conducted by using a population-based electronic health record database in Zhejiang, China. Enrolled participants were children born from January 1, 2017, to December 31, 2017, and who were inoculated with the live-attenuated Japanese encephalitis vaccine (JE-L) or inactivated Japanese encephalitis vaccine (JE-I) as the most recent vaccine at 24 months of age. The study was carried out between January 1, 2019, and December 31, 2019. All inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months were recorded. The Andersen-Gill model was used to assess the NSEs of JE-L against LRTIs in children and compared with those of JE-I as the most recent vaccine. Results: A total of 810 children born in 2017 were enrolled, of whom 585 received JE-L (JE-L cohort) and 225 received JE-I (JE-I cohort) as their last vaccine. The JE-L cohort showed a reduced risk of LRTIs (adjusted hazard ratio [aHR] 0.537, 95\% CI 0.416-0.693), including pneumonia (aHR 0.501, 95\% CI 0.393-0.638) and acute bronchitis (aHR 0.525, 95\% CI 0.396-0.698) at 25 months to 35 months of age. The NSEs provided by JE-L were especially pronounced in female children (aHR 0.305, 95\% CI 0.198-0.469) and children without chronic diseases (aHR 0.553, 95\% CI 0.420-0.729), without siblings (aHR 0.361, 95\% CI 0.255-0.511), with more than 30 inpatient and outpatient hospital visits prior to 24 months of age (aHR 0.163, 95\% CI 0.091-0.290), or with 5 to 10 inpatient and outpatient hospital visits due to infectious diseases prior to 24 months old (aHR 0.058, 95\% CI 0.017-0.202). Conclusions: Compared with JE-I, receiving JE-L as the most recent vaccine was associated with lower risk of inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months. The nature of NSEs induced by JE-L should be considered for policymakers and physicians when recommending JE vaccines to those at high risk of infection from the Japanese encephalitis virus. ",
doi="10.2196/53040",
url="https://publichealth.jmir.org/2024/1/e53040",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498052"
}


@Article{info:doi/10.2196/47979,
author="Vike, L. Nicole
and Bari, Sumra
and Stefanopoulos, Leandros
and Lalvani, Shamal
and Kim, Woo Byoung
and Maglaveras, Nicos
and Block, Martin
and Breiter, C. Hans
and Katsaggelos, K. Aggelos",
title="Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="18",
volume="10",
pages="e47979",
keywords="reward",
keywords="aversion",
keywords="judgment",
keywords="relative preference theory",
keywords="cognitive science",
keywords="behavioral economics",
keywords="machine learning",
keywords="balanced random forest",
keywords="mediation",
keywords="moderation",
keywords="mobile phone",
keywords="smartphone",
abstract="Background: Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake. Objective: This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction. Methods: We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction. Results: Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30\% and 38\% (vs 74.2\% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8\%) and AUROC (79\%) with moderate to high accuracy (70.8\%) and balanced recall (69.6\%) and specificity (74.2\%). It should be noted that, for BRF, the negative predictive value was <50\% despite good specificity. For BRF and random forest, 63\% to 75\% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake. Conclusions: The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization). ",
doi="10.2196/47979",
url="https://publichealth.jmir.org/2024/1/e47979",
url="http://www.ncbi.nlm.nih.gov/pubmed/38315620"
}


@Article{info:doi/10.2196/51331,
author="Gonz{\'a}lez-Salinas, I. Anna
and Andrade, L. Elizabeth
and Abroms, C. Lorien
and G{\'o}mez, Kaitlyn
and Favetto, Carla
and G{\'o}mez, M. Valeria
and Collins, K. Karen",
title="Latino Parents' Reactions to and Engagement With a Facebook Group--Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="14",
volume="8",
pages="e51331",
keywords="COVID-19",
keywords="misinformation",
keywords="social media",
keywords="Latino parents",
keywords="Spanish",
keywords="vaccines",
keywords="digital intervention",
abstract="Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants' reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ?18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants' exposure, reactions, and engagement, we used participants' responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40\%) or 4 to 6 (18/55, 33\%) times per week and viewing 1 to 2 (23/55, 42\%) or 3 to 4 (16/55, 29\%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89\%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93\%) and helpful (50/55, 91\%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82\%) and supportive (19/55, 35\%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53\%), understanding child risk levels (29/55, 53\%), and the science behind COVID-19 (24/55, 44\%). The preferred formats were educational posts that could be read (38/55, 69\%) and videos, including expert (28/55, 51\%) and instructional (26/55, 47\%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29\%) or 3 to 4 (15/55, 27\%) times per week and commenting on posts 1 to 2 (16/55, 29\%) or <1 (20/55, 36\%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine--related health promotion. ",
doi="10.2196/51331",
url="https://formative.jmir.org/2024/1/e51331",
url="http://www.ncbi.nlm.nih.gov/pubmed/38483457"
}


@Article{info:doi/10.2196/48255,
author="Kumwichar, Ponlagrit
and Poonsiri, Chittawan
and Botwright, Siobhan
and Sirichumroonwit, Natchalaikorn
and Loharjun, Bootsakorn
and Thawillarp, Supharerk
and Cheewaruangroj, Nontawit
and Chokchaisiripakdee, Amorn
and Teerawattananon, Yot
and Chongsuvivatwong, Virasakdi",
title="Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="5",
volume="10",
pages="e48255",
keywords="COVID-19",
keywords="heterologous vaccine",
keywords="vaccine",
keywords="vaccine effectiveness",
keywords="durability",
keywords="time",
keywords="waning",
keywords="real-world",
keywords="public health",
keywords="vaccination strategy",
keywords="health outcome",
keywords="vaccines",
keywords="vaccination",
keywords="unvaccinated",
keywords="big data",
keywords="registry",
keywords="registries",
keywords="health outcomes",
keywords="effectiveness",
keywords="SARS-CoV-2",
keywords="cohort",
keywords="database",
keywords="databases",
keywords="vaccinated",
keywords="Cochran-Mantel-Haenszel",
keywords="Mantel-Haenszel",
keywords="regression",
keywords="risk",
keywords="risks",
keywords="association",
keywords="associations",
keywords="odds ratio",
keywords="odds ratios",
abstract="Background: The durability of heterologous COVID-19 vaccine effectiveness (VE) has been primarily studied in high-income countries, while evaluation of heterologous vaccine policies in low- and middle-income countries remains limited. Objective: We aimed to evaluate the duration during which the VE of heterologous COVID-19 vaccine regimens in mitigating serious outcomes, specifically severe COVID-19 and death following hospitalization with COVID-19, remains over 50\%. Methods: We formed a dynamic cohort by linking records of Thai citizens aged ?18 years from citizen vital, COVID-19 vaccine, and COVID-19 cases registry databases between May 2021 and July 2022. Encrypted citizen identification numbers were used to merge the data between the databases. This study focuses on 8 common heterologous vaccine sequences: CoronaVac/ChAdOx1, ChAdOx1/BNT162b2, CoronaVac/CoronaVac/ChAdOx1, CoronaVac/ChAdOx1/ChAdOx1, CoronaVac/ChAdOx1/BNT162b2, BBIBP-CorV/BBIBP-CorV/BNT162b2, ChAdOx1/ChAdOx1/BNT162b2, and ChAdOx1/ChAdOx1/mRNA-1273. Nonimmunized individuals were considered for comparisons. The cohort was stratified according to the vaccination status, age, sex, province location, month of vaccination, and outcome. Data analysis employed logistic regression to determine the VE, accounting for potential confounders and durability over time, with data observed over a follow-up period of 7 months. Results: This study includes 52,580,841 individuals, with approximately 17,907,215 and 17,190,975 receiving 2- and 3-dose common heterologous vaccines (not mutually exclusive), respectively. The 2-dose heterologous vaccinations offered approximately 50\% VE against severe COVID-19 and death following hospitalization with COVID-19 for 2 months; however, the protection significantly declined over time. The 3-dose heterologous vaccinations sustained over 50\% VE against both outcomes for at least 8 months, as determined by logistic regression with durability time-interaction modeling. The vaccine sequence consisting of CoronaVac/CoronaVac/ChAdOx1 demonstrated >80\% VE against both outcomes, with no evidence of VE waning. The final monthly measured VE of CoronaVac/CoronaVac/ChAdOx1 against severe COVID-19 and death following hospitalization at 7 months after the last dose was 82\% (95\% CI 80.3\%-84\%) and 86.3\% (95\% CI 83.6\%-84\%), respectively. Conclusions: In Thailand, within a 7-month observation period, the 2-dose regimens could not maintain a 50\% VE against severe and fatal COVID-19 for over 2 months, but all of the 3-dose regimens did. The CoronaVac/CoronaVac/ChAdOx1 regimen showed the best protective effect against severe and fatal COVID-19. The estimated durability of 50\% VE for at least 8 months across all 3-dose heterologous COVID-19 vaccine regimens supports the adoption of heterologous prime-boost vaccination strategies, with a primary series of inactivated virus vaccine and boosting with either a viral vector or an mRNA vaccine, to prevent similar pandemics in low- and middle-income countries. ",
doi="10.2196/48255",
url="https://publichealth.jmir.org/2024/1/e48255",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441923"
}


@Article{info:doi/10.2196/47257,
author="Hakim, Hina
and Driedger, Michelle S.
and Gagnon, Dominique
and Chevrier, Julien
and Roch, Genevi{\`e}ve
and Dub{\'e}, Eve
and Witteman, O. Holly",
title="Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review",
journal="JMIR Serious Games",
year="2024",
month="Feb",
day="29",
volume="12",
pages="e47257",
keywords="digital gamified tools",
keywords="digital game",
keywords="vaccination",
keywords="gamification",
keywords="vaccine uptake",
keywords="scoping review",
keywords="review method",
keywords="vaccine",
keywords="gamified",
keywords="COVID-19",
keywords="COVID",
keywords="SARS-CoV-2",
keywords="health behaviour",
keywords="health behavior",
keywords="health promotion",
keywords="behavior change",
keywords="behaviour change",
abstract="Background: Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. Objective: In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. Methods: We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. Results: Of 1402 records, we included 28 (2\%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25\%) explained the development of the tool, 16 (57\%) described evaluation, and 2 (7\%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44\%) were web-based tools, 8 (32\%) mobile (native mobile or mobile-enabled web) apps, and 6 (24\%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. Conclusions: Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts. ",
doi="10.2196/47257",
url="https://games.jmir.org/2024/1/e47257",
url="http://www.ncbi.nlm.nih.gov/pubmed/38421688"
}


@Article{info:doi/10.2196/53982,
author="Ming, Bo-Wen
and Li, Li
and Huang, Hao-Neng
and Ma, Jia-Jun
and Shi, Chen
and Xu, Xiao-Han
and Yang, Zhou
and Ou, Chun-Quan",
title="The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis",
journal="JMIR Public Health Surveill",
year="2024",
month="Feb",
day="28",
volume="10",
pages="e53982",
keywords="hepatitis A",
keywords="incidence",
keywords="Expanded Program on Immunization",
keywords="vaccine",
keywords="interrupted time series",
keywords="intervention",
keywords="China",
abstract="Background: The high prevalence of hepatitis A delivered a blow to public health decades ago. The World Health Organization (WHO) set a goal to eliminate viral hepatitis including hepatitis A by 2030. In 2008, hepatitis A vaccines were integrated into the Expanded Program on Immunization (EPI) in China to alleviate the burden of hepatitis A, although the effectiveness of the EPI has not been well investigated. Objective: We aimed to evaluate the intervention effect at both provincial and national levels on the incidence of hepatitis A in the Chinese mainland from 2005 to 2019. Methods: Based on the monthly reported number of hepatitis A cases from 2005 to 2019 in each provincial-level administrative division, we adopted generalized additive models with an interrupted time-series design to estimate province-specific effects of the EPI on the incidence of hepatitis A among the target population (children aged 2-9 years) from 2005 to 2019. We then pooled province-specific effect estimates using random-effects meta-analyses. We also assessed the effect among the nontarget population and the whole population. Results: A total of 98,275 hepatitis A cases among children aged 2-9 years were reported in the Chinese mainland from 2005 to 2019, with an average annual incidence of 5.33 cases per 100,000 persons. Nationally, the EPI decreased the hepatitis A incidence by 80.77\% (excess risk [ER] --80.77\%, 95\% CI --85.86\% to --72.92\%) during the study period, guarding an annual average of 28.52 (95\% empirical CI [eCI] 27.37-29.00) cases per 100,000 persons among the target children against hepatitis A. Western China saw a more significant effect of the EPI on the decrease in the incidence of hepatitis A among the target children. A greater number of target children were protected from onset in Northwest and Southwest China, with an excess incidence rate of --129.72 (95\% eCI --135.67 to --117.86) and --66.61 (95\% eCI --67.63 to --64.22) cases per 100,000 persons on average, respectively. Intervention effects among nontarget (ER --32.88\%, 95\% CI --39.76\% to --25.21\%) and whole populations (ER --31.97\%, 95\% CI --39.61\% to --23.37\%) were relatively small. Conclusions: The EPI has presented a lasting positive effect on the containment of hepatitis A in the target population in China. The EPI's effect on the target children also provided a degree of indirect protection for unvaccinated individuals. The continuous surveillance of hepatitis A and the maintenance of mass vaccination should shore up the accomplishment in the decline of hepatitis A incidence to ultimately achieve the goal set by the WHO. ",
doi="10.2196/53982",
url="https://publichealth.jmir.org/2024/1/e53982",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416563"
}


@Article{info:doi/10.2196/47817,
author="Agha, Sohail
and Nsofor, Ifeanyi
and Bernard, Drew
and Francis, Sarah
and Rao, Nandan",
title="Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings",
journal="Interact J Med Res",
year="2024",
month="Feb",
day="26",
volume="13",
pages="e47817",
keywords="behavioral insights",
keywords="COVID-19",
keywords="Nigeria",
keywords="surveys",
keywords="vaccination",
abstract="Background: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. Objective: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. Methods: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ?18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US \$0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US \$1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents' vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. Results: About 56\% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95\% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95\% CI 1.33-2.93), and respondents' perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95\% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95\% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95\% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. Conclusions: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians' fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies. ",
doi="10.2196/47817",
url="https://www.i-jmr.org/2024/1/e47817",
url="http://www.ncbi.nlm.nih.gov/pubmed/38407956"
}


@Article{info:doi/10.2196/44258,
author="Kopila{\vs}, Vanja
and Nasadiuk, Khrystyna
and Martinelli, Lucia
and Lhotska, Lenka
and Todorovic, Zoran
and Vidmar, Matjaz
and Machado, Helena
and Svalastog, Lydia Anna
and Gajovi{\'c}, Sre{\'c}ko",
title="Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework",
journal="JMIR Hum Factors",
year="2024",
month="Feb",
day="19",
volume="11",
pages="e44258",
keywords="SARS-CoV-2 virus",
keywords="COVID-19 vaccination",
keywords="pandemic",
keywords="hesitancy",
keywords="safety",
keywords="vaccination",
keywords="COVID-19",
keywords="tool",
keywords="implementation",
keywords="vaccine hesitancy",
keywords="effectiveness",
keywords="sociocultural",
keywords="communication",
keywords="disinformation",
abstract="Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors' subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2{\texttimes}2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. ",
doi="10.2196/44258",
url="https://humanfactors.jmir.org/2024/1/e44258",
url="http://www.ncbi.nlm.nih.gov/pubmed/38373020"
}


@Article{info:doi/10.2196/51137,
author="Haji Said, Ahmed
and Winskell, Kate
and Bednarczyk, A. Robert
and Reardon, E. Erin
and Vasudevan, Lavanya",
title="Interactive Narrative--Based Digital Health Interventions for Vaccine Communication: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="9",
volume="13",
pages="e51137",
keywords="narrative",
keywords="storytelling",
keywords="digital health",
keywords="social media",
keywords="interactive",
keywords="vaccine",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="vaccine communication",
abstract="Background: Interactive narrative--based digital health interventions hold promise for effectively addressing the complex determinants of vaccine hesitancy and promoting effective communication across a wide range of settings and vaccine types. Synthesizing evidence related to the implementation and evaluation of these interventions could offer valuable perspectives for shaping future strategies in vaccine communication. Prior systematic and scoping reviews have examined narrative-based vaccine communication interventions but not the inclusion of interactivity in such interventions. Objective: The overall objective of the scoping review is to summarize the evidence on the use of interactive narrative--based digital health interventions for vaccine communication. Specific research questions focus on describing the use of interactive narrative--based digital health interventions (RQ1), describing evaluations of the impact of interactive narrative--based digital health interventions on promoting vaccine uptake (RQ2), and factors associated with their implementation (RQ3). Methods: A detailed search string will be used to search the following databases for records that are relevant to the review questions: PubMed, Embase, Scopus, Web of Science, CINAHL, and PsycINFO. Two reviewers will independently screen the titles and abstracts of identified records against the predefined eligibility criteria. Subsequently, eligible records will undergo comprehensive full-text screening by 2 independent reviewers to assess their relevance to review questions. A data charting tool will be developed and used to extract relevant information from the included articles. The extracted information will be analyzed following the review questions and presented as a narrative summary. Tabular or graphical representations will be used to display review findings, as relevant. Results: Public health informationists were consulted to develop the detailed search strategy. The final search string comprised terms related to narrative communication, digital health, and vaccines. The search string was customized to each proposed publication database and implemented on April 18, 2023. A total of 4474 unique records were identified using the search strategy and imported into the Covidence (Veritas Health Innovation Ltd) review management software for title and abstract screening. Title and abstract screening of identified records are ongoing as of December 29, 2023. Conclusions: To our knowledge, this will be the first scoping review to investigate the features of interactive narrative--based digital health interventions and their role in vaccine communication. The goal of this study is to provide a comprehensive overview of the current research landscape and identify prevailing gaps in knowledge. The findings will provide insights for future research and development of novel applications of interactive narrative--based digital health vaccine communication interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/51137 ",
doi="10.2196/51137",
url="https://www.researchprotocols.org/2024/1/e51137",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335024"
}


@Article{info:doi/10.2196/52523,
author="Vasudevan, Lavanya
and Ostermann, Jan
and Thielman, Nathan
and Baumgartner, Noel Joy
and Solomon, David
and Mosses, Anna
and Hobbie, Amy
and Hair, L. Nicole
and Liang, Chen
and van Zwetselaar, Marco
and Mfinanga, Sayoki
and Ngadaya, Esther",
title="Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study",
journal="JMIR Res Protoc",
year="2024",
month="Jan",
day="12",
volume="13",
pages="e52523",
keywords="childhood vaccinations",
keywords="timeliness",
keywords="vaccine hesitancy",
keywords="digital health",
keywords="community health workers",
keywords="Tanzania",
keywords="low- and middle-income countries",
keywords="SMS",
keywords="reminder",
keywords="conditional incentive",
abstract="Background: Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. Objective: This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. Methods: The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50\% intervention group children and n=600, 50\% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. Results: The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. Conclusions: This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317 International Registered Report Identifier (IRRID): PRR1-10.2196/52523 ",
doi="10.2196/52523",
url="https://www.researchprotocols.org/2024/1/e52523",
url="http://www.ncbi.nlm.nih.gov/pubmed/38214956"
}


@Article{info:doi/10.2196/50276,
author="Hansen, Rita-Kristin
and Baiju, Nikita
and Gabarron, Elia",
title="Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="26",
volume="25",
pages="e50276",
keywords="social media",
keywords="vaccines",
keywords="vaccination",
keywords="randomized controlled trials",
keywords="information sources",
abstract="Background: Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs. Objective: This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children. Methods: The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. Results: This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non--general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12). Conclusions: The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination. ",
doi="10.2196/50276",
url="https://www.jmir.org/2023/1/e50276",
url="http://www.ncbi.nlm.nih.gov/pubmed/38147375"
}


@Article{info:doi/10.2196/46009,
author="Zhang, Shaohua
and Li, Jianbin
and Xu, Ruonan
and Chen, Qianjun
and Sun, Gang
and Lin, Ying
and Cao, Yali
and Chen, Yiding
and Geng, Cuizhi
and Teng, Yuee
and Nie, Jianyun
and Li, Xinzheng
and Xu, Guiying
and Liu, Xinlan
and Jin, Feng
and Fan, Zhimin
and Luo, Ting
and Liu, Hong
and Wang, Fu-sheng
and Jiang, Zefei",
title="Safety of COVID-19 Vaccination in Patients With Breast Cancer: Cross-Sectional Study in China",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="7",
volume="9",
pages="e46009",
keywords="breast cancer",
keywords="COVID-19 vaccines",
keywords="patients reported adverse events",
keywords="healthy population",
keywords="vaccine safety",
abstract="Background: The widespread use of vaccines against the novel coronavirus disease (COVID-19) has become one of the most effective means to establish a population immune barrier. Patients with cancer are vulnerable to COVID-19 infection, adverse events, and high mortality, and should be the focus of epidemic prevention and treatment. However, real-world data on the safety of vaccines for patients with breast cancer are still scarce. Objective: This study aims to compare the safety of COVID-19 vaccines between patients vaccinated before or after being diagnosed with breast cancer. Methods: Patients with breast cancer who sought medical advice from October 2021 to December 2021 were screened. Those who received COVID-19 vaccines were enrolled in this study to analyze the safety of the vaccines. The primary outcome was patient-reported adverse events (AEs). All events after vaccine injection were retrospectively documented from the patients. Results: A total of 15,455 patients with breast cancer from 41 hospitals in 20 provinces in China were screened, and 5766 patients who received COVID-19 vaccines were enrolled. Of those enrolled, 45.1\% (n=2599) of patients received vaccines before breast cancer diagnosis, 41.3\% (n=2379) were vaccinated after diagnosis, and 13.6\% (n=784) did not known the accurate date of vaccination or cancer diagnosis. Among the patients vaccinated after diagnosis, 85.4\% (n=2032) were vaccinated 1 year after cancer diagnosis and 95.4\% (n=2270) were vaccinated during early-stage cancer. Of all 5766 vaccinated patients, 93.9\% (n=5415) received an inactivated vaccine, 3.7\% (n=213) received a recombinant subunit vaccine, and 2.4\% (n=138) received other vaccines, including adenovirus and mRNA vaccines. In the first injection of vaccines, 24.4\% (n=10, 95\% CI 11.2-37.5) of patients who received an adenovirus vaccine reported AEs, compared to only 12.5\% (n=677, 95\% CI 11.6-13.4) of those who received an inactivated vaccine. Patients with metastatic breast cancer reported the highest incidence of AEs (n=18, 16.5\%, 95\% CI 9.5-23.5). Following the second injection, patients who received an inactivated vaccine (n=464, 8.7\%, 95\% CI 8.0-9.5) and those who received a recombinant vaccine (n=25, 8.7\%, 95\% CI 5.5-12.0) reported the same incidence of AEs. No significant differences in patient-reported AEs were found between the healthy population and patients with breast cancer (16.4\% vs 16.9\%, respectively); the most common AEs were local pain (11.1\% vs 9.1\%, respectively), fatigue (5.5\% vs 6.3\%, respectively), and muscle soreness (2.3\% vs 3.6\%, respectively). The type of vaccine and time window of vaccination had little impact on patient-reported AEs. Conclusions: Compared with patients vaccinated before breast cancer diagnosis, there were no significant differences in patient-reported AEs in the patients vaccinated after diagnosis. Thus, it is safe for patients with breast cancer, especially for those in the early stage, to receive COVID-19 vaccines. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055509; https://tinyurl.com/33zzj882 ",
doi="10.2196/46009",
url="https://publichealth.jmir.org/2023/1/e46009",
url="http://www.ncbi.nlm.nih.gov/pubmed/38060302"
}


@Article{info:doi/10.2196/48511,
author="Li, Guanjian
and Zhang, Rongqiu
and Song, Bing
and Wang, Chao
and Shen, Qunshan
and He, Xiaojin
and Cao, Yunxia",
title="Effects of SARS-CoV-2 Vaccines on Sperm Quality: Systematic Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Dec",
day="6",
volume="9",
pages="e48511",
keywords="COVID-19 vaccine",
keywords="SARS-CoV-2",
keywords="reproductive system",
keywords="fertility",
keywords="sperm quality",
abstract="Background: The COVID-19 pandemic, caused by SARS-CoV-2, has triggered a global public health crisis of unprecedented proportions. SARS-CoV-2 vaccination is a highly effective strategy for preventing infections and severe COVID-19 outcomes. Although several studies have concluded that COVID-19 vaccines are unlikely to affect fertility, concerns have arisen regarding adverse events, including the potential impact on fertility; these concerns are plagued by limited and inconsistent evidence. Objective: This review aims to provide a recent assessment of the literature on the impact of COVID-19 vaccines on male sperm quality. The possible impact of COVID-19 vaccines on fertility potential was also examined to draw a clearer picture and to evaluate the effects of COVID-19 on male reproductive health. Methods: PubMed, Scopus, Web of Science, Embase, and Cochrane databases were searched from their inception to October 2023. Eligible studies included articles reporting SARS-CoV-2 vaccination and human semen quality and fertility, as well as the impact of vaccination on assisted reproductive technology treatment outcomes. The quality of cohort studies was assessed using the Newcastle-Ottawa Scale, and the quality of cross-sectional studies was assessed using the quality evaluation criteria recommended by the Agency for Healthcare Research and Quality. The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: The initial literature search yielded 4691 records by searching 5 peer-reviewed databases (PubMed, Scopus, Web of Science, Embase, and Cochrane). Finally, 24 relevant studies were selected for our study. There were evident research inequalities at the regional level, with the United States and Western European countries contributing 38\% (9/24) of the studies, Middle Eastern countries contributing 38\% (9/24), China accounting for 21\% (5/24), and Africa and South America accounting for none. Nonetheless, the overall quality of the included studies was generally good. Our results demonstrated that serious side effects of the COVID-19 vaccine are extremely rare, and men experience few problems with sperm parameters or reproductive potential after vaccination. Conclusions: On the basis of the studies published so far, the COVID-19 vaccine is safe for male reproductive health. Obviously, vaccination is a wise option rather than experience serious adverse symptoms of viral infections. These instances of evidence may help reduce vaccine hesitancy and increase vaccination coverage, particularly among reproductive-age couples. As new controlled trials and prospective cohort studies with larger sample sizes emerge, the possibility of a negative effect of the COVID-19 vaccine on sperm quality must be further clarified. ",
doi="10.2196/48511",
url="https://publichealth.jmir.org/2023/1/e48511",
url="http://www.ncbi.nlm.nih.gov/pubmed/37976132"
}


@Article{info:doi/10.2196/43700,
author="Sigalo, Nekabari
and Frias-Martinez, Vanessa",
title="Using COVID-19 Vaccine Attitudes Found in Tweets to Predict Vaccine Perceptions in Traditional Surveys: Infodemiology Study",
journal="JMIR Infodemiology",
year="2023",
month="Nov",
day="30",
volume="3",
pages="e43700",
keywords="social media",
keywords="Twitter",
keywords="COVID-19",
keywords="vaccine",
keywords="surveys",
keywords="SARS-CoV-2",
keywords="vaccinations",
keywords="hesitancy",
abstract="Background: Traditionally, surveys are conducted to answer questions related to public health but can be costly to execute. However, the information that researchers aim to extract from surveys could potentially be retrieved from social media, which possesses data that are highly accessible and lower in cost to collect. Objective: This study aims to evaluate whether attitudes toward COVID-19 vaccines collected from the Household Pulse Survey (HPS) could be predicted using attitudes extracted from Twitter (subsequently rebranded X). Ultimately, this study aimed to determine whether Twitter can provide us with similar information to that observed in traditional surveys or whether saving money comes at the cost of losing rich data. Methods: COVID-19 vaccine attitudes were extracted from the HPS conducted between January 6 and May 25, 2021. Twitter's streaming application programming interface was used to collect COVID-19 vaccine tweets during the same period. A sentiment and emotion analysis of tweets was conducted to examine attitudes toward the COVID-19 vaccine on Twitter. Generalized linear models and generalized linear mixed models were used to evaluate the ability of COVID-19 vaccine attitudes on Twitter to predict vaccine attitudes in the HPS. Results: The results revealed that vaccine perceptions expressed on Twitter performed well in predicting vaccine perceptions in the survey. Conclusions: These findings suggest that the information researchers aim to extract from surveys could potentially also be retrieved from a more accessible data source, such as Twitter. Leveraging Twitter data alongside traditional surveys can provide a more comprehensive and nuanced understanding of COVID-19 vaccine perceptions, facilitating evidence-based decision-making and tailored public health strategies. ",
doi="10.2196/43700",
url="https://infodemiology.jmir.org/2023/1/e43700",
url="http://www.ncbi.nlm.nih.gov/pubmed/37903294"
}


@Article{info:doi/10.2196/50367,
author="Tin, Jason
and Stevens, Hannah
and Rasul, Ehab Muhammad
and Taylor, D. Laramie",
title="Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="29",
volume="7",
pages="e50367",
keywords="incivility",
keywords="vaccine hesitancy",
keywords="moral foundations",
keywords="COVID-19",
keywords="vaccines",
keywords="morality",
keywords="social media",
keywords="natural language processing",
keywords="machine learning",
abstract="Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, ``vaccinate'' and ``Pfizer'') and mandates (eg, ``forced'' and ``mandating''). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10\% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. ",
doi="10.2196/50367",
url="https://formative.jmir.org/2023/1/e50367",
url="http://www.ncbi.nlm.nih.gov/pubmed/38019581"
}


@Article{info:doi/10.2196/47334,
author="Ou, Lihong
and Chen, Chia-Chen Angela
and Amresh, Ashish",
title="The Effectiveness of mHealth Interventions Targeting Parents and Youth in Human Papillomavirus Vaccination: Systematic Review",
journal="JMIR Pediatr Parent",
year="2023",
month="Nov",
day="21",
volume="6",
pages="e47334",
keywords="human papillomavirus",
keywords="mobile health",
keywords="mHealth",
keywords="parents",
keywords="systematic review",
keywords="vaccination",
keywords="youth",
keywords="mobile phone",
abstract="Background: The prevalence of human papillomavirus (HPV) and its related cancers is a major global concern. In the United States, routine HPV vaccination is recommended for youth aged 11 or 12 years. Despite HPV being the most common sexually transmitted infection and the vaccine's proven efficacy, the vaccination rate among US youth remains below the recommended 80\% completion rate. Mobile health (mHealth) interventions have demonstrated promise in improving health. Examining and synthesizing the current evidence about the impact of mHealth interventions on vaccination coverage in youth and intervention characteristics could guide future mHealth interventions aimed at mitigating the vaccination gap and disease burden. Objective: This study aims to conduct a systematic review to assess the effectiveness of mHealth interventions on parental intent to vaccinate youth against HPV and youth's vaccine uptake. Methods: We searched empirical papers through databases including Google Scholar, PubMed, CINAHL, PsycINFO, and Cochrane Library. The inclusion criteria were the following: (1) published between January 2011 and December 2022; (2) using mHealth aimed to improve HPV vaccination rate; (3) targeted unvaccinated youth or their parents; and (4) measured HPV-related knowledge, vaccination intention, or vaccine uptake. Overall, 3 researchers screened and appraised the quality of the eligible papers using the Melnyk Levels of Evidence and the Cochrane Grading of Recommendations Assessment, Development, and Evaluation methodology. Disagreements in search results and result interpretation were resolved through consensus. Results: Overall, 17 studies that met the inclusion criteria were included in the final review. Most studies were conducted in the United States (14/17, 82\%), used a randomized controlled trial design (12/17, 71\%), and adopted behavior change theories or a culture-centric approach (10/17, 59\%). mHealth interventions included SMS text message reminders, motivational SMS text messages, computer-tailored or tablet-tailored interventions, smartphone?apps, web-based tailored interventions, social media (Facebook) campaigns, digital videos, and digital storytelling interventions. Approximately 88\% (15/17) of the mHealth interventions demonstrated positive effects on knowledge, intention, or behaviors related to HPV vaccination. Overall, 12\% (2/17) reported limited or no intervention impact on vaccine uptake or vaccine series completion. Effective vaccine uptake was commonly seen in interventions based on behavior change theories and those that provided culturally relevant information. Conclusions: This systematic review identified the impact of mHealth interventions among unvaccinated youth and their parents, which showed improvement in HPV-related knowledge, vaccination intention, or vaccine initiation. The interventions that incorporated theories and culture-centric approaches revealed the most promising results. Although these outcomes are encouraging, future studies are needed to investigate factors associated with the success of interventions using SMS text messaging or social media. More studies are also needed for a better understanding of the intervention elements that boost the responses of age-specific and ethnicity-specific populations. ",
doi="10.2196/47334",
url="https://pediatrics.jmir.org/2023/1/e47334",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988155"
}


@Article{info:doi/10.2196/49753,
author="Zhou, Xinyu
and Song, Suhang
and Zhang, Ying
and Hou, Zhiyuan",
title="Deep Learning Analysis of COVID-19 Vaccine Hesitancy and Confidence Expressed on Twitter in 6 High-Income Countries: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="6",
volume="25",
pages="e49753",
keywords="COVID-19 vaccine",
keywords="hesitancy",
keywords="confidence",
keywords="social media",
keywords="machine learning",
abstract="Background: An ongoing monitoring of national and subnational trajectory of COVID-19 vaccine hesitancy could offer support in designing tailored policies on improving vaccine uptake. Objective: We aim to track the temporal and spatial distribution of COVID-19 vaccine hesitancy and confidence expressed on Twitter during the entire pandemic period in major English-speaking countries. Methods: We collected 5,257,385 English-language tweets regarding COVID-19 vaccination between January 1, 2020, and June 30, 2022, in 6 countries---the United States, the United Kingdom, Australia, New Zealand, Canada, and Ireland. Transformer-based deep learning models were developed to classify each tweet as intent to accept or reject COVID-19 vaccination and the belief that COVID-19 vaccine is effective or unsafe. Sociodemographic factors associated with COVID-19 vaccine hesitancy and confidence in the United States were analyzed using bivariate and multivariable linear regressions. Results: The 6 countries experienced similar evolving trends of COVID-19 vaccine hesitancy and confidence. On average, the prevalence of intent to accept COVID-19 vaccination decreased from 71.38\% of 44,944 tweets in March 2020 to 34.85\% of 48,167 tweets in June 2022 with fluctuations. The prevalence of believing COVID-19 vaccines to be unsafe continuously rose by 7.49 times from March 2020 (2.84\% of 44,944 tweets) to June 2022 (21.27\% of 48,167 tweets). COVID-19 vaccine hesitancy and confidence varied by country, vaccine manufacturer, and states within a country. The democrat party and higher vaccine confidence were significantly associated with lower vaccine hesitancy across US states. Conclusions: COVID-19 vaccine hesitancy and confidence evolved and were influenced by the development of vaccines and viruses during the pandemic. Large-scale self-generated discourses on social media and deep learning models provide a cost-efficient approach to monitoring routine vaccine hesitancy. ",
doi="10.2196/49753",
url="https://www.jmir.org/2023/1/e49753",
url="http://www.ncbi.nlm.nih.gov/pubmed/37930788"
}


@Article{info:doi/10.2196/47563,
author="De Gaetano, Alessandro
and Bajardi, Paolo
and Gozzi, Nicol{\`o}
and Perra, Nicola
and Perrotta, Daniela
and Paolotti, Daniela",
title="Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="31",
volume="25",
pages="e47563",
keywords="COVID-19",
keywords="vaccines",
keywords="social behaviors",
keywords="online surveys",
keywords="nonpharmaceutical interventions",
keywords="survey",
keywords="vaccination",
keywords="behavior",
keywords="NPIs",
keywords="prevention",
abstract="Background: During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout. Objective: The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants. Methods: We developed an online survey named ``COVID-19 Prevention and Behavior Survey'' that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants. Results: We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95\% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95\% CI 1.22-2.03). Conclusions: This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine. ",
doi="10.2196/47563",
url="https://www.jmir.org/2023/1/e47563",
url="http://www.ncbi.nlm.nih.gov/pubmed/37906219"
}


@Article{info:doi/10.2196/48641,
author="Chau, Brian
and Taba, Melody
and Dodd, Rachael
and McCaffery, Kirsten
and Bonner, Carissa",
title="Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="18",
volume="12",
pages="e48641",
keywords="twitch",
keywords="social media",
keywords="COVID-19",
keywords="vaccination communication",
keywords="video gaming",
keywords="gaming",
keywords="health promotion",
keywords="streaming",
abstract="Background: Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research. Objective: This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research. Methods: The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology. Results: The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments. Conclusions: This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on. International Registered Report Identifier (IRRID): RR1-10.2196/48641 ",
doi="10.2196/48641",
url="https://www.researchprotocols.org/2023/1/e48641",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851494"
}


@Article{info:doi/10.2196/46951,
author="Chen, Chia-Chen Angela
and Kim, Wonsun Sunny
and Ou, Lihong
and Todd, Michael
and Larkey, Linda",
title="Digital Storytelling Intervention to Promote Human Papillomavirus Vaccination Among At-Risk Asian Immigrant Populations: Pilot Intervention Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="4",
volume="7",
pages="e46951",
keywords="digital storytelling",
keywords="human papillomavirus",
keywords="immigrants",
keywords="Korean",
keywords="Vietnamese",
keywords="vaccination",
abstract="Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) calls for researchers to address this public health concern through HPV vaccination. Despite disparities in HPV-associated cancers in Korean Americans and Vietnamese Americans, their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve HPV vaccination rates. Digital storytelling (a specific form of cultural narrative) shows promise as an effective culture-centric health promotion strategy. Objective: The aim of this quasi-experimental single-group study was to assess the feasibility, acceptability, and preliminary effects of a culturally and linguistically congruent digital storytelling intervention on Korean American and Vietnamese American mothers' attitudes and intention in vaccinating their children against HPV. We also examined if the association between attitudes and intention differed by their child's sex (boy vs girl) and by ethnicity (Korean American vs Vietnamese American). Methods: Participants were recruited via multiple avenues (eg, ethnic minority community organizations, social media, and flyers posted in local Asian supermarkets and nail salons). Web-based, valid, and reliable measures were administered to collect data preintervention and postintervention. Descriptive statistics, paired and independent sample t tests, the chi-square test, and the McNemar test were used to describe the distributions of variables and to examine the differences between subgroups and changes in key variables over time. Logistic regression models were used to examine associations of mothers' HPV- and vaccine-related attitudes with vaccination intention and to explore if the association between attitudes and vaccination intention differed by the target children's sex or ethnicity. Results: In our sample of 50 Korean American mothers (mean age 42.8, SD 4.8 years) and 114 Vietnamese American mothers (mean age 41.5, SD 5.4 years), 36\% (18/50) of Korean American and 51\% (58/114) of Vietnamese American mothers reported that their children received free or reduced-price lunches at school. After the intervention, mothers' attitudes toward HPV and the vaccine (t163=2.49, P=.01) and intention to vaccinate their children improved significantly (X21=18.38, P<.001). The measure of mothers' negative attitudes toward HPV and the vaccine was significantly associated with higher vaccination intention (odds ratio 0.27, 95\% CI 0.14-0.51; P<.001), adjusting for background variables (sociodemographic characteristics) and other HPV-related variables (family cancer history, prior HPV education, and HPV communication with health care providers). Findings did not suggest that a child's sex or ethnicity moderated the association between attitudes and vaccination intention. Conclusions: This remotely delivered intervention using digital stories was feasible and acceptable, and showed preliminary effects on promoting Korean American and Vietnamese American mothers' intention to vaccinate their children against HPV. Future research that uses a randomized controlled trial design with a larger and more diverse sample and includes children's vaccination status will help understand the effect of the intervention. ",
doi="10.2196/46951",
url="https://formative.jmir.org/2023/1/e46951",
url="http://www.ncbi.nlm.nih.gov/pubmed/36877658"
}


@Article{info:doi/10.2196/42758,
author="Passanante, Aly
and Pertwee, Ed
and Lin, Leesa
and Lee, Yoonsup Kristi
and Wu, T. Joseph
and Larson, J. Heidi",
title="Conversational AI and Vaccine Communication: Systematic Review of the Evidence",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="3",
volume="25",
pages="e42758",
keywords="chatbots",
keywords="artificial intelligence",
keywords="conversational AI",
keywords="vaccine communication",
keywords="vaccine hesitancy",
keywords="conversational agent",
keywords="COVID-19",
keywords="vaccine information",
keywords="health information",
abstract="Background: Since the mid-2010s, use of conversational artificial intelligence (AI; chatbots) in health care has expanded significantly, especially in the context of increased burdens on health systems and restrictions on in-person consultations with health care providers during the COVID-19 pandemic. One emerging use for conversational AI is to capture evolving questions and communicate information about vaccines and vaccination. Objective: The objective of this systematic review was to examine documented uses and evidence on the effectiveness of conversational AI for vaccine communication. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Web of Science, PsycINFO, MEDLINE, Scopus, CINAHL Complete, Cochrane Library, Embase, Epistemonikos, Global Health, Global Index Medicus, Academic Search Complete, and the University of London library database were searched for papers on the use of conversational AI for vaccine communication. The inclusion criteria were studies that included (1) documented instances of conversational AI being used for the purpose of vaccine communication and (2) evaluation data on the impact and effectiveness of the intervention. Results: After duplicates were removed, the review identified 496 unique records, which were then screened by title and abstract, of which 38 were identified for full-text review. Seven fit the inclusion criteria and were assessed and summarized in the findings of this review. Overall, vaccine chatbots deployed to date have been relatively simple in their design and have mainly been used to provide factual information to users in response to their questions about vaccines. Additionally, chatbots have been used for vaccination scheduling, appointment reminders, debunking misinformation, and, in some cases, for vaccine counseling and persuasion. Available evidence suggests that chatbots can have a positive effect on vaccine attitudes; however, studies were typically exploratory in nature, and some lacked a control group or had very small sample sizes. Conclusions: The review found evidence of potential benefits from conversational AI for vaccine communication. Factors that may contribute to the effectiveness of vaccine chatbots include their ability to provide credible and personalized information in real time, the familiarity and accessibility of the chatbot platform, and the extent to which interactions with the chatbot feel ``natural'' to users. However, evaluations have focused on the short-term, direct effects of chatbots on their users. The potential longer-term and societal impacts of conversational AI have yet to be analyzed. In addition, existing studies do not adequately address how ethics apply in the field of conversational AI around vaccines. In a context where further digitalization of vaccine communication can be anticipated, additional high-quality research will be required across all these areas. ",
doi="10.2196/42758",
url="https://www.jmir.org/2023/1/e42758",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788057"
}


@Article{info:doi/10.2196/45980,
author="Bacon, Elizabeth
and An, Lawrence
and Yang, Penny
and Hawley, Sarah
and Van Horn, Lee M.
and Resnicow, Ken",
title="Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="27",
volume="7",
pages="e45980",
keywords="COVID-19 vaccination",
keywords="health communication",
keywords="psychological predictors",
keywords="psychology",
keywords="public health",
keywords="conspiracy beliefs",
keywords="vaccine misinformation",
keywords="religious beliefs",
keywords="anti-vaccination beliefs",
keywords="reactance",
keywords="dogmatism",
keywords="political beliefs",
keywords="health care system distrust",
keywords="gender roles",
keywords="gender",
keywords="online survey",
keywords="USA",
keywords="adults",
keywords="death",
keywords="illness",
keywords="virus",
keywords="psychosocial",
abstract="Background: Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30\% of US adults remain unvaccinated against COVID-19. The majority (81\%) of these unvaccinated adults say they will ``definitely not'' be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster. Objective: This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19--specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity. Methods: We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19--specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no. Results: Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19--related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake. Conclusions: The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance. ",
doi="10.2196/45980",
url="https://formative.jmir.org/2023/1/e45980",
url="http://www.ncbi.nlm.nih.gov/pubmed/37756115"
}


@Article{info:doi/10.2196/49061,
author="Ng, Margaret Yee Man
and Hoffmann Pham, Katherine
and Luengo-Oroz, Miguel",
title="Exploring YouTube's Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="15",
volume="25",
pages="e49061",
keywords="algorithmic auditing",
keywords="antivaccine sentiment",
keywords="crowdsourcing",
keywords="recommendation systems",
keywords="watch history",
keywords="YouTube",
abstract="Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube's algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users' experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube's recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube's recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface's RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6\% at all steps in users' recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube's recommendation system acts as a ``rabbit hole'' may be inaccurate and that YouTube may instead be following a ``blockbuster'' strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. ",
doi="10.2196/49061",
url="https://www.jmir.org/2023/1/e49061",
url="http://www.ncbi.nlm.nih.gov/pubmed/37713243"
}


@Article{info:doi/10.2196/44461,
author="L{\"o}sch, Lea
and Zuiderent-Jerak, Teun
and Kunneman, Florian
and Syurina, Elena
and Bongers, Marloes
and Stein, L. Mart
and Chan, Michelle
and Willems, Willemine
and Timen, Aura",
title="Capturing Emerging Experiential Knowledge for Vaccination Guidelines Through Natural Language Processing: Proof-of-Concept Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="14",
volume="25",
pages="e44461",
keywords="guidelines as topic",
keywords="COVID-19",
keywords="public health",
keywords="natural language processing",
keywords="NLP",
keywords="social media",
keywords="stakeholder engagement",
keywords="vaccine",
keywords="vaccination",
keywords="health policy",
keywords="coronavirus",
keywords="SARS-CoV-2",
abstract="Background: Experience-based knowledge and value considerations of health professionals, citizens, and patients are essential to formulate public health and clinical guidelines that are relevant and applicable to medical practice. Conventional methods for incorporating such knowledge into guideline development often involve a limited number of representatives and are considered to be time-consuming. Including experiential knowledge can be crucial during rapid guidance production in response to a pandemic but it is difficult to accomplish. Objective: This proof-of-concept study explored the potential of artificial intelligence (AI)--based methods to capture experiential knowledge and value considerations from existing data channels to make these insights available for public health guideline development. Methods: We developed and examined AI-based methods in relation to the COVID-19 vaccination guideline development in the Netherlands. We analyzed Dutch messages shared between December 2020 and June 2021 on social media and on 2 databases from the Dutch National Institute for Public Health and the Environment (RIVM), where experiences and questions regarding COVID-19 vaccination are reported. First, natural language processing (NLP) filtering techniques and an initial supervised machine learning model were developed to identify this type of knowledge in a large data set. Subsequently, structural topic modeling was performed to discern thematic patterns related to experiences with COVID-19 vaccination. Results: NLP methods proved to be able to identify and analyze experience-based knowledge and value considerations in large data sets. They provide insights into a variety of experiential knowledge that is difficult to obtain otherwise for rapid guideline development. Some topics addressed by citizens, patients, and professionals can serve as direct feedback to recommendations in the guideline. For example, a topic pointed out that although travel was not considered as a reason warranting prioritization for vaccination in the national vaccination campaign, there was a considerable need for vaccines for indispensable travel, such as cross-border informal caregiving, work or study, or accessing specialized care abroad. Another example is the ambiguity regarding the definition of medical risk groups prioritized for vaccination, with many citizens not meeting the formal priority criteria while being equally at risk. Such experiential knowledge may help the early identification of problems with the guideline's application and point to frequently occurring exceptions that might initiate a revision of the guideline text. Conclusions: This proof-of-concept study presents NLP methods as viable tools to access and use experience-based knowledge and value considerations, possibly contributing to robust, equitable, and applicable guidelines. They offer a way for guideline developers to gain insights into health professionals, citizens, and patients' experience-based knowledge, especially when conventional methods are difficult to implement. AI-based methods can thus broaden the evidence and knowledge base available for rapid guideline development and may therefore be considered as an important addition to the toolbox of pandemic preparedness. ",
doi="10.2196/44461",
url="https://www.jmir.org/2023/1/e44461",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610972"
}


@Article{info:doi/10.2196/41364,
author="Lin, Li-Yin
and Lin, Chun-Ji
and Kuan, Chen-I
and Chiou, Hung-Yi",
title="Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="12",
volume="7",
pages="e41364",
keywords="COVID-19",
keywords="vaccine acceptance",
keywords="vaccine hesitancy",
keywords="google trends",
keywords="public health",
keywords="vaccination",
keywords="health promotion",
keywords="thematic analysis",
keywords="infoveillance",
abstract="Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term ``??`` (vaccine), selected ''??'' (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, ``political role'' was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords ``side effects,'' ``vaccine associated deaths,'' and ``vaccine protection'' continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as ``side effects'' prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and ``side effects'' and ``vaccine protection'' during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. ",
doi="10.2196/41364",
url="https://formative.jmir.org/2023/1/e41364",
url="http://www.ncbi.nlm.nih.gov/pubmed/37698904"
}


@Article{info:doi/10.2196/45867,
author="Hirabayashi, Mai
and Shibata, Daisaku
and Shinohara, Emiko
and Kawazoe, Yoshimasa",
title="Influence of Tweets Indicating False Rumors on COVID-19 Vaccination: Case Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="5",
volume="7",
pages="e45867",
keywords="coronavirus",
keywords="correlation",
keywords="COVID-19",
keywords="disinformation",
keywords="false information",
keywords="infodemiology",
keywords="misinformation",
keywords="rumor",
keywords="rumor-indication",
keywords="SARS-CoV-2",
keywords="social media",
keywords="tweet",
keywords="Twitter",
keywords="vaccination",
keywords="vaccine",
abstract="Background: As of December 2022, the outbreak of COVID-19 showed no sign of abating, continuing to impact people's lives, livelihoods, economies, and more. Vaccination is an effective way to achieve mass immunity. However, in places such as Japan, where vaccination is voluntary, there are people who choose not to receive the vaccine, even if an effective vaccine is offered. To promote vaccination, it is necessary to clarify what kind of information on social media can influence attitudes toward vaccines. Objective: False rumors and counterrumors are often posted and spread in large numbers on social media, especially during emergencies. In this paper, we regard tweets that contain questions or point out errors in information as counterrumors. We analyze counterrumors tweets related to the COVID-19 vaccine on Twitter. We aimed to answer the following questions: (1) what kinds of COVID-19 vaccine--related counterrumors were posted on Twitter, and (2) are the posted counterrumors related to social conditions such as vaccination status? Methods: We use the following data sets: (1) counterrumors automatically collected by the ``rumor cloud'' (18,593 tweets); and (2) the number of COVID-19 vaccine inoculators from September 27, 2021, to August 15, 2022, published on the Prime Minister's Office's website. First, we classified the contents contained in counterrumors. Second, we counted the number of COVID-19 vaccine--related counterrumors from data set 1. Then, we examined the cross-correlation coefficients between the numbers of data sets 1 and 2. Through this verification, we examined the correlation coefficients for the following three periods: (1) the same period of data; (2) the case where the occurrence of the suggestion of counterrumors precedes the vaccination (negative time lag); and (3) the case where the vaccination precedes the occurrence of counterrumors (positive time lag). The data period used for the validation was from October 4, 2021, to April 18, 2022. Results: Our classification results showed that most counterrumors about the COVID-19 vaccine were negative. Moreover, the correlation coefficients between the number of counterrumors and vaccine inoculators showed significant and strong positive correlations. The correlation coefficient was over 0.7 at ?8, ?7, and ?1 weeks of lag. Results suggest that the number of vaccine inoculators tended to increase with an increase in the number of counterrumors. Significant correlation coefficients of 0.5 to 0.6 were observed for lags of 1 week or more and 2 weeks or more. This implies that an increase in vaccine inoculators increases the number of counterrumors. These results suggest that the increase in the number of counterrumors may have been a factor in inducing vaccination behavior. Conclusions: Using quantitative data, we were able to reveal how counterrumors influence the vaccination status of the COVID-19 vaccine. We think that our findings would be a foundation for considering countermeasures of vaccination. ",
doi="10.2196/45867",
url="https://formative.jmir.org/2023/1/e45867",
url="http://www.ncbi.nlm.nih.gov/pubmed/37669092"
}


@Article{info:doi/10.2196/42921,
author="Long, D. Millie
and van Deen, K. Welmoed
and Weisbein, Laura
and Khalil, Carine
and Appel, L. Keren
and Zhang, Xian
and Chen, Wenli
and Zubrod, Lori
and Maris, Robbie
and Ghafari, Afsoon
and Dupuy, Taylor
and Ha, Y. Christina
and Spiegel, R. Brennan M.
and Almario, V. Christopher
and Melmed, Y. Gil",
title="Web-Based Video Education to Improve Uptake of Influenza Vaccination and Other Preventive Health Recommendations in Adults With Inflammatory Bowel Disease: Randomized Controlled Trial of Project PREVENT",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="23",
volume="25",
pages="e42921",
keywords="preventative",
keywords="education",
keywords="inflammatory bowel disease (IBD)",
keywords="adults",
keywords="inflammation",
keywords="disease",
keywords="risk",
keywords="infections",
keywords="bone",
keywords="cancer",
keywords="development",
keywords="patient",
keywords="interview",
keywords="intervention",
keywords="prevention",
keywords="vaccination",
keywords="influenza",
abstract="Background: Patients with inflammatory bowel disease (IBD) are at increased risk of infections, bone fractures, and skin cancers. Objective: We developed preventive health videos using a patient-centered approach and tested their impact on preventive health uptake. Methods: Five animated videos explaining preventive health recommendations in IBD were iteratively developed with patient-centered focus groups and interviews. A randomized controlled trial was then conducted in a web-based IBD cohort to test the impact of video- versus text-based educational interventions. The primary outcome was receipt of the influenza vaccine. Secondary outcomes included intention to receive other preventive health services. Results: Five animated videos were developed with patient input. A total of 1056 patients with IBD were then randomized to receive the video (n=511) or text-only (n=545) interventions; 55\% (281/511) of the video group and 57\% (311/545) of the text-only group had received their influenza vaccine in the prior year. Immediately after the intervention, 73\% (502/683) of patients reported their intention to receive the vaccine, with no difference by the type of intervention (75\%, 231/307, for the video group and 72\%, 271/376, for the text-only group). The proportion of patients who actually received the influenza vaccine after the intervention also did not differ by messaging type (P=.07). The strongest predictor of both intention to receive and actual receipt of the influenza vaccine was prior influenza vaccination. Older age was also associated with a higher likelihood of the intention to receive (age 36-75 years relative to 18-35 years; P=.006) and actual receipt (age >75 years relative to 18-35 years; P=.05) of the influenza vaccine. Conclusions: The proportion of patients receiving the influenza vaccine was high in both groups, but there was no difference in receipt of or in the intention to receive preventive health recommendations by type of messaging. Notably, a portion of patients in both groups had intended to be vaccinated but did not ultimately receive the vaccine. Further evaluation of patient-education strategies is warranted to improve preventive health uptake among patients with IBD. Trial Registration: ClinicalTrials.gov NCT05997537; https://clinicaltrials.gov/ct2/show/NCT05997537 ",
doi="10.2196/42921",
url="https://www.jmir.org/2023/1/e42921",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610821"
}


@Article{info:doi/10.2196/47018,
author="Ngah, Emerencia Yayah
and Raoufi, Ghazal
and Amirkhani, Maral
and Esmaeili, Ashkan
and Nikooifard, Rasa
and Ghaemi Mood, Shidrokh
and Rahmanian, Ava
and Boltena, Tadesse Minyahil
and Aga, Eresso
and Neogi, Ujjwal
and Ikomey Mondinde, George
and El-Khatib, Ziad",
title="Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="9",
volume="12",
pages="e47018",
keywords="immunization",
keywords="children",
keywords="Cameroon",
keywords="digital health",
keywords="global health",
keywords="nonrandomized controlled trial",
keywords="child vaccination",
abstract="Background: Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. Objective: We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. Methods: This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. Results: A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Conclusions: Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. International Registered Report Identifier (IRRID): DERR1-10.2196/47018 ",
doi="10.2196/47018",
url="https://www.researchprotocols.org/2023/1/e47018",
url="http://www.ncbi.nlm.nih.gov/pubmed/37556178"
}


@Article{info:doi/10.2196/45069,
author="Zaidi, Zainab
and Ye, Mengbin
and Samon, Fergus
and Jama, Abdisalan
and Gopalakrishnan, Binduja
and Gu, Chenhao
and Karunasekera, Shanika
and Evans, Jamie
and Kashima, Yoshihisa",
title="Topics in Antivax and Provax Discourse: Yearlong Synoptic Study of COVID-19 Vaccine Tweets",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="8",
volume="25",
pages="e45069",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="antivax",
keywords="stance detection",
keywords="topic modeling",
keywords="misinformation",
keywords="disinformation",
abstract="Background: Developing an understanding of the public discourse on COVID-19 vaccination on social media is important not only for addressing the ongoing COVID-19 pandemic but also for future pathogen outbreaks. There are various research efforts in this domain, although, a need still exists for a comprehensive topic-wise analysis of tweets in favor of and against COVID-19 vaccines. Objective: This study characterizes the discussion points in favor of and against COVID-19 vaccines posted on Twitter during the first year of the pandemic. The aim of this study was primarily to contrast the views expressed by both camps, their respective activity patterns, and their correlation with vaccine-related events. A further aim was to gauge the genuineness of the concerns expressed in antivax tweets. Methods: We examined a Twitter data set containing 75 million English tweets discussing the COVID-19 vaccination from March 2020 to March 2021. We trained a stance detection algorithm using natural language processing techniques to classify tweets as antivax or provax and examined the main topics of discourse using topic modeling techniques. Results: Provax tweets (37 million) far outnumbered antivax tweets (10 million) and focused mostly on vaccine development, whereas antivax tweets covered a wide range of topics, including opposition to vaccine mandate and concerns about safety. Although some antivax tweets included genuine concerns, there was a large amount of falsehood. Both stances discussed many of the same topics from opposite viewpoints. Memes and jokes were among the most retweeted messages. Most tweets from both stances (9,007,481/10,566,679, 85.24\% antivax and 24,463,708/37,044,507, 66.03\% provax tweets) came from dual-stance users who posted both provax and antivax tweets during the observation period. Conclusions: This study is a comprehensive account of COVID-19 vaccine discourse in the English language on Twitter from March 2020 to March 2021. The broad range of discussion points covered almost the entire conversation, and their temporal dynamics revealed a significant correlation with COVID-19 vaccine--related events. We did not find any evidence of polarization and prevalence of antivax discourse over Twitter. However, targeted countering of falsehoods is important because only a small fraction of antivax discourse touched on a genuine issue. Future research should examine the role of memes and humor in driving web-based social media activity. ",
doi="10.2196/45069",
url="https://www.jmir.org/2023/1/e45069",
url="http://www.ncbi.nlm.nih.gov/pubmed/37552535"
}


@Article{info:doi/10.2196/43720,
author="Arshanapally, Suraj
and Starr, Tiearra
and Elsberry, Blackmun Lauren
and Rinker, Robin",
title="The Use of Travel as an Appeal to Motivate Millennial Parents on Facebook to Get Vaccinated Against COVID-19: Message Framing Evaluation",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="1",
volume="7",
pages="e43720",
keywords="COVID-19",
keywords="coronavirus",
keywords="vaccination",
keywords="travel",
keywords="parents",
keywords="millennial",
keywords="appeal",
keywords="health communication",
keywords="social media",
keywords="Facebook",
keywords="infectious disease",
keywords="message testing",
keywords="public health",
keywords="messaging",
keywords="parenting",
keywords="program",
abstract="Background: In summer 2021, the Centers for Disease Control and Prevention recommended that people get fully vaccinated against COVID-19 before fall travel to protect themselves and others from getting and spreading COVID-19 and new variants. Only 61\% of parents had reported receiving at least 1 dose of the COVID-19 vaccine, according to a Kaiser Family Foundation study. Millennial parents, ages 25 to 40 years, were a particularly important parent population because they were likely to have children aged 12 years or younger (the age cutoff for COVID-19 vaccine eligibility during this time period) and were still planning to travel. Since Facebook has been identified as a popular platform for millennials and parents, the Centers for Disease Control and Prevention's Travelers' Health Branch determined an evaluation of public health messages was needed to identify which message appeals would resonate best with this population on Facebook. Objective: The objective was to evaluate which travel-based public health message appeals aimed at addressing parental concerns and sentiments about COVID-19 vaccination would resonate most with Millennial parents (25 to 40 years old) using Facebook Ads Manager and social media metrics. Methods: Six travel-based public health message appeals on parental concerns and sentiments around COVID-19 were developed and disseminated to millennial parents using Facebook Ads Manager. The messages ran from October 23, 2021, to November 8, 2021. Primary outcomes included the number of people reached and the number of impressions delivered. Secondary outcomes included engagements, clicks, click-through rate, and audience sentiments. A thematic analysis was conducted to analyze comments. The advertisement budget was evaluated by cost-per-mille and cost-per-click metrics. Results: All messages reached a total of 6,619,882 people and garnered 7,748,375 impressions. The Family (n=3,572,140 people reached, 53.96\%; 4,515,836 impressions, 58.28\%) and Return to normalcy (n=1,639,476 people reached, 24.77\%; 1,754,227 impressions, 22.64\%) message appeals reached the greatest number of people and garnered the most impressions out of all 6 message appeals. The Family message appeal received 3255 engagements (60.46\%), and the Return to normalcy message appeal received 1148 engagements (21.28\%). The Family appeal also received the highest number of positive post reactions (n=82, 28.37\%). Most of the comments portrayed negative opinions about COVID-19 vaccination (n=46, 68.66\%). All 6 message appeals were either on par with or outperformed cost-per-mille benchmarks set by other similar public health campaigns. Conclusions: Health communicators can use travel, specifically the Family and Return to normalcy message appeals, to successfully reach parents in their future COVID-19 vaccination campaigns and potentially inform health communication messaging efforts for other vaccine-preventable infectious disease campaigns. Public health programs can also utilize the lessons learned from this evaluation to communicate important COVID-19 information to their parent populations through travel messaging. ",
doi="10.2196/43720",
url="https://formative.jmir.org/2023/1/e43720",
url="http://www.ncbi.nlm.nih.gov/pubmed/37437085"
}


@Article{info:doi/10.2196/43628,
author="Jin, Qiang
and Raza, Hassan Syed
and Yousaf, Muhammad
and Zaman, Umer
and Ogadimma, C. Emenyeonu
and Shah, Ali Amjad
and Core, Rachel
and Malik, Aqdas",
title="Assessing How Risk Communication Surveillance Prompts COVID-19 Vaccine Acceptance Among Internet Users by Applying the Situational Theory of Problem Solving: Cross-Sectional Study",
journal="JMIR Form Res",
year="2023",
month="Jul",
day="26",
volume="7",
pages="e43628",
keywords="COVID-19",
keywords="vaccine safety",
keywords="risk communication",
keywords="digital interventions",
keywords="health communication",
keywords="Situational Theory of Problem Solving",
abstract="Background: The World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine--related infodemics as a significant risk perception factor hindering mass vaccination campaigns. Objective: Given the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication--laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. Methods: This study used a cross-sectional research design vis-{\`a}-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. Results: The results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. Conclusions: These pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one's knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response. ",
doi="10.2196/43628",
url="https://formative.jmir.org/2023/1/e43628",
url="http://www.ncbi.nlm.nih.gov/pubmed/37315198"
}


@Article{info:doi/10.2196/41582,
author="Marani, Husayn
and Song, Yunju Melodie
and Jamieson, Margaret
and Roerig, Monika
and Allin, Sara",
title="Public Officials' Engagement on Social Media During the Rollout of the COVID-19 Vaccine: Content Analysis of Tweets",
journal="JMIR Infodemiology",
year="2023",
month="Jul",
day="20",
volume="3",
pages="e41582",
keywords="Twitter",
keywords="COVID-19",
keywords="vaccines",
keywords="sentiment analysis",
keywords="public officials",
abstract="Background: Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis, such as the COVID-19 pandemic, during which government officials played a strong role in promoting public health measures such as vaccines. Objective: In Canada, provincial COVID-19 vaccine rollout was delivered in 3 phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions. Methods: We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging the social media artificial intelligence tool Brandwatch Analytics, we constructed a list of public officials in 3 jurisdictions (Ontario, Alberta, and British Columbia) organized across 6 public official types and then conducted an English and French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the 3 phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were extracted for additional annotation. We specifically annotated sentiment toward public officials' vaccine responses (ie, positive, negative, and neutral) in each tweet and annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type. Results: Among the 6 categories of public officials, 142 prominent accounts were included from Ontario, Alberta, and British Columbia. In total, 270 tweets were included in the content analysis and 212 tweets were direct tweets by public officials. Public officials mostly used Twitter for information provision (139/212, 65.6\%), followed by horizontal engagement (37/212, 17.5\%), citizen engagement (24/212, 11.3\%), and public service announcements (12/212, 5.7\%). Information provision by government bodies (eg, provincial government and public health authorities) or municipal leaders is more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.5\% (139/270) of all the tweets, whereas positive sentiment was the second most common sentiment (117/270, 43.3\%). In Ontario, 60\% (54/90) of the tweets were positive. Negative sentiment (eg, public officials criticizing vaccine rollout) accounted for 12\% (11/90) of all the tweets. Conclusions: As governments continue to promote the uptake of the COVID-19 booster doses, findings from this study are useful in informing how governments can best use social media to engage with the public to achieve democratic goals. ",
doi="10.2196/41582",
url="https://infodemiology.jmir.org/2023/1/e41582",
url="http://www.ncbi.nlm.nih.gov/pubmed/37315194"
}


@Article{info:doi/10.2196/45263,
author="Thai-Van, Hung
and Valnet-Rabier, Marie-Blanche
and Anciaux, Ma{\"e}va
and Lambert, Aude
and Maurier, Ana{\"i}s
and Cottin, Judith
and Pietri, Tessa
and Dest{\`e}re, Alexandre
and Damin-Pernik, Marl{\`e}ne
and Perrouin, Fanny
and Bagheri, Haleh",
title="Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="14",
volume="9",
pages="e45263",
keywords="mRNA COVID-19 vaccine",
keywords="COVID-19",
keywords="messenger RNA",
keywords="tozinameran",
keywords="elasomeran",
keywords="sudden sensorineural hearing loss",
keywords="audiogram",
keywords="positive rechallenge",
keywords="spontaneous reporting",
keywords="postmarketing",
keywords="surveillance",
keywords="pharmacovigilance",
abstract="Background: The World Health Organization recently described sudden sensorineural hearing loss (SSNHL) as a possible adverse effect of COVID-19 vaccines. Recent discordant pharmacoepidemiologic studies invite robust clinical investigations of SSNHL after COVID-19 messenger RNA (mRNA) vaccines. This postmarketing surveillance study, overseen by French public health authorities, is the first to clinically document postvaccination SSNHL and examine the role of potential risk factors. Objective: This nationwide study aimed to assess the relationship between SSNHL and exposure to mRNA COVID-19 vaccines and estimate the reporting rate (Rr) of SSNHL after mRNA vaccination per 1 million doses (primary outcome). Methods: We performed a retrospective review of all suspected cases of SSNHL after mRNA COVID-19 vaccination spontaneously reported in France between January 2021 and February 2022 based on a comprehensive medical evaluation, including the evaluation of patient medical history, side and range of hearing loss, and hearing recovery outcomes after a minimum period of 3 months. The quantification of hearing loss and assessment of hearing recovery outcomes were performed according to a grading system modified from the Siegel criteria. A cutoff of 21 days was used for the delay onset of SSNHL. The primary outcome was estimated using the total number of doses of each vaccine administered during the study period in France as the denominator. Results: From 400 extracted cases for tozinameran and elasomeran, 345 (86.3\%) spontaneous reports were selected. After reviewing complementary data, 49.6\% (171/345) of documented cases of SSNHL were identified. Of these, 83\% (142/171) of SSNHL cases occurred after tozinameran vaccination: Rr=1.45/1,000,000 injections; no difference for the rank of injections; complete recovery in 22.5\% (32/142) of cases; median delay onset before day 21=4 days (median age 51, IQR 13-83 years); and no effects of sex. A total of 16.9\% (29/171) of SSNHL cases occurred after elasomeran vaccination: Rr=1.67/1,000,000 injections; rank effect in favor of the first injection (P=.03); complete recovery in 24\% (7/29) of cases; median delay onset before day 21=8 days (median age 47, IQR 33-81 years); and no effects of sex. Autoimmune, cardiovascular, or audiovestibular risk factors were present in approximately 29.8\% (51/171) of the cases. SSNHL was more often unilateral than bilateral for both mRNA vaccines (P<.001 for tozinameran; P<.003 for elasomeran). There were 13.5\% (23/142) of cases of profound hearing loss, among which 74\% (17/23) did not recover a serviceable ear. A positive rechallenge was documented for 8 cases. Conclusions: SSNHL after COVID-19 mRNA vaccines are very rare adverse events that do not call into question the benefits of mRNA vaccines but deserve to be known given the potentially disabling impact of sudden deafness. Therefore, it is essential to properly characterize postinjection SSNHL, especially in the case of a positive rechallenge, to provide appropriate individualized recommendations. ",
doi="10.2196/45263",
url="https://publichealth.jmir.org/2023/1/e45263",
url="http://www.ncbi.nlm.nih.gov/pubmed/37071555"
}


@Article{info:doi/10.2196/42958,
author="Huang, Yiman
and Zhang, Ling
and Fu, Jiaqi
and Wu, Yijin
and Wang, Hao
and Xiao, Weijun
and Xin, You
and Dai, Zhenwei
and Si, Mingyu
and Chen, Xu
and Jia, Mengmeng
and Leng, Zhiwei
and Cui, Dan
and Su, Xiaoyou",
title="COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jul",
day="3",
volume="9",
pages="e42958",
keywords="COVID-19",
keywords="COVID-19 survivors",
keywords="vaccine hesitancy",
keywords="complacency",
keywords="confidence",
keywords="convenience",
keywords="cross-sectional questionnaire",
keywords="health education",
keywords="health promotion",
keywords="public health",
abstract="Background: Although patients recovered from COVID-19 already have immunity gained from natural infection, they are still at risk of reinfection due to the emergence of new variants of COVID-19 and the diminishing of naturally acquired immunity over time. Vaccination is associated with efficacious protection against COVID-19 infection and could boost infection-acquired immunity; however, various COVID-19 survivors have not been vaccinated due to vaccine hesitancy. Objective: The aim of this study was to investigate COVID-19 vaccine hesitancy and related factors among COVID-19 survivors. Methods: A cross-sectional questionnaire survey was conducted among patients who recovered from COVID-19 infection in Wuhan, China, between June 10 and July 25, 2021. The questionnaire included sociodemographic information, items on COVID-19 infection, the COVID-19 vaccine hesitancy scale based on the 3Cs (complacency, convenience, and confidence) model, trust in vaccine manufacturers and health facilities, and reasons for the decision to accept COVID-19 vaccination. Multivariate logistic regression analysis was used to assess the factors influencing COVID-19 vaccine hesitancy. Results: Among the 1422 participants, 538 (37.8\%) were not vaccinated against COVID-19. The COVID-19--recovered patients who self-reported having a current unhealthy status expressed more hesitancy about the COVID-19 vaccine than those who perceived themselves to be healthy (odds ratio [OR] 0.45, 95\% CI 0.28-0.71). Compared to the asymptomatic patients, patients with mild symptoms were more likely to receive a COVID-19 vaccine (OR 1.67, 95\% CI 1.02-2.82). Regarding the 3Cs model, high complacency (P=.005) and low convenience (P=.004) were significant negative factors for COVID-19 vaccination. Trust in vaccine manufacturers and health facilities was a significant positive factor for COVID-19 vaccination (OR 1.14, 95\% CI 1.09-1.19). ``Self-needs'' was the main reason for patients to receive the COVID-19 vaccine, whereas ``already have antibodies and do not need vaccination'' was the main reason for patients to not receive the COVID-19 vaccine. Conclusions: Among the three major factors of vaccine hesitancy, complacency proved to be the most notable among COVID-19--recovered patients. Therefore, educational campaigns can focus on raising the awareness of risk of infection and the benefits of vaccination to reduce complacency toward vaccination among this population. In particular, for individuals who have recovered from COVID-19, improving factors related to convenience such as transportation, the environment of vaccination, and providing door-to-door service was also deemed necessary to facilitate their vaccination. In addition, addressing the concerns about vaccination of COVID-19--recovered patients could foster trust and promote their uptake of vaccination. ",
doi="10.2196/42958",
url="https://publichealth.jmir.org/2023/1/e42958",
url="http://www.ncbi.nlm.nih.gov/pubmed/37247615"
}


@Article{info:doi/10.2196/39576,
author="Wynn, S. Chelsea
and Fiks, G. Alexander
and Localio, Russell
and Shults, Justine
and Nekrasova, Ekaterina
and Shone, P. Laura
and Torres, Alessandra
and Griffith, Miranda
and Unger, Rebecca
and Ware, Ann Leigh
and Kelly, Kate Mary
and Stockwell, S. Melissa",
title="Examination of Text Message Plans and Baseline Usage of Families Enrolled in a Text Message Influenza Vaccine Reminder Trial: Survey Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="30",
volume="7",
pages="e39576",
keywords="influenza vaccine",
keywords="mHealth",
keywords="mobile phone",
keywords="pediatric",
keywords="primary care",
keywords="PROS",
keywords="reminders",
keywords="text message",
abstract="Background: Mobile health (mHealth) is quickly expanding as a method of health promotion, but some interventions may not be familiar or comfortable for potential users. SMS text messaging has been investigated as a low-cost, accessible way to provide vaccine reminders. Most (97\%) US adults own a cellphone and of those adults most use SMS text messaging. However, understanding patterns of SMS text message plan type and use in diverse primary care populations needs more investigation. Objective: We sought to use a survey to examine baseline SMS text messaging and data plan patterns among families willing to accept SMS text message vaccine reminders. Methods: As part of a National Institutes of Health (NIH)--funded national study (Flu2Text) conducted during the 2017-2018 and 2018-2019 influenza seasons, families of children needing a second seasonal influenza vaccine dose were recruited in pediatric primary care offices at the time of their first dose. Practices were from the American Academy of Pediatrics' (AAP) Pediatric Research in Office Settings (PROS) research network, the Children's Hospital of Philadelphia, and Columbia University. A survey was administered via telephone (Season 1) or electronically (Season 2) at enrollment. Standardized (adjusted) proportions for SMS text message plan type and texting frequency were calculated using logistic regression that was adjusted for child and caregiver demographics. Results: Responses were collected from 1439 participants (69\% of enrolled). The mean caregiver age was 32 (SD 6) years, and most children (n=1355, 94.2\%) were aged 6-23 months. Most (n=1357, 94.3\%) families were English-speaking. Most (n=1331, 92.8\%) but not all participants had an unlimited SMS text messaging plan and sent or received texts at least once daily (n=1313, 91.5\%). SMS text messaging plan type and use at baseline was uniform across most but not all subgroups. However, there were some differences in the study population's SMS text messaging plan type and usage. Caregivers who wanted Spanish SMS text messages were less likely than those who chose English to have an unlimited SMS text messaging plan (n=61, 86.7\% vs n=1270, 94\%; risk difference --7.2\%, 95\% CI --27.1 to --1.8). There were no significant differences in having an unlimited plan associated with child's race, ethnicity, age, health status, insurance type, or caregiver education level. SMS text messaging use at baseline was not uniform across all subgroups. Nearly three-quarters (n=1030, 71.9\%) of participants had received some form of SMS text message from their doctor's office; most common were appointment reminders (n=1014, 98.4\%), prescription (n=300, 29.1\%), and laboratory notifications (n=117, 11.4\%). Even the majority (n=64, 61.5\%) of those who did not have unlimited plans and who texted less than daily (n=72, 59\%) reported receipt of these SMS text messages. Conclusions: In this study, most participants had access to unlimited SMS text messaging plans and texted at least once daily. However, infrequent texting and lack of access to an unlimited SMS text messaging plan did not preclude enrolling to receive SMS text message reminders in pediatric primary care settings. ",
doi="10.2196/39576",
url="https://formative.jmir.org/2023/1/e39576",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389945"
}


@Article{info:doi/10.2196/38388,
author="Lee, Yun Hee
and Xiong, Serena
and Sur, Aparajita
and Khang, Tounhia
and Vue, Bai
and Culhane-Pera, A. Kathleen
and Pergament, Shannon
and Torres, Beatriz M.
and Koopmeiners, S. Joseph
and Desai, Jay",
title="Evaluating Human Papillomavirus eHealth in Hmong Adolescents to Promote Vaccinations: Pilot Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="20",
volume="7",
pages="e38388",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="community-based participatory action research",
keywords="CBPAR",
keywords="eHealth",
keywords="website",
keywords="social cognitive theory",
keywords="Hmong",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) is a common sexually transmitted infection, causing multiple cancers, including cervical, penile, and anal. Infection and subsequent health risks caused by HPV can be diminished by HPV vaccination. Unfortunately, vaccination rates among Hmong Americans are substantially lower than those among other racial and ethnic groups, despite having higher cervical cancer rates than non-Hispanic White women. Such disparities and sparse literature highlight the need for innovative and culturally appropriate educational interventions to improve HPV vaccine rates in Hmong Americans. Objective: We aimed to develop and evaluate the effectiveness and usability of an innovative web-based eHealth educational website, the Hmong Promoting Vaccines website (HmongHPV website), for Hmong-American parents and adolescents to improve their knowledge, self-efficacy, and decision-making capacities to obtain HPV vaccinations. Methods: Through social cognitive theory and community-based participatory action research process, we created a theory-driven and culturally and linguistically appropriate website for Hmong parents and adolescents. We conducted a pre-post intervention pilot study to assess the website's effectiveness and usability. Overall, 30 Hmong-American parent and adolescent dyads responded to questions about HPV and HPV vaccine knowledge, self-efficacy, and decision-making at preintervention, 1 week after intervention, and at the 5-week follow-up. Participants responded to survey questions about website content and processes at 1 and 5 weeks, and a subset of 20 dyad participants participated in telephone interviews 6 weeks later. We used paired t tests (2-tailed) to measure the change in knowledge, self-efficacy, and decision-making processes, and used template analysis to identify a priori themes for website usability. Results: Participants' HPV and HPV vaccine knowledge improved significantly from pre- to postintervention stage and follow-up. Knowledge scores increased from preintervention to 1 week after intervention for both parents (HPV knowledge, P=.01; vaccine knowledge, P=.01) and children (HPV knowledge, P=.01; vaccine knowledge, P<.001), which were sustained at the 5-week follow-up. Parents' average self-efficacy score increased from 21.6 at baseline to 23.9 (P=.007) at post intervention and 23.5 (P=.054) at follow-up. Similar improvements were observed in the teenagers' self-efficacy scores (from 30.3 at baseline to 35.6, P=.009, at post intervention and 35.9, P=.006, at follow-up). Collaborative decision-making between parents and adolescents improved immediately after using the website (P=.002) and at follow-up (P=.02). The interview data also revealed that the website's content was informative and engaging; in particular, participants enjoyed the web-based quizzes and vaccine reminders. Conclusions: This theory-driven, community-based participatory action research--designed and culturally and linguistically appropriate educational website was well received. It improved Hmong parents' and adolescents' knowledge, self-efficacy, and decision-making processes regarding HPV vaccination. Future studies should examine the website's impact on HPV vaccine uptake and its potential for broader use across various settings (eg, clinics and schools). ",
doi="10.2196/38388",
url="https://formative.jmir.org/2023/1/e38388",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338961"
}


@Article{info:doi/10.2196/45696,
author="Kim, Wonsun Sunny
and Chen, Chia-Chen Angela
and Ou, Lihong
and Larkey, Linda
and Todd, Michael
and Han, Yooro",
title="Developing a Culturally and Linguistically Congruent Digital Storytelling Intervention in Vietnamese and Korean American Mothers of Human Papillomavirus--Vaccinated Children: Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="14",
volume="7",
pages="e45696",
keywords="Vietnamese",
keywords="Korean",
keywords="Asia",
keywords="cultural",
keywords="digital storytelling",
keywords="storytelling",
keywords="story",
keywords="stories",
keywords="HPV",
keywords="vaccine",
keywords="vaccination",
keywords="feasibility",
keywords="digital intervention",
keywords="mortality rate",
keywords="ratio",
keywords="odd",
keywords="rate",
keywords="deep analysis",
keywords="social media",
keywords="child",
keywords="immigrant",
keywords="mother",
keywords="immunization",
keywords="inoculation",
keywords="inoculate",
keywords="communication",
keywords="culture",
keywords="language",
keywords="human papillomavirus",
keywords="photo",
keywords="video",
keywords="digital",
keywords="microphone",
keywords="conversation",
keywords="dialogue",
keywords="Research Electronic Data Capture",
keywords="voiceover",
keywords="soundtrack",
keywords="writing",
keywords="write",
keywords="script",
keywords="health status",
keywords="health insurance",
keywords="survey",
keywords="questionnaire",
keywords="qualitative",
keywords="constructivist",
keywords="constructivism",
abstract="Background: The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) call for researchers to address this public health concern through HPV vaccination. Disparities of HPV-associated cancers in Vietnamese and Korean Americans exist, yet their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve their HPV vaccination rates. We adopted digital storytelling (DST) that combines oral storytelling with computer-based technology (digital images, audio recording, and music) as a promising approach for facilitating the communication of culturally relevant health messages. Objective: This study aimed to (1) assess the feasibility and acceptability of intervention development through DST workshops, (2) conduct an in-depth analysis of the cultural experience that shapes HPV attitudes, and (3) explore aspects of the DST workshop experience that could inform future formative and intervention work. Methods: Through community partners, social media, and snowball sampling, we recruited 2 Vietnamese American and 6 Korean American mothers (mean age 41.4, SD 5.8 years) who had children vaccinated against HPV. Three virtual DST workshops were conducted between July 2021 and January 2022. Our team supported mothers to develop their own stories. Mothers completed web-based surveys before and after the workshop and provided feedback on each other's story ideas and the workshop experience. We used descriptive statistics to summarize quantitative data and constant comparative analysis to analyze qualitative data collected in the workshop and field notes. Results: Eight digital stories were developed in the DST workshops. They were well accepted, and the mothers showed overall satisfaction and relevant indicators (eg, would recommend it to others, would attend a similar workshop, it was worth their time; mean 4.2-5, range 1-5). Mothers found the process rewarding and appreciated the opportunity to share their stories in group settings and learn from each other. The 6 major themes that emerged from the data reflect the mothers' rich personal experiences, attitudes, and perceptions about their child's HPV vaccination, which included (1) showing parents' love and responsibility; (2) HPV and related knowledge, awareness, and attitudes; (3) factors influencing vaccine decision-making; (4) source of information and information sharing; (5) response to children's being vaccinated; and (6) cultural perspectives on health care and HPV vaccination. Conclusions: Our findings suggest that a virtual DST workshop is a highly feasible and acceptable approach to engaging Vietnamese American and Korean American immigrant mothers in developing culturally and linguistically congruent DST interventions. Further research is needed to test the efficacy and effectiveness of digital stories as an intervention for Vietnamese American and Korean American mothers of unvaccinated children. This process of developing an easy-to-deliver, culturally and linguistically aligned, and holistic web-based DST intervention can be implemented with other populations in other languages. ",
doi="10.2196/45696",
url="https://formative.jmir.org/2023/1/e45696",
url="http://www.ncbi.nlm.nih.gov/pubmed/37314851"
}


@Article{info:doi/10.2196/47713,
author="Chaney, Cunard Sarah
and Mechael, Patricia",
title="So Many Choices, How Do I Choose? Considerations for Selecting Digital Health Interventions to Support Immunization Confidence and Demand",
journal="J Med Internet Res",
year="2023",
month="May",
day="24",
volume="25",
pages="e47713",
keywords="immunization",
keywords="social listening",
keywords="mobile messaging",
keywords="service delivery",
keywords="low- and middle-income countries",
keywords="LMIC",
keywords="vaccines",
keywords="demand",
keywords="mHealth",
keywords="vaccine confidence",
keywords="public health system",
keywords="vaccination",
keywords="children",
keywords="community health",
keywords="digital health intervention",
keywords="health promotion",
doi="10.2196/47713",
url="https://www.jmir.org/2023/1/e47713",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223980"
}


@Article{info:doi/10.2196/44714,
author="Lenti, Jacopo
and Mejova, Yelena
and Kalimeri, Kyriaki
and Panisson, Andr{\'e}
and Paolotti, Daniela
and Tizzani, Michele
and Starnini, Michele",
title="Global Misinformation Spillovers in the Vaccination Debate Before and During the COVID-19 Pandemic: Multilingual Twitter Study",
journal="JMIR Infodemiology",
year="2023",
month="May",
day="24",
volume="3",
pages="e44714",
keywords="vaccination hesitancy",
keywords="vaccine",
keywords="misinformation",
keywords="Twitter",
keywords="social media",
keywords="COVID-19",
abstract="Background: Antivaccination views pervade online social media, fueling distrust in scientific expertise and increasing the number of vaccine-hesitant individuals. Although previous studies focused on specific countries, the COVID-19 pandemic has brought the vaccination discourse worldwide, underpinning the need to tackle low-credible information flows on a global scale to design effective countermeasures. Objective: This study aimed to quantify cross-border misinformation flows among users exposed to antivaccination (no-vax) content and the effects of content moderation on vaccine-related misinformation. Methods: We collected 316 million vaccine-related Twitter (Twitter, Inc) messages in 18 languages from October 2019 to March 2021. We geolocated users in 28 different countries and reconstructed a retweet network and cosharing network for each country. We identified communities of users exposed to no-vax content by detecting communities in the retweet network via hierarchical clustering and manual annotation. We collected a list of low-credibility domains and quantified the interactions and misinformation flows among no-vax communities of different countries. Results: The findings showed that during the pandemic, no-vax communities became more central in the country-specific debates and their cross-border connections strengthened, revealing a global Twitter antivaccination network. US users are central in this network, whereas Russian users also became net exporters of misinformation during vaccination rollout. Interestingly, we found that Twitter's content moderation efforts, in particular the suspension of users following the January 6 US Capitol attack, had a worldwide impact in reducing the spread of misinformation about vaccines. Conclusions: These findings may help public health institutions and social media platforms mitigate the spread of health-related, low-credibility information by revealing vulnerable web-based communities. ",
doi="10.2196/44714",
url="https://infodemiology.jmir.org/2023/1/e44714",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223965"
}


@Article{info:doi/10.2196/45417,
author="Quon, M. Cameron
and Walker, Macey
and Graves, Lisa",
title="The Influence of Mass Media on the COVID-19 Vaccination Decision-making Process: Prospective Survey-Based Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="17",
volume="25",
pages="e45417",
keywords="accuracy",
keywords="attitudes",
keywords="behavior",
keywords="communication",
keywords="COVID-19",
keywords="decision-making",
keywords="dissemination",
keywords="efficacy",
keywords="employment",
keywords="mass media",
keywords="reliability",
keywords="safety",
keywords="survey study",
keywords="usage",
keywords="vaccination",
keywords="vaccine hesitancy",
abstract="Background: Vaccine hesitancy during the COVID-19 pandemic was exacerbated by an infodemic of conflating accurate and inaccurate information with divergent political messages, leading to varying adherence to health-related behaviors. In addition to the media, people received information about COVID-19 and the vaccine from their physicians and closest networks of family and friends. Objective: This study explored individuals' decision-making processes in receiving the COVID-19 vaccine, focusing on the influence of specific media outlets, political orientation, personal networks, and the physician-patient relationship. We also evaluated the effect of other demographic data like age and employment status. Methods: An internet survey was disseminated through the Western Michigan University Homer Stryker MD School of Medicine Facebook account. The survey included questions on media sources for COVID-19 information, political affiliation, presidential candidate choice, and multiple Likert-type agreement scale questions on conceptions of the vaccine. Each respondent was assigned a media source score, which represented the political leaning of their media consumption. This was calculated using a model based on data from the Pew Research Center that assigned an ideological profile to various news outlets. Results: The sample consisted of 1757 respondents, with 89.58\% (1574/1757) of them choosing to take the COVID-19 vaccine. Those employed part-time and the unemployed were at 1.94 (95\% CI 1.15-3.27) and 2.48 (95\% CI 1.43-4.39) greater odds of choosing the vaccine than those employed full-time. For every 1-year increase in age, there was a 1.04 (95\% CI 1.02-1.06) multiplicative increase in odds of choosing to receive the vaccine. For every 1-point increase in media source score toward more Liberal or Democrat, there was a 1.06 (95\% CI 1.04-1.07) multiplicative increase in odds of choosing to take the COVID-19 vaccine. The Likert-type agreement scale showed statistically significant differences (P<.001) between respondents; those who chose the vaccine agreed more strongly on their belief in the safety and efficacy of vaccines, the influence of their personal beliefs, and the encouragement and positive experiences of family and friends. Most respondents rated their personal relationship with their physician to be good, but this factor did not correlate with differences in vaccine decision. Conclusions: Although multiple factors are involved, the role of mass media in shaping attitudes toward vaccines cannot be ignored, especially its ability to spread misinformation and foster division. Surprisingly, the effect of one's personal physician may not weigh as heavily in one's decision-making process, potentially indicating the need for physicians to alter their communication style, including involvement in social media. In the era of information overload, effective communication is critical in ensuring the dissemination of accurate and reliable information to optimize the vaccination decision-making process. ",
doi="10.2196/45417",
url="https://www.jmir.org/2023/1/e45417",
url="http://www.ncbi.nlm.nih.gov/pubmed/37195740"
}


@Article{info:doi/10.2196/45493,
author="Wang, Yingcheng
and Fekadu, Ginenus
and You, Hoi-sze Joyce",
title="Cost-Effectiveness Analyses of Digital Health Technology for Improving the Uptake of Vaccination Programs: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="15",
volume="25",
pages="e45493",
keywords="cost-effectiveness analyses",
keywords="digital health technology",
keywords="vaccination coverage",
keywords="vaccine",
keywords="systematic review",
abstract="Background: Vaccination is the most effective strategy to prevent infectious diseases, yet vaccination coverage has not reached the target level. To promote vaccination uptake, digital health interventions (DHIs) have been used in various vaccination programs. Objective: This study aimed to perform a systematic review of the cost-effectiveness analyses of DHIs for the improvement of the uptake of vaccination programs. Methods: A literature review was conducted in MEDLINE (Ovid), Embase (Ovid), APA PsycINFO (Ovid), Web of Science, Scopus, CINAHL Ultimate (EBSCOhost), Center for Review and Dissemination, and Institute for IEEE Xplore up to October 2022. Health economic evaluations that met the following inclusion criteria were included: (1) adult or pediatric vaccination programs; (2) interventions delivered through digital technology; (3) full-scale health economic analyses including cost-effectiveness, cost-utility, cost-benefit, or cost-consequence analyses; and (4) evaluations conducted by model-based or trial-based analyses. The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Results: The systematic review included 7 studies. Four of the cost-effectiveness studies were conducted by model-based analyses, and 3 were trial-based analyses. One study reported the additional cost per quality-adjusted life years (QALYs) gained, whereas 6 studies reported the additional cost per individual vaccinated (or return case). The vaccines targeted the human papillomavirus (HPV) vaccine, influenza vaccination, measles-mumps-rubella (MMR) vaccine, and children immunization at different ages. The DHIs were delivered by television campaign, web-based decision aid, SMS text message, telephone, and computer-generated recall letters. The studies were classified as very good (n=5) and good (n=2) qualities. One study concluded that the DHI was cost-saving, and 6 studies concluded that the DHI was cost-effective. Conclusions: This study is the first systematic review on cost-effectiveness analyses of DHIs to improve vaccination uptake. All included studies have good to very good quality on study assessment and reported the DHIs to be cost-saving or cost-effective in the improvement of vaccination uptake. ",
doi="10.2196/45493",
url="https://www.jmir.org/2023/1/e45493",
url="http://www.ncbi.nlm.nih.gov/pubmed/37184916"
}


@Article{info:doi/10.2196/39700,
author="Bota, Brianne A.
and Bettinger, A. Julie
and Sarfo-Mensah, Shirley
and Lopez, Jimmy
and Smith, P. David
and Atkinson, M. Katherine
and Bell, Cameron
and Marty, Kim
and Serhan, Mohamed
and Zhu, T. David
and McCarthy, E. Anne
and Wilson, Kumanan",
title="Comparing the Use of a Mobile App and a Web-Based Notification Platform for Surveillance of Adverse Events Following Influenza Immunization: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2023",
month="May",
day="8",
volume="9",
pages="e39700",
keywords="active participant--centered reporting",
keywords="health technology",
keywords="adverse event reporting",
keywords="mobile apps",
keywords="immunization",
keywords="vaccine",
keywords="safety",
keywords="influenza",
keywords="campaign",
keywords="apps",
keywords="mobile",
keywords="surveillance",
keywords="pharmacovigilance",
abstract="Background: Vaccine safety surveillance is a core component of?vaccine pharmacovigilance. In Canada, active, participant-centered vaccine surveillance is available for influenza vaccines and has been used for COVID-19 vaccines. Objective: The objective of this study is to evaluate the effectiveness and feasibility of using a mobile app for reporting participant-centered seasonal influenza adverse events following immunization (AEFIs) compared to a web-based notification system. Methods: Participants were randomized to influenza vaccine safety reporting via a mobile app or a web-based notification platform. All participants were invited to complete a user experience survey. Results: Among the 2408 randomized participants, 1319 (54\%) completed their safety survey 1 week after vaccination, with a higher completion rate among the web-based notification platform users (767/1196, 64\%) than among mobile app users (552/1212, 45\%; P<.001). Ease-of-use ratings were high for the web-based notification platform users (99\% strongly agree or agree) and 88.8\% of them strongly agreed or agreed that the system made reporting AEFIs easier. Web-based notification platform users supported the statement that a web-based notification-only approach would make it easier for public health professionals to detect vaccine safety signals (91.4\%, agreed or strongly agreed). Conclusions: Participants in this study were significantly more likely to respond to a web-based safety survey rather than within a mobile app. These results suggest that mobile apps present an additional barrier for use compared to the web-based notification--only approach. Trial Registration: ClinicalTrials.gov NCT05794113; https://clinicaltrials.gov/show/NCT05794113 ",
doi="10.2196/39700",
url="https://publichealth.jmir.org/2023/1/e39700",
url="http://www.ncbi.nlm.nih.gov/pubmed/37155240"
}


@Article{info:doi/10.2196/43873,
author="Williams, J. Christopher
and Kranzler, C. Elissa
and Luchman, N. Joseph
and Denison, Benjamin
and Fischer, Sean
and Wonder, Thomas
and Ostby, Ronne
and Vines, Monica
and Weinberg, Jessica
and Petrun Sayers, L. Elizabeth
and Kurti, N. Allison
and Trigger, Sarah
and Hoffman, Leah
and Peck, A. Joshua F.",
title="The Initial Relationship Between the United States Department of Health and Human Services' Digital COVID-19 Public Education Campaign and Vaccine Uptake: Campaign Effectiveness Evaluation",
journal="J Med Internet Res",
year="2023",
month="May",
day="3",
volume="25",
pages="e43873",
keywords="communication campaign",
keywords="COVID-19",
keywords="COVID-19 pandemic",
keywords="COVID-19 vaccination",
keywords="public education campaign",
keywords="public health campaign",
keywords="social marketing",
keywords="marketing",
keywords="campaign",
keywords="vaccination",
keywords="patient education",
keywords="United States",
keywords="vaccine",
keywords="digital impression",
keywords="public education",
abstract="Background: Over 1 million people in the United States have died of COVID-19. In response to this public health crisis, the US Department of Health and Human Services launched the We Can Do This public education campaign in April 2021 to increase vaccine confidence. The campaign uses a mix of digital, television, print, radio, and out-of-home channels to reach target audiences. However, the impact of this campaign on vaccine uptake has not yet been assessed. Objective: We aimed to address this gap by assessing the association between the We Can Do This COVID-19 public education campaign's digital impressions and the likelihood of first-dose COVID-19 vaccination among US adults. Methods: A nationally representative sample of 3642 adults recruited from a US probability panel was surveyed over 3 waves (wave 1: January to February 2021; wave 2: May to June 2021; and wave 3: September to November 2021) regarding COVID-19 vaccination, vaccine confidence, and sociodemographics. Survey data were merged with weekly paid digital campaign impressions delivered to each respondent's media market (designated market area [DMA]) during that period. The unit of analysis was the survey respondent--broadcast week, with respondents nested by DMA. Data were analyzed using a multilevel logit model with varying intercepts by DMA and time-fixed effects. Results: The We Can Do This digital campaign was successful in encouraging first-dose COVID-19 vaccination. The findings were robust to multiple modeling specifications, with the independent effect of the change in the campaign's digital dose remaining practically unchanged across all models. Increases in DMA-level paid digital campaign impressions in a given week from --30,000 to 30,000 increased the likelihood of first-dose COVID-19 vaccination by 125\%. Conclusions: Results from this study provide initial evidence of the We Can Do This campaign's digital impact on vaccine uptake. The size and length of the Department of Health and Human Services We Can Do This public education campaign make it uniquely situated to examine the impact of a digital campaign on COVID-19 vaccination, which may help inform future vaccine communication efforts and broader public education efforts. These findings suggest that campaign digital dose is positively associated with COVID-19 vaccination uptake among US adults; future research assessing campaign impact on reduced COVID-19--attributed morbidity and mortality and other benefits is recommended. This study indicates that digital channels have played an important role in the COVID-19 pandemic response. Digital outreach may be integral in addressing future pandemics and could even play a role in addressing nonpandemic public health crises. ",
doi="10.2196/43873",
url="https://www.jmir.org/2023/1/e43873",
url="http://www.ncbi.nlm.nih.gov/pubmed/36939670"
}


@Article{info:doi/10.2196/34315,
author="Chopra, Harshita
and Vashishtha, Aniket
and Pal, Ridam
and 
and Tyagi, Ananya
and Sethi, Tavpritesh",
title="Mining Trends of COVID-19 Vaccine Beliefs on Twitter With Lexical Embeddings: Longitudinal Observational Study",
journal="JMIR Infodemiology",
year="2023",
month="May",
day="2",
volume="3",
pages="e34315",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="vaccine hesitancy",
keywords="public health",
keywords="unsupervised word embeddings",
keywords="natural language preprocessing",
keywords="social media",
keywords="Twitter",
abstract="Background: Social media plays a pivotal role in disseminating news globally and acts as a platform for people to express their opinions on various topics. A wide variety of views accompany COVID-19 vaccination drives across the globe, often colored by emotions that change along with rising cases, approval of vaccines, and multiple factors discussed online. Objective: This study aims to analyze the temporal evolution of different emotions and the related influencing factors in tweets belonging to 5 countries with vital vaccine rollout programs, namely India, the United States, Brazil, the United Kingdom, and Australia. Methods: We extracted a corpus of nearly 1.8 million Twitter posts related to COVID-19 vaccination and created 2 classes of lexical categories---emotions and influencing factors. Using cosine distance from selected seed words' embeddings, we expanded the vocabulary of each category and tracked the longitudinal change in their strength from June 2020 to April 2021 in each country. Community detection algorithms were used to find modules in positive correlation networks. Results: Our findings indicated the varying relationship among emotions and influencing factors across countries. Tweets expressing hesitancy toward vaccines represented the highest mentions of health-related effects in all countries, which reduced from 41\% to 39\% in India. We also observed a significant change (P<.001) in the linear trends of categories like hesitation and contentment before and after approval of vaccines. After the vaccine approval, 42\% of tweets coming from India and 45\% of tweets from the United States represented the ``vaccine\_rollout'' category. Negative emotions like rage and sorrow gained the highest importance in the alluvial diagram and formed a significant module with all the influencing factors in April 2021, when India observed the second wave of COVID-19 cases. Conclusions: By extracting and visualizing these tweets, we propose that such a framework may help guide the design of effective vaccine campaigns and be used by policy makers to model vaccine uptake and targeted interventions. ",
doi="10.2196/34315",
url="https://infodemiology.jmir.org/2023/1/e34315",
url="http://www.ncbi.nlm.nih.gov/pubmed/37192952"
}


@Article{info:doi/10.2196/34163,
author="Matas, L. Jennifer
and Landry, G. Latrice
and Lee, LaTasha
and Hansel, Shantoy
and Coudray, S. Makella
and Mata-McMurry, V. Lina
and Chalasani, Nishanth
and Xu, Liou
and Stair, Taylor
and Edwards, Christina
and Puckrein, Gary
and Meyer, William
and Wiltz, Gary
and Sampson, Marian
and Gregerson, Paul
and Barron, Charles
and Marable, Jeffrey
and Akinboboye, Olakunle
and Il'yasova, Dora",
title="Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="27",
volume="9",
pages="e34163",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="underrepresented in research",
keywords="minority populations",
keywords="federally qualified health center (FQHC)",
keywords="public health",
keywords="COVID-19",
abstract="Background: COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. Objective: This study aims to characterize COVID-19 vaccine hesitancy in underserved diverse populations. Methods: The Minority and Rural Coronavirus Insights Study (MRCIS) recruited a convenience sample of adults (age?18, N=3735) from federally qualified health centers (FQHCs) in California, the Midwest (Illinois/Ohio), Florida, and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as a response of ``no'' or ``undecided'' to the question ``Would you get a coronavirus vaccine if it was available?'' (``yes'' categorized as not hesitant). Cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed using the chi-square test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95\% CIs. Interactions between geography and each demographic characteristic were evaluated in separate models. Results: The strongest vaccine hesitancy variability was by geographic region: California, 27.8\% (range 25.0\%-30.6\%); the Midwest, 31.4\% (range 27.3\%-35.4\%); Louisiana, 59.1\% (range 56.1\%-62.1\%); and Florida, 67.3\% (range 64.3\%-70.2\%). The expected estimates for the general population were lower: 9.7\% (California), 15.3\% (Midwest), 18.2\% (Florida), and 27.0\% (Louisiana). The demographic patterns also varied by geography. An inverted U-shaped age pattern was found, with the highest prevalence among ages 25-34 years in Florida (n=88, 80.0\%,) and Louisiana (n=54, 79.4\%; P<.05). Females were more hesitant than males in the Midwest (n= 110, 36.4\% vs n= 48, 23.5\%), Florida (n=458, 71.6\% vs n=195, 59.3\%), and Louisiana (n= 425, 66.5\% vs. n=172, 46.5\%; P<.05). Racial/ethnic differences were found in California, with the highest prevalence among non-Hispanic Black participants (n=86, 45.5\%), and in Florida, with the highest among Hispanic (n=567, 69.3\%) participants (P<.05), but not in the Midwest and Louisiana. The main effect model confirmed the U-shaped association with age: strongest association with age 25-34 years (OR 2.29, 95\% CI 1.74-3.01). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. Compared to males in California, the associations with the female gender were strongest in Florida (OR=7.88, 95\% CI 5.96-10.41) and Louisiana (OR=6.09, 95\% CI 4.55-8.14). Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida (OR=11.18, 95\% CI 7.01-17.85) and Black in Louisiana (OR=8.94, 95\% CI 5.53-14.47). However, the strongest race/ethnicity variability was observed within California and Florida: the ORs varied 4.6- and 2-fold between racial/ethnic groups in these regions, respectively. Conclusions: These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns. ",
doi="10.2196/34163",
url="https://publichealth.jmir.org/2023/1/e34163",
url="http://www.ncbi.nlm.nih.gov/pubmed/36811869"
}


@Article{info:doi/10.2196/42278,
author="Faroun, Hayette
and Zary, Nabil
and Baqer, Khalifa
and Alkhaja, Farida
and Gad, Kareem
and Alameddine, Mohamad
and Al Suwaidi, Hanan",
title="Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="17",
volume="12",
pages="e42278",
keywords="COVID-19",
keywords="mass vaccination center",
keywords="MVC",
keywords="health care services",
keywords="key success factors",
keywords="critical success factors",
keywords="CSFs",
keywords="service-oriented architecture",
keywords="SOA",
keywords="campaign",
keywords="vaccine",
keywords="immunize",
keywords="immunization",
keywords="inoculation",
keywords="health information system",
keywords="HIS",
keywords="information system",
keywords="semistructured interviews",
keywords="Q-methodology",
keywords="vaccination",
keywords="health promotion",
keywords="vaccine campaign",
keywords="health information",
keywords="global health",
keywords="health care service",
keywords="simulation modeling",
abstract="Background: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. Objective: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. Methods: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. Results: As of July 2022, 30 SSIs were conducted with the research participants. Conclusions: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. International Registered Report Identifier (IRRID): DERR1-10.2196/42278 ",
doi="10.2196/42278",
url="https://www.researchprotocols.org/2023/1/e42278",
url="http://www.ncbi.nlm.nih.gov/pubmed/36541889"
}


@Article{info:doi/10.2196/45051,
author="Wu, Xiaoqian
and Li, Ziyu
and Xu, Lin
and Li, Pengfei
and Liu, Ming
and Huang, Cheng",
title="COVID-19 Vaccine--Related Information on the WeChat Public Platform: Topic Modeling and Content Analysis",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="14",
volume="25",
pages="e45051",
keywords="health belief model",
keywords="COVID-19 vaccines",
keywords="WeChat",
keywords="content analysis",
keywords="topic modeling",
keywords="public health",
keywords="COVID-19",
abstract="Background: The COVID-19 vaccine is an effective tool in the fight against the COVID-19 outbreak. As the main channel of information dissemination in the context of the epidemic, social media influences public trust and acceptance of the vaccine. The rational application of health behavior theory is a guarantee of effective public health information dissemination. However, little is known about the application of health behavior theory in web-based COVID-19 vaccine messages, especially from Chinese social media posts. Objective: This study aimed to understand the main topics and communication characteristics of hot papers related to COVID-19 vaccine on the WeChat platform and assess the health behavior theory application with the aid of health belief model (HBM). Methods: A systematic search was conducted on the Chinese social media platform WeChat to identify COVID-19 vaccine--related papers. A coding scheme was established based on the HBM, and the sample was managed and coded using NVivo 12 (QSR International) to assess the application of health behavior theory. The main topics of the papers were extracted through the Latent Dirichlet Allocation algorithm. Finally, temporal analysis was used to explore trends in the evolution of themes and health belief structures in the papers. Results: A total of 757 papers were analyzed. Almost all (671/757, 89\%) of the papers did not have an original logo. By topic modeling, 5 topics were identified, which were vaccine development and effectiveness (267/757, 35\%), disease infection and protection (197/757, 26\%), vaccine safety and adverse reactions (52/757, 7\%), vaccine access (136/757, 18\%), and vaccination science popularization (105/757, 14\%). All papers identified at least one structure in the extended HBM, but only 29 papers included all of the structures. Descriptions of solutions to obstacles (585/757, 77\%) and benefit (468/757, 62\%) were the most emphasized components in all samples. Relatively few elements of susceptibility (208/757, 27\%) and the least were descriptions of severity (135/757, 18\%). Heat map visualization revealed the change in health belief structure before and after vaccine entry into the market. Conclusions: To the best of our knowledge, this is the first study to assess the structural expression of health beliefs in information related to the COVID-19 vaccine on the WeChat public platform based on an HBM. The study also identified topics and communication characteristics before and after the market entry of vaccines. Our findings can inform customized education and communication strategies to promote vaccination not only in this pandemic but also in future pandemics. ",
doi="10.2196/45051",
url="https://www.jmir.org/2023/1/e45051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37058349"
}


@Article{info:doi/10.2196/40186,
author="Remmel, Christopher
and Tuli, Gaurav
and Varrelman, J. Tanner
and Han, R. Aimee
and Angkab, Pakkanan
and Kosiyaporn, Hathairat
and Netrpukdee, Chanikarn
and Sorndamrih, Supatnuj
and Thamarangsi, Thaksaphon
and Brownstein, S. John
and Astley, M. Christina",
title="COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="13",
volume="9",
pages="e40186",
keywords="COVID-19 vaccines",
keywords="Thailand",
keywords="survey",
keywords="vaccines",
keywords="COVID-19",
keywords="pandemic",
keywords="public health",
keywords="health policy",
keywords="epidemiology",
keywords="social media",
keywords="vaccine hesitancy",
abstract="Background: The third most severe COVID-19 wave in the middle of 2021 coincided with the dual challenges of limited vaccine supply and lagging acceptance in Bangkok, Thailand. Understanding of persistent vaccine hesitancy during the ``608'' campaign to vaccinate those aged over 60 years and 8 medical risk groups was needed. On-the-ground surveys place further demands on resources and are scale limited. We leveraged the University of Maryland COVID-19 Trends and Impact Survey (UMD-CTIS), a digital health survey conducted among daily Facebook user samples, to fill this need and inform regional vaccine rollout policy. Objective: The aims of this study were to characterize COVID-19 vaccine hesitancy, frequent reasons for hesitancy, mitigating risk behaviors, and the most trusted sources of COVID-19 information through which to combat vaccine hesitancy in Bangkok, Thailand during the 608 vaccine campaign. Methods: We analyzed 34,423 Bangkok UMD-CTIS responses between June and October 2021, coinciding with the third COVID-19 wave. Sampling consistency and representativeness of the UMD-CTIS respondents were evaluated by comparing distributions of demographics, 608 priority groups, and vaccine uptake over time with source population data. Estimates of vaccine hesitancy in Bangkok and 608 priority groups were tracked over time. Frequently cited hesitancy reasons and trusted information sources were identified according to the 608 group and degree of hesitancy. Kendall tau was used to test statistical associations between vaccine acceptance and vaccine hesitancy. Results: The Bangkok UMD-CTIS respondents had similar demographics over weekly samples and compared to the Bangkok source population. Respondents self-reported fewer pre-existing health conditions compared to census data overall but had a similar prevalence of the important COVID-19 risk factor diabetes. UMD-CTIS vaccine uptake rose in parallel with national vaccination statistics, while vaccine hesitancy and degree of hesitancy declined (?7\% hesitant per week). Concerns about vaccination side effects (2334/3883, 60.1\%) and wanting to wait and see (2410/3883, 62.1\%) were selected most frequently, while ``not liking vaccines'' (281/3883, 7.2\%) and ``religious objections'' (52/3883, 1.3\%) were selected least frequently. Greater vaccine acceptance was associated positively with wanting to ``wait and see'' and negatively with ``don't believe I need (the vaccine)'' (Kendall tau 0.21 and ?0.22, respectively; adjusted P<.001). Scientists and health experts were most frequently cited as trusted COVID-19 information sources (13,600/14,033, 96.9\%), even among vaccine hesitant respondents. Conclusions: Our findings provide policy and health experts with evidence that vaccine hesitancy was declining over the study timeframe. Hesitancy and trust analyses among the unvaccinated support Bangkok policy measures to address vaccine safety and efficacy concerns through health experts rather than government or religious officials. Large-scale surveys enabled by existing widespread digital networks offer an insightful minimal-infrastructure resource for informing region-specific health policy needs. ",
doi="10.2196/40186",
url="https://publichealth.jmir.org/2023/1/e40186",
url="http://www.ncbi.nlm.nih.gov/pubmed/36811852"
}


@Article{info:doi/10.2196/43041,
author="Cunningham-Erves, Jennifer
and Wilkins, H. Consuelo
and Dempsey, F. Amanda
and Jones, L. Jessica
and Thompson, Chris
and Edwards, Kathryn
and Davis, Megan
and Mayberry, S. Lindsay
and Landsittal, Douglas
and Hull, C. Pamela",
title="Development of a Tailored Mobile Phone--Based Intervention to Facilitate Parent-Child Communication and Build Human Papillomavirus Vaccine Confidence: Formative Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="4",
volume="7",
pages="e43041",
keywords="human papillomavirus",
keywords="HPV",
keywords="vaccine",
keywords="hesitancy",
keywords="parent-child communication",
keywords="theory",
keywords="mobile health",
keywords="mHealth",
keywords="adolescents",
keywords="patient education",
abstract="Background: Human papillomavirus (HPV) vaccine hesitancy is on the rise, and provider communication is a first-line strategy to address parental concerns. The use of the presumptive approach and motivational interviewing by providers may not be enough to influence parental decision-making owing to the providers' limited time, self-efficacy, and skills to implement these strategies. Interventions to enhance provider communication and build parental HPV vaccine confidence have been undertested. Delivering tailored patient education to parents via mobile phones before they visit the health care provider may address time constraints during clinic visits and positively affect vaccine uptake. Objective: This study aimed to describe the development and evaluate the acceptability of a mobile phone--based, family-focused intervention guided by theory to address concerns of HPV vaccine--hesitant parents before the clinic visit, as well as explore intervention use to facilitate parent-child communication. Methods: The health belief model and theory of reasoned action guided intervention content development. A multilevel stakeholder engagement process was used to iteratively develop the HPVVaxFacts intervention, including a community advisory board review, a review by an advisory panel comprising HPV vaccine--hesitant parents, a health communications expert review, semistructured qualitative interviews with HPV vaccine--hesitant parents (n=31) and providers (n=15), and a content expert review. Inductive thematic analysis was used to identify themes in the interview data. Results: The qualitative interviews yielded 4 themes: overall views toward mobile device use for health information, acceptability of HPVVaxFacts, facilitators of HPVVaxFacts use, and barriers to HPVVaxFacts use. In parent interviews after reviewing HPVVaxFacts prototypes, almost all parents (29/31, 94\%) stated they intended to have their child vaccinated. Most of the parents stated that they liked the added adolescents' corner to engage in optional parent-child communication (ie, choice to share and discuss information with their child; 27/31, 87\%) and shared decision-making in some cases (8/31, 26\%). After incorporating all input, the final intervention consisted of a 10-item survey to identify the top 3 concerns of parents, followed by tailored education that was mapped to each of the following concerns: evidential messages, images or graphics to enhance comprehension and address low literacy, links to credible websites, a provider video, suggested questions to ask their child's physician, and an optional adolescents' corner to educate the patient and support parent-child communication. Conclusions: The multilevel stakeholder-engaged process used to iteratively develop this novel intervention for HPV vaccine--hesitant families can be used as a model to develop future mobile health interventions. This intervention is currently being pilot-tested in preparation for a randomized controlled trial aiming to increase HPV vaccination among adolescent children of vaccine-hesitant parents in a clinic setting. Future research can adapt HPVVaxFacts for other vaccines and use in other settings (eg, health departments and pharmacies). ",
doi="10.2196/43041",
url="https://formative.jmir.org/2023/1/e43041",
url="http://www.ncbi.nlm.nih.gov/pubmed/37014680"
}


@Article{info:doi/10.2196/44491,
author="Argyropoulos, D. Christos
and Leckler, Janina
and Salmanton-Garc{\'i}a, Jon
and Constantinou, Marinos
and Alexandrou, Alexandra
and Themistocleous, Sophia
and Noula, Evgenia
and Shiamakkides, George
and Nearchou, Andria
and Stewart, A. Fiona
and Albus, Kerstin
and Koniordou, Markela
and Kopsidas, Ioannis
and Spivak, Orly
and Hellemans, Margot
and Hendrickx, Greet
and Davis, Joanna Ruth
and Azzini, Maria Anna
and Simon, Valle Paula
and Carcas-Sansuan, Javier Antonio
and Askling, Hervius Helena
and Vene, Sirkka
and Prellezo, Baranda Jana
and {\'A}lvarez-Barco, Elena
and Macken, J. Alan
and Di Marzo, Romina
and Lu{\'i}s, Catarina
and Olesen, F. Ole
and Frias Iniesta, A. Jesus
and Barta, Imre
and T{\'o}th, Krisztina
and Akova, Murat
and Bonten, J. Marc M.
and Cohen-Kandli, Miriam
and Cox, Jane Rebecca
and Sou{\v c}kov{\'a}, Lenka
and Husa, Petr
and Jancoriene, Ligita
and Launay, Odile
and Lundgren, Jens
and Mallon, Patrick
and Armeftis, Charis
and Marques, Laura
and Naucler, Pontus
and Ochando, Jordi
and Tacconelli, Evelina
and van Damme, Pierre
and Zaoutis, Theoklis
and Hofstraat, Sanne
and Bruijning-Verhagen, Patricia
and Zeitlinger, Markus
and Cornely, A. Oliver
and Pana, Dorothea Zoi",
title="Enhancing Public Health Communication Regarding Vaccine Trials: Design and Development of the Pan-European VACCELERATE Toolkit",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="3",
volume="9",
pages="e44491",
keywords="vaccine trials",
keywords="volunteer registry",
keywords="educational material",
keywords="promotional material",
keywords="patient education",
keywords="health communication",
keywords="health promotion",
keywords="public health",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="vaccine",
keywords="vaccination",
keywords="hesitancy",
keywords="campaign",
keywords="misinformation",
abstract="Background: The pan-European VACCELERATE network aims to implement the first transnational harmonized and sustainable vaccine trial Volunteer Registry, being a single entry point for potential volunteers of large-scale vaccine trials across Europe. This work exhibits a set of harmonized vaccine trial--related educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network. Objective: This study primarily aimed to design and develop a standard toolkit to increase positive attitudes and access to trustworthy information for better access and increased recruitment to vaccine trials for the public. More specifically, the produced tools are focused on inclusiveness and equity, and are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (older individuals, migrants, children, and adolescents). The promotional and educational material is aligned with the main objectives of the Volunteer Registry to increase public literacy and awareness regarding vaccine-related clinical research or trials and trial participation, including informed consent and legal issues, side effects, and frequently asked questions regarding vaccine trial design. Methods: Tools were developed per the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity, and are adjusted to local country-wise requirements to improve public health communication. The produced tools are selected based on the cognitive theory, inclusiveness, and equity of differently aged and underrepresented groups, and standardized material from several official trustworthy sources (eg, COVID-19 Vaccines Global Access; the European Centre for Disease Prevention and Control; the European Patients' Academy on Therapeutic Innovation; Gavi, the Vaccine Alliance; and the World Health Organization). A team of multidisciplinary specialists (infectious diseases, vaccine research, medicine, and education) edited and reviewed the subtitles and scripts of the educational videos, extended brochures, interactive cards, and puzzles. Graphic designers selected the color palette, audio settings, and dubbing for the video story-tales and implemented QR codes. Results: This study presents the first set of harmonized promotional and educational materials and tools (ie, educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (eg, COVID-19 vaccines). These tools inform the public about possible benefits and disadvantages of trial participation and build confidence among participants about the safety and efficacy of COVID-19 vaccines and the health care system. This material has been translated into several languages and is intended to be freely and easily accessible to facilitate dissemination among VACCELERATE network participant countries and the European and global scientific, industrial, and public community. Conclusions: The produced material could help fill knowledge gaps of health care personnel, providing the appropriate future patient education for vaccine trials, and tackling vaccine hesitancy and parents' concerns for potential participation of children in vaccine trials. ",
doi="10.2196/44491",
url="https://publichealth.jmir.org/2023/1/e44491",
url="http://www.ncbi.nlm.nih.gov/pubmed/36878478"
}


@Article{info:doi/10.2196/43497,
author="Ahmed, Wasim
and Das, Ronnie
and Vidal-Alaball, Josep
and Hardey, Mariann
and Fuster-Casanovas, A{\"i}na",
title="Twitter's Role in Combating the Magnetic Vaccine Conspiracy Theory: Social Network Analysis of Tweets",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="31",
volume="25",
pages="e43497",
keywords="COVID-19",
keywords="coronavirus",
keywords="Twitter",
keywords="social network analysis",
keywords="misinformation",
keywords="online social capital",
abstract="Background: The popularity of the magnetic vaccine conspiracy theory and other conspiracy theories of a similar nature creates challenges to promoting vaccines and disseminating accurate health information. Objective: Health conspiracy theories are gaining in popularity. This study's objective was to evaluate the Twitter social media network related to the magnetic vaccine conspiracy theory and apply social capital theory to analyze the unique social structures of influential users. As a strategy for web-based public health surveillance, we conducted a social network analysis to identify the important opinion leaders sharing the conspiracy, the key websites, and the narratives. Methods: A total of 18,706 tweets were retrieved and analyzed by using social network analysis. Data were retrieved from June 1 to June 13, 2021, using the keyword vaccine magnetic. Tweets were retrieved via a dedicated Twitter application programming interface. More specifically, the Academic Track application programming interface was used, and the data were analyzed by using NodeXL Pro (Social Media Research Foundation) and Gephi. Results: There were a total of 22,762 connections between Twitter users within the data set. This study found that the most influential user within the network consisted of a news account that was reporting on the magnetic vaccine conspiracy. There were also several other users that became influential, such as an epidemiologist, a health economist, and a retired sports athlete who exerted their social capital within the network. Conclusions: Our study found that influential users were effective broadcasters against the conspiracy, and their reach extended beyond their own networks of Twitter followers. We emphasize the need for trust in influential users with regard to health information, particularly in the context of the widespread social uncertainty resulting from the COVID-19 pandemic, when public sentiment on social media may be unpredictable. This study highlights the potential of influential users to disrupt information flows of conspiracy theories via their unique social capital. ",
doi="10.2196/43497",
url="https://www.jmir.org/2023/1/e43497",
url="http://www.ncbi.nlm.nih.gov/pubmed/36927550"
}


@Article{info:doi/10.2196/39383,
author="Wittenauer, Rachel
and Dolan, B. Samantha
and Njoroge, Anne
and Onyango, Penina
and Owiso, George
and Rabinowitz, Peter
and Puttkammer, Nancy",
title="Usability and Acceptability of Electronic Immunization Registry Data Entry Workflows From the Health Care Worker Perspective in Siaya, Kenya (Part 3): Pre-Post Study",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="30",
volume="7",
pages="e39383",
keywords="workflow",
keywords="digital health",
keywords="electronic immunization registry",
keywords="usability",
keywords="acceptability",
keywords="health care worker",
keywords="technology adoption",
abstract="Background: Digital health tools such as electronic immunization registries (EIRs) have the potential to improve patient care and alleviate the challenges that arise from the use of paper-based clinic records for reporting. To address some of these challenges, the Kenya Ministry of Health and the International Training and Education Center for Health Kenya implemented an EIR system in 161 immunizing clinics in Siaya County between 2018 and 2019. The successful implementation of digital health tools depends on many factors, one of which is alignment between the technology and the context in which it is used. One important aspect of that implementation context is the perceptions of the health care workers (HCWs) using the EIR. Objective: This study aimed to evaluate HCWs' perceptions of the usability and acceptability of multiple clinic workflows using the new EIR. Methods: We performed a mixed methods pre-post study using semistructured interviews with HCWs at 6 facilities in Siaya County, Kenya. We interviewed HCWs at each facility 4 times: at baseline and once after the implementation of 3 different workflow modifications (n=24 interviews). The baseline state was dual data entry with paper records and the EIR. We then implemented 3 workflow modifications for 1 full day each: fully paperless data entry, preparation of an appointment diary before patient visits for the day, and a combination of the 2 workflows. We compared ratings and themes across interviews after each of the 4 workflows to understand the changes in the usability and acceptability of the EIR. Results: HCWs considered the EIR clinic workflows to be usable and acceptable. Of the modified workflows, HCWs perceived the fully paperless workflow most favorably. In all workflows, HCWs' perceived benefits included ease of clinical decision-making using the EIR, reduced mental burden of data entry when using the EIR, and ease of identification of errors. Perceived barriers to the workflow included contextual challenges such as staffing shortages and lack of network connectivity, EIR platform challenges such as errors in saving records and missing fields, and workflow challenges such as the dual data entry burden of using paper and digital tools simultaneously. Conclusions: Fully paperless EIR implementation shows great promise from a workflow acceptability standpoint, contingent upon the presence of supporting contextual clinic factors and the resolution of system performance and design challenges. Rather than trying to identify a singular best workflow, future efforts should provide adequate flexibility for HCWs to implement the new system in their unique clinic context. Future EIR implementation stands to benefit from continued monitoring of EIR adoption acceptability during implementation, both for Siaya's program and for other efforts around the globe, as digital health interventions become more widely used. ",
doi="10.2196/39383",
url="https://formative.jmir.org/2023/1/e39383",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995755"
}


@Article{info:doi/10.2196/38404,
author="Jones, Ffion Leah
and Bonfield, Stefanie
and Farrell, Jade
and Weston, Dale",
title="Understanding the Public's Attitudes Toward COVID-19 Vaccines in Nottinghamshire, United Kingdom: Qualitative Social Media Analysis",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="29",
volume="25",
pages="e38404",
keywords="COVID-19",
keywords="vaccine",
keywords="social media",
keywords="qualitative",
keywords="vaccine hesitancy",
keywords="infodemic",
keywords="misinformation",
keywords="infodemiology",
keywords="online health information",
keywords="content analysis",
keywords="Facebook",
keywords="Twitter",
keywords="transmission",
abstract="Background: COVID-19 vaccines remain central to the UK government's plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7\% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. Objective: This study aims to understand the public's attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. Methods: A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. Results: A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. Conclusions: The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions. ",
doi="10.2196/38404",
url="https://www.jmir.org/2023/1/e38404",
url="http://www.ncbi.nlm.nih.gov/pubmed/36812390"
}


@Article{info:doi/10.2196/41882,
author="Li, Yue
and Gee, William
and Jin, Kun
and Bond, Robert",
title="Examining Homophily, Language Coordination, and Analytical Thinking in Web-Based Conversations About Vaccines on Reddit: Study Using Deep Neural Network Language Models and Computer-Assisted Conversational Analyses",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="23",
volume="25",
pages="e41882",
keywords="vaccine hesitancy",
keywords="social media",
keywords="web-based conversations",
keywords="neural network language models",
keywords="computer-assisted conversational analyses",
abstract="Background: Vaccine hesitancy has been deemed one of the top 10 threats to global health. Antivaccine information on social media is a major barrier to addressing vaccine hesitancy. Understanding how vaccine proponents and opponents interact with each other on social media may help address vaccine hesitancy. Objective: We aimed to examine conversations between vaccine proponents and opponents on Reddit to understand whether homophily in web-based conversations impedes opinion exchange, whether people are able to accommodate their languages to each other in web-based conversations, and whether engaging with opposing viewpoints stimulates higher levels of analytical thinking. Methods: We analyzed large-scale conversational text data about human vaccines on Reddit from 2016 to 2018. Using deep neural network language models and computer-assisted conversational analyses, we obtained each Redditor's stance on vaccines, each post's stance on vaccines, each Redditor's language coordination score, and each post or comment's analytical thinking score. We then performed chi-square tests, 2-tailed t tests, and multilevel modeling to test 3 questions of interest. Results: The results show that both provaccine and antivaccine Redditors are more likely to selectively respond to Redditors who indicate similar views on vaccines (P<.001). When Redditors interact with others who hold opposing views on vaccines, both provaccine and antivaccine Redditors accommodate their language to out-group members (provaccine Redditors: P=.044; antivaccine Redditors: P=.047) and show no difference in analytical thinking compared with interacting with congruent views (P=.63), suggesting that Redditors do not engage in motivated reasoning. Antivaccine Redditors, on average, showed higher analytical thinking in their posts and comments than provaccine Redditors (P<.001). Conclusions: This study shows that although vaccine proponents and opponents selectively communicate with their in-group members on Reddit, they accommodate their language and do not engage in motivated reasoning when communicating with out-group members. These findings may have implications for the design of provaccine campaigns on social media. ",
doi="10.2196/41882",
url="https://www.jmir.org/2023/1/e41882",
url="http://www.ncbi.nlm.nih.gov/pubmed/36951921"
}


@Article{info:doi/10.2196/39777,
author="Dolan, B. Samantha
and Wittenauer, Rachel
and Njoroge, Anne
and Onyango, Penina
and Owiso, George
and Shearer, C. Jessica
and Lober, B. William
and Liu, Shan
and Puttkammer, Nancy
and Rabinowitz, Peter",
title="Time Utilization Among Immunization Clinics Using an Electronic Immunization Registry (Part 2): Time and Motion Study of Modified User Workflows",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="16",
volume="7",
pages="e39777",
keywords="immunizations",
keywords="electronic immunization registry",
keywords="workflow",
keywords="time and motion",
keywords="digital health intervention",
keywords="mixed methods evaluation",
abstract="Background: Digital health interventions have the potential to improve the provision of health care services through digitized data collection and management. Low- and middle-income countries are beginning to introduce electronic immunization registries (EIRs) into their routine immunization services to better capture and store childhood vaccination information. Especially in Africa, where 25\% of children remain unimmunized or underimmunized, technologies that can help identify children due for a vaccination are particularly important for improving vaccination coverage. However, an improved understanding of the effectiveness of these systems is needed to develop and deploy sustainable EIRs in low- and middle-income countries. Objective: We conducted an interventional pretest-posttest design study that sought to improve time efficiency through workflow modifications in Kenyan immunization clinics. Our aim was to describe how activity times differed after introducing workflow modifications that could potentially reduce the time needed to perform routine data entry activities. Our intent was to demonstrate changes in efficiency when moving from the existing dual--data entry workflow to a future paperless workflow by health facility size and experience length of health care workers (HCWs). Methods: We tested how 3 workflow modifications would affect time utilization among HCWs using the EIR at the point of care compared with baseline immunization clinic workflows. Our outcome of interest was the time taken to complete individual activities and a patient's total time in the clinic where we compared the time spent during the baseline workflow with that during the modified workflow. We used a standardized tool to observe and document the immunization clinic workflow. To estimate differences in time utilization, we used bivariate analyses and fit multivariate linear mixed-effects models. Results: Our study found that for HCWs using an EIR, the introduction of modified workflows decreased the amount of time needed to provide services to children seen in the immunization clinic. With a baseline mean time of 10 minutes spent per child, this decreased by about 3 minutes when the preparation modification was introduced and almost 5 minutes for the paperless and combined modifications. Results pertaining to the EIR's performance and ability to connect to the internet were particularly insightful about potential causes of delays. Conclusions: We were able to conduct a concise clinical simulation exercise by introducing modified workflows and estimating their impact on time utilization in immunization clinics using an EIR. We found that the paperless workflow provided the largest time savings when delivering services, although this was threatened by poor EIR performance and internet connectivity. This study demonstrated that not only should digital health interventions be built and adapted for particular use cases but existing user workflows also need to adapt to new technology. ",
doi="10.2196/39777",
url="https://formative.jmir.org/2023/1/e39777",
url="http://www.ncbi.nlm.nih.gov/pubmed/36927606"
}


@Article{info:doi/10.2196/42890,
author="Molokwu, Jennifer
and Mendez, Melissa
and Bracamontes, Christina",
title="The Effect of Clinical Decision Prompts in Improving Human Papillomavirus Vaccination Rates in a Multispecialty Practice in a Predominantly Hispanic Population: Quasi-Experimental Study",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="15",
volume="9",
pages="e42890",
keywords="HPV",
keywords="HPV vaccination",
keywords="electronic clinical decision support",
keywords="EMR prompt",
keywords="clinical",
keywords="decision",
keywords="vaccine",
keywords="pediatrics",
keywords="age",
keywords="ethnicity",
keywords="race",
keywords="language",
keywords="immunization",
abstract="Background: The human papillomavirus (HPV) is implicated in the causal pathway of cancers of the vulva, vagina, penis, cervix, anus, and oropharyngeal region. It is the most common sexually transmitted infection in the United States. Despite the documented safety and effectiveness of the HPV vaccine, rates lag behind those of other vaccines given at the same age. Objective: Provider recommendation is identified as a robust predictor of HPV vaccine uptake, and physician-prompting is shown to increase the provision of preventive care services in general. Theoretically, providing reminders to providers should increase opportunities for providing HPV vaccine recommendations and therefore affect vaccination rates. The objective of our study was to assess the effectiveness of an electronic medical record (EMR) prompt in improving HPV vaccination rates in an academic clinic setting caring for a predominantly Hispanic border population. Methods: We used a quasi-experimental design with a retrospective chart audit to evaluate the effect of a clinical decision prompt (CDP) on improving HPV immunization rates in different specialty settings. We introduced an EMR prompt to remind providers to recommend the HPV vaccine when seeing appropriate patients in an obstetrics and gynecology (OBGYN), pediatrics (PD), and family medicine (FM) clinic in a large multispecialty academic group located along the Texas-Mexico border. We assessed HPV vaccination rates in all the departments involved before and after introducing the prompts. Participants included male and female patients between the ages of 9 and 26 years, presenting at the clinics between January 2014 and December 2015. Results: We reviewed over 2800 charts in all 3 clinics. After adjusting for age, ethnicity, race, type of insurance, preferred language, and clinic, the odds of immunization were 92\% (P<.001) higher in patients after the prompt implementation of the EMR. In addition, there was an overall statistically significant increase in the overall HPV vaccination completion rates after implementing the CDP (31.96\% vs 21.22\%; P<.001). Again, OBGYN saw the most significant improvement in vaccination completion rates, with rates at follow-up 66.02\% higher than baseline rates (P=.04). PD and FM had somewhat similar but no less impressive improvements (57.7\% and 58.36\%; P<.001). Conclusions: Implementing an EMR CDP improved our overall odds of HPV vaccination completion by 92\%. We theorize that the decision prompts remind health care providers to discuss or recommend the HPV vaccination during clinical service delivery. CDPs in the EMR help increase HPV vaccination rates in multiple specialties and are a low-cost intervention for improving vaccination rates. ",
doi="10.2196/42890",
url="https://cancer.jmir.org/2023/1/e42890",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920453"
}


@Article{info:doi/10.2196/39775,
author="Dolan, B. Samantha
and Wittenauer, Rachel?
and Shearer, C. Jessica
and Njoroge, Anne
and Onyango, Penina
and Owiso, George
and Lober, B. William
and Liu, Shan
and Puttkammer, Nancy
and Rabinowitz, Peter",
title="Integration of a Digital Health Intervention Into Immunization Clinic Workflows in Kenya: Qualitative, Realist Evaluation of Technology Usability",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="14",
volume="7",
pages="e39775",
keywords="immunizations",
keywords="electronic immunization registry",
keywords="workflow",
keywords="usability",
keywords="realist research",
abstract="Background: In an effort to increase vaccination coverage in low-resource settings, digital tools have been introduced to better track immunization records, improve data management practices, and provide improved access to vaccination coverage data for decision-making. Despite the potential of these electronic systems to improve the provision of health services, few digital health interventions have been institutionalized at scale in low- and middle-income countries. Objective: In this paper, we aimed to describe how health care workers in Kenya had integrated an electronic immunization registry into their immunization clinic workflows and to use these findings to inform the development of a refined program theory on the registry's usability. Methods: Informed by realist methodology, we developed a program theory to explain usability of the electronic immunization registry. We designed a qualitative study based on our theory to describe the barriers and facilitators influencing data entry and use. Qualitative data were collected through semistructured interviews with users and workflow observations of immunization clinic sessions. Our findings were summarized by context-mechanism-outcome relationships formed after analyzing our key themes across interviews and workflow observations. Using these relationships, we were able to identify common rules for future implementers. Results: Across the 12 facilities included in our study, 19 health care workers were interviewed, and 58 workflow sessions were observed. The common rules developed from our qualitative findings are as follows: rule 1---ensure that the users complete training to build familiarity with the system, understand the value of the system and data, and know where to find support; rule 2---confirm that the system captures all data needed for users to provide routine health care services and is easy to navigate; rule 3---identify work-arounds for poor network, system performance, and too few staff or resources; and rule 4---make users aware of expected changes to their workflow, and how these changes might differ over time and by facility size or number of patients. Upon study completion, we revised the program theory to reflect the importance of the goals and workflows of electronic immunization registries aligning with reality. Conclusions: We created a deeper understanding of the underlying mechanisms for usability of the registry. We found that the electronic immunization registry had high acceptability among users; however, there were numerous barriers to using the system, even under ideal conditions, causing a misalignment between the system and the reality of the users' workflows and their environment. Human-centered design and human-factors methods can assist during pilot stages to better align systems with users' needs and again after scale-up to ensure that interventions are suitable for all user settings. ",
doi="10.2196/39775",
url="https://formative.jmir.org/2023/1/e39775",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917157"
}


@Article{info:doi/10.2196/40575,
author="Honcharov, Vlad
and Li, Jiawei
and Sierra, Maribel
and Rivadeneira, A. Natalie
and Olazo, Kristan
and Nguyen, T. Thu
and Mackey, K. Tim
and Sarkar, Urmimala",
title="Public Figure Vaccination Rhetoric and Vaccine Hesitancy: Retrospective Twitter Analysis",
journal="JMIR Infodemiology",
year="2023",
month="Mar",
day="10",
volume="3",
pages="e40575",
keywords="Twitter",
keywords="anti-vaccination",
keywords="Biterm Topic modeling",
keywords="inductive content analysis",
keywords="COVID-19",
keywords="social media",
keywords="health information",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="infodemiology",
keywords="misinformation",
abstract="Background: Social media has emerged as a critical mass communication tool, with both health information and misinformation now spread widely on the web. Prior to the COVID-19 pandemic, some public figures promulgated anti-vaccine attitudes, which spread widely on social media platforms. Although anti-vaccine sentiment has pervaded social media throughout the COVID-19 pandemic, it is unclear to what extent interest in public figures is generating anti-vaccine discourse. Objective: We examined Twitter messages that included anti-vaccination hashtags and mentions of public figures to assess the connection between interest in these individuals and the possible spread of anti-vaccine messages. Methods: We used a data set of COVID-19--related Twitter posts collected from the public streaming application programming interface from March to October 2020 and filtered it for anti-vaccination hashtags ``antivaxxing,'' ``antivaxx,'' ``antivaxxers,'' ``antivax,'' ``anti-vaxxer,'' ``discredit,'' ``undermine,'' ``confidence,'' and ``immune.'' Next, we applied the Biterm Topic model (BTM) to output topic clusters associated with the entire corpus. Topic clusters were manually screened by examining the top 10 posts most highly correlated in each of the 20 clusters, from which we identified 5 clusters most relevant to public figures and vaccination attitudes. We extracted all messages from these clusters and conducted inductive content analysis to characterize the discourse. Results: Our keyword search yielded 118,971 Twitter posts after duplicates were removed, and subsequently, we applied BTM to parse these data into 20 clusters. After removing retweets, we manually screened the top 10 tweets associated with each cluster (200 messages) to identify clusters associated with public figures. Extraction of these clusters yielded 768 posts for inductive analysis. Most messages were either pro-vaccination (n=329, 43\%) or neutral about vaccination (n=425, 55\%), with only 2\% (14/768) including anti-vaccination messages. Three main themes emerged: (1) anti-vaccination accusation, in which the message accused the public figure of holding anti-vaccination beliefs; (2) using ``anti-vax'' as an epithet; and (3) stating or implying the negative public health impact of anti-vaccination discourse. Conclusions: Most discussions surrounding public figures in common hashtags labelled as ``anti-vax'' did not reflect anti-vaccination beliefs. We observed that public figures with known anti-vaccination beliefs face scorn and ridicule on Twitter. Accusing public figures of anti-vaccination attitudes is a means of insulting and discrediting the public figure rather than discrediting vaccines. The majority of posts in our sample condemned public figures expressing anti-vax beliefs by undermining their influence, insulting them, or expressing concerns over public health ramifications. This points to a complex information ecosystem, where anti-vax sentiment may not reside in common anti-vax--related keywords or hashtags, necessitating further assessment of the influence that public figures have on this discourse. ",
doi="10.2196/40575",
url="https://infodemiology.jmir.org/2023/1/e40575",
url="http://www.ncbi.nlm.nih.gov/pubmed/37113377"
}


@Article{info:doi/10.2196/43893,
author="Wang, Qiang
and Yang, Liuqing
and Li, Lan
and Liu, Chang
and Jin, Hui
and Lin, Leesa",
title="Willingness to Vaccinate Against Herpes Zoster and Its Associated Factors Across WHO Regions: Global Systematic Review and Meta-Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="9",
volume="9",
pages="e43893",
keywords="herpes zoster vaccine",
keywords="willingness",
keywords="associated factors",
keywords="systematic review",
abstract="Background: A life-course immunization approach would enhance the quality of life across all age groups and improve societal well-being. The herpes zoster (HZ) vaccine is highly recommended for older adults to prevent HZ infection and related complications. The proportions of willingness to receive the HZ vaccine varies across countries, and various kinds of factors, including sociodemographics and individual perceptions, influence the willingness to vaccinate. Objective: We aim to estimate the HZ vaccination willingness rate and identify factors associated with vaccine uptake willingness across all World Health Organization (WHO) regions. Methods: A global systematic search was performed on PubMed, Web of Science, and the Cochrane Library for all papers related to the HZ vaccine published until June 20, 2022. Study characteristics were extracted for each included study. Using double arcsine transformation, vaccination willingness rates with 95\% CIs were pooled and reported. The willingness rate and associated factors were analyzed by geographical context. Associated factors were also summarized based on Health Belief Model (HBM) constructs. Results: Of the 26,942 identified records, 13 (0.05\%) papers were included, covering 14,066 individuals from 8 countries in 4 WHO regions (Eastern Mediterranean Region, European Region, Region of the Americas, and Western Pacific Region). The pooled vaccination willingness rate was 55.74\% (95\% CI 40.85\%-70.13\%). Of adults aged ?50 years, 56.06\% were willing to receive the HZ vaccine. After receiving health care workers' (HCWs) recommendations, 75.19\% of individuals were willing to get the HZ vaccine; without HCWs' recommendations, the willingness rate was only 49.39\%. The willingness rate was more than 70\% in the Eastern Mediterranean Region and approximately 55\% in the Western Pacific Region. The willingness rate was the highest in the United Arab Emirates and the lowest in China and the United Kingdom. The perception of HZ severity and susceptibility was positively associated with vaccination willingness. The perceived barriers to vaccination willingness (main reasons for unwillingness) included low trust in the effectiveness of the HZ vaccine, concerns about safety, financial concerns, and being unaware of the HZ vaccine's availability. Older individuals, those having lower education, or those having lower income levels were less likely to willing to be vaccinated. Conclusions: Only 1 in 2 individuals showed a willingness to be vaccinated against HZ. The willingness rate was the highest in the Eastern Mediterranean Region. Our findings show the critical role HCWs play in promoting HZ vaccination. Monitoring HZ vaccination willingness is necessary to inform public health decision-making. These findings provide critical insights for designing future life-course immunization programs. ",
doi="10.2196/43893",
url="https://publichealth.jmir.org/2023/1/e43893",
url="http://www.ncbi.nlm.nih.gov/pubmed/36892937"
}


@Article{info:doi/10.2196/38072,
author="Nguyen, Vincent
and Liu, Yunzhe
and Mumford, Richard
and Flanagan, Benjamin
and Patel, Parth
and Braithwaite, Isobel
and Shrotri, Madhumita
and Byrne, Thomas
and Beale, Sarah
and Aryee, Anna
and Fong, Erica Wing Lam
and Fragaszy, Ellen
and Geismar, Cyril
and Navaratnam, D. Annalan M.
and Hardelid, Pia
and Kovar, Jana
and Pope, Addy
and Cheng, Tao
and Hayward, Andrew
and Aldridge, Robert
and ",
title="Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="8",
volume="9",
pages="e38072",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccination",
keywords="global positioning system",
keywords="GPS",
keywords="movement tracking",
keywords="geographical tracking",
keywords="mobile app",
keywords="health application",
keywords="surveillance",
keywords="public health",
keywords="mHealth",
keywords="mobile surveillance",
keywords="tracking device",
keywords="geolocation",
abstract="Background: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. Objective: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. Methods: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. Results: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95\% CI --50.08 to --31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95\% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95\% CI --19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95\% CI 38.6-149.00; P=.69) in the 30 days after vaccination. Conclusions: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period. ",
doi="10.2196/38072",
url="https://publichealth.jmir.org/2023/1/e38072",
url="http://www.ncbi.nlm.nih.gov/pubmed/36884272"
}


@Article{info:doi/10.2196/41575,
author="Berger, Jiri
and Bruthans, Jan
and Kofr{\'a}nek, Ji?{\'i}",
title="Improving Implementation of an Electronic Prescription System for COVID-19 Vaccination in the Czech Republic: Process Modeling Approach",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="3",
volume="7",
pages="e41575",
keywords="eHealth",
keywords="electronic prescription",
keywords="process modeling",
keywords="state diagram",
keywords="COVID-19",
keywords="vaccination",
keywords="vaccine",
keywords="medical",
keywords="communication",
keywords="platform",
abstract="Background: It is very difficult to find a consensus that will be accepted by most players when creating health care legislation. The Czech electronic prescription system was launched in 2011 and new functions were introduced in 2018. To ensure that these functions will not conflict with any other existing law, a process modeling tool based on the patent ``Method and system for automated requirements modeling'' was used successfully in the Czech Republic for the first time. Objective: The aim of this project was to develop another successful application of process modeling to add COVID-19 vaccination records to the existing electronic prescription system. Methods: The method employed was based on the mathematical theory of hierarchical state diagrams and process models. In the first step, sketches that record the results of informal discussions, interviews, meetings, and workshops were prepared. Subsequently, the architecture containing the main participants and their high-level interactions was drafted. Finally, detailed process diagrams were drawn. Each semiresult was discussed with all involved team members and stakeholders to incorporate all comments. By repeating this procedure, individual topics were gradually resolved and the areas of discussion were narrowed down until reaching complete agreement. Results: This method proved to be faster, clearer, and significantly simpler than other methods. Owing to the use of graphic tools and symbols, the risk of errors, inaccuracies, and misunderstandings was significantly reduced. The outcome was used as an annex to the bill in the legislative process. One of the main benefits of this approach is gaining a higher level of understanding for all parties involved (ie, legislators, the medical community, patient organizations, and information technology professionals). The process architecture model in a form of a graphic scheme has proven to be a valuable communication platform and facilitated negotiation between stakeholders. Moreover, this model helped to avoid several inconsistencies that appeared during workshops and discussions. Our method worked successfully even when participants were from different knowledge areas. Conclusions: The vaccination record process model was drafted in 3 weeks and it took a total of 2 months to pass the bill. In comparison, the initial introduction of the electronic prescription system using conventional legislative methods took over 1 year, involving immediate creation of a text with legislative intent, followed by paragraph-by-section wording of the legislation that was commented on directly. These steps are repeated over and over, as any change in any part of the text has to be checked and rechecked within the entire document. Compared with conventional methods, we have shown that using our method for the process of modification of legislation related to such a complex issue as the integration of COVID-19 vaccination into an electronic prescription model significantly simplifies the preparation of a legislative standard. ",
doi="10.2196/41575",
url="https://formative.jmir.org/2023/1/e41575",
url="http://www.ncbi.nlm.nih.gov/pubmed/36787233"
}


@Article{info:doi/10.2196/42227,
author="Pierri, Francesco
and DeVerna, R. Matthew
and Yang, Kai-Cheng
and Axelrod, David
and Bryden, John
and Menczer, Filippo",
title="One Year of COVID-19 Vaccine Misinformation on Twitter: Longitudinal Study",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="24",
volume="25",
pages="e42227",
keywords="content analysis",
keywords="COVID-19",
keywords="infodemiology",
keywords="misinformation",
keywords="online health information",
keywords="social media",
keywords="trend analysis",
keywords="Twitter",
keywords="vaccines",
keywords="vaccine hesitancy",
abstract="Background: Vaccinations play a critical role in mitigating the impact of COVID-19 and other diseases. Past research has linked misinformation to increased hesitancy and lower vaccination rates. Gaps remain in our knowledge about the main drivers of vaccine misinformation on social media and effective ways to intervene. Objective: Our longitudinal study had two primary objectives: (1) to investigate the patterns of prevalence and contagion of COVID-19 vaccine misinformation on Twitter in 2021, and (2) to identify the main spreaders of vaccine misinformation. Given our initial results, we further considered the likely drivers of misinformation and its spread, providing insights for potential interventions. Methods: We collected almost 300 million English-language tweets related to COVID-19 vaccines using a list of over 80 relevant keywords over a period of 12 months. We then extracted and labeled news articles at the source level based on third-party lists of low-credibility and mainstream news sources, and measured the prevalence of different kinds of information. We also considered suspicious YouTube videos shared on Twitter. We focused our analysis of vaccine misinformation spreaders on verified and automated Twitter accounts. Results: Our findings showed a relatively low prevalence of low-credibility information compared to the entirety of mainstream news. However, the most popular low-credibility sources had reshare volumes comparable to those of many mainstream sources, and had larger volumes than those of authoritative sources such as the US Centers for Disease Control and Prevention and the World Health Organization. Throughout the year, we observed an increasing trend in the prevalence of low-credibility news about vaccines. We also observed a considerable amount of suspicious YouTube videos shared on Twitter. Tweets by a small group of approximately 800 ``superspreaders'' verified by Twitter accounted for approximately 35\% of all reshares of misinformation on an average day, with the top superspreader (@RobertKennedyJr) responsible for over 13\% of retweets. Finally, low-credibility news and suspicious YouTube videos were more likely to be shared by automated accounts. Conclusions: The wide spread of misinformation around COVID-19 vaccines on Twitter during 2021 shows that there was an audience for this type of content. Our findings are also consistent with the hypothesis that superspreaders are driven by financial incentives that allow them to profit from health misinformation. Despite high-profile cases of deplatformed misinformation superspreaders, our results show that in 2021, a few individuals still played an outsized role in the spread of low-credibility vaccine content. As a result, social media moderation efforts would be better served by focusing on reducing the online visibility of repeat spreaders of harmful content, especially during public health crises. ",
doi="10.2196/42227",
url="https://www.jmir.org/2023/1/e42227",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735835"
}


@Article{info:doi/10.2196/42357,
author="Beirakdar, Safwat
and Klingborg, Leon
and Herzig van Wees, Sibylle",
title="Attitudes of Swedish Language Twitter Users Toward COVID-19 Vaccination: Exploratory Qualitative Study",
journal="JMIR Infodemiology",
year="2023",
month="Feb",
day="22",
volume="3",
pages="e42357",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="COVID-19 vaccines",
keywords="social media",
keywords="Twitter",
keywords="qualitative analysis",
keywords="World Health Organization",
keywords="WHO's 3C model",
abstract="Background: Social media have played an important role in shaping COVID-19 vaccine choices during the pandemic. Understanding people's attitudes toward the vaccine as expressed on social media can help address the concerns of vaccine-hesitant individuals. Objective: The aim of this study was to understand the attitudes of Swedish-speaking Twitter users toward COVID-19 vaccines. Methods: This was an exploratory qualitative study that used a social media--listening approach. Between January and March 2022, a total of 2877 publicly available tweets in Swedish were systematically extracted from Twitter. A deductive thematic analysis was conducted using the World Health Organization's 3C model (confidence, complacency, and convenience). Results: Confidence in the safety and effectiveness of the COVID-19 vaccine appeared to be a major concern expressed on Twitter. Unclear governmental strategies in managing the pandemic in Sweden and the belief in conspiracy theories have further influenced negative attitudes toward vaccines. Complacency---the perceived risk of COVID-19 was low and booster vaccination was unnecessary; many expressed trust in natural immunity. Convenience---in terms of accessing the right information and the vaccine---highlighted a knowledge gap about the benefits and necessity of the vaccine, as well as complaints about the quality of vaccination services. Conclusions: Swedish-speaking Twitter users in this study had negative attitudes toward COVID-19 vaccines, particularly booster vaccines. We identified attitudes toward vaccines and misinformation, indicating that social media monitoring can help policy makers respond by developing proactive health communication interventions. ",
doi="10.2196/42357",
url="https://infodemiology.jmir.org/2023/1/e42357",
url="http://www.ncbi.nlm.nih.gov/pubmed/37012999"
}


@Article{info:doi/10.2196/40269,
author="Siddiqi, Arif Danya
and Ali, Feroz Rozina
and Shah, Taighoon Mubarak
and Dharma, Kumar Vijay
and Khan, Ali Anokhi
and Roy, Tapash
and Chandir, Subhash",
title="Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2023",
month="Feb",
day="17",
volume="6",
pages="e40269",
keywords="missed opportunities for vaccination",
keywords="mobile-based immunization decision support system",
keywords="catch-up immunizations",
abstract="Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization--recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators' understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8\% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8\% (17,378/17,961) of all immunization doses. A total of 3.2\% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. ",
doi="10.2196/40269",
url="https://pediatrics.jmir.org/2023/1/e40269",
url="http://www.ncbi.nlm.nih.gov/pubmed/36800221"
}


@Article{info:doi/10.2196/42671,
author="Hong, Yimin
and Xie, Fang
and An, Xinyu
and Lan, Xue
and Liu, Chunhe
and Yan, Lei
and Zhang, Han",
title="Evolution of Public Attitudes and Opinions Regarding COVID-19 Vaccination During the Vaccine Campaign in China: Year-Long Infodemiology Study of Weibo Posts",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="16",
volume="25",
pages="e42671",
keywords="COVID-19 vaccines",
keywords="social media",
keywords="infodemiology",
keywords="sentiment analysis",
keywords="opinion analysis",
keywords="monitoring public attitude",
keywords="gender differences",
keywords="LDA",
keywords="COVID-19",
abstract="Background: Monitoring people's perspectives on the COVID-19 vaccine is crucial for understanding public vaccination hesitancy and developing effective, targeted vaccine promotion strategies. Although this is widely recognized, studies on the evolution of public opinion over the course of an actual vaccination campaign are rare. Objective: We aimed to track the evolution of public opinion and sentiment toward COVID-19 vaccines in online discussions over an entire vaccination campaign. Moreover, we aimed to reveal the pattern of gender differences in attitudes and perceptions toward vaccination. Methods: We collected COVID-19 vaccine--related posts by the general public that appeared on Sina Weibo from January 1, 2021, to December 31, 2021; this period covered the entire vaccination process in China. We identified popular discussion topics using latent Dirichlet allocation. We further examined changes in public sentiment and topics during the 3 stages of the vaccination timeline. Gender differences in perceptions toward vaccination were also investigated. Results: Of 495,229 crawled posts, 96,145 original posts from individual accounts were included. Most posts presented positive sentiments (positive: 65,981/96,145, 68.63\%; negative: 23,184/96,145, 24.11\%; neutral: 6980/96,145, 7.26\%). The average sentiment scores were 0.75 (SD 0.35) for men and 0.67 (SD 0.37) for women. The overall trends in sentiment scores showed a mixed response to the number of new cases and significant events related to vaccine development and important holidays. The sentiment scores showed a weak correlation with new case numbers (R=0.296; P=.03). Significant sentiment score differences were observed between men and women (P<.001). Common and distinguishing characteristics were found among frequently discussed topics during the different stages, with significant differences in topic distribution between men and women (January 1, 2021, to March 31, 2021: $\chi$23=3030.9; April 1, 2021, to September 30, 2021: $\chi$24=8893.8; October 1, 2021, to December 31, 2021: $\chi$25=3019.5; P<.001). Women were more concerned with side effects and vaccine effectiveness. In contrast, men reported broader concerns around the global pandemic, the progress of vaccine development, and economics affected by the pandemic. Conclusions: Understanding public concerns regarding vaccination is essential for reaching vaccine-induced herd immunity. This study tracked the year-long evolution of attitudes and opinions on COVID-19 vaccines according to the different stages of vaccination in China. These findings provide timely information that will enable the government to understand the reasons for low vaccine uptake and promote COVID-19 vaccination nationwide. ",
doi="10.2196/42671",
url="https://www.jmir.org/2023/1/e42671",
url="http://www.ncbi.nlm.nih.gov/pubmed/36795467"
}


@Article{info:doi/10.2196/39166,
author="Li, Qingfeng
and Peng, Cheng James
and Mohan, Diwakar
and Lake, Brennan
and Euler, Ruiz Alex
and Weir, Brian
and Kan, Lena
and Yang, Cui
and Labrique, Alain",
title="Using Location Intelligence to Evaluate the COVID-19 Vaccination Campaign in the United States: Spatiotemporal Big Data Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Feb",
day="16",
volume="9",
pages="e39166",
keywords="COVID-19 vaccine",
keywords="vaccine campaign",
keywords="big data",
keywords="vaccination",
keywords="vaccine",
keywords="COVID-19",
keywords="uptake",
keywords="effectiveness",
keywords="barriers",
keywords="hesitancy",
keywords="health information",
abstract="Background: Highly effective COVID-19 vaccines are available and free of charge in the United States. With adequate coverage, their use may help return life back to normal and reduce COVID-19--related hospitalization and death. Many barriers to widespread inoculation have prevented herd immunity, including vaccine hesitancy, lack of vaccine knowledge, and misinformation. The Ad Council and COVID Collaborative have been conducting one of the largest nationwide targeted campaigns (``It's Up to You'') to communicate vaccine information and encourage timely vaccination across the United States. More than 300 major brands, digital and print media companies, and community-based organizations support the campaigns to reach distinct audiences. Objective: The goal of this study was to use aggregated mobility data to assess the effectiveness of the campaign on COVID-19 vaccine uptake. Methods: Campaign exposure data were collected from the Cuebiq advertising impact measurement platform consisting of about 17 million opted-in and deidentified mobile devices across the country. A Bayesian spatiotemporal hierarchical model was developed to assess campaign effectiveness through estimating the association between county-level campaign exposure and vaccination rates reported by the Centers for Disease Control and Prevention. To minimize potential bias in exposure to the campaign, the model included several control variables (eg, age, race or ethnicity, income, and political affiliation). We also incorporated conditional autoregressive residual models to account for apparent spatiotemporal autocorrelation. Results: The data set covers a panel of 3104 counties from 48 states and the District of Columbia during a period of 22 weeks (March 29 to August 29, 2021). Officially launched in February 2021, the campaign reached about 3\% of the anonymous devices on the Cuebiq platform by the end of March, which was the start of the study period. That exposure rate gradually declined to slightly above 1\% in August 2021, effectively ending the study period. Results from the Bayesian hierarchical model indicate a statistically significant positive association between campaign exposure and vaccine uptake at the county level. A campaign that reaches everyone would boost the vaccination rate by 2.2\% (95\% uncertainty interval: 2.0\%-2.4\%) on a weekly basis, compared to the baseline case of no campaign. Conclusions: The ``It's Up to You'' campaign is effective in promoting COVID-19 vaccine uptake, suggesting that a nationwide targeted mass media campaign with multisectoral collaborations could be an impactful health communication strategy to improve progress against this and future pandemics. Methodologically, the results also show that location intelligence and mobile phone--based monitoring platforms can be effective in measuring impact of large-scale digital campaigns in near real time. ",
doi="10.2196/39166",
url="https://publichealth.jmir.org/2023/1/e39166",
url="http://www.ncbi.nlm.nih.gov/pubmed/36626835"
}


@Article{info:doi/10.2196/35601,
author="Duong, Thien Huong
and Hopfer, Suellen",
title="Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="15",
volume="7",
pages="e35601",
keywords="cancer prevention",
keywords="Vietnamese",
keywords="family communication",
keywords="intervention",
keywords="colorectal cancer",
keywords="human papillomavirus vaccine",
keywords="HPV vaccine",
keywords="Papanicolaou test",
keywords="mobile phone",
abstract="Background: Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. Objective: In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members' motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. Methods: Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. Results: In total, 13 (65\%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members' receptivity to the messages. Themes that could potentially impact family members' willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of h?i th?m, respect for a physician's recommendation, prevention versus symptom orientation, the family health advocate's bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. Conclusions: The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families. ",
doi="10.2196/35601",
url="https://formative.jmir.org/2023/1/e35601",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790844"
}


@Article{info:doi/10.2196/41240,
author="Budhwani, Henna
and Maragh-Bass, C. Allysha
and Tolley, E. Elizabeth
and Comello, G. Maria Leonora
and Stoner, D. Marie C.
and Adams Larsen, Margo
and Brambilla, Donald
and Muessig, E. Kathryn
and Pettifor, Audrey
and Bond, L. Christyenne
and Toval, Christina
and Hightow-Weidman, B. Lisa",
title="Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Feb",
day="13",
volume="12",
pages="e41240",
keywords="COVID-19",
keywords="COVID",
keywords="vaccine hesitancy framework",
keywords="African American",
keywords="young adults",
keywords="implementation science",
keywords="digital health",
keywords="mHealth",
keywords="behavioral intervention",
keywords="vaccination",
keywords="intervention",
keywords="mortality",
keywords="USA",
abstract="Background: Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. Objective: In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. Methods: Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University's institutional review board approved the study (STUDY00003617). Results: Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. Conclusions: If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329 International Registered Report Identifier (IRRID): DERR1-10.2196/41240 ",
doi="10.2196/41240",
url="https://www.researchprotocols.org/2023/1/e41240",
url="http://www.ncbi.nlm.nih.gov/pubmed/36689557"
}


@Article{info:doi/10.2196/40057,
author="Zang, Shujie
and Zhang, Xu
and Xing, Yuting
and Chen, Jiaxian
and Lin, Leesa
and Hou, Zhiyuan",
title="Applications of Social Media and Digital Technologies in COVID-19 Vaccination: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="10",
volume="25",
pages="e40057",
keywords="social media",
keywords="digital health",
keywords="COVID-19",
keywords="vaccination",
keywords="review",
abstract="Background: Social media and digital technologies have played essential roles in disseminating information and promoting vaccination during the COVID-19 pandemic. There is a need to summarize the applications and analytical techniques of social media and digital technologies in monitoring vaccine attitudes and administering COVID-19 vaccines. Objective: We aimed to synthesize the global evidence on the applications of social media and digital technologies in COVID-19 vaccination and to explore their avenues to promote COVID-19 vaccination. Methods: We searched 6 databases (PubMed, Scopus, Web of Science, Embase, EBSCO, and IEEE Xplore) for English-language articles from December 2019 to August 2022. The search terms covered keywords relating to social media, digital technology, and COVID-19 vaccines. Articles were included if they provided original descriptions of applications of social media or digital health technologies/solutions in COVID-19 vaccination. Conference abstracts, editorials, letters, commentaries, correspondence articles, study protocols, and reviews were excluded. A modified version of the Appraisal Tool for Cross-Sectional Studies (AXIS tool) was used to evaluate the quality of social media--related studies. The review was undertaken with the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Results: A total of 178 articles were included in our review, including 114 social media articles and 64 digital technology articles. Social media has been applied for sentiment/emotion analysis, topic analysis, behavioral analysis, dissemination and engagement analysis, and information quality analysis around COVID-19 vaccination. Of these, sentiment analysis and topic analysis were the most common, with social media data being primarily analyzed by lexicon-based and machine learning techniques. The accuracy and reliability of information on social media can seriously affect public attitudes toward COVID-19 vaccines, and misinformation often leads to vaccine hesitancy. Digital technologies have been applied to determine the COVID-19 vaccination strategy, predict the vaccination process, optimize vaccine distribution and delivery, provide safe and transparent vaccination certificates, and perform postvaccination surveillance. The applied digital technologies included algorithms, blockchain, mobile health, the Internet of Things, and other technologies, although with some barriers to their popularization. Conclusions: The applications of social media and digital technologies in addressing COVID-19 vaccination--related issues represent an irreversible trend. Attention should be paid to the ethical issues and health inequities arising from the digital divide while applying and promoting these technologies. ",
doi="10.2196/40057",
url="https://www.jmir.org/2023/1/e40057",
url="http://www.ncbi.nlm.nih.gov/pubmed/36649235"
}


@Article{info:doi/10.2196/43007,
author="Sossenheimer, Philip
and Hong, Grace
and Devon-Sand, Anna
and Lin, Steven",
title="Voice Assistants' Responses to Questions About the COVID-19 Vaccine: National Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="8",
volume="7",
pages="e43007",
keywords="artificial intelligence",
keywords="mHealth",
keywords="misinformation",
keywords="public health",
keywords="vaccination hesitancy",
keywords="vaccination",
keywords="online",
keywords="COVID-19",
keywords="information",
keywords="users",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Artificial intelligence-powered voice assistants (VAs), such as Apple Siri, Google Assistant, and Amazon Alexa, interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information. Objective: In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. Methods: A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed was conducted online from April 22 to 28, 2021. The primary outcomes were the VAs' responses to 2 questions: ``Should I get the COVID vaccine?'' and ``Is the COVID vaccine safe?'' Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi-square or Fisher exact test for categorical variables. Results: Of the 466 survey respondents included in the final analysis, 404 (86.7\%) used Apple Siri, 53 (11.4\%) used Google Assistant, and 9 (1.9\%) used Amazon Alexa. In response to the question ``Is the COVID vaccine safe?'' 419 (89.9\%) users received a direct response, of which 408 (97.3\%) had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3\% (11/207) had a positive connotation and 94.7\% (196/207) had a neutral connotation. In response to the question ``Should I get the COVID vaccine?'' 93.1\% (434/466) of users received a list of websites, of which 91.5\% (1155/1262) had a neutral connotation. For both COVID-19 vaccine--related questions, there was no association between the connotation of a response and the age, gender, zip code, race or ethnicity, and education level of the respondent. Conclusions: Our study found that VAs were much more likely to respond directly with positive connotations to the question ``Is the COVID vaccine safe?'' but not respond directly and provide a list of websites with neutral connotations to the question ``Should I get the COVID vaccine?'' To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination. ",
doi="10.2196/43007",
url="https://formative.jmir.org/2023/1/e43007",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719815"
}


@Article{info:doi/10.2196/42623,
author="Park, Susan
and Suh, Young-Kyoon",
title="A Comprehensive Analysis of COVID-19 Vaccine Discourse by Vaccine Brand on Twitter in Korea: Topic and Sentiment Analysis",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="31",
volume="25",
pages="e42623",
keywords="COVID-19",
keywords="vaccine",
keywords="vaccination",
keywords="Pfizer",
keywords="Moderna",
keywords="AstraZeneca",
keywords="Janssen",
keywords="Novavax",
abstract="Background: ?The unprecedented speed of COVID-19 vaccine development and approval has raised public concern about its safety. However, studies on public discourses and opinions on social media focusing on adverse events (AEs) related to COVID-19 vaccine are rare. Objective: ?This study aimed to analyze Korean tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, Janssen, and Novavax) after the vaccine rollout, explore the topics and sentiments of tweets regarding COVID-19 vaccines, and examine their changes over time. We also analyzed topics and sentiments focused on AEs related to vaccination using only tweets with terms about AEs. Methods: ?We devised a sophisticated methodology consisting of 5 steps: keyword search on Twitter, data collection, data preprocessing, data analysis, and result visualization. We used the Twitter Representational State Transfer application programming interface for data collection. A total of 1,659,158 tweets were collected from February 1, 2021, to March 31, 2022. Finally, 165,984 data points were analyzed after excluding retweets, news, official announcements, advertisements, duplicates, and tweets with <2 words. We applied a variety of preprocessing techniques that are suitable for the Korean language. We ran a suite of analyses using various Python packages, such as latent Dirichlet allocation, hierarchical latent Dirichlet allocation, and sentiment analysis. Results: ?The topics related to COVID-19 vaccines have a very large spectrum, including vaccine-related AEs, emotional reactions to vaccination, vaccine development and supply, and government vaccination policies. Among them, the top major topic was AEs related to COVID-19 vaccination. The AEs ranged from the adverse reactions listed in the safety profile (eg, myalgia, fever, fatigue, injection site pain, myocarditis or pericarditis, and thrombosis) to unlisted reactions (eg, irregular menstruation, changes in appetite and sleep, leukemia, and deaths). Our results showed a notable difference in the topics for each vaccine brand. The topics pertaining to the Pfizer vaccine mainly mentioned AEs. Negative public opinion has prevailed since the early stages of vaccination. In the sentiment analysis based on vaccine brand, the topics related to the Pfizer vaccine expressed the strongest negative sentiment. Conclusions: ?Considering the discrepancy between academic evidence and public opinions related to COVID-19 vaccination, the government should provide accurate information and education. Furthermore, our study suggests the need for management to correct the misinformation related to vaccine-related AEs, especially those affecting negative sentiments. This study provides valuable insights into the public discourses and opinions regarding COVID-19 vaccination. ",
doi="10.2196/42623",
url="https://www.jmir.org/2023/1/e42623",
url="http://www.ncbi.nlm.nih.gov/pubmed/36603153"
}


@Article{info:doi/10.2196/43055,
author="Tran, Xuan Bach
and Do, Linh Anh
and Boyer, Laurent
and Auquier, Pascal
and Le, Thi Huong
and Le Vu, Ngoc Minh
and Dang, Thi Trang Huyen
and Cao, Minh Khuy
and Le, Thi Linh Dieu
and Cu, Ngoc Lam Tung
and Ly, Viet Bang
and Nguyen, Thi Duong Anh
and Nguyen, Duc Manh
and Latkin, A. Carl
and Ho, M. Roger C.
and Ho, H. Cyrus S.
and Zhang, B. Melvyn W.",
title="Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="31",
volume="9",
pages="e43055",
keywords="COVID-19",
keywords="epidemic",
keywords="vaccine",
keywords="booster",
keywords="willingness to take",
keywords="willingness to pay",
keywords="Vietnam",
keywords="policy",
keywords="feasibility",
keywords="acceptability",
keywords="infection",
keywords="vaccination",
keywords="social media",
keywords="intervention",
abstract="Background: The COVID-19 booster vaccination rate has declined despite the wide availability of vaccines. As COVID-19 is becoming endemic and charges for regular booster vaccination are being introduced, measuring public acceptance and the willingness to pay for regular COVID-19 boosters is ever more crucial. Objective: This study aims to (1) investigate public acceptance for regular COVID-19 boosters, (2) assess the willingness to pay for a COVID-19 booster shot, and (3) identify factors associated with vaccine hesitancy. Our results will provide crucial insights into and implications for policy response as well as the development of a feasible and effective vaccination campaign during Vietnam's waning vaccine immunity period. Methods: A cross-sectional study was conducted among 871 Vietnamese online participants from April to August 2022. An online questionnaire based on the discrete choice experiment (DCE) design was developed, distributed using the snowball sampling method, and subsequently conjointly analyzed on the Qualtrics platform. A history of COVID-19 infection and vaccination, health status, willingness to vaccinate, willingness to pay, and other factors were examined. Results: Among the participants, 761 (87.4\%) had received or were waiting for a COVID-19 booster shot. However, the willingness to pay was low at US \$8.02, and most participants indicated an unwillingness to pay (n=225, 25.8\%) or a willingness to pay for only half of the vaccine costs (n=222, 25.4\%). Although information insufficiency and a wariness toward vaccines were factors most associated with the unwillingness to pay, long-term side effects, immunity duration, and mortality rate were the attributes the participants were most concerned with during the vaccine decision-making period. Participants who had children less than 18 years old in their homes infected with COVID-19 had a lower willingness to pay (odds ratio [OR] 0.54, 95\% CI 0.39-0.74). Respondents who had children under 12 years old in their family who received at least 1 vaccine dose had a higher willingness to pay (OR 2.03, 95\% CI 1.12-3.66). The burden of medical expenses (OR 0.33, 95\% CI 0.25-0.45) and fear of the vaccine (OR 0.93, 95\% CI 0.86-1.00) were negative factors associated with the level of willingness to pay. Conclusions: A significant inconsistency between high acceptance and a low willingness to pay underscores the role of vaccine information and public trust. In addition to raising awareness about the most concerning characteristics of the COVID-19 booster, social media and social listening should be used in collaboration with health professionals to establish a 2-way information exchange. Work incentives and suitable mandates should continue to encourage workforce participation. Most importantly, all interventions should be conducted with informational transparency to strengthen trust between the public and authorities. ",
doi="10.2196/43055",
url="https://publichealth.jmir.org/2023/1/e43055",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599156"
}


@Article{info:doi/10.2196/39045,
author="Perez-Ramos, G. Jose
and Leon-Thomas, Mariela
and Smith, L. Sabrina
and Silverman, Laura
and Perez-Torres, Claudia
and Hall, C. Wyatte
and Iadarola, Suzannah",
title="COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="25",
volume="7",
pages="e39045",
keywords="mHealth",
keywords="ICT",
keywords="Information and Communication Technology",
keywords="community",
keywords="chatbot",
keywords="COVID-19",
keywords="health equity",
keywords="mobile health",
keywords="health outcome",
keywords="health disparity",
keywords="minority population",
keywords="health care gap",
keywords="chatbot tool",
keywords="user experience",
keywords="chatbot development",
keywords="health information",
abstract="Background: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. Objective: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named ``Ana'' and (2) characterize and evaluate user experiences of these innovative technologies. Methods: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of {\ss} chatbots were tested, and a total of 22 {\ss} testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. Results: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87\% (n=221) of English users and 22.14\% (n=62) of Spanish users returned to use Ana at least once; 18.49\% (n=64) among the English version users and 18.57\% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the ``smiley'' and ``loved'' emojis, and negative ranking comprised the ``neutral,'' ``sad,'' and ``mad'' emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06\%; Spanish: n=41, 77.35\%) versus the former (English: n=23, 35.93\%; Spanish: n=12, 22.64\%). Conclusions: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19--related information. ",
doi="10.2196/39045",
url="https://formative.jmir.org/2023/1/e39045",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630649"
}


@Article{info:doi/10.2196/42837,
author="Lee, Minjung
and Oh, Bumjo
and Yoon, Nan-He
and Kim, Shinkyeong
and Jung, Young-Il",
title="The Evaluation of Web-Based Communication Interventions to Support Decisions About COVID-19 Vaccination Among Patients With Underlying Medical Conditions: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="19",
volume="12",
pages="e42837",
keywords="COVID-19",
keywords="vaccine",
keywords="decision-making",
keywords="randomized controlled trial",
keywords="patient decision aid",
abstract="Background: The timeliness of raising vaccine acceptance and uptake among the public is essential to overcoming COVID-19; however, the decision-making process among patients with underlying medical conditions is complex, leading individuals to vaccine hesitancy because of their health status. Although vaccine implementation is more effective when deployed as soon as possible, vaccine hesitancy is a significant threat to the success of vaccination programs. Objective: This study aims to evaluate the effectiveness of a communication tool for patients with underlying medical conditions who should decide whether to receive a COVID-19 vaccine. Methods: This 3-arm prospective randomized controlled trial will test the effect of the developed communication intervention, which is fully automated, patient decision aid (SMART-DA), and user-centered information (SMART-DA-$\alpha$). The web-based intervention was developed to help decision-making regarding COVID-19 vaccination among patients with underlying medical conditions. Over 450 patients will be enrolled on the web from a closed panel access website and randomly assigned to 1 of 3 equal groups stratified by their underlying disease, sex, age, and willingness to receive a COVID-19 vaccine. SMART-DA-$\alpha$ provides additional information targeted at helping patients' decision-making regarding COVID-19 vaccination. Implementation outcomes are COVID-19 vaccination intention, vaccine knowledge, decisional conflict, stress related to decision-making, and attitudes toward vaccination, and was self-assessed through questionnaires. Results: This study was funded in 2020 and approved by the Clinical Research Information Service, Republic of Korea. Data were collected from December 2021 to January 2022. This paper was initially submitted before data analysis. The results are expected to be published in the winter of 2023. Conclusions: We believe that the outcomes of this study will provide valuable new insights into the potential of decision aids for supporting informed decision-making regarding COVID-19 vaccination and discovering the barriers to making informed decisions regarding COVID-19 vaccination, especially among patients with underlying medical conditions. This study will provide knowledge about the common needs, fears, and perceptions concerning vaccines among patients, which can help tailor information for individuals and develop policies to support them. Trial Registration: Korea Clinical Information Service KCT0006945; https://cris.nih.go.kr/cris/search/detailSearch.do/20965 International Registered Report Identifier (IRRID): DERR1-10.2196/42837 ",
doi="10.2196/42837",
url="https://www.researchprotocols.org/2023/1/e42837",
url="http://www.ncbi.nlm.nih.gov/pubmed/36599054"
}


@Article{info:doi/10.2196/40201,
author="Zhao, Sihong
and Hu, Simeng
and Zhou, Xiaoyu
and Song, Suhang
and Wang, Qian
and Zheng, Hongqiu
and Zhang, Ying
and Hou, Zhiyuan",
title="The Prevalence, Features, Influencing Factors, and Solutions for COVID-19 Vaccine Misinformation: Systematic Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Jan",
day="11",
volume="9",
pages="e40201",
keywords="COVID-19",
keywords="COVID-19 vaccine",
keywords="misinformation",
keywords="anti-vaccine",
keywords="review",
keywords="social media",
keywords="survey",
abstract="Background: During the COVID-19 pandemic, infodemic spread even more rapidly than the pandemic itself. The COVID-19 vaccine hesitancy has been prevalent worldwide and hindered pandemic exiting strategies. Misinformation around COVID-19 vaccines is a vital contributor to vaccine hesitancy. However, no evidence systematically summarized COVID-19 vaccine misinformation. Objective: This review aims to synthesize the global evidence on misinformation related to COVID-19 vaccines, including its prevalence, features, influencing factors, impacts, and solutions for combating misinformation. Methods: We performed a systematic review by searching 5 peer-reviewed databases (PubMed, Embase, Web of Science, Scopus, and EBSCO). We included original articles that investigated misinformation related to COVID-19 vaccines and were published in English from January 1, 2020, to August 18, 2022. We excluded publications that did not cover or focus on COVID-19 vaccine misinformation. The Appraisal tool for Cross-Sectional Studies, version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2), and Critical Appraisal Skills Programme Checklist were used to assess the study quality. The review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and registered with PROSPERO (CRD42021288929). Results: Of the 8864 studies identified, 91 observational studies and 11 interventional studies met the inclusion criteria. Misinformation around COVID-19 vaccines covered conspiracy, concerns on vaccine safety and efficacy, no need for vaccines, morality, liberty, and humor. Conspiracy and safety concerns were the most prevalent misinformation. There was a great variation in misinformation prevalence, noted among 2.5\%-55.4\% in the general population and 6.0\%-96.7\% in the antivaccine/vaccine hesitant groups from survey-based studies, and in 0.1\%-41.3\% on general online data and 0.5\%-56\% on antivaccine/vaccine hesitant data from internet-based studies. Younger age, lower education and economic status, right-wing and conservative ideology, and having psychological problems enhanced beliefs in misinformation. The content, format, and source of misinformation influenced its spread. A 5-step framework was proposed to address vaccine-related misinformation, including identifying misinformation, regulating producers and distributors, cutting production and distribution, supporting target audiences, and disseminating trustworthy information. The debunking messages/videos were found to be effective in several experimental studies. Conclusions: Our review provides comprehensive and up-to-date evidence on COVID-19 vaccine misinformation and helps responses to vaccine infodemic in future pandemics. Trial Registration: PROSPERO CRD42021288929; https://tinyurl.com/2prejtfa ",
doi="10.2196/40201",
url="https://publichealth.jmir.org/2023/1/e40201",
url="http://www.ncbi.nlm.nih.gov/pubmed/36469911"
}


@Article{info:doi/10.2196/40291,
author="Kaplan, Samantha
and von Isenburg, Megan
and Waldrop, Lucy",
title="Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="11",
volume="7",
pages="e40291",
keywords="antivaccination behavior",
keywords="web archiving",
keywords="content analysis",
keywords="COVID-19 vaccines",
keywords="COVID-19",
keywords="vaccine",
keywords="website",
keywords="web",
keywords="pandemic",
keywords="safety",
keywords="science",
keywords="content",
abstract="Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. ",
doi="10.2196/40291",
url="https://formative.jmir.org/2023/1/e40291",
url="http://www.ncbi.nlm.nih.gov/pubmed/36548948"
}


@Article{info:doi/10.2196/39220,
author="Montagni, Ilaria
and Pouymayou, Aude
and Pereira, Edwige
and Tzourio, Christophe
and Sch{\"u}ck, St{\'e}phane
and Texier, Nathalie
and Gonz{\'a}lez-Caballero, Luis Juan
and ",
title="Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale",
journal="J Med Internet Res",
year="2022",
month="Dec",
day="14",
volume="24",
number="12",
pages="e39220",
keywords="Internet",
keywords="literacy",
keywords="measurement",
keywords="vaccination",
keywords="vaccine",
keywords="health information",
keywords="health literacy",
keywords="online",
keywords="content",
keywords="validity",
keywords="reliability",
keywords="digital literacy",
abstract="Background: The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online. Objective: This study aims to develop a tool measuring DVL and assess its psychometric properties. Methods: A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity. Results: We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01). Conclusions: The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL. ",
doi="10.2196/39220",
url="https://www.jmir.org/2022/12/e39220",
url="http://www.ncbi.nlm.nih.gov/pubmed/36515982"
}


@Article{info:doi/10.2196/35712,
author="Domingueti, Daniel
and Barbosa Feres Carvalho, Darlinton
and Colombo Dias, Roberto Diego
and Oliveira, Concei{\c{c}}{\~a}o Val{\'e}ria",
title="Software-Based Simulation on a 3D Environment for Vaccination Teaching and Learning: Design Science Research",
journal="JMIR Med Educ",
year="2022",
month="Dec",
day="2",
volume="8",
number="4",
pages="e35712",
keywords="software simulation",
keywords="vaccination room",
keywords="immunization",
keywords="teaching",
keywords="training",
keywords="evaluation",
keywords="virtual world",
keywords="Unity3D",
keywords="SUS",
keywords="UTAUT2",
abstract="Background: Student training requires specific laboratories for vaccination practice, which are usually limited, and even professionals' continuing education regularly lacks proper care. Thus, new methodologies, concepts, and technologies, such as software-based simulations, are in highly demand. Objective: This work aims to develop a 3D virtual environment to support teaching activities in the vaccination room. The software-based simulation must contribute positively to teaching considering a variable set of scenarios. Methods: We applied the design science research method to guide the work. First, the concepts and opportunities were raised, which we used to build the simulation (ie, the proposed technological artifact). The development was assisted by a specialist, in which we sought to create a vaccination room according to Brazilian standards. The artifact evaluation was achieved in 2 stages: (1) an evaluation to validate the design with experts through the Delphi method; and (2) a field evaluation with nursing students to validate aspects of usability (System Usability Scale [SUS]) and technology acceptance and use (Unified Theory of Acceptance and Use of Technology version 2). Results: We built the simulation software using the Unity game engine. An additional module was also developed to create simulation scenarios and view the students' performance reports. The design evaluation showed that the proposed solution is adequate. Students' evaluations confirm good usability (SUS score of 81.4), besides highlighting Performance Expectation as the most positively influential factor of Behavioral Intention. Effort Expectancy is positively affected by younger users. Both evaluation audiences cited the high relevance of the proposed artifact for teaching. Points for improvement are also reported. Conclusions: The research accomplished its goal of creating a software-based simulation to support teaching scenarios in the vaccination room. The evaluations still reveal desirable improvements and user behavior toward this kind of technological artifact. ",
doi="10.2196/35712",
url="https://mededu.jmir.org/2022/4/e35712",
url="http://www.ncbi.nlm.nih.gov/pubmed/36459390"
}


@Article{info:doi/10.2196/39109,
author="Nguyen, Elaine
and Wright, Melanie
and Holmes, John
and Cleveland, Kevin
and Oliphant, Catherine
and Nies, Mary
and Robinson, Renee",
title="Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States",
journal="JMIR Form Res",
year="2022",
month="Dec",
day="1",
volume="6",
number="12",
pages="e39109",
keywords="COVID-19",
keywords="COVID-19 vaccines",
keywords="vaccine hesitancy",
keywords="cross-sectional studies",
keywords="rural populations",
abstract="Background: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. Objective: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. Methods: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators' previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ?18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. Results: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent's health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. Conclusions: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers. ",
doi="10.2196/39109",
url="https://formative.jmir.org/2022/12/e39109",
url="http://www.ncbi.nlm.nih.gov/pubmed/36067411"
}


@Article{info:doi/10.2196/37559,
author="Kim, Jung Sunny
and Schiffelbein, E. Jenna
and Imset, Inger
and Olson, L. Ardis",
title="Countering Antivax Misinformation via Social Media: Message-Testing Randomized Experiment for Human Papillomavirus Vaccination Uptake",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="24",
volume="24",
number="11",
pages="e37559",
keywords="misinformation",
keywords="vaccine hesitancy",
keywords="vaccine communication",
keywords="social media",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
abstract="Background: Suboptimal adolescent human papillomavirus (HPV) vaccination rates have been attributed to parental perceptions of the HPV vaccine. The internet has been cited as a setting where misinformation and controversy about HPV vaccination have been amplified. Objective: We aimed to test message effectiveness in changing parents' attitudes and behavioral intentions toward HPV vaccination. Methods: We conducted a web-based message-testing experiment with 6 control messages and 25 experimental messages and 5 from each of the 5 salient themes about HPV vaccination (theme 1: safety, side effects, risk, and ingredient concerns and long-term or major adverse events; theme 2: distrust of the health care system; theme 3: HPV vaccine effectiveness concerns; theme 4: connection to sexual activity; and theme 5: misinformation about HPV or HPV vaccine). Themes were identified from previous web-based focus group research with parents, and specific messages were developed by the study team using content from credible scientific sources. Through an iterative process of message development, the messages were crafted to be appropriate for presentation on a social media platform. Among the 1713 participants recruited via social media and crowdsourcing sites, 1043 eligible parents completed a pretest survey questionnaire. Participants were then randomly assigned to 1 of the 31 messages and asked to complete a posttest survey questionnaire that assessed attitudes toward the vaccine and perceived effectiveness of the viewed message. A subgroup of participants (189/995, 19\%) with unvaccinated children aged 9 to 14 years was also assessed for their behavioral intention to vaccinate their children against HPV. Results: Parents in the experimental group had increased positive attitudes toward HPV vaccination compared with those in the control group (t969=3.03, P=.003), which was associated with increased intention to vaccinate among parents of unvaccinated children aged 9 to 14 years (r=1.14, P=.05). At the thematic level, we identified 4 themes (themes 2-5) that were relatively effective in increasing behavioral intentions by positively influencing attitudes toward the HPV vaccine ($\chi$25=5.97, P=.31, root mean square error of approximation [RMSEA]=0.014, comparative fit index [CFI]=0.91, standardized root mean square residual [SRMR]=0.031). On the message level, messages that provided scientific evidence from government-related sources (eg, the Centers for Disease Control and Prevention) and corrected misinformation (eg, ``vaccines like the HPV vaccine are simply a way for pharmaceutical companies to make money. That isn't true'') were effective in forming positive perceptions toward the HPV vaccination messages. Conclusions: Evidence-based messages directly countering misinformation and promoting HPV vaccination in social media environments can positively influence parents' attitudes and behavioral intentions to vaccinate their children against HPV. ",
doi="10.2196/37559",
url="https://www.jmir.org/2022/11/e37559",
url="http://www.ncbi.nlm.nih.gov/pubmed/36422887"
}


@Article{info:doi/10.2196/40701,
author="Wang, Dandan
and Zhou, Yadong
and Ma, Feicheng",
title="Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="18",
volume="24",
number="11",
pages="e40701",
keywords="COVID-19",
keywords="COVID-19 vaccine",
keywords="echo chamber",
keywords="opinion leader",
keywords="structural hole spanner",
keywords="topic",
keywords="sentiment",
keywords="social media",
keywords="vaccine hesitancy",
keywords="public health",
keywords="vaccination",
keywords="health promotion",
keywords="online campaign",
keywords="social network analysis",
abstract="Background: Social media provide an ideal medium for breeding and reinforcing vaccine hesitancy, especially during public health emergencies. Algorithmic recommendation--based technology along with users' selective exposure and group pressure lead to online echo chambers, causing inefficiency in vaccination promotion. Avoiding or breaking echo chambers largely relies on key users' behavior. Objective: With the ultimate goal of eliminating the impact of echo chambers related to vaccine hesitancy on social media during public health emergencies, the aim of this study was to develop a framework to quantify the echo chamber effect in users' topic selection and attitude contagion about COVID-19 vaccines or vaccinations; detect online opinion leaders and structural hole spanners based on network attributes; and explore the relationships of their behavior patterns and network locations, as well as the relationships of network locations and impact on topic-based and attitude-based echo chambers. Methods: We called the Sina Weibo application programming interface to crawl tweets related to the COVID-19 vaccine or vaccination and user information on Weibo, a Chinese social media platform. Adopting social network analysis, we examined the low echo chamber effect based on topics in representational networks of information, according to attitude in communication flow networks of users under different interactive mechanisms (retweeting, commenting). Statistical and visual analyses were used to characterize behavior patterns of key users (opinion leaders, structural hole spanners), and to explore their function in avoiding or breaking topic-based and attitude-based echo chambers. Results: Users showed a low echo chamber effect in vaccine-related topic selection and attitude interaction. For the former, the homophily was more obvious in retweeting than in commenting, whereas the opposite trend was found for the latter. Speakers, replicators, and monologists tended to be opinion leaders, whereas common users, retweeters, and networkers tended to be structural hole spanners. Both leaders and spanners tended to be ``bridgers'' to disseminate diverse topics and communicate with users holding cross-cutting attitudes toward COVID-19 vaccines. Moreover, users who tended to echo a single topic could bridge multiple attitudes, while users who focused on diverse topics also tended to serve as bridgers for different attitudes. Conclusions: This study not only revealed a low echo chamber effect in vaccine hesitancy, but further elucidated the underlying reasons from the perspective of users, offering insights for research about the form, degree, and formation of echo chambers, along with depolarization, social capital, stakeholder theory, user portraits, dissemination pattern of topic, and sentiment. Therefore, this work can help to provide strategies for public health and public opinion managers to cooperate toward avoiding or correcting echo chamber chaos and effectively promoting online vaccine campaigns. ",
doi="10.2196/40701",
url="https://www.jmir.org/2022/11/e40701",
url="http://www.ncbi.nlm.nih.gov/pubmed/36367965"
}


@Article{info:doi/10.2196/42261,
author="Ljaji{\'c}, Adela
and Prodanovi{\'c}, Nikola
and Medvecki, Darija
and Ba{\vs}aragin, Bojana
and Mitrovi{\'c}, Jelena",
title="Uncovering the Reasons Behind COVID-19 Vaccine Hesitancy in Serbia: Sentiment-Based Topic Modeling",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="17",
volume="24",
number="11",
pages="e42261",
keywords="topic modeling",
keywords="sentiment analysis",
keywords="LDA",
keywords="NMF",
keywords="BERT",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="Twitter",
keywords="Serbian language processing",
keywords="vaccine",
keywords="public health",
keywords="NLP",
keywords="vaccination",
keywords="Serbia",
abstract="Background: Since the first COVID-19 vaccine appeared, there has been a growing tendency to automatically determine public attitudes toward it. In particular, it was important to find the reasons for vaccine hesitancy, since it was directly correlated with pandemic protraction. Natural language processing (NLP) and public health researchers have turned to social media (eg, Twitter, Reddit, and Facebook) for user-created content from which they can gauge public opinion on vaccination. To automatically process such content, they use a number of NLP techniques, most notably topic modeling. Topic modeling enables the automatic uncovering and grouping of hidden topics in the text. When applied to content that expresses a negative sentiment toward vaccination, it can give direct insight into the reasons for vaccine hesitancy. Objective: This study applies NLP methods to classify vaccination-related tweets by sentiment polarity and uncover the reasons for vaccine hesitancy among the negative tweets in the Serbian language. Methods: To study the attitudes and beliefs behind vaccine hesitancy, we collected 2 batches of tweets that mention some aspects of COVID-19 vaccination. The first batch of 8817 tweets was manually annotated as either relevant or irrelevant regarding the COVID-19 vaccination sentiment, and then the relevant tweets were annotated as positive, negative, or neutral. We used the annotated tweets to train a sequential bidirectional encoder representations from transformers (BERT)-based classifier for 2 tweet classification tasks to augment this initial data set. The first classifier distinguished between relevant and irrelevant tweets. The second classifier used the relevant tweets and classified them as negative, positive, or neutral. This sequential classifier was used to annotate the second batch of tweets. The combined data sets resulted in 3286 tweets with a negative sentiment: 1770 (53.9\%) from the manually annotated data set and 1516 (46.1\%) as a result of automatic classification. Topic modeling methods (latent Dirichlet allocation [LDA] and nonnegative matrix factorization [NMF]) were applied using the 3286 preprocessed tweets to detect the reasons for vaccine hesitancy. Results: The relevance classifier achieved an F-score of 0.91 and 0.96 for relevant and irrelevant tweets, respectively. The sentiment polarity classifier achieved an F-score of 0.87, 0.85, and 0.85 for negative, neutral, and positive sentiments, respectively. By summarizing the topics obtained in both models, we extracted 5 main groups of reasons for vaccine hesitancy: concern over vaccine side effects, concern over vaccine effectiveness, concern over insufficiently tested vaccines, mistrust of authorities, and conspiracy theories. Conclusions: This paper presents a combination of NLP methods applied to find the reasons for vaccine hesitancy in Serbia. Given these reasons, it is now possible to better understand the concerns of people regarding the vaccination process. ",
doi="10.2196/42261",
url="https://www.jmir.org/2022/11/e42261",
url="http://www.ncbi.nlm.nih.gov/pubmed/36301673"
}


@Article{info:doi/10.2196/38425,
author="Ackleh-Tingle, V. Jonathan
and Jordan, M. Natalie
and Onwubiko, N. Udodirim
and Chandra, Christina
and Harton, E. Paige
and Rentmeester, T. Shelby
and Chamberlain, T. Allison",
title="Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices' Websites in the United States: Cross-sectional Website Content Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="17",
volume="6",
number="11",
pages="e38425",
keywords="primary care",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="health communications",
keywords="health information",
keywords="health website",
keywords="family practice",
keywords="vaccine information",
keywords="online health",
keywords="health platform",
keywords="online information",
abstract="Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices' website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10\% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8\%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2\%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1\%). In total, 550 (57.1\%) practices mentioned COVID-19 vaccines on their practices' website home page, specifically, and 726 (75.3\%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7\% among single-location practices, n=114, 52.5\% among practices with 2-9 locations, n=66, 56.4\% among practices with 10-19 locations, and n=304, 77.6\% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95\% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers' influence on established and prospective patients who search the internet for information about COVID-19 vaccines. ",
doi="10.2196/38425",
url="https://formative.jmir.org/2022/11/e38425",
url="http://www.ncbi.nlm.nih.gov/pubmed/36343211"
}


@Article{info:doi/10.2196/37203,
author="Kasting, L. Monica
and Macy, T. Jonathan
and Grannis, J. Shaun
and Wiensch, J. Ashley
and Lavista Ferres, M. Juan
and Dixon, E. Brian",
title="Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="14",
volume="8",
number="11",
pages="e37203",
keywords="SARS-CoV-2",
keywords="COVID-19 vaccines",
keywords="vaccination intention",
keywords="vaccine hesitancy",
keywords="Health Belief Model",
keywords="reasoned action approach",
keywords="COVID-19",
keywords="vaccination",
keywords="public health",
keywords="online survey",
keywords="health intervention",
keywords="logistic regression",
keywords="demographic",
abstract="Background: The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy. Objective: The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none. Methods: This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone. Results: The majority of participants were male (n=974, 59.3\%), White (n=1347, 82.0\%), and non-Hispanic (n=1518, 92.4\%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5\%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95\% CI 1.04-1.06), other race (AOR 0.47, 95\% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95\% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95\% CI 2.42-5.73), self-efficacy (AOR 1.75, 95\% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95\% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs. Conclusions: Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted. ",
doi="10.2196/37203",
url="https://publichealth.jmir.org/2022/11/e37203",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219842"
}


@Article{info:doi/10.2196/36712,
author="Giner-Soriano, Maria
and de Dios, Vanessa
and Ouchi, Dan
and Vilaplana-Carnerero, Carles
and Monteagudo, M{\`o}nica
and Morros, Rosa",
title="Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="11",
volume="8",
number="11",
pages="e36712",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="influenza vaccines",
keywords="pneumonia",
keywords="electronic health records",
keywords="primary health care",
keywords="vaccination",
keywords="public health",
keywords="cohort study",
keywords="epidemiology",
keywords="eHeatlh",
keywords="health outcome",
keywords="mortality",
abstract="Background: A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. Objective: This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. Methods: We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. Results: We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9\%) having been vaccinated at least once and 194,858 (63.1\%) having never been vaccinated. In total, 21,721 (19\%) vaccinated individuals and 11,000 (5.7\%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95\% CI 1.10-1.19), recently (OR 1.13, 95\% CI 1.10-1.18), or recurrently (OR 1.10, 95\% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. Conclusions: We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting. ",
doi="10.2196/36712",
url="https://publichealth.jmir.org/2022/11/e36712",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265160"
}


@Article{info:doi/10.2196/39670,
author="Tennant, Ryan
and Tetui, Moses
and Grindrod, Kelly
and Burns, M. Catherine",
title="Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="10",
volume="9",
number="4",
pages="e39670",
keywords="cognitive work analysis",
keywords="contextual design",
keywords="COVID-19",
keywords="decision making",
keywords="health care system",
keywords="pandemic",
keywords="vaccination clinics",
keywords="workplace stress",
abstract="Background: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. Objective: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. Methods: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Results: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Conclusions: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making. ",
doi="10.2196/39670",
url="https://humanfactors.jmir.org/2022/4/e39670",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219839"
}


@Article{info:doi/10.2196/40175,
author="Kwan, Ho Tsz
and Wong, Sze Ngai
and Chan, Pok Chin
and Yeoh, Kiong Eng
and Wong, Yeung-shan Samuel
and Lee, Shan Shui",
title="Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="9",
volume="8",
number="11",
pages="e40175",
keywords="COVID-19",
keywords="SARS-CoV-2 antigen testing",
keywords="COVID-19 vaccine",
keywords="mass screening",
keywords="antigen test",
keywords="epidemiology",
keywords="Omicron",
keywords="Hong Kong",
keywords="public health",
keywords="outbreak",
keywords="epidemic",
keywords="screening",
keywords="transmission",
keywords="online",
keywords="vaccination",
keywords="vaccines",
keywords="surveillance",
abstract="Background: The COVID-19 Omicron BA.2 epidemic wave in Hong Kong peaked in the first quarter of 2022. Following the implementation of stringent public health measures, the daily number of reported cases fell from over 50,000 to below 2000. Although outbreaks steadily receded, the government rolled out a 3-day ``voluntary universal rapid testing'' campaign to invite all citizens to self-perform a rapid antigen test (RAT) daily to identify undetected prevalent infections. Objective: This study aimed to evaluate the uptake and results of RAT mass screening to estimate the population's residual epidemic burden and assess the risk of further transmission. Methods: A cross-sectional study comprising an open web-based population-based survey was conducted a week after the RAT campaign. Participants were asked to report their COVID-19 vaccination and infection history and the RAT performance and test result during the period. They were also invited to report their coliving individuals' test performance and results. Reasons for nonuptake were enquired. Testing and positive rates were age-adjusted. Determinants of undergoing RAT were identified using univariable and multivariable logistic regression models. Results: In total, particulars from 21,769 individuals were reported by 8338 participants. The overall age-adjusted testing rate was 74.94\% (95\% CI 73.71\%-76.18\%), with over 80\% of participants in the age groups between 45-84 years having self-performed RAT during the campaign period. After age-adjustment, 1.03\% (95\% CI 0.86\%-1.21\%) of participants tested positive. The positive rates in the age groups between 20-29 years and >84 years exceeded 2\%. Taking into account the positive rate and 5819 reported cases during the period, the cases identified in the campaign might account for 7.65\% (95\% CI 6.47\%-9.14\%) of all infections. Testers were more likely to be female, older, not previously diagnosed with COVID-19, and have received COVID-19 vaccination. Adjusting for the number of household members, those living with a child aged <12 years and whose household members were also tested were more likely to have self-performed an RAT. Main reasons for not performing an RAT included the absence of symptoms (598/1108, 53.97\%), disbelief of the appropriateness of the campaign as an antiepidemic measure (355/1108, 32.04\%), and a recent COVID-19 diagnosis (332/1108, 29.96\%). Conclusions: The residual population burden remained substantial in spite of the clear evidence of a receding epidemic wave. Despite caution in generalization to the Hong Kong population, the high participation rate in mass screening indicated that the voluntary RAT was well accepted, making it a feasible option for implementation as a complementary means of public health surveillance. ",
doi="10.2196/40175",
url="https://publichealth.jmir.org/2022/11/e40175",
url="http://www.ncbi.nlm.nih.gov/pubmed/36240027"
}


@Article{info:doi/10.2196/37579,
author="MacDonald, E. Shannon
and Marfo, Emmanuel
and Sell, Hannah
and Assi, Ali
and Frank-Wilson, Andrew
and Atkinson, Katherine
and Kellner, D. James
and McNeil, Deborah
and Klein, Kristin
and Svenson, W. Lawrence",
title="Text Message Reminders to Improve Immunization Appointment Attendance in Alberta, Canada: The Childhood Immunization Reminder Project Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Nov",
day="8",
volume="10",
number="11",
pages="e37579",
keywords="text message",
keywords="SMS",
keywords="immunization reminder",
keywords="reminder-recall",
keywords="routine immunization",
keywords="childhood",
keywords="immunization",
keywords="reminder",
keywords="children",
keywords="language barrier",
keywords="Canada",
keywords="vaccine",
keywords="vaccination",
keywords="coverage",
abstract="Background: Vaccine coverage for 18-month-old children in Canada is often below the recommended level, which may be partially because of parental forgetfulness. SMS text message reminders have been shown to potentially improve childhood immunization uptake but have not been widely used in Alberta, Canada. In addition, it has been noted that language barriers may impede immunization service delivery but continue to remain unaddressed in many existing reminder and recall systems. Objective: This study aimed to assess the effectiveness and acceptability of using SMS text messages containing a link to web-based immunization information in different languages to remind parents of their child's 18-month immunization appointment. Methods: The Childhood Immunization Reminder Project was a pilot intervention at 2 public health centers, one each in Lethbridge and Edmonton, Alberta, Canada. Two SMS text message reminders were sent to parents: a booking reminder 3 months before their child turned 18 months old and an appointment reminder 3 days before their scheduled appointment. Booking reminders included a link to the study website hosting immunization information in 9 languages. To evaluate intervention effectiveness, we compared the absolute attendance no-show rates before the intervention and after the intervention. The acceptability of the intervention was evaluated through web-based surveys completed by parents and public health center staff. Google Analytics was used to determine how often web-based immunization information was accessed, from where, and in which languages. Results: Following the intervention, the health center in Edmonton had a reduction of 6.4\% (95\% CI 3\%-9.8\%) in appointment no-shows, with no change at the Lethbridge Health Center (0.8\%, 95\% CI ?1.4\% to 3\%). The acceptability surveys were completed by 222 parents (response rate: 23.9\%) and 22 staff members. Almost all (>95\%) respondents indicated that the reminders were helpful and provided useful suggestions for improvement. All surveyed parents (222/222, 100\%) found it helpful to read web-based immunization information in their language of choice. Google Analytics data showed that immunization information was most often read in English (118/207, 57\%), Punjabi (52/207, 25.1\%), Arabic (13/207, 6.3\%), Spanish (12/207, 5.8\%), Italian (4/207, 1.9\%), Chinese (4/207, 1.9\%), French (2/207, 0.9\%), Tagalog (1/207, 0.5\%), and Vietnamese (1/207, 0.5\%). Conclusions: The study's findings support the use of SMS text message reminders as a convenient and acceptable method to minimize parental forgetfulness and potentially reduce appointment no-shows. The diverse languages accessed in web-based immunization information suggest the need to provide appropriate translated immunization information. Further research is needed to evaluate the impact of SMS text message reminders on childhood immunization coverage in different settings. ",
doi="10.2196/37579",
url="https://mhealth.jmir.org/2022/11/e37579",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346666"
}


@Article{info:doi/10.2196/38898,
author="Kshirsagar, Meghana
and Nasir, Md
and Mukherjee, Sumit
and Becker, Nicholas
and Dodhia, Rahul
and Weeks, B. William
and Ferres, Lavista Juan
and Richardson, Barbra",
title="The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data",
journal="JMIR Public Health Surveill",
year="2022",
month="Nov",
day="8",
volume="8",
number="11",
pages="e38898",
keywords="breakthroughs",
keywords="vaccines",
keywords="Pfizer",
keywords="Moderna",
keywords="Janssen",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="coronavirus",
keywords="infectious disease",
keywords="viral infection",
keywords="vaccination",
keywords="breakthrough infection",
keywords="public health",
keywords="health policy",
keywords="decision making",
keywords="booster vaccine",
keywords="mortality",
keywords="hospitalization",
keywords="healthcare system",
abstract="Background: Several risk factors have been identified for severe COVID-19 disease by the scientific community. In this paper, we focus on understanding the risks for severe COVID-19 infections after vaccination (ie, in breakthrough SARS-CoV-2 infections). Studying these risks by vaccine type, age, sex, comorbidities, and any prior SARS-CoV-2 infection is important to policy makers planning further vaccination efforts. Objective: We performed a comparative study of the risks of hospitalization (n=1140) and mortality (n=159) in a SARS-CoV-2 positive cohort of 19,815 patients who were all fully vaccinated with the Pfizer, Moderna, or Janssen vaccines. Methods: We performed Cox regression analysis to calculate the risk factors for developing a severe breakthrough SARS-CoV-2 infection in the study cohort by controlling for vaccine type, age, sex, comorbidities, and a prior SARS-CoV-2 infection. Results: We found lower hazard ratios for those receiving the Moderna vaccine (P<.001) and Pfizer vaccine (P<.001), with the lowest hazard rates being for Moderna, as compared to those who received the Janssen vaccine, independent of age, sex, comorbidities, vaccine type, and prior SARS-CoV-2 infection. Further, individuals who had a SARS-CoV-2 infection prior to vaccination had some increased protection over and above the protection already provided by the vaccines, from hospitalization (P=.001) and death (P=.04), independent of age, sex, comorbidities, and vaccine type. We found that the top statistically significant risk factors for severe breakthrough SARS-CoV-2 infections were age of >50, male gender, moderate and severe renal failure, severe liver disease, leukemia, chronic lung disease, coagulopathy, and alcohol abuse. Conclusions: Among individuals who were fully vaccinated, the risk of severe breakthrough SARS-CoV-2 infection was lower for recipients of the Moderna or Pfizer vaccines and higher for recipients of the Janssen vaccine. These results from our analysis at a population level will be helpful to public health policy makers. Our result on the influence of a previous SARS-CoV-2 infection necessitates further research into the impact of multiple exposures on the risk of developing severe COVID-19. ",
doi="10.2196/38898",
url="https://publichealth.jmir.org/2022/11/e38898",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265135"
}


@Article{info:doi/10.2196/41914,
author="Gabashvili, S. Irene",
title="The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e41914",
keywords="COVID-19",
keywords="COVID-19 vaccines",
keywords="vaccine adverse events",
keywords="breakthrough infections",
keywords="decentralized participatory study",
keywords="elderly",
keywords="older individuals",
keywords="medically underserved populations",
keywords="aging",
keywords="elderly population",
keywords="vaccination",
keywords="genetic disparity",
keywords="microbiome disparity",
keywords="impaired immunity",
abstract="Background: Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective: The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods: The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results: Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79--year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions: The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration: ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID): RR2-10.1101/2021.06.28.21256779 ",
doi="10.2196/41914",
url="https://formative.jmir.org/2022/11/e41914",
url="http://www.ncbi.nlm.nih.gov/pubmed/36309347"
}


@Article{info:doi/10.2196/38164,
author="Darville-Sanders, Gabrielle
and Reinoso, Humberto
and MacInnes, Jann
and Corluyan, Emilie
and Munroe, Dominique
and Mathis, W. Mary
and Madden, Lamarca Suzie
and Hamrick, Johnathan
and Dickerson, Lisa
and Gaddis, Cheryl",
title="HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e38164",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="provider communication",
keywords="medical trainees",
keywords="immunization",
keywords="vaccine",
keywords="communication",
keywords="student",
keywords="sexually transmitted infection",
keywords="STI",
keywords="United States of America",
keywords="USA",
keywords="young adult",
keywords="teen",
keywords="patient",
keywords="parent",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. Objective: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. Methods: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. Results: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach $\alpha$ indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport ($\alpha$=.796), patient respect or empathy ($\alpha$=.737), provider interview or intake ($\alpha$=.9), patient counseling or education ($\alpha$=.935), provider communication closure ($\alpha$=.896), and provider knowledge ($\alpha$=.824). Conclusions: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee's individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates. ",
doi="10.2196/38164",
url="https://formative.jmir.org/2022/11/e38164",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331545"
}


@Article{info:doi/10.2196/38153,
author="Fuster-Casanovas, A{\"i}na
and Das, Ronnie
and Vidal-Alaball, Josep
and Lopez Segui, Francesc
and Ahmed, Wasim",
title="The \#VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Oct",
day="28",
volume="8",
number="10",
pages="e38153",
keywords="Twitter",
keywords="social media",
keywords="COVID-19",
keywords="misinformation",
keywords="vaccination",
keywords="public health",
keywords="vaccine hesitancy",
keywords="infodemiology",
keywords="health campaign",
keywords="content analysis",
keywords="social network",
keywords="layout algorithm",
abstract="Background: Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children's Emergency Fund), alongside other organizations, were promoting the hashtag \#VaccinesWork. Objective: The aim of this paper is to analyze the \#VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved. Methods: The data set used in this study consists of 11,085 tweets containing the \#VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm. Results: The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario. Conclusions: This study investigated the discussions surrounding the \#VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter. ",
doi="10.2196/38153",
url="https://publichealth.jmir.org/2022/10/e38153",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219832"
}


@Article{info:doi/10.2196/39157,
author="Okonkwo, Wilfred Chinedu
and Amusa, Babatunde Lateef
and Twinomurinzi, Hossana",
title="COVID-Bot, an Intelligent System for COVID-19 Vaccination Screening: Design and Development",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="27",
volume="6",
number="10",
pages="e39157",
keywords="chatbot",
keywords="COVID-Bot",
keywords="COVID-19",
keywords="students",
keywords="vaccine",
keywords="exemption letter",
keywords="vaccination",
keywords="artificial intelligence",
abstract="Background: Coronavirus continues to spread worldwide, causing various health and economic disruptions. One of the most important approaches to controlling the spread of this disease is to use an artificial intelligence (AI)--based technological intervention, such as a chatbot system. Chatbots can aid in the fight against the spread of COVID-19. Objective: This paper introduces COVID-Bot, an intelligent interactive system that can help screen students and confirm their COVID-19 vaccination status. Methods: The design and development of COVID-Bot followed the principles of the design science research (DSR) process, which is a research method for creating a new scientific artifact. COVID-Bot was developed and implemented using the SnatchBot chatbot application programming interface (API) and its predefined tools, which are driven by various natural language processing algorithms. Results: An evaluation was carried out through a survey that involved 106 university students in determining the functionality, compatibility, reliability, and usability of COVID-Bot. The findings indicated that 92 (86.8\%) of the participants agreed that the chatbot functions well, 85 (80.2\%) agreed that it fits well with their mobile devices and their lifestyle, 86 (81.1\%) agreed that it has the potential to produce accurate and consistent responses, and 85 (80.2\%) agreed that it is easy to use. The average obtained $\alpha$ was .87, indicating satisfactory reliability. Conclusions: This study demonstrates that incorporating chatbot technology into the educational system can combat the spread of COVID-19 among university students. The intelligent system does this by interacting with students to determine their vaccination status. ",
doi="10.2196/39157",
url="https://formative.jmir.org/2022/10/e39157",
url="http://www.ncbi.nlm.nih.gov/pubmed/36301616"
}


@Article{info:doi/10.2196/38316,
author="van Kampen, Katherine
and Laski, Jeremi
and Herman, Gabrielle
and Chan, M. Teresa",
title="Investigating COVID-19 Vaccine Communication and Misinformation on TikTok: Cross-sectional Study",
journal="JMIR Infodemiology",
year="2022",
month="Oct",
day="25",
volume="2",
number="2",
pages="e38316",
keywords="TikTok",
keywords="COVID-19 vaccines",
keywords="vaccinations",
keywords="misinformation",
keywords="COVID-19",
keywords="Infodemiology",
keywords="social media",
keywords="health information",
keywords="content analysis",
keywords="vaccine hesitancy",
keywords="public health",
keywords="web-based health information",
abstract="Background: The COVID-19 pandemic has highlighted the need for reliable information, especially around vaccines. Vaccine hesitancy is a growing concern and a great threat to broader public health. The prevalence of social media within our daily lives emphasizes the importance of accurately analyzing how health information is being disseminated to the public. TikTok is of particular interest, as it is an emerging social media platform that young adults may be increasingly using to access health information. Objective: The objective of this study was to examine and describe the content within the top 100 TikToks trending with the hashtag \#covidvaccine. Methods: The top 250 most viewed TikToks with the hashtag \#covidvaccine were batch downloaded on July 1, 2021, with their respective metadata. Each TikTok was subsequently viewed and encoded by 2 independent reviewers. Coding continued until 100 TikToks could be included based on language and content. Descriptive features were recorded including health care professional (HCP) status of creator, verification of HCP status, genre, and misinformation addressed. Primary inclusion criteria were any TikToks in English with discussion of a COVID-19 vaccine. Results: Of 102 videos included, the median number of plays was 1,700,000, with median shares of 9224 and 62,200 followers. Upon analysis, 14.7\% (15/102) of TikToks included HCPs, of which 80\% (12/102) could be verified via social media or regulatory body search; 100\% (15/15) of HCP-created TikToks supported vaccine use, and overall, 81.3\% (83/102) of all TikToks (created by either a layperson or an HCP) supported vaccine use. Conclusions: As the pandemic continues, vaccine hesitancy poses a threat to lifting restrictions, and discovering reasons for this hesitancy is important to public health measures. This study summarizes the discourse around vaccine use on TikTok. Importantly, it opens a frank discussion about the necessity to incorporate new social media platforms into medical education, so we might ensure our trainees are ready to engage with patients on novel platforms. ",
doi="10.2196/38316",
url="https://infodemiology.jmir.org/2022/2/e38316",
url="http://www.ncbi.nlm.nih.gov/pubmed/36338548"
}


@Article{info:doi/10.2196/40408,
author="Melton, A. Chad
and White, M. Brianna
and Davis, L. Robert
and Bednarczyk, A. Robert
and Shaban-Nejad, Arash",
title="Fine-tuned Sentiment Analysis of COVID-19 Vaccine--Related Social Media Data: Comparative Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="17",
volume="24",
number="10",
pages="e40408",
keywords="sentiment analysis",
keywords="DistilRoBERTa",
keywords="natural language processing",
keywords="social media",
keywords="Twitter",
keywords="Reddit",
keywords="COVID-19",
keywords="vaccination",
keywords="vaccine",
keywords="content analysis",
keywords="public health",
keywords="surveillance",
keywords="misinformation",
keywords="infodemiology",
keywords="information quality",
abstract="Background: The emergence of the novel coronavirus (COVID-19) and the necessary separation of populations have led to an unprecedented number of new social media users seeking information related to the pandemic. Currently, with an estimated 4.5 billion users worldwide, social media data offer an opportunity for near real-time analysis of large bodies of text related to disease outbreaks and vaccination. These analyses can be used by officials to develop appropriate public health messaging, digital interventions, educational materials, and policies. Objective: Our study investigated and compared public sentiment related to COVID-19 vaccines expressed on 2 popular social media platforms---Reddit and Twitter---harvested from January 1, 2020, to March 1, 2022. Methods: To accomplish this task, we created a fine-tuned DistilRoBERTa model to predict the sentiments of approximately 9.5 million tweets and 70 thousand Reddit comments. To fine-tune our model, our team manually labeled the sentiment of 3600 tweets and then augmented our data set through back-translation. Text sentiment for each social media platform was then classified with our fine-tuned model using Python programming language and the Hugging Face sentiment analysis pipeline. Results: Our results determined that the average sentiment expressed on Twitter was more negative (5,215,830/9,518,270, 54.8\%) than positive, and the sentiment expressed on Reddit was more positive (42,316/67,962, 62.3\%) than negative. Although the average sentiment was found to vary between these social media platforms, both platforms displayed similar behavior related to the sentiment shared at key vaccine-related developments during the pandemic. Conclusions: Considering this similar trend in shared sentiment demonstrated across social media platforms, Twitter and Reddit continue to be valuable data sources that public health officials can use to strengthen vaccine confidence and combat misinformation. As the spread of misinformation poses a range of psychological and psychosocial risks (anxiety and fear, etc), there is an urgency in understanding the public perspective and attitude toward shared falsities. Comprehensive educational delivery systems tailored to a population's expressed sentiments that facilitate digital literacy, health information--seeking behavior, and precision health promotion could aid in clarifying such misinformation. ",
doi="10.2196/40408",
url="https://www.jmir.org/2022/10/e40408",
url="http://www.ncbi.nlm.nih.gov/pubmed/36174192"
}


@Article{info:doi/10.2196/38949,
author="Jain, Shikha
and Dhaon, R. Serena
and Majmudar, Shivani
and Zimmermann, J. Laura
and Mordell, Lisa
and Walker, Garth
and Wallia, Amisha
and Akbarnia, Halleh
and Khan, Ali
and Bloomgarden, Eve
and Arora, M. Vineet",
title="Empowering Health Care Workers on Social Media to Bolster Trust in Science and Vaccination During the Pandemic: Making IMPACT Using a Place-Based Approach",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="17",
volume="24",
number="10",
pages="e38949",
keywords="misinformation",
keywords="COVID-19",
keywords="place-based",
keywords="infodemic",
keywords="infographic",
keywords="social media",
keywords="advocacy",
keywords="infodemiology",
keywords="vaccination",
keywords="health care worker",
keywords="policy maker",
keywords="health policy",
keywords="community health",
abstract="Background: Given the widespread and concerted efforts to propagate health misinformation on social media, particularly centered around vaccination during the pandemic, many groups of clinicians and scientists were organized on social media to tackle misinformation and promote vaccination, using a national or international lens. Although documenting the impact of such social media efforts, particularly at the community level, can be challenging, a more hyperlocal or ``place-based approach'' for social media campaigns could be effective in tackling misinformation and improving public health outcomes at a community level. Objective: We aimed to describe and document the effectiveness of a place-based strategy for a coordinated group of Chicago health care workers on social media to tackle misinformation and improve vaccination rates in the communities they serve. Methods: The Illinois Medical Professionals Action Collaborative Team (IMPACT) was founded in March 2020 in response to the COVID-19 pandemic, with representatives from major academic teaching hospitals in Chicago (eg, University of Chicago, Northwestern University, University of Illinois, and Rush University) and community-based organizations. Through crowdsourcing on multiple social media platforms (eg, Facebook, Twitter, and Instagram) with a place-based approach, IMPACT engaged grassroots networks of thousands of Illinois health care workers and the public to identify gaps, needs, and viewpoints to improve local health care delivery during the pandemic. Results: To address vaccine misinformation, IMPACT created 8 ``myth debunking'' infographics and a ``vaccine information series'' of 14 infographics that have generated >340,000 impressions and informed the development of vaccine education for the Chicago Public Libraries. IMPACT delivered 13 policy letters focusing on different topics, such as health care worker personal protective equipment, universal masking, and vaccination, with >4000 health care workers signatures collected through social media and delivered to policy makers; it published over 50 op-eds on COVID-19 topics in high-impact news outlets and contributed to >200 local and national news features.Using the crowdsourcing approach on IMPACT social media channels, IMPACT mobilized health care and lay volunteers to staff >400 vaccine events for >120,000 individuals, many in Chicago's hardest-hit neighborhoods. The group's recommendations have influenced public health awareness campaigns and initiatives, as well as research, advocacy, and policy recommendations, and they have been recognized with local and national awards. Conclusions: A coordinated group of health care workers on social media, using a hyperlocal place-based approach, can not only work together to address misinformation but also collaborate to boost vaccination rates in their surrounding communities. ",
doi="10.2196/38949",
url="https://www.jmir.org/2022/10/e38949",
url="http://www.ncbi.nlm.nih.gov/pubmed/35917489"
}


@Article{info:doi/10.2196/41012,
author="Dub{\'e}, Eve
and MacDonald, E. Shannon
and Manca, Terra
and Bettinger, A. Julie
and Driedger, Michelle S.
and Graham, Janice
and Greyson, Devon
and MacDonald, E. Noni
and Meyer, Samantha
and Roch, Genevi{\`e}ve
and Vivion, Maryline
and Aylsworth, Laura
and Witteman, O. Holly
and G{\'e}linas-Gascon, F{\'e}lix
and Marques Sathler Guimaraes, Lucas
and Hakim, Hina
and Gagnon, Dominique
and B{\'e}chard, Beno{\^i}t
and Gramaccia, A. Julie
and Khoury, Richard
and Tremblay, S{\'e}bastien",
title="Understanding the Influence of Web-Based Information, Misinformation, Disinformation, and Reinformation on COVID-19 Vaccine Acceptance: Protocol for a Multicomponent Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="17",
volume="11",
number="10",
pages="e41012",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="misinformation",
keywords="vaccine decisions",
keywords="disinformation",
keywords="online",
keywords="vaccine",
keywords="vaccination",
abstract="Background: The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people's decision to refuse or delay recommended vaccination for themselves or their children. Objective: The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. Methods: Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. Results: As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. Conclusions: The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. International Registered Report Identifier (IRRID): DERR1-10.2196/41012 ",
doi="10.2196/41012",
url="https://www.researchprotocols.org/2022/10/e41012",
url="http://www.ncbi.nlm.nih.gov/pubmed/36191171"
}


@Article{info:doi/10.2196/36818,
author="Shaw Jr, George
and Nadkarni, Devaki
and Phann, Eric
and Sielaty, Rachel
and Ledenyi, Madeleine
and Abnowf, Razaan
and Xu, Qian
and Arredondo, Paul
and Chen, Shi",
title="Separating Features From Functionality in Vaccination Apps: Computational Analysis",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="11",
volume="6",
number="10",
pages="e36818",
keywords="vaccines",
keywords="mobile health",
keywords="mHealth",
keywords="principal component analysis",
keywords="PCA",
keywords="k-means clustering",
keywords="information exchange",
keywords="mobile phone",
abstract="Background: Some latest estimates show that approximately 95\% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps' design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps' descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1\% (131/211) and 37.9\% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4\%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5\%) were iOS apps, 55 (46.2\%) were for the Android operating system, and 11 (9.2\%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7\% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. ",
doi="10.2196/36818",
url="https://formative.jmir.org/2022/10/e36818",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222791"
}


@Article{info:doi/10.2196/38710,
author="Marshall, J. Nell
and Lee, L. Jennifer
and Schroeder, Jessica
and Lee, Wei-Nchih
and See, Jermyn
and Madjid, Mohammad
and Munagala, R. Mrudula
and Piette, D. John
and Tan, Litjen
and Vardeny, Orly
and Greenberg, Michael
and Liska, Jan
and Mercer, Monica
and Samson, Sandrine",
title="Influence of Digital Intervention Messaging on Influenza Vaccination Rates Among Adults With Cardiovascular Disease in the United States: Decentralized Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="7",
volume="24",
number="10",
pages="e38710",
keywords="influenza",
keywords="randomized trial",
keywords="public health",
keywords="cardiovascular disease",
keywords="immunization",
keywords="vaccination",
keywords="digital messaging",
keywords="digital intervention",
keywords="mobile health",
keywords="mHealth",
abstract="Background: Seasonal influenza affects 5\% to 15\% of Americans annually, resulting in preventable deaths and substantial economic impact. Influenza infection is particularly dangerous for people with cardiovascular disease, who therefore represent a priority group for vaccination campaigns. Objective: We aimed to assess the effects of digital intervention messaging on self-reported rates of seasonal influenza vaccination. Methods: This was a randomized, controlled, single-blind, and decentralized trial conducted at individual locations throughout the United States over the 2020-2021 influenza season. Adults with self-reported cardiovascular disease who were members of the Achievement mobile platform were randomized to receive or not receive a series of 6 patient-centered digital intervention messages promoting influenza vaccination. The primary end point was the between-group difference in self-reported vaccination rates at 6 months after randomization. Secondary outcomes included the levels of engagement with the messages and the relationship between vaccination rates and engagement with the messages. Subgroup analyses examined variation in intervention effects by race. Controlling for randomization group, we examined the impact of other predictors of vaccination status, including cardiovascular condition type, vaccine drivers or barriers, and vaccine knowledge. Results: Of the 49,138 randomized participants, responses on the primary end point were available for 11,237 (22.87\%; 5575 in the intervention group and 5662 in the control group) participants. The vaccination rate was significantly higher in the intervention group (3418/5575, 61.31\%) than the control group (3355/5662, 59.25\%; relative risk 1.03, 95\% CI 1.004-1.066; P=.03). Participants who were older, more educated, and White or Asian were more likely to report being vaccinated. The intervention was effective among White participants (P=.004) but not among people of color (P=.42). The vaccination rate was 13 percentage points higher among participants who completed all 6 intervention messages versus none, and at least 2 completed messages appeared to be needed for effectiveness. Participants who reported a diagnosis of COVID-19 were more likely to be vaccinated for influenza regardless of treatment assignment. Conclusions: This personalized, evidence-based digital intervention was effective in increasing vaccination rates in this population of high-risk people with cardiovascular disease. Trial Registration: ClinicalTrials.gov NCT04584645; https://clinicaltrials.gov/ct2/show/NCT04584645 ",
doi="10.2196/38710",
url="https://www.jmir.org/2022/10/e38710",
url="http://www.ncbi.nlm.nih.gov/pubmed/36206046"
}


@Article{info:doi/10.2196/39063,
author="Luk, Tsun Tzu
and Lui, Tung Judy Hiu
and Wang, Ping Man",
title="Efficacy, Usability, and Acceptability of a Chatbot for Promoting COVID-19 Vaccination in Unvaccinated or Booster-Hesitant Young Adults: Pre-Post Pilot Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="4",
volume="24",
number="10",
pages="e39063",
keywords="COVID-19",
keywords="coronavirus",
keywords="vaccine",
keywords="immunization",
keywords="booster",
keywords="vaccine hesitancy",
keywords="chatbot",
keywords="conversational agent",
keywords="virtual assistant",
keywords="Chinese",
keywords="young adult",
keywords="youth",
keywords="health promotion",
keywords="health intervention",
keywords="chatbot usability",
keywords="pandemic",
keywords="booster hesitancy",
keywords="web-based survey",
keywords="students",
keywords="university students",
abstract="Background: COVID-19 vaccines are highly effective in preventing severe disease and death but are underused. Interventions to address COVID-19 vaccine hesitancy are paramount to reducing the burden of COVID-19. Objective: We aimed to evaluate the preliminary efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination and examine the factors associated with COVID-19 vaccine hesitancy. Methods: In November 2021, we conducted a pre-post pilot study to evaluate ``Vac Chat, Fact Check,'' a web-based chatbot for promoting COVID-19 vaccination. We conducted a web-based survey (N=290) on COVID-19 vaccination at a university in Hong Kong. A subset of 46 participants who were either unvaccinated (n=22) or were vaccinated but hesitant to receive boosters (n=24) were selected and given access to the chatbot for a 7-day trial period. The chatbot provided information about COVID-19 vaccination (eg, efficacy and common side effects), debunked common myths about the vaccine, and included a decision aid for selecting vaccine platforms (inactivated and mRNA vaccines). The main efficacy outcome was changes in the COVID-19 Vaccine Hesitancy Scale (VHS) score (range 9-45) from preintervention (web-based survey) to postintervention (immediately posttrial). Other efficacy outcomes included changes in intention to vaccinate or receive boosters and willingness to encourage others to vaccinate on a scale from 1 (not at all) to 5 (very). Usability was assessed by the System Usability Scale (range 0-100). Linear regression was used to examine the factors associated with COVID-19 VHS scores in all survey respondents. Results: The mean (SD) age of all survey respondents was 21.4 (6.3) years, and 61\% (177/290) of respondents were female. Higher eHealth literacy (B=--0.26; P<.001) and perceived danger of COVID-19 (B=--0.17; P=.009) were associated with lower COVID-19 vaccine hesitancy, adjusting for age, sex, chronic disease status, previous flu vaccination, and perceived susceptibility to COVID-19. The main efficacy outcome of COVID-19 VHS score significantly decreased from 28.6 (preintervention) to 24.5 (postintervention), with a mean difference of --4.2 (P<.001) and an effect size (Cohen d) of 0.94. The intention to vaccinate increased from 3.0 to 3.9 (P<.001) in unvaccinated participants, whereas the intention to receive boosters increased from 1.9 to 2.8 (P<.001) in booster-hesitant participants. Willingness to encourage others to vaccinate increased from 2.7 to 3.0 (P=.04). At postintervention, the median (IQR) System Usability Scale score was 72.5 (65-77.5), whereas the median (IQR) recommendation score was 7 (6-8) on a scale from 0 to 10. In a post hoc 4-month follow-up, 82\% (18/22) of initially unvaccinated participants reported having received the COVID-19 vaccine, whereas 29\% (7/24) of booster-hesitant participants received boosters. Conclusions: This pilot study provided initial evidence to support the efficacy, usability, and acceptability of a chatbot for promoting COVID-19 vaccination in young adults who were unvaccinated or booster-hesitant. ",
doi="10.2196/39063",
url="https://www.jmir.org/2022/10/e39063",
url="http://www.ncbi.nlm.nih.gov/pubmed/36179132"
}


@Article{info:doi/10.2196/35744,
author="Fu, Chunye
and Lyu, Xiaokang
and Mi, Mingdi",
title="Collective Value Promotes the Willingness to Share Provaccination Messages on Social Media in China: Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="4",
volume="6",
number="10",
pages="e35744",
keywords="individual value",
keywords="collective value",
keywords="vaccination",
keywords="message-sharing willingness",
keywords="perceived responsibility",
keywords="misinformation",
keywords="vaccine misinformation",
keywords="public health",
keywords="influenza vaccine",
keywords="social media",
keywords="COVID-19",
abstract="Background: The proliferation of vaccine misinformation on social media has seriously corrupted the public's confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed. Objective: This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value. Methods: We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6\%) and experiment 2 (n=200, 44.4\%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform's randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2. Results: The valid sample included 213 adults in experiment 1 (females: n=151, 70.9\%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8\%; single: n=131, 61.5\%) and 171 adults in experiment 2 (females: n=106, 62.0\%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3\%; single: n=95, 55.6\%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F3,166=4.96, P=.03, $\eta$2=0.03). The reverse result was found for the willingness to share provaccination messages (F3,165=6.87, P=.01, $\eta$2=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F3,165=6.87, P=.01, $\eta$2=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95\% lower limit confidence interval [LLCI] 0.41, 95\% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F3,166=5.96, P=.02, $\eta$2=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing. Conclusions: Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role. ",
doi="10.2196/35744",
url="https://formative.jmir.org/2022/10/e35744",
url="http://www.ncbi.nlm.nih.gov/pubmed/36067417"
}


@Article{info:doi/10.2196/39504,
author="Ferawati, Kiki
and Liew, Kongmeng
and Aramaki, Eiji
and Wakamiya, Shoko",
title="Monitoring Mentions of COVID-19 Vaccine Side Effects on Japanese and Indonesian Twitter: Infodemiological Study",
journal="JMIR Infodemiology",
year="2022",
month="Oct",
day="4",
volume="2",
number="2",
pages="e39504",
keywords="COVID-19",
keywords="vaccine",
keywords="COVID-19 vaccine",
keywords="Pfizer",
keywords="Moderna",
keywords="vaccine side effects",
keywords="side effects",
keywords="Twitter",
keywords="logistic regression",
abstract="Background: The year 2021 was marked by vaccinations against COVID-19, which spurred wider discussion among the general population, with some in favor and some against vaccination. Twitter, a popular social media platform, was instrumental in providing information about the COVID-19 vaccine and has been effective in observing public reactions. We focused on tweets from Japan and Indonesia, 2 countries with a large Twitter-using population, where concerns about side effects were consistently stated as a strong reason for vaccine hesitancy. Objective: This study aimed to investigate how Twitter was used to report vaccine-related side effects and to compare the mentions of these side effects from 2 messenger RNA (mRNA) vaccine types developed by Pfizer and Moderna, in Japan and Indonesia. Methods: We obtained tweet data from Twitter using Japanese and Indonesian keywords related to COVID-19 vaccines and their side effects from January 1, 2021, to December 31, 2021. We then removed users with a high frequency of tweets and merged the tweets from multiple users as a single sentence to focus on user-level analysis, resulting in a total of 214,165 users (Japan) and 12,289 users (Indonesia). Then, we filtered the data to select tweets mentioning Pfizer or Moderna only and removed tweets mentioning both. We compared the side effect counts to the public reports released by Pfizer and Moderna. Afterward, logistic regression models were used to compare the side effects for the Pfizer and Moderna vaccines for each country. Results: We observed some differences in the ratio of side effects between the public reports and tweets. Specifically, fever was mentioned much more frequently in tweets than would be expected based on the public reports. We also observed differences in side effects reported between Pfizer and Moderna vaccines from Japan and Indonesia, with more side effects reported for the Pfizer vaccine in Japanese tweets and more side effects with the Moderna vaccine reported in Indonesian tweets. Conclusions: We note the possible consequences of vaccine side effect surveillance on Twitter and information dissemination, in that fever appears to be over-represented. This could be due to fever possibly having a higher severity or measurability, and further implications are discussed. ",
doi="10.2196/39504",
url="https://infodemiology.jmir.org/2022/2/e39504",
url="http://www.ncbi.nlm.nih.gov/pubmed/36277140"
}


@Article{info:doi/10.2196/37848,
author="Si, Mingyu
and Su, Xiaoyou
and Jiang, Yu
and Wang, Wenjun
and Zhang, Xi
and Gu, Xiaofen
and Ma, Li
and Li, Jing
and Zhang, Shaokai
and Ren, Zefang
and Liu, Yuanli
and Qiao, Youlin",
title="An Internet-Based Education Program for Human Papillomavirus Vaccination Among Female College Students in Mainland China: Application of the Information-Motivation-Behavioral Skills Model in a Cluster Randomized Trial",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="30",
volume="24",
number="9",
pages="e37848",
keywords="human papillomavirus vaccination",
keywords="internet-based education",
keywords="information-motivation-behavioral skills model",
keywords="female college students",
keywords="China",
abstract="Background: Patients diagnosed with cervical cancer in the last 2 decades were mainly young females. Human papillomavirus (HPV) vaccination is the most radical way to prevent HPV infection and cervical cancer. However, most female college students in mainland China have not yet been vaccinated, and their relevant knowledge is limited. Theory-based education delivered via the internet is a potentially accessible and useful way to promote HPV vaccination among this population. Objective: This 3-month follow-up study intended to identify the feasibility and efficacy of an information-motivation-behavioral skills (IMB) model--based online intervention for promoting awareness and willingness regarding HPV vaccination among female college students. Methods: A 7-day online HPV education program for female college students in mainland China was developed using a cluster randomized trial design. Recruitment and questionnaire surveys were performed online without face-to-face contact. SPSS 23.0 was used for statistical analysis. The chi-square test and t test were used to compare differences in qualitative and continuous variables between intervention and control groups. The generalized estimating equation was used to test the effectiveness of the intervention with a consideration of the time factor. Results: Among 3867 participants, 102 had been vaccinated against HPV before the study (vaccination rate of 2.6\%). A total of 3484 participants were followed up after the baseline survey, with no statistical difference in the loss rate between the intervention and control groups during the intervention and follow-up periods. At different follow-up time points, HPV-related knowledge, and the motivation, behavioral skills, and willingness regarding HPV vaccination were higher in the intervention group than in the control group. HPV-related knowledge was statistically different between the 2 groups, while the motivation, behavioral skills, and willingness regarding HPV vaccination only showed statistical differences right after the intervention, reaching a peak right after the intervention and then gradually reducing over time. Furthermore, there was no statistical difference in the HPV vaccination rate between the 2 groups. Conclusions: IMB model--based online education could be a promising way to increase the HPV vaccination rate and reduce the burden of HPV infection and cervical cancer among high-risk female college students in China. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900025476; http://www.chictr.org.cn/showprojen.aspx? proj=42672 International Registered Report Identifier (IRRID): RR2-DOI:10.1186/s12889-019-7903-x ",
doi="10.2196/37848",
url="https://www.jmir.org/2022/9/e37848",
url="http://www.ncbi.nlm.nih.gov/pubmed/36178723"
}


@Article{info:doi/10.2196/38070,
author="Maragh-Bass, Allysha
and Comello, Leonora Maria
and Tolley, Ellen Elizabeth
and Stevens Jr, Darrell
and Wilson, Jade
and Toval, Christina
and Budhwani, Henna
and Hightow-Weidman, Lisa",
title="Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="26",
volume="6",
number="9",
pages="e38070",
keywords="young Black adults",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="digital storytelling",
keywords="community-based participatory research",
keywords="digital health intervention",
abstract="Background: Despite high rates of novel COVID-19, acceptance of COVID-19 vaccination is low among Black adults. In response, we developed a digital health intervention (Tough Talks-COVID) that includes digital stories created in a workshop we held with young Black adults. Objective: Our formative research using digital storytelling workshops asked 3 research questions: (1) What issues did participants have in conceptualizing their stories, and what themes emerged from the stories they created? (2) What issues did participants have related to production techniques, and which techniques were utilized in stories? and (3) Overall, how did participants evaluate their workshop experience? Methods: Participants were workshop-eligible if they were vaccine-accepting based on a baseline survey fielded in late 2021. Final participants (N=11) completed a consent process, all 3 workshops, and a media release form for their digital story. The first 2 workshops provided background information and hands-on digital storytelling skills from pre- to postproduction. The third workshop served as a screening and feedback session for participants' final videos. Qualitative and quantitative feedback elements were incorporated into all 3 sessions. Results: Digital stories addressed one or more of 4 broad themes: (1) COVID-19 vulnerability, (2) community connections, (3) addressing vaccine hesitancy, and (4) countering vaccine misinformation. Participants incorporated an array of technical approaches, including unique creative elements such as cartoon images and instant messaging tools to convey social interactions around COVID-19 decision-making. Most (9/11, 82\%) strongly agreed the digital storytelling workshops were delivered as expected; 10 of 11 agreed (n=5) or strongly agreed (n=5) that they had some ideas about what story to tell by the end of the first workshop, and most (8/11, 73\%) strongly agreed they had narrowed down their ideas by workshop two. Of the participants, 9 felt they would very likely (n=6) or likely (n=3) use digital storytelling techniques for personal use in the future, and even more were very likely (n=7) to use the techniques for professional use. Conclusions: Our study is one of the first to incorporate digital storytelling as a central component to a digital health intervention and the only one to do so with exclusive focus on young Black adults. Our emphasis on digital storytelling was shown to be highly acceptable. Similar approaches, including careful consideration of the ethical challenges of community-based participatory approaches, are applicable to other populations experiencing both COVID-19 inequities and marginalization, such as other age demographics and people of color. ",
doi="10.2196/38070",
url="https://formative.jmir.org/2022/9/e38070",
url="http://www.ncbi.nlm.nih.gov/pubmed/36155984"
}


@Article{info:doi/10.2196/37274,
author="Jo, Soojung
and Pituch, A. Keenan
and Howe, Nancy",
title="The Relationships Between Social Media and Human Papillomavirus Awareness and Knowledge: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Sep",
day="20",
volume="8",
number="9",
pages="e37274",
keywords="papillomavirus infections",
keywords="vaccination",
keywords="social media",
keywords="health promotion",
keywords="public reporting of health care data",
keywords="human papillomavirus",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection. HPV can infect both females and males, and it can cause many cancers, including anal, cervical, vaginal, vulvar, and penile cancers. HPV vaccination rates are lower than vaccination rates within other national vaccination programs, despite its importance. Research literature indicates that people obtain health-related information from internet sources and social media; however, the association between such health-seeking behavior on social media and HPV-related behaviors has not been consistently demonstrated in the literature. Objective: This study aims to examine the association between social media usage and HPV knowledge and HPV awareness. Methods: This study analyzed public health data collected through the Health Information National Trends Survey (HINTS) conducted by the US National Cancer Institute. The analysis used data collected in 2020; in total, 2948 responses were included in the analysis. Six HPV-related questions were used to identify HPV awareness, HPV vaccine awareness, and HPV knowledge about HPV-related cancers. Four questions about social media usage and one question about online health information--seeking behavior were used to analyze the associations between social media usage and HPV-related behaviors. Initially, six logistic regressions were conducted using replicate weights. Based on the results, significant factors were included in a second set of regression analyses that also included demographic variables. Results: About half of the respondents were aware of HPV (68.40\%), the HPV vaccine (64.04\%), and the relationship between HPV and cervical cancer (48.00\%). However, fewer respondents were knowledgeable about the relationships between HPV and penile cancer (19.18\%), anal cancer (18.33\%), and oral cancer (19.86\%). Although social media usage is associated with HPV awareness, HPV vaccine awareness, and knowledge of cervical cancer, these associations were not significant after adjusting for demographic variables. Those less likely to report HPV awareness and knowledge included older participants, males, those with a household income of less than US \$20,000, those with a formal education equal to or less than high school, or those who resided in a household where adults are not fluent in English. Conclusions: After adjusting for demographic variables, social media use was not related to HPV knowledge and awareness, and survey respondents were generally not aware that HPV can lead to specific types of cancer, other than cervical cancer. These results suggest that perhaps a lack of high-quality information on social media may impede HPV awareness and knowledge. Efforts to educate the public about HPV via social media might be improved by using techniques like storytelling or infographics, especially targeting vulnerable populations, such as older participants, males, those with low incomes, those with less formal education, or those who reside in the United States but are not fluent in English. ",
doi="10.2196/37274",
url="https://publichealth.jmir.org/2022/9/e37274",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125858"
}


@Article{info:doi/10.2196/35121,
author="Christensen, Bente
and Laydon, Daniel
and Chelkowski, Tadeusz
and Jemielniak, Dariusz
and Vollmer, Michaela
and Bhatt, Samir
and Krawczyk, Konrad",
title="Quantifying Changes in Vaccine Coverage in Mainstream Media as a Result of the COVID-19 Outbreak: Text Mining Study",
journal="JMIR Infodemiology",
year="2022",
month="Sep",
day="20",
volume="2",
number="2",
pages="e35121",
keywords="data mining",
keywords="COVID-19",
keywords="vaccine",
keywords="text mining",
keywords="change",
keywords="coverage",
keywords="communication",
keywords="media",
keywords="social media",
keywords="news",
keywords="outbreak",
keywords="acceptance",
keywords="hesitancy",
keywords="understanding",
keywords="knowledge",
keywords="sentiment",
abstract="Background: Achieving herd immunity through vaccination depends upon the public's acceptance, which in turn relies on their understanding of its risks and benefits. The fundamental objective of public health messaging on vaccines is therefore the clear communication of often complex information and, increasingly, the countering of misinformation. The primary outlet shaping public understanding is mainstream online news media, where coverage of COVID-19 vaccines was widespread. Objective: We used text-mining analysis on the front pages of mainstream online news to quantify the volume and sentiment polarization of vaccine coverage. Methods: We analyzed 28 million articles from 172 major news sources across 11 countries between July 2015 and April 2021. We employed keyword-based frequency analysis to estimate the proportion of overall articles devoted to vaccines. We performed topic detection using BERTopic and named entity recognition to identify the leading subjects and actors mentioned in the context of vaccines. We used the Vader Python module to perform sentiment polarization quantification of all collated English-language articles. Results: The proportion of front-page articles mentioning vaccines increased from 0.1\% to 4\% with the outbreak of COVID-19. The number of negatively polarized articles increased from 6698 in 2015-2019 to 28,552 in 2020-2021. However, overall vaccine coverage before the COVID-19 pandemic was slightly negatively polarized (57\% negative), whereas coverage during the pandemic was positively polarized (38\% negative). Conclusions: Throughout the pandemic, vaccines have risen from a marginal to a widely discussed topic on the front pages of major news outlets. Mainstream online media has been positively polarized toward vaccines, compared with mainly negative prepandemic vaccine news. However, the pandemic was accompanied by an order-of-magnitude increase in vaccine news that, due to low prepandemic frequency, may contribute to a perceived negative sentiment. These results highlight important interactions between the volume of news and overall polarization. To the best of our knowledge, our work is the first systematic text mining study of front-page vaccine news headlines in the context of COVID-19. ",
doi="10.2196/35121",
url="https://infodemiology.jmir.org/2022/2/e35121",
url="http://www.ncbi.nlm.nih.gov/pubmed/36348981"
}


@Article{info:doi/10.2196/37775,
author="Yousef, Murooj
and Dietrich, Timo
and Rundle-Thiele, Sharyn",
title="Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="15",
volume="6",
number="9",
pages="e37775",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="sentiment analysis",
keywords="public health campaigns",
keywords="vaccine uptake",
keywords="Twitter",
keywords="social media",
keywords="vaccines",
abstract="Background: The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19--related events on sentiment and vaccine uptake. Objective: This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine. Methods: Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine--related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined. Results: The majority of collected tweets expressed negative (n=91,052, 66\%) rather than positive (n=21,686, 16\%) or neutral (n=24,785, 18\%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment. Conclusions: The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning. ",
doi="10.2196/37775",
url="https://formative.jmir.org/2022/9/e37775",
url="http://www.ncbi.nlm.nih.gov/pubmed/36007136"
}


@Article{info:doi/10.2196/38297,
author="Thompson, L. Erika
and Preston, M. Sharice
and Francis, R. Jenny K.
and Rodriguez, A. Serena
and Pruitt, L. Sandi
and Blackwell, James-Michael
and Tiro, A. Jasmin",
title="Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey",
journal="JMIR Pediatr Parent",
year="2022",
month="Sep",
day="14",
volume="5",
number="3",
pages="e38297",
keywords="HPV vaccination",
keywords="human papillomavirus",
keywords="social media",
keywords="decision-making",
keywords="vaccination",
keywords="teens",
keywords="adolescents",
keywords="parent",
keywords="USA",
keywords="United States",
keywords="misinformation",
keywords="internet",
keywords="survey",
keywords="unvaccinated",
keywords="child",
keywords="online",
keywords="health",
keywords="literacy",
keywords="decision",
keywords="health care",
keywords="teen",
keywords="vaccine",
abstract="Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents' perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7\% (n=533) had an HPV-vaccinated child, 38.8\% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4\% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be ``undecided/not wanting the vaccine'' if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95\% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95\% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95\% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. ",
doi="10.2196/38297",
url="https://pediatrics.jmir.org/2022/3/e38297",
url="http://www.ncbi.nlm.nih.gov/pubmed/36103216"
}


@Article{info:doi/10.2196/37635,
author="Stevens, Hannah
and Rasul, Ehab Muhammad
and Oh, Jung Yoo",
title="Emotions and Incivility in Vaccine Mandate Discourse: Natural Language Processing Insights",
journal="JMIR Infodemiology",
year="2022",
month="Sep",
day="13",
volume="2",
number="2",
pages="e37635",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="vaccine mandates",
keywords="natural language processing",
keywords="incivility",
keywords="LIWC",
keywords="Linguistic Inquiry and Word Count",
keywords="Twitter",
abstract="Background: Despite vaccine availability, vaccine hesitancy has inhibited public health officials' efforts to mitigate the COVID-19 pandemic in the United States. Although some US elected officials have responded by issuing vaccine mandates, others have amplified vaccine hesitancy by broadcasting messages that minimize vaccine efficacy. The politically polarized nature of COVID-19 information on social media has given rise to incivility, wherein health attitudes often hinge more on political ideology than science. Objective: To the best of our knowledge, incivility has not been studied in the context of discourse regarding COVID-19 vaccines and mandates. Specifically, there is little focus on the psychological processes that elicit uncivil vaccine discourse and behaviors. Thus, we investigated 3 psychological processes theorized to predict discourse incivility---namely, anxiety, anger, and sadness. Methods: We used 2 different natural language processing approaches: (1) the Linguistic Inquiry and Word Count computational tool and (2) the Google Perspective application programming interface (API) to analyze a data set of 8014 tweets containing terms related to COVID-19 vaccine mandates from September 14, 2021, to October 1, 2021. To collect the tweets, we used the Twitter API Tweet Downloader Tool (version 2). Subsequently, we filtered through a data set of 375,000 vaccine-related tweets using keywords to extract tweets explicitly focused on vaccine mandates. We relied on the Linguistic Inquiry and Word Count computational tool to measure the valence of linguistic anger, sadness, and anxiety in the tweets. To measure dimensions of post incivility, we used the Google Perspective API. Results: This study resolved discrepant operationalizations of incivility by introducing incivility as a multifaceted construct and explored the distinct emotional processes underlying 5 dimensions of discourse incivility. The findings revealed that 3 types of emotions---anxiety, anger, and sadness---were uniquely associated with dimensions of incivility (eg, toxicity, severe toxicity, insult, profanity, threat, and identity attacks). Specifically, the results showed that anger was significantly positively associated with all dimensions of incivility (all P<.001), whereas sadness was significantly positively related to threat (P=.04). Conversely, anxiety was significantly negatively associated with identity attack (P=.03) and profanity (P=.02). Conclusions: The results suggest that our multidimensional approach to incivility is a promising alternative to understanding and intervening in the psychological processes underlying uncivil vaccine discourse. Understanding specific emotions that can increase or decrease incivility such as anxiety, anger, and sadness can enable researchers and public health professionals to develop effective interventions against uncivil vaccine discourse. Given the need for real-time monitoring and automated responses to the spread of health information and misinformation on the web, social media platforms can harness the Google Perspective API to offer users immediate, automated feedback when it detects that a comment is uncivil. ",
doi="10.2196/37635",
url="https://infodemiology.jmir.org/2022/2/e37635",
url="http://www.ncbi.nlm.nih.gov/pubmed/36188420"
}


@Article{info:doi/10.2196/39144,
author="Stoner, CD Marie
and Browne, N. Erica
and Tweedy, David
and Pettifor, E. Audrey
and Maragh-Bass, C. Allysha
and Toval, Christina
and Tolley, E. Elizabeth
and Comello, G. Maria Leonora
and Muessig, E. Kathryn
and Budhwani, Henna
and Hightow-Weidman, B. Lisa",
title="Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="2",
volume="6",
number="9",
pages="e39144",
keywords="COVID-19",
keywords="COVID-19 vaccination",
keywords="young people",
keywords="vaccination motivations",
keywords="vaccination beliefs",
keywords="online survey",
keywords="health disparity",
keywords="minority population",
keywords="vaccine hesitancy",
keywords="misinformation",
keywords="vaccine safety",
abstract="Background: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results: Roughly 28 (19\%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50\%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one's own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54\%) and mistrust of vaccine safety (n=13, 46\%), of effectiveness (n=12, 43\%), and of the government's involvement with vaccines (n=12, 43\%). Experiences of discrimination (n=60, 40\%) and mistrust of vaccines (n=54, 36\%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation. ",
doi="10.2196/39144",
url="https://formative.jmir.org/2022/9/e39144",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969516"
}


@Article{info:doi/10.2196/37656,
author="Bhagavathula, Srikanth Akshaya
and Massey, M. Philip",
title="Google Trends on Human Papillomavirus Vaccine Searches in the United States From 2010 to 2021: Infodemiology Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Aug",
day="29",
volume="8",
number="8",
pages="e37656",
keywords="Google Trends",
keywords="HPV vaccine",
keywords="Google search",
keywords="attitude",
keywords="infodemiology",
keywords="searches",
keywords="United States of America",
abstract="Background: The human papillomavirus (HPV) vaccine is recommended for adolescents and young adults to prevent HPV-related cancers and genital warts. However, HPV vaccine uptake among the target age groups is suboptimal. Objective: The aim of this infodemiology study was to examine public online searches in the United States related to the HPV vaccine from January 2010 to December 2021. Methods: Google Trends (GT) was used to explore online searches related to the HPV vaccine from January 1, 2010, to December 31, 2021. Online searches and queries on the HPV vaccine were investigated using relative search volumes (RSVs). Analysis of variance was performed to investigate quarterly differences in HPV vaccine searches in each year from 2010 to 2021. A joinpoint regression was used to identify statistically significant changes over time; the $\alpha$ level was set to .05. Results: The year-wise online search volume related to the HPV vaccine increased from 2010 to 2021, often following federal changes related to vaccine administration. Joinpoint regression analysis showed that HPV vaccine searches significantly increased on average by 8.6\% (95\% CI 5.9\%-11.4\%) across each year from 2010 to 2021. Moreover, HPV vaccine searches demonstrated a similar pattern across years, with search interest increasing through August nearly every year. At the state level, the highest 12-year mean RSV was observed in California (59.9, SD 14.3) and the lowest was observed in Wyoming (17.4, SD 8.5) during the period of 2010-2021. Conclusions: Online searches related to the HPV vaccine increased by an average of 8.6\% across each year from 2010 to 2021, with noticeable spikes corresponding to key changes in vaccine recommendations. We identified patterns across years and differences at the state level in the online search interest related to the HPV vaccine. Public health organizations can use GT as a tool to characterize the public interest in and promote the HPV vaccine in the United States. ",
doi="10.2196/37656",
url="https://publichealth.jmir.org/2022/8/e37656",
url="http://www.ncbi.nlm.nih.gov/pubmed/36036972"
}


@Article{info:doi/10.2196/36210,
author="Buller, David
and Walkosz, Barbara
and Henry, Kimberly
and Woodall, Gill W.
and Pagoto, Sherry
and Berteletti, Julia
and Kinsey, Alishia
and Divito, Joseph
and Baker, Katie
and Hillhouse, Joel",
title="Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages",
journal="JMIR Infodemiology",
year="2022",
month="Aug",
day="23",
volume="2",
number="2",
pages="e36210",
keywords="social media",
keywords="COVID-19",
keywords="vaccination",
keywords="nonpharmaceutical interventions",
keywords="information source",
keywords="misinformation",
keywords="vaccine",
keywords="public health",
keywords="COVID-19 prevention",
keywords="health promotion",
abstract="Background: Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance. Objective: In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media. Methods: A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) {\texttimes} 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother--daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages. Results: Nearly all mothers (n=298, 98.3\%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1\%, completed the 3-week posttest; n=273, 90.1\%, completed the 6-week posttest; n=275, 90.8\%, completed the 9-week posttest; and n=244, 80.5\%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=--0.10, 95\% CI --0.12 to --0.08, P<.001) and daughters (b=--0.10, 95\% CI --0.18 to --0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95\% CI 0.19-0.49, P<.001; daughters: b=0.17, 95\% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=--0.04, 95\% CI --0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95\% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95\% CI 0.09-0.49, P<.01; daughters: b=0.31, 95\% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95\% CI 1.83-6.53, P<.001; daughters: b=3.36, 95\% CI 1.67-5.04, P<.001). Mothers' intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=--0.50, 95\% CI --0.99 to --0.01, P=.05). Conclusions: Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general. Trial Registration: ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807 ",
doi="10.2196/36210",
url="https://infodemiology.jmir.org/2022/2/e36210",
url="http://www.ncbi.nlm.nih.gov/pubmed/36039372"
}


@Article{info:doi/10.2196/38043,
author="Zidoun, Youness
and Kaladhara, Sreelekshmi
and Powell, Leigh
and Nour, Radwa
and Al Suwaidi, Hanan
and Zary, Nabil",
title="Contextual Conversational Agent to Address Vaccine Hesitancy: Protocol for a Design-Based Research Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="23",
volume="11",
number="8",
pages="e38043",
keywords="conversational agent",
keywords="design-based research",
keywords="chatbot",
keywords="Rasa",
keywords="NLU",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="misinformation",
keywords="vaccination",
keywords="iterative design",
keywords="health communication",
keywords="health information",
keywords="System Usability Scale",
abstract="Background: Since the beginning of the COVID-19 pandemic, people have been exposed to misinformation, leading to many myths about SARS-CoV-2 and the vaccines against it. As this situation does not seem to end soon, many authorities and health organizations, including the World Health Organization (WHO), are utilizing conversational agents (CAs) in their fight against it. Although the impact and usage of these novel digital strategies are noticeable, the design of the CAs remains key to their success. Objective: This study describes the use of design-based research (DBR) for contextual CA design to address vaccine hesitancy. In addition, this protocol will examine the impact of DBR on CA design to understand how this iterative process can enhance accuracy and performance. Methods: A DBR methodology will be used for this study. Each phase of analysis, design, and evaluation of each design cycle inform the next one via its outcomes. An anticipated generic strategy will be formed after completing the first iteration. Using multiple research studies, frameworks and theoretical approaches are tested and evaluated through the different design cycles. User perception of the CA will be analyzed or collected by implementing a usability assessment during every evaluation phase using the System Usability Scale. The PARADISE (PARAdigm for Dialogue System Evaluation) method will be adopted to calculate the performance of this text-based CA. Results: Two phases of the first design cycle (design and evaluation) were completed at the time of this writing (April 2022). The research team is currently reviewing the natural-language understanding model as part of the conversation-driven development (CDD) process in preparation for the first pilot intervention, which will conclude the CA's first design cycle. In addition, conversational data will be analyzed quantitatively and qualitatively as part of the reflection and revision process to inform the subsequent design cycles. This project plans for three rounds of design cycles, resulting in various studies spreading outcomes and conclusions. The results of the first study describing the entire first design cycle are expected to be submitted for publication before the end of 2022. Conclusions: CAs constitute an innovative way of delivering health communication information. However, they are primarily used to contribute to behavioral change or educate people about health issues. Therefore, health chatbots' impact should be carefully designed to meet outcomes. DBR can help shape a holistic understanding of the process of CA conception. This protocol describes the design of VWise, a contextual CA that aims to address vaccine hesitancy using the DBR methodology. The results of this study will help identify the strengths and flaws of DBR's application to such innovative projects. ",
doi="10.2196/38043",
url="https://www.researchprotocols.org/2022/8/e38043",
url="http://www.ncbi.nlm.nih.gov/pubmed/35797423"
}


@Article{info:doi/10.2196/37821,
author="Delanerolle, Gayathri
and Williams, Robert
and Stipancic, Ana
and Byford, Rachel
and Forbes, Anna
and Tsang, M. Ruby S.
and Anand, N. Sneha
and Bradley, Declan
and Murphy, Siobh{\'a}n
and Akbari, Ashley
and Bedston, Stuart
and Lyons, A. Ronan
and Owen, Rhiannon
and Torabi, Fatemeh
and Beggs, Jillian
and Chuter, Antony
and Balharry, Dominique
and Joy, Mark
and Sheikh, Aziz
and Hobbs, Richard F. D.
and de Lusignan, Simon",
title="Methodological Issues in Using a Common Data Model of COVID-19 Vaccine Uptake and Important Adverse Events of Interest: Feasibility Study of Data and Connectivity COVID-19 Vaccines Pharmacovigilance in the United Kingdom",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="22",
volume="6",
number="8",
pages="e37821",
keywords="Systematized Nomenclature of Medicine",
keywords="COVID-19 vaccines",
keywords="COVID-19",
keywords="sinus thrombosis",
keywords="anaphylaxis",
keywords="pharmacovigilance",
keywords="vaccine uptake",
keywords="medical outcome",
keywords="clinical coding system",
keywords="health database",
keywords="health information",
keywords="clinical outcome",
keywords="vaccine effect",
keywords="data model",
abstract="Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom. Objective: This study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization's International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d). Methods: Exposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom's devolved nations' health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days. Results: We listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84\%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17\%) and 4 (44\%), respectively, to include in our repeated cross-sectional studies. Conclusions: This approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool. ",
doi="10.2196/37821",
url="https://formative.jmir.org/2022/8/e37821",
url="http://www.ncbi.nlm.nih.gov/pubmed/35786634"
}


@Article{info:doi/10.2196/37300,
author="Yin, Dean-Chen Jason",
title="Media Data and Vaccine Hesitancy: Scoping Review",
journal="JMIR Infodemiology",
year="2022",
month="Aug",
day="10",
volume="2",
number="2",
pages="e37300",
keywords="review",
keywords="social media",
keywords="traditional media",
keywords="vaccine hesitancy",
keywords="natural language processing",
keywords="digital epidemiology",
abstract="Background: Media studies are important for vaccine hesitancy research, as they analyze how the media shapes risk perceptions and vaccine uptake. Despite the growth in studies in this field owing to advances in computing and language processing and an expanding social media landscape, no study has consolidated the methodological approaches used to study vaccine hesitancy. Synthesizing this information can better structure and set a precedent for this growing subfield of digital epidemiology. Objective: This review aimed to identify and illustrate the media platforms and methods used to study vaccine hesitancy and how they build or contribute to the study of the media's influence on vaccine hesitancy and public health. Methods: This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search was conducted on PubMed and Scopus for any studies that used media data (social media or traditional media), had an outcome related to vaccine sentiment (opinion, uptake, hesitancy, acceptance, or stance), were written in English, and were published after 2010. Studies were screened by only 1 reviewer and extracted for media platform, analysis method, the theoretical models used, and outcomes. Results: In total, 125 studies were included, of which 71 (56.8\%) used traditional research methods and 54 (43.2\%) used computational methods. Of the traditional methods, most used content analysis (43/71, 61\%) and sentiment analysis (21/71, 30\%) to analyze the texts. The most common platforms were newspapers, print media, and web-based news. The computational methods mostly used sentiment analysis (31/54, 57\%), topic modeling (18/54, 33\%), and network analysis (17/54, 31\%). Fewer studies used projections (2/54, 4\%) and feature extraction (1/54, 2\%). The most common platforms were Twitter and Facebook. Theoretically, most studies were weak. The following five major categories of studies arose: antivaccination themes centered on the distrust of institutions, civil liberties, misinformation, conspiracy theories, and vaccine-specific concerns; provaccination themes centered on ensuring vaccine safety using scientific literature; framing being important and health professionals and personal stories having the largest impact on shaping vaccine opinion; the coverage of vaccination-related data mostly identifying negative vaccine content and revealing deeply fractured vaccine communities and echo chambers; and the public reacting to and focusing on certain signals---in particular cases, deaths, and scandals---which suggests a more volatile period for the spread of information. Conclusions: The heterogeneity in the use of media to study vaccines can be better consolidated through theoretical grounding. Areas of suggested research include understanding how trust in institutions is associated with vaccine uptake, how misinformation and information signaling influence vaccine uptake, and the evaluation of government communications on vaccine rollouts and vaccine-related events. The review ends with a statement that media data analyses, though groundbreaking in approach, should supplement---not supplant---current practices in public health research. ",
doi="10.2196/37300",
url="https://infodemiology.jmir.org/2022/2/e37300",
url="http://www.ncbi.nlm.nih.gov/pubmed/37113443"
}


@Article{info:doi/10.2196/38351,
author="Mehta, N. Shivani
and Burger, C. Zoe
and Meyers-Pantele, A. Stephanie
and Garfein, S. Richard
and Ortiz, O. Dayanna
and Mudhar, K. Pavan
and Kothari, B. Smit
and Kothari, Jigna
and Meka, Meena
and Rodwell, Timothy",
title="Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="4",
volume="6",
number="8",
pages="e38351",
keywords="COVID-19",
keywords="knowledge",
keywords="attitude",
keywords="practices",
keywords="KAP survey",
keywords="vaccine hesitancy",
keywords="Latinx",
keywords="Latinx cohort",
keywords="minority population",
keywords="primary care",
keywords="sociodemographic characteristic",
keywords="public health",
keywords="vulnerable population",
keywords="epidemiology",
abstract="Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.? Methods: Participants aged ?18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1\% (n=191) were female, 77\% (n=204) had at most a high school degree, 34.7\% (n=92) had an annual income <US \$25,000, and 11.7\% (n=31) had previously tested positive for COVID-19. We found high knowledge regarding transmission and spread; moderate knowledge regarding symptoms awareness; overall negative attitudes, which included high pessimism in government public health efforts and high amounts of fear, anxiety, and frustration due to COVID-19 pandemic; and moderate participation in preventive practices. A college education was positively associated with a higher knowledge score than those without a college education ($\beta$=0.14, 95\% CI 0.01-1.60; P=.04) when adjusted for covariates. Male gender had a positive association with COVID-19 attitude scores compared to female gender ($\beta$=1.61, 95\% CI 0.50-2.72; P=.05), and male gender was negatively associated with the COVID-19 practices score compared to female gender ($\beta$=--0.16, 95\% CI --0.56 to --0.06; P=.03), when both were adjusted for covariates. Among a subset of 203 patients, 26.6\% (n=54) indicated that if the vaccine was available, they would not take a COVID-19 vaccine, and 18.7\% (n=38) were unsure. Conclusions: Good knowledge and preventative practices in the population may have reflected effective public health messaging and the implementation of public health laws during the first wave of the pandemic; however, the overall fear and anxiety may have reflected the negative impact that the pandemic had on vulnerable populations such as the Latinx community. Although our data are a reflection of a previous time in the pandemic, we believe it captures a critical time that can be used to provide unique insights regarding potential avenues to better protect the Latinx communities against future vaccine-resistant COVID-19 strains. International Registered Report Identifier (IRRID): RR2-10.2196/25265 ",
doi="10.2196/38351",
url="https://formative.jmir.org/2022/8/e38351",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925649"
}


@Article{info:doi/10.2196/38076,
author="Weerakoon, M. Sitara
and Henson-Garcia, Mike
and Valerio-Shewmaker, A. Melissa
and Messiah, E. Sarah
and Knell, Gregory",
title="Contributions of Trustworthiness, Health Literacy, and Self-Efficacy in Communicating With COVID-19 Vaccine--Hesitant Audiences: Web-Based Survey Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="1",
volume="6",
number="8",
pages="e38076",
keywords="vaccine hesitancy",
keywords="health literacy",
keywords="COVID-19",
keywords="COVID-19 vaccine hesitancy",
keywords="health communication",
keywords="vaccination",
keywords="health professional",
keywords="health information  \emspace",
abstract="Background: Large-scale health communication challenges during the COVID-19 pandemic, such as widespread misinformation and distrust in health care professionals, have influenced reluctance to take the COVID-19 vaccine, also known as vaccine hesitancy. Trust in health professionals, adequate health literacy, and high self-efficacy are key components of actively pursuing preventative and protective health care measures. These factors may be associated with intentions to seek and complete a COVID-19 vaccine dosing. Objective: The objective of this analysis was to identify factors associated with COVID-19 vaccine hesitancy. Methods: In February 2021, US adults (N=5872) responded to a web-based survey on COVID-19 vaccine hesitancy and components of health communication (trust in sources of health information, health literacy, and self-efficacy). Multivariable logistic regression models were used to explore associations between these factors and vaccine hesitancy while adjusting for key demographics. We hypothesized that low levels of trust, health literacy, and self-efficacy would be associated with increased vaccine hesitancy. Results: The adjusted odds of vaccine hesitancy was greater among those who placed little to no trust in health professionals compared to those who held a lot of trust (adjusted odds ratio [AOR] 8.54, 95\% CI 6.52-11.19). The odds of vaccine hesitancy was also greater among those who felt frustrated about finding health information compared to those who did not (AOR 2.10, 95\% CI 1.62-2.70). Participants who had little to no confidence in receiving health advice or information had greater odds of vaccine hesitancy compared to those who had a lot of confidence (AOR 3.05, 95\% CI 2.34-3.97). Conclusions: This study underscores the importance of trust between health professionals and their patients, and a need for improving health literacy regarding vaccines. Perceptions of mistrust and low levels of health literacy were associated with high levels of vaccine hesitancy, providing empirical support of framing these factors as perceived barriers to vaccine uptake. ",
doi="10.2196/38076",
url="https://formative.jmir.org/2022/8/e38076",
url="http://www.ncbi.nlm.nih.gov/pubmed/35878123"
}


@Article{info:doi/10.2196/38781,
author="Cunningham-Erves, Jennifer
and Brandt, M. Heather
and Sanderson, Maureen
and Clarkson, Kristin
and Lee, Omaran
and Schlundt, David
and Bonnet, Kemberlee
and Davis, Jamaine",
title="Development of a Theory-Based, Culturally Appropriate Message Library for Use in Interventions to Promote COVID-19 Vaccination Among African Americans: Formative Research",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="28",
volume="6",
number="7",
pages="e38781",
keywords="African American",
keywords="Black American",
keywords="Black",
keywords="minority",
keywords="ethnic",
keywords="culturally sensitive",
keywords="cultural sensitivity",
keywords="inclusive",
keywords="vulnerable",
keywords="COVID-19",
keywords="vaccination",
keywords="vaccine",
keywords="health promotion",
keywords="campaign",
keywords="messaging",
keywords="culturally appropriate",
keywords="theory",
keywords="adults",
keywords="children",
keywords="disparity",
keywords="health belief model",
keywords="community engagement",
keywords="public engagement",
keywords="public awareness",
keywords="community-based",
keywords="health information",
keywords="health communication",
keywords="health intervention",
keywords="vulnerable population",
keywords="community health",
keywords="patient education",
abstract="Background: Disparities in COVID-19 incidence, hospitalization, and mortality rates among African Americans suggest the need for targeted interventions. Use of targeted, theory-driven messages in behavioral and communication interventions could empower African Americans to engage in behaviors that prevent COVID-19. Objective: To address this need, we performed a formative study that aimed to develop and design a culturally appropriate, theory-based library of messages targeting concerns around COVID-19 vaccines that could be used in behavioral and communication interventions for African Americans. Methods: Message development occurred between January 2021 and February 2022. Initial messages were designed by a multidisciplinary team of researchers, community leaders, and community members. Kreuter's 5 strategies (ie, linguistic, peripheral, evidential, sociocultural, and constituent-involving strategies) were used to achieve cultural appropriateness. After forming a community-academic partnership, message development occurred in 4 phases: (1) adaptation of a message library using the literature, (2) review by 6 clinical and research experts for content validation, (3) input and review by a 6-member community advisory panel (CAP), and (4) message pretesting with African Americans via semistructured interviews in a qualitative study. Results: Themes from the semistructured interviews among 30 African Americans were as follows: (1) community reactions to the messages, (2) community questions and information needs, (3) suggestions for additional content, and (4) suggestions to improve comprehension, relevance, and trustworthiness. Feedback from the CAP, community members, and scientific experts was used by members of the community-academic partnership to iteratively update message content to maximize cultural appropriateness. The final message library had 18 message subsets for adults and 17 message subsets for parents and caregivers of children. These subsets were placed into 3 categories: (1) vaccine development, (2) vaccine safety, and (3) vaccine effectiveness. Conclusions: We used a 4-phase, systematic process using multiple community engagement approaches to create messages for African Americans to support interventions to improve COVID-19 vaccination rates among adults and children. The newly developed messages were deemed to be culturally appropriate according to experts and members of the African American community. Future research should evaluate the impact of these messages on COVID-19 vaccination rates among African Americans. ",
doi="10.2196/38781",
url="https://formative.jmir.org/2022/7/e38781",
url="http://www.ncbi.nlm.nih.gov/pubmed/35781223"
}


@Article{info:doi/10.2196/33260,
author="Ahmed, Naheed
and Boxley, Christian
and Dixit, Ram
and Krevat, Seth
and Fong, Allan
and Ratwani, M. Raj
and Wesley, B. Deliya",
title="Evaluation of a Text Message--Based COVID-19 Vaccine Outreach Program Among Older Patients: Cross-sectional Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="18",
volume="6",
number="7",
pages="e33260",
keywords="vaccine outreach",
keywords="text messaging",
keywords="elderly patients",
keywords="evaluation",
keywords="smartphone",
keywords="text message",
keywords="SMS",
keywords="appointment",
keywords="elderly",
keywords="older adults",
keywords="vaccine",
keywords="effectiveness",
keywords="engagement",
keywords="cross-sectional",
abstract="Background: COVID-19 vaccines are vital tools in the defense against infection and serious disease due to SARS-CoV-2. There are many challenges to implementing mass vaccination campaigns for large, diverse populations from crafting vaccine promotion messages to reaching individuals in a timely and effective manner. During this unprecedented period, with COVID-19 mass vaccination campaigns essential for protecting vulnerable patient populations and attaining herd immunity, health care systems were faced with the dual challenges of vaccine outreach and distribution. Objective: The aim of this cross-sectional study was to assess the effectiveness of a COVID-19 vaccine text outreach approach for patients aged 65 years and older. Our goal was to determine whether this approach was successful in scheduling patients for COVID-19 vaccine appointments. Methods: We developed SMS text messages using the Tavoca platform. These messages informed patients of their vaccine eligibility and allowed them to indicate their interest in scheduling an appointment via a specific method (email or phone) or indicate their lack of interest in the vaccine. We tracked the status of these messages and how patients responded. Messages were sent to patients aged 65 years and older (N=30,826) at a nonprofit health care system in Washington, DC. Data were collected and examined from January 14 to May 10, 2021. Data were analyzed using multivariate multinomial and binary logistic regression models in SAS (version 9.4; SAS Institute Inc). Results: Approximately 57\% of text messages were delivered to patients, but many messages received no response from patients (40\%). Additionally, 42.1\% (12,978/30,826) of messages were not delivered. Of the patients who expressed interest in the vaccine (2938/30,826, 9.5\%), Black or African American patients preferred a phone call rather than an email for scheduling their appointment (odds ratio [OR] 1.69, 95\% CI 1.29-2.21) compared to White patients. Patients aged 70-74 years were more likely to schedule an appointment (OR 1.38, 95\% CI 1.01-1.89) than those aged 65-69 years, and Black or African American patients were more likely to schedule an appointment (OR 2.90, 95\% CI 1.72-4.91) than White patients. Conclusions: This study provides insights into some advantages and challenges of using a text messaging vaccine outreach for patients aged 65 years and older. Lessons learned from this vaccine campaign underscore the importance of using multiple outreach methods and sharing of patient vaccination status between health systems, along with a patient-centered approach to address vaccine hesitancy and access issues. ",
doi="10.2196/33260",
url="https://formative.jmir.org/2022/7/e33260",
url="http://www.ncbi.nlm.nih.gov/pubmed/35724339"
}


@Article{info:doi/10.2196/32969,
author="Garrett, M. Paul
and White, P. Joshua
and Dennis, Simon
and Lewandowsky, Stephan
and Yang, Cheng-Ta
and Okan, Yasmina
and Perfors, Andrew
and Little, R. Daniel
and Kozyreva, Anastasia
and Lorenz-Spreen, Philipp
and Kusumi, Takashi
and Kashima, Yoshihisa",
title="Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="15",
volume="8",
number="7",
pages="e32969",
keywords="COVID-19",
keywords="immunity passport",
keywords="vaccination passport",
keywords="cross-cultural",
keywords="health policy",
keywords="digital certificates",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="policy",
keywords="international",
abstract="Background: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. Objective: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. Methods: We collected 13,678 participants through online representative sampling across six countries---Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom---during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Results: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43\%) and the United Kingdom (759/1484, 51.15\%); followed by Taiwan (2841/5989, 47.44\%), Australia (963/2086, 46.16\%), and Spain (693/1491, 46.48\%); and was the lowest in Japan (241/1081, 22.94\%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95\% CI 1.13-1.22), personal concern (OR 1.07, 95\% CI 1.00-1.16), perceived virus severity (OR 1.07, 95\% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95\% CI 2.36-2.66), liking immunity passports (OR 2.77, 95\% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95\% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95\% CI 0.82-0.98), immunity passport concern (OR 0.61, 95\% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95\% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Conclusions: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world. ",
doi="10.2196/32969",
url="https://publichealth.jmir.org/2022/7/e32969",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377317"
}


@Article{info:doi/10.2196/37454,
author="Hanson, L. Bridget
and Finley, Kari
and Otto, Jay
and Ward, J. Nicholas",
title="Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="13",
volume="9",
number="3",
pages="e37454",
keywords="behavioral beliefs",
keywords="health literacy",
keywords="vaccination",
keywords="trusted sources",
keywords="social media",
keywords="vaccine hesitancy",
keywords="health information",
keywords="masking",
keywords="healthcare",
keywords="public health",
keywords="health beliefs",
abstract="Background: During the ongoing COVID-19 pandemic and in preparation for future public health crises, it is important to understand the relationship between individuals' health beliefs, including their trust in various sources of health information, and their engagement in mitigation behaviors. Objective: We sought to identify relationships between trust in various sources of health information and the behavioral beliefs related to vaccination and mask wearing as well as to understand how behavioral beliefs related to vaccination differ by willingness to be vaccinated. Methods: We conducted an online survey of 1034 adults in the United States and assessed their trust in federal, local, and media sources of health information; their beliefs about vaccination; and their masking intention and vaccination willingness. Results: Using regression, masking intention was predicted by trust in the World Health Organization (P<.05) and participants' state public health offices (P<.05), while vaccine willingness was predicted by trust in participants' own health care providers (P<.05) and pharmaceutical companies (P<.001). Compared to individuals with low willingness to be vaccinated, individuals with high willingness indicated greater endorsement of beliefs that vaccines would support a return to normalcy, are safe, and are a social responsibility (P<.001 for all). Conclusions: Results can be used to inform ongoing public health messaging campaigns to manage the COVID-19 pandemic and increase readiness for the next pandemic. Additionally, results support the need to bolster the public's trust in health care agencies as well as to enhance trust and respect in health care providers to increase people's adoption of mitigation behaviors. ",
doi="10.2196/37454",
url="https://humanfactors.jmir.org/2022/3/e37454",
url="http://www.ncbi.nlm.nih.gov/pubmed/35830238"
}


@Article{info:doi/10.2196/37744,
author="Kumar, Anish
and Ren, Jennifer
and Ornstein, A. Katherine
and Gliatto, M. Peter",
title="Using Machine Learning to Efficiently Vaccinate Homebound Patients Against COVID-19: A Real-time Immunization Campaign",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="12",
volume="24",
number="7",
pages="e37744",
keywords="home care",
keywords="covid",
keywords="vaccination",
keywords="COVID-19",
keywords="machine learning",
keywords="vaccine",
keywords="geographic cluster",
keywords="patient data",
keywords="clustering algorithm",
keywords="geospatial",
keywords="digital surveillance",
keywords="public health",
keywords="logistic operation",
keywords="electronic health record integration",
doi="10.2196/37744",
url="https://www.jmir.org/2022/7/e37744",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679053"
}


@Article{info:doi/10.2196/38418,
author="Weeks, Rose
and Cooper, Lyra
and Sangha, Pooja
and Sedoc, Jo{\~a}o
and White, Sydney
and Toledo, Assaf
and Gretz, Shai
and Lahav, Dan
and Martin, Nina
and Michel, Alexandra
and Lee, Hyoung Jae
and Slonim, Noam
and Bar-Zeev, Naor",
title="Chatbot-Delivered COVID-19 Vaccine Communication Message Preferences of Young Adults and Public Health Workers in Urban American Communities: Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="6",
volume="24",
number="7",
pages="e38418",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="chatbots",
keywords="AI",
keywords="artificial intelligence",
keywords="natural language processing",
keywords="social media",
keywords="vaccine communication",
keywords="digital health",
keywords="misinformation",
keywords="infodemic",
keywords="infodemiology",
keywords="conversational agent",
keywords="public health",
keywords="user need",
keywords="vaccination",
keywords="health communication",
keywords="online health information",
abstract="Background: Automated conversational agents, or chatbots, have a role in reinforcing evidence-based guidance delivered through other media and offer an accessible, individually tailored channel for public engagement. In early-to-mid 2021, young adults and minority populations disproportionately affected by COVID-19 in the United States were more likely to be hesitant toward COVID-19 vaccines, citing concerns regarding vaccine safety and effectiveness. Successful chatbot communication requires purposive understanding of user needs. Objective: We aimed to review the acceptability of messages to be delivered by a chatbot named VIRA from Johns Hopkins University. The study investigated which message styles were preferred by young, urban-dwelling Americans as well as public health workers, since we anticipated that the chatbot would be used by the latter as a job aid. Methods: We conducted 4 web-based focus groups with 20 racially and ethnically diverse young adults aged 18-28 years and public health workers aged 25-61 years living in or near eastern-US cities. We tested 6 message styles, asking participants to select a preferred response style for a chatbot answering common questions about COVID-19 vaccines. We transcribed, coded, and categorized emerging themes within the discussions of message content, style, and framing. Results: Participants preferred messages that began with an empathetic reflection of a user concern and concluded with a straightforward, fact-supported response. Most participants disapproved of moralistic or reasoning-based appeals to get vaccinated, although public health workers felt that such strong statements appealing to communal responsibility were warranted. Responses tested with humor and testimonials did not appeal to the participants. Conclusions: To foster credibility, chatbots targeting young people with vaccine-related messaging should aim to build rapport with users by deploying empathic, reflective statements, followed by direct and comprehensive responses to user queries. Further studies are needed to inform the appropriate use of user-customized testimonials and humor in the context of chatbot communication. ",
doi="10.2196/38418",
url="https://www.jmir.org/2022/7/e38418",
url="http://www.ncbi.nlm.nih.gov/pubmed/35737898"
}


@Article{info:doi/10.2196/37806,
author="Ngai, Bik Cindy Sing
and Singh, Gill Rita
and Yao, Le",
title="Impact of COVID-19 Vaccine Misinformation on Social Media Virality: Content Analysis of Message Themes and Writing Strategies",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="6",
volume="24",
number="7",
pages="e37806",
keywords="antivaccine misinformation",
keywords="content themes",
keywords="writing strategies",
keywords="COVID-19",
keywords="virality",
keywords="social media",
keywords="content analysis",
abstract="Background: Vaccines serve an integral role in containing pandemics, yet vaccine hesitancy is prevalent globally. One key reason for this hesitancy is the pervasiveness of misinformation on social media. Although considerable research attention has been drawn to how exposure to misinformation is closely associated with vaccine hesitancy, little scholarly attention has been given to the investigation or robust theorizing of the various content themes pertaining to antivaccine misinformation about COVID-19 and the writing strategies in which these content themes are manifested. Virality of such content on social media exhibited in the form of comments, shares, and reactions has practical implications for COVID-19 vaccine hesitancy. Objective: We investigated whether there were differences in the content themes and writing strategies used to disseminate antivaccine misinformation about COVID-19 and their impact on virality on social media. Methods: We constructed an antivaccine misinformation database from major social media platforms during September 2019-August 2021 to examine how misinformation exhibited in the form of content themes and how these themes manifested in writing were associated with virality in terms of likes, comments, and shares. Antivaccine misinformation was retrieved from two globally leading and widely cited fake news databases, COVID Global Misinformation Dashboard and International Fact-Checking Network Corona Virus Facts Alliance Database, which aim to track and debunk COVID-19 misinformation. We primarily focused on 140 Facebook posts, since most antivaccine misinformation posts on COVID-19 were found on Facebook. We then  employed quantitative content analysis to examine the content themes (ie, safety concerns, conspiracy theories, efficacy concerns) and manifestation strategies of misinformation (ie, mimicking of news and scientific reports in terms of the format and language features, use of a conversational style, use of amplification) in these posts and their association with virality of misinformation in the form of likes, comments, and shares. Results: Our study revealed that safety concern was the most prominent content theme and a negative predictor of likes and shares. Regarding the writing strategies manifested in content themes, a conversational style and mimicking of news and scientific reports via the format and language features were frequently employed in COVID-19 antivaccine misinformation, with the latter being a positive predictor of likes. Conclusions: This study contributes to a richer research-informed understanding of which concerns about content theme and manifestation strategy need to be countered on antivaccine misinformation circulating on social media so that accurate information on COVID-19 vaccines can be disseminated to the public, ultimately reducing vaccine hesitancy. The liking of COVID-19 antivaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus. ",
doi="10.2196/37806",
url="https://www.jmir.org/2022/7/e37806",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731969"
}


@Article{info:doi/10.2196/37920,
author="Sargent, H. Rikki
and Laurie, Shaelyn
and Weakland, F. Leo
and Lavery, V. James
and Salmon, A. Daniel
and Orenstein, A. Walter
and Breiman, F. Robert",
title="Use of Random Domain Intercept Technology to Track COVID-19 Vaccination Rates in Real Time Across the United States: Survey Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="1",
volume="24",
number="7",
pages="e37920",
keywords="COVID-19",
keywords="vaccination rates",
keywords="Random Domain Intercept Technology",
keywords="health technology",
keywords="vaccination",
keywords="vaccine tracker",
keywords="web-based survey",
keywords="epidemiology",
keywords="health data",
keywords="digital tool",
keywords="online intercept sampling",
keywords="health service",
abstract="Background: Accurate and timely COVID-19 vaccination coverage data are vital for informing targeted, effective messaging and outreach and identifying barriers to equitable health service access. However, gathering vaccination rate data is challenging, and efforts often result in information that is either limited in scope (eg, limited to administrative data) or delayed (impeding the ability to rapidly respond). The evaluation of innovative technologies and approaches that can assist in addressing these limitations globally are needed. Objective: The objective of this survey study was to assess the validity of Random Domain Intercept Technology (RDIT; RIWI Corp) for tracking self-reported vaccination rates in real time at the US national and state levels. RDIT---a form of online intercept sampling---has the potential to address the limitations of current vaccination tracking systems by allowing for the measurement of additional data (eg, attitudinal data) and real-time, rapid data collection anywhere there is web access. Methods: We used RDIT from June 30 to July 26, 2021, to reach a broad sample of US adult (aged ?18 years) web users and asked questions related to COVID-19 vaccination. Self-reported vaccination status was used as the focus of this validation exercise. National- and state-level RDIT-based vaccination rates were compared to Centers for Disease Control and Prevention (CDC)--reported national and state vaccination rates. Johns Hopkins University's and Emory University's institutional review boards designated this project as public health practice to inform message development (not human subjects research). Results: By using RDIT, 63,853 adult web users reported their vaccination status (6.2\% of the entire 1,026,850 American web-using population that was exposed to the survey). At the national level, the RDIT-based estimate of adult COVID-19 vaccine coverage was slightly higher (44,524/63,853, 69.7\%; 95\% CI 69.4\%-70.1\%) than the CDC-reported estimate (67.9\%) on July 15, 2021 (ie, midway through data collection; t63,852=10.06; P<.001). The RDIT-based and CDC-reported state-level estimates were strongly and positively correlated (r=0.90; P<.001). RDIT-based estimates were within 5 percentage points of the CDC's estimates for 29 states. Conclusions: This broad-reaching, real-time data stream may provide unique advantages for tracking the use of a range of vaccines and for the timely evaluation of vaccination interventions. Moreover, RDIT could be harnessed to rapidly assess demographic, attitudinal, and behavioral constructs that are not available in administrative data, which could allow for deeper insights into the real-time predictors of vaccine uptake--enabling targeted and timely interventions. ",
doi="10.2196/37920",
url="https://www.jmir.org/2022/7/e37920",
url="http://www.ncbi.nlm.nih.gov/pubmed/35709335"
}


@Article{info:doi/10.2196/33995,
author="Yao, Yan
and Chai, Ruiyu
and Yang, Jianzhou
and Zhang, Xiangjun
and Huang, Xiaojie
and Yu, Maohe
and Fu, Geng-feng
and Lan, Guanghua
and Qiao, Ying
and Zhou, Qidi
and Li, Shuyue
and Xu, Junjie",
title="Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="30",
volume="8",
number="6",
pages="e33995",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="PLWHA",
keywords="structural equation modeling",
abstract="Background: Many countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA. Objective: This study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA. Methods: The study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy. Results: Among 1735 participants, 41.61\% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making. Conclusions: COVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA's trust of medical professionals. ",
doi="10.2196/33995",
url="https://publichealth.jmir.org/2022/6/e33995",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486810"
}


@Article{info:doi/10.2196/34231,
author="Hagen, Loni
and Fox, Ashley
and O'Leary, Heather
and Dyson, DeAndre
and Walker, Kimberly
and Lengacher, A. Cecile
and Hernandez, Raquel",
title="The Role of Influential Actors in Fostering the Polarized COVID-19 Vaccine Discourse on Twitter: Mixed Methods of Machine Learning and Inductive Coding",
journal="JMIR Infodemiology",
year="2022",
month="Jun",
day="30",
volume="2",
number="1",
pages="e34231",
keywords="COVID-19, vaccine hesitancy, social media, influential actors",
keywords="influencer",
keywords="Twitter",
abstract="Background: Since COVID-19 vaccines became broadly available to the adult population, sharp divergences in uptake have emerged along partisan lines. Researchers have indicated a polarized social media presence contributing to the spread of mis- or disinformation as being responsible for these growing partisan gaps in uptake. Objective: The major aim of this study was to investigate the role of influential actors in the context of the community structures and discourse related to COVID-19 vaccine conversations on Twitter that emerged prior to the vaccine rollout to the general population and discuss implications for vaccine promotion and policy. Methods: We collected tweets on COVID-19 between July 1, 2020, and July 31, 2020, a time when attitudes toward the vaccines were forming but before the vaccines were widely available to the public. Using network analysis, we identified different naturally emerging Twitter communities based on their internal information sharing. A PageRank algorithm was used to quantitively measure the level of ``influentialness'' of Twitter accounts and identifying the ``influencers,'' followed by coding them into different actor categories. Inductive coding was conducted to describe discourses shared in each of the 7 communities. Results: Twitter vaccine conversations were highly polarized, with different actors occupying separate ``clusters.'' The antivaccine cluster was the most densely connected group. Among the 100 most influential actors, medical experts were outnumbered both by partisan actors and by activist vaccine skeptics or conspiracy theorists. Scientists and medical actors were largely absent from the conservative network, and antivaccine sentiment was especially salient among actors on the political right. Conversations related to COVID-19 vaccines were highly polarized along partisan lines, with ``trust'' in vaccines being manipulated to the political advantage of partisan actors. Conclusions: These findings are informative for designing improved vaccine information communication strategies to be delivered on social media especially by incorporating influential actors. Although polarization and echo chamber effect are not new in political conversations in social media, it was concerning to observe these in health conversations on COVID-19 vaccines during the vaccine development process. ",
doi="10.2196/34231",
url="https://infodemiology.jmir.org/2022/1/e34231",
url="http://www.ncbi.nlm.nih.gov/pubmed/35814809"
}


@Article{info:doi/10.2196/37077,
author="Saini, Vipin
and Liang, Li-Lin
and Yang, Yu-Chen
and Le, Mai Huong
and Wu, Chun-Ying",
title="The Association Between Dissemination and Characteristics of Pro-/Anti-COVID-19 Vaccine Messages on Twitter: Application of the Elaboration Likelihood Model",
journal="JMIR Infodemiology",
year="2022",
month="Jun",
day="27",
volume="2",
number="1",
pages="e37077",
keywords="COVID-19",
keywords="Twitter",
keywords="provaccine",
keywords="antivaccine",
keywords="elaboration likelihood model",
keywords="infodemiology",
keywords="dissemination",
keywords="content analysis",
keywords="emotional valence",
keywords="social media",
abstract="Background: Messages on one's stance toward vaccination on microblogging sites may affect the reader's decision on whether to receive a vaccine. Understanding the dissemination of provaccine and antivaccine messages relating to COVID-19 on social media is crucial; however, studies on this topic have remained limited. Objective: This study applies the elaboration likelihood model (ELM) to explore the characteristics of vaccine stance messages that may appeal to Twitter users. First, we examined the associations between the characteristics of vaccine stance tweets and the likelihood and number of retweets. Second, we identified the relative importance of the central and peripheral routes in decision-making on sharing a message. Methods: English-language tweets from the United States that contained provaccine and antivaccine hashtags (N=150,338) were analyzed between April 26 and August 26, 2021. Logistic and generalized negative binomial regressions were conducted to predict retweet outcomes. The content-related central-route predictors were measured using the numbers of hashtags and mentions, emotional valence, emotional intensity, and concreteness. The content-unrelated peripheral-route predictors were measured using the numbers of likes and followers and whether the source was a verified user. Results: Content-related characteristics played a prominent role in shaping decisions regarding whether to retweet antivaccine messages. Particularly, positive valence (incidence rate ratio [IRR]=1.32, P=.03) and concreteness (odds ratio [OR]=1.17, P=.01) were associated with higher numbers and likelihood of retweets of antivaccine messages, respectively; emotional intensity (subjectivity) was associated with fewer retweets of antivaccine messages (OR=0.78, P=.03; IRR=0.80, P=.04). However, these factors had either no or only small effects on the sharing of provaccine tweets. Retweets of provaccine messages were primarily determined by content-unrelated characteristics, such as the numbers of likes (OR=2.55, IRR=2.24, P<.001) and followers (OR=1.31, IRR=1.28, P<.001). Conclusions: The dissemination of antivaccine messages is associated with both content-related and content-unrelated characteristics. By contrast, the dissemination of provaccine messages is primarily driven by content-unrelated characteristics. These findings signify the importance of leveraging the peripheral route to promote the dissemination of provaccine messages. Because antivaccine tweets with positive emotions, objective content, and concrete words are more likely to be disseminated, policymakers should pay attention to antivaccine messages with such characteristics. ",
doi="10.2196/37077",
url="https://infodemiology.jmir.org/2022/1/e37077",
url="http://www.ncbi.nlm.nih.gov/pubmed/35783451"
}


@Article{info:doi/10.2196/38423,
author="Xue, Haoning
and Gong, Xuanjun
and Stevens, Hannah",
title="COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="21",
volume="24",
number="6",
pages="e38423",
keywords="COVID-19 vaccine",
keywords="fact checking",
keywords="misinformation correction",
keywords="sentiment analysis",
keywords="social media",
keywords="COVID-19",
keywords="vaccination",
keywords="misinformation",
keywords="health information",
keywords="online information",
keywords="infodemic",
keywords="public sentiment",
abstract="Background: Effective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy. Objective: This work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem. Methods: We collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem. Results: The percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=--0.92, df=21, t=--10.94, 95\% CI --0.97 to --0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95\% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95\% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95\% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=--0.62, df=25, t=--3.94, 95\% CI --0.81 to --0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95\% CI 0.00-0.12, t=2.03, P=.04). Conclusions: The percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media. ",
doi="10.2196/38423",
url="https://www.jmir.org/2022/6/e38423",
url="http://www.ncbi.nlm.nih.gov/pubmed/35671409"
}


@Article{info:doi/10.2196/35754,
author="Ritschl, Valentin
and Eibensteiner, Fabian
and Mosor, Erika
and Omara, Maisa
and Sperl, Lisa
and Nawaz, A. Faisal
and Siva Sai, Chandragiri
and Cenanovic, Merisa
and Devkota, Prasad Hari
and Hribersek, Mojca
and De, Ronita
and Klager, Elisabeth
and Schaden, Eva
and Kletecka-Pulker, Maria
and V{\"o}lkl-Kernstock, Sabine
and Willschke, Harald
and Aufricht, Christoph
and Atanasov, G. Atanas
and Stamm, Tanja",
title="Mandatory Vaccination Against COVID-19: Twitter Poll Analysis on Public Health Opinion",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="21",
volume="6",
number="6",
pages="e35754",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="vaccination",
keywords="Twitter",
keywords="survey",
keywords="mandatory vaccination",
keywords="vaccination hesitancy",
keywords="coronavirus",
keywords="hesitancy",
keywords="social media",
keywords="questionnaire",
keywords="mandatory",
keywords="support",
keywords="poll",
keywords="opinion",
keywords="public health",
keywords="perception",
abstract="Background: On January 30, 2020, the World Health Organization Emergency Committee declared the rapid worldwide spread of COVID-19 a global health emergency. By December 2020, the safety and efficacy of the first COVID-19 vaccines had been demonstrated. However, international vaccination coverage rates have remained below expectations (in Europe at the time of manuscript submission). Controversial mandatory vaccination is currently being discussed and has already been introduced in some countries (Austria, Greece, and Italy). We used the Twitter survey system as a viable method to quickly and comprehensively gather international public health insights on mandatory vaccination against COVID-19. Objective: The purpose of this study was to better understand the public's perception of mandatory COVID-19 vaccination in real time using Twitter polls. Methods: Two Twitter polls were developed (in the English language) to seek the public's opinion on the possibility of mandatory vaccination. The polls were pinned to the Digital Health and Patient Safety Platform's (based in Vienna, Austria) Twitter timeline for 1 week in mid-November 2021, 3 days after the official public announcement of mandatory COVID-19 vaccination in Austria. Twitter users were asked to participate and retweet the polls to reach the largest possible audience. Results: Our Twitter polls revealed two extremes on the topic of mandatory vaccination against COVID-19. Almost half of the 2545 respondents (n=1246, 49\%) favor mandatory vaccination, at least in certain areas. This attitude contrasts with the 45.7\% (n=1162) who categorically reject mandatory vaccination. Over one-quarter (n=621, 26.3\%) of participating Twitter users said they would never get vaccinated, as reflected by the current Western European and North American vaccination coverage rate. Concatenating interpretation of these two polls should be done cautiously as participating populations might substantially differ. Conclusions: Mandatory vaccination against COVID-19 (in at least certain areas) is favored by less than 50\%, whereas it is opposed by almost half of the surveyed Twitter users. Since (social) media strongly influences public perceptions and views, and social media discussions and surveys are specifically susceptible to the ``echo chamber effect,'' the results should be interpreted as a momentary snapshot. Therefore, the results of this study need to be complemented by long-term surveys to maintain their validity. ",
doi="10.2196/35754",
url="https://formative.jmir.org/2022/6/e35754",
url="http://www.ncbi.nlm.nih.gov/pubmed/35617671"
}


@Article{info:doi/10.2196/34666,
author="Yang, Liuqing
and Ji, Lili
and Wang, Qiang
and Xu, Yan
and Yang, Guoping
and Cui, Tingting
and Shi, Naiyang
and Zhu, Lin
and Xiu, Shixin
and Jin, Hui
and Zhen, Shiqi",
title="Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="20",
volume="8",
number="6",
pages="e34666",
keywords="vaccine",
keywords="theory of planned behavior",
keywords="attitude",
keywords="subjective norms",
keywords="perceived behavior control",
keywords="moderator",
keywords="mediation",
abstract="Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases. Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices. Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior---in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation---to test the validity of the theoretical framework. Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude ($\beta$=--0.052, P<.001) and subjective norms ($\beta$=--0.028, P=.006) with perceived behavioral control were significant. Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior. ",
doi="10.2196/34666",
url="https://publichealth.jmir.org/2022/6/e34666",
url="http://www.ncbi.nlm.nih.gov/pubmed/35723904"
}


@Article{info:doi/10.2196/34615,
author="Piltch-Loeb, Rachael
and Su, Max
and Hughes, Brian
and Testa, Marcia
and Goldberg, Beth
and Braddock, Kurt
and Miller-Idriss, Cynthia
and Maturo, Vanessa
and Savoia, Elena",
title="Testing the Efficacy of Attitudinal Inoculation Videos to Enhance COVID-19 Vaccine Acceptance: Quasi-Experimental Intervention Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="20",
volume="8",
number="6",
pages="e34615",
keywords="attitudinal inoculation",
keywords="intervention",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="vaccine",
keywords="vaccination",
keywords="public health",
keywords="health intervention",
keywords="misinformation",
keywords="infodemiology",
keywords="vaccine misinformation",
abstract="Background: Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. Objective: This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. Methods: We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical (``Narrative'') presentation of information, intervention video 2 focusing on delivering a fact-based information (``Fact''), and intervention video 3 using a hybrid design (``Hybrid''). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics (``Recognize''), willingness to share misinformation (``Share''), and willingness to take the COVID-19 vaccine (``Willingness''). Results: There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). Conclusions: Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation. ",
doi="10.2196/34615",
url="https://publichealth.jmir.org/2022/6/e34615",
url="http://www.ncbi.nlm.nih.gov/pubmed/35483050"
}


@Article{info:doi/10.2196/37327,
author="Johnson, K. Randi
and Marker, M. Katie
and Mayer, David
and Shortt, Jonathan
and Kao, David
and Barnes, C. Kathleen
and Lowery, T. Jan
and Gignoux, R. Christopher",
title="COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="13",
volume="8",
number="6",
pages="e37327",
keywords="COVID-19",
keywords="surveillance",
keywords="pandemic",
keywords="biobank",
keywords="EHR",
keywords="public health",
keywords="integrated data",
keywords="population health",
keywords="health monitoring",
keywords="electronic health record",
keywords="eHealth",
keywords="health record",
keywords="emergency response",
keywords="vaccination status",
keywords="vaccination",
keywords="testing",
keywords="symptom",
keywords="disease impact",
abstract="Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a ``confirmed case'' of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9\%) survey respondents, 10,661 (42.5\%) had been tested for COVID-19, and of those, 1366 (12.8\%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6\%) and family life (n=12,233, 48.8\%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3\%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4\%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4\%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. ",
doi="10.2196/37327",
url="https://publichealth.jmir.org/2022/6/e37327",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486493"
}


@Article{info:doi/10.2196/37133,
author="Liu, Jia",
title="HIV Digital Vaccine Strategy: Proposal for Applying Blockchain in Preventing the Spread of HIV",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="13",
volume="11",
number="6",
pages="e37133",
keywords="HIV",
keywords="blockchain",
keywords="digital vaccine",
keywords="decentralized surveillance",
abstract="Background: The HIV epidemic imposes a heavy burden on societal development. Protection of susceptible populations is the most feasible method for eliminating the spread of HIV. In the absence of a biological vaccine, the definitive solution is enabling susceptible populations to recognize and avoid high-risk sexual behavior. Objective: The objective of this study is to use specific technologies and strategies to establish a system by which high-HIV-risk individuals can determine the HIV infection status of one another anonymously, conveniently, and credibly. Methods: This study proposes an HIV digital vaccine (HDV) strategy, a decentralized application (Dapp) based on blockchain for use by individuals with a high risk of HIV and accredited testing agencies (ATAs). Following testing, only the HIV-negative results (or linked information) are uploaded to the blockchain, which results in high-risk individuals being able to determine the HIV-negative status of each other anonymously, conveniently, and credibly. Results: Future work includes the following: (1) a survey of the willingness to use Dapps among high-HIV-risk populations, (2) a larger framework containing both HDV and people living with HIV (PLH) and discussing the influence of HDV on PLH and its possible solutions, and (3) coordinating with the blockchain development team, ATAs, community-based organizations, and third-party organizations to raise funds, develop the Dapp, formulate detailed plans, and publicize and promote it. The exact timeline for achieving these objectives cannot be determined at present. Conclusions: The HDV strategy may reduce the occurrence of high-risk sexual behavior and effectively protect susceptible populations; combined with current strategies, it is a promising solution to prevent the spread of HIV. The included concepts of decentralized surveillance and surveillance as intervention may spark a change in current infectious disease prevention and control modes to introduce beneficial innovations in public health systems globally. International Registered Report Identifier (IRRID): PRR1-10.2196/37133 ",
doi="10.2196/37133",
url="https://www.researchprotocols.org/2022/6/e37133",
url="http://www.ncbi.nlm.nih.gov/pubmed/35700007"
}


@Article{info:doi/10.2196/37466,
author="Niu, Qian
and Liu, Junyu
and Kato, Masaya
and Nagai-Tanima, Momoko
and Aoyama, Tomoki",
title="The Effect of Fear of Infection and Sufficient Vaccine Reservation Information on Rapid COVID-19 Vaccination in Japan: Evidence From a Retrospective Twitter Analysis",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="9",
volume="24",
number="6",
pages="e37466",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="Japan",
keywords="social media",
keywords="text mining",
abstract="Background: The global public health and socioeconomic impacts of the COVID-19 pandemic have been substantial, rendering herd immunity by COVID-19 vaccination an important factor for protecting people and retrieving the economy. Among all the countries, Japan became one of the countries with the highest COVID-19 vaccination rates in several months, although vaccine confidence in Japan is the lowest worldwide. Objective: We attempted to find the reasons for rapid COVID-19 vaccination in Japan given its lowest vaccine confidence levels worldwide, through Twitter analysis.? Methods: We downloaded COVID-19--related Japanese tweets from a large-scale public COVID-19 Twitter chatter data set within the timeline of February 1 and September 30, 2021. The daily number of vaccination cases was collected from the official website of the Prime Minister's Office of Japan. After preprocessing, we applied unigram and bigram token analysis and then calculated the cross-correlation and Pearson correlation coefficient (r) between the term frequency and daily vaccination cases. We then identified vaccine sentiments and emotions of tweets and used the topic modeling to look deeper into the dominant emotions.? Results: We selected 190,697 vaccine-related tweets after filtering. Through n-gram token analysis, we discovered the top unigrams and bigrams over the whole period. In all the combinations of the top 6 unigrams, tweets with both keywords ``reserve'' and ``venue'' showed the largest correlation with daily vaccination cases (r=0.912; P<.001). On sentiment analysis, negative sentiment overwhelmed positive sentiment, and fear was the dominant emotion across the period. For the latent Dirichlet allocation model on tweets with fear emotion, the two topics were identified as ``infect'' and ``vaccine confidence.'' The expectation of the number of tweets generated from topic ``infect'' was larger than that generated from topic ``vaccine confidence.'' Conclusions: Our work indicates that awareness of the danger of COVID-19 might increase the willingness to get vaccinated. With a sufficient vaccine supply, effective delivery of vaccine reservation information may be an important factor for people to get vaccinated. We did not find evidence for increased vaccine confidence in Japan during the period of our study.?We recommend policy makers to share accurate and prompt information about the infectious diseases and vaccination and to make efforts on smoother delivery of vaccine reservation information. ",
doi="10.2196/37466",
url="https://www.jmir.org/2022/6/e37466",
url="http://www.ncbi.nlm.nih.gov/pubmed/35649182"
}


@Article{info:doi/10.2196/33484,
author="Yu, Hanzhi
and Du, Runming
and Wang, Minmin
and Yu, Fengyun
and Yang, Juntao
and Jiao, Lirui
and Wang, Zhuoran
and Liu, Haitao
and Wu, Peixin
and B{\"a}rnighausen, Till
and Xue, Lan
and Wang, Chen
and McMahon, Shannon
and Geldsetzer, Pascal
and Chen, Simiao",
title="Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China",
journal="JMIR Public Health Surveill",
year="2022",
month="Jun",
day="7",
volume="8",
number="6",
pages="e33484",
keywords="COVID-19 vaccines",
keywords="China",
keywords="global allocation",
keywords="public attitudes",
keywords="cross-sectional",
keywords="survey",
keywords="vaccines",
keywords="COVID-19",
keywords="pandemic",
keywords="public health",
keywords="health policy",
keywords="epidemiology",
abstract="Background: COVID-19 vaccines are in short supply worldwide. China was among the first countries to pledge supplies of the COVID-19 vaccine as a global public product, and to date, the country has provided more than 600 million vaccines to more than 200 countries and regions with low COVID-19 vaccination rates. Understanding the public's attitude in China toward the global distribution of COVID-19 vaccines could inform global and national decisions, policies, and debates. Objective: The aim of this study was to determine the attitudes of adults living in China regarding the global allocation of COVID-19 vaccines developed in China and how these attitudes vary across provinces and by sociodemographic characteristics. Methods: We conducted a cross-sectional online survey among adults registered with the survey company KuRunData. The survey asked participants 31 questions about their attitudes regarding the global allocation of COVID-19 vaccines developed in China. We disaggregated responses by province and sociodemographic characteristics. All analyses used survey sampling weights. Results: A total of 10,000 participants completed the questionnaire. Participants generally favored providing COVID-19 vaccines to foreign countries before fulfilling domestic needs (75.6\%, 95\% CI 74.6\%-76.5\%). Women (3778/4921, 76.8\%; odds ratio 1.18, 95\% CI 1.07-1.32; P=.002) and those living in rural areas (3123/4065, 76.8\%; odds ratio 1.13, 95\% CI 1.01-1.27; P=.03) were especially likely to hold this opinion. Most respondents preferred providing financial support through international platforms rather than directly offering support to individual countries (72.1\%, 95\% CI 71\%-73.1\%), while for vaccine products they preferred direct provision to relevant countries instead of via a delivery platform such as COVAX (77.3\%, 95\% CI 76.3\%-78.2\%). Conclusions: Among our survey sample, we found that adults are generally supportive of the international distribution of COVID-19 vaccines, which may encourage policy makers to support and implement the distribution of COVID-19 vaccines developed in China worldwide. Conducting similar surveys in other countries could help align policy makers' actions on COVID-19 vaccine distribution with the preferences of their constituencies. ",
doi="10.2196/33484",
url="https://publichealth.jmir.org/2022/6/e33484",
url="http://www.ncbi.nlm.nih.gov/pubmed/35483084"
}


@Article{info:doi/10.2196/31968,
author="Adeyinka, A. Daniel
and Neudorf, Cory
and Camillo, A. Cheryl
and Marks, N. Wendie
and Muhajarine, Nazeem",
title="COVID-19 Vaccination and Public Health Countermeasures on Variants of Concern in Canada: Evidence From a Spatial Hierarchical Cluster Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="31",
volume="8",
number="5",
pages="e31968",
keywords="COVID-19",
keywords="variants of concern",
keywords="stringency index",
keywords="mobility index",
keywords="vaccination coverage",
keywords="machine learning",
keywords="Canada",
abstract="Background: There is mounting evidence that the third wave of COVID-19 incidence is declining, yet variants of concern (VOCs) continue to present public health challenges in Canada. The emergence of VOCs has sparked debate on how to effectively control their impacts on the Canadian population. Objective: Provincial and territorial governments have implemented a wide range of policy measures to protect residents against community transmission of COVID-19, but research examining the specific impact of policy countermeasures on the VOCs in Canada is needed. Our study objective was to identify provinces with disproportionate prevalence of VOCs relative to COVID-19 mitigation efforts in provinces and territories in Canada. Methods: We analyzed publicly available provincial- and territorial-level data on the prevalence of VOCs in relation to mitigating factors, summarized in 3 measures: (1) strength of public health countermeasures (stringency index), (2) the extent to which people moved about outside their homes (mobility index), and (3) the proportion of the provincial or territorial population that was fully vaccinated (vaccine uptake). Using spatial agglomerative hierarchical cluster analysis (unsupervised machine learning), provinces and territories were grouped into clusters by stringency index, mobility index, and full vaccine uptake. The Kruskal-Wallis test was used to compare the prevalence of VOCs (Alpha, or B.1.1.7; Beta, or B.1.351; Gamma, or P.1; and Delta, or B.1.617.2 variants) across the clusters. Results: We identified 3 clusters of vaccine uptake and countermeasures. Cluster 1 consisted of the 3 Canadian territories and was characterized by a higher degree of vaccine deployment and fewer countermeasures. Cluster 2 (located in Central Canada and the Atlantic region) was typified by lower levels of vaccine deployment and moderate countermeasures. The third cluster, which consisted of provinces in the Pacific region, Central Canada, and the Prairies, exhibited moderate vaccine deployment but stronger countermeasures. The overall and variant-specific prevalences were significantly different across the clusters. Conclusions: This ``up to the point'' analysis found that implementation of COVID-19 public health measures, including the mass vaccination of populations, is key to controlling VOC prevalence rates in Canada. As of June 15, 2021, the third wave of COVID-19 in Canada is declining, and those provinces and territories that had implemented more comprehensive public health measures showed lower VOC prevalence. Public health authorities and governments need to continue to communicate the importance of sociobehavioural preventive measures, even as populations in Canada continue to receive their primary and booster doses of vaccines. ",
doi="10.2196/31968",
url="https://publichealth.jmir.org/2022/5/e31968",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486447"
}


@Article{info:doi/10.2196/37328,
author="Zhu, Patricia
and Tatar, Ovidiu
and Griffin-Mathieu, Gabrielle
and Perez, Samara
and Haward, Ben
and Zimet, Gregory
and Tunis, Matthew
and Dub{\'e}, {\`E}ve
and Rosberger, Zeev",
title="The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="30",
volume="8",
number="5",
pages="e37328",
keywords="COVID-19",
keywords="vaccination",
keywords="altruism",
keywords="prosocial motives",
keywords="video intervention",
keywords="randomized controlled trial",
keywords="younger adults",
keywords="vaccine hesitancy",
keywords="public health",
keywords="youth",
keywords="digital intervention",
keywords="health intervention",
keywords="health promotion",
keywords="web survey",
keywords="digital health",
keywords="online health",
keywords="health information",
abstract="Background: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video's efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50\%, in the video arm, n=687, 50\%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine ($\chi$21=20.55, P<.001). The between-group difference in postintervention intentions ($\chi$23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a ``push'' for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration: ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228 ",
doi="10.2196/37328",
url="https://publichealth.jmir.org/2022/5/e37328",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544437"
}


@Article{info:doi/10.2196/38034,
author="Powell, Leigh
and Nour, Radwa
and Zidoun, Youness
and Kaladhara, Sreelekshmi
and Al Suwaidi, Hanan
and Zary, Nabil",
title="A Web-Based Public Health Intervention for Addressing Vaccine Misinformation: Protocol for Analyzing Learner Engagement and Impacts on the Hesitancy to Vaccinate",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="30",
volume="11",
number="5",
pages="e38034",
keywords="public health",
keywords="population health",
keywords="education",
keywords="gamification",
keywords="COVID-19",
keywords="vaccination",
keywords="misinformation",
keywords="infodemic",
keywords="vaccine hesitancy",
keywords="web-based health",
keywords="web-based intervention",
keywords="learning design",
keywords="dissemination",
abstract="Background: A barrier to successful COVID-19 vaccine campaigns is the ongoing misinformation pandemic, or infodemic, which is contributing to vaccine hesitancy. Web-based population health interventions have been shown to impact health behaviors positively. For web-based interventions to be successful, they must use effective learning design strategies that seek to address known issues with learner engagement and retention. To know if an intervention successfully addresses vaccine hesitancy, there must be some embedded measure for comparing learners preintervention and postintervention. Objective: This protocol aims to describe a study on the effectiveness of a web-based population health intervention that is designed to address vaccine misinformation and hesitancy. The study will examine learner analytics to understand what aspects of the learning design for the intervention were effective and implement a validated instrument---the Adult Vaccine Hesitancy Scale---to measure if any changes in vaccine hesitancy were observed preintervention and postintervention. Methods: We developed a fully web-based population health intervention to help learners identify misinformation concerning COVID-19 and share the science behind vaccinations. Intervention development involves using a design-based research approach to output more effective interventions in which data can be analyzed to improve future health interventions. The study will use a quasi-experimental design in which a pre-post survey will be provided and compared statistically. Learning analytics will also be generated based on the engagement and retention data collected through the intervention to understand what aspects of our learning design are effective. Results: The web-based intervention was released to the public in September 2021, and data collection is ongoing. No external marketing or advertising has been done to market the course, making our current population of 486 participants our pilot study population. An analysis of this initial population will enable the revision of the intervention, which will then be marketed to a broader audience. Study outcomes are expected to be published by August 2022. We anticipate the release of the revised intervention by May 2022. Conclusions: Disseminating accurate information to the public during pandemic situations is vital to contributing to positive health outcomes, such as those among people getting vaccinated. Web-based interventions are valuable, as they can reach people anytime and anywhere. However, web-based interventions must use sound learning design to help incentivize engagement and motivate learners to learn and must provide a means of evaluating the intervention to determine its impact. Our study will examine both the learning design and the effectiveness of the intervention by using the analytics collected within the intervention and a statistical analysis of a validated instrument to determine if learners had a change in vaccine hesitancy as a result of what they learned. International Registered Report Identifier (IRRID): DERR1-10.2196/38034 ",
doi="10.2196/38034",
url="https://www.researchprotocols.org/2022/5/e38034",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451967"
}


@Article{info:doi/10.2196/32543,
author="Hussain, Zain
and Sheikh, Zakariya
and Tahir, Ahsen
and Dashtipour, Kia
and Gogate, Mandar
and Sheikh, Aziz
and Hussain, Amir",
title="Artificial Intelligence--Enabled Social Media Analysis for Pharmacovigilance of COVID-19 Vaccinations in the United Kingdom: Observational Study",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="27",
volume="8",
number="5",
pages="e32543",
keywords="COVID-19",
keywords="artificial intelligence",
keywords="deep learning",
keywords="Facebook",
keywords="health informatics",
keywords="natural language processing",
keywords="public health",
keywords="sentiment analysis",
keywords="social media",
keywords="Twitter",
keywords="infodemiology",
keywords="vaccination",
abstract="Background: ?The rollout of vaccines for COVID-19 in the United Kingdom started in December 2020. Uptake has been high, and there has been a subsequent reduction in infections, hospitalizations, and deaths among vaccinated individuals. However, vaccine hesitancy remains a concern, in particular relating to adverse effects following immunization (AEFIs). Social media analysis has the potential to inform policy makers about AEFIs being discussed by the public as well as public attitudes toward the national immunization campaign. Objective: ?We sought to assess the frequency and nature of AEFI-related mentions on social media in the United Kingdom and to provide insights on public sentiments toward COVID-19 vaccines. Methods: ?We extracted and analyzed over 121,406 relevant Twitter and Facebook posts, from December 8, 2020, to April 30, 2021. These were thematically filtered using a 2-step approach, initially using COVID-19--related keywords and then using vaccine- and manufacturer-related keywords. We identified AEFI-related keywords and modeled their word frequency to monitor their trends over 2-week periods. We also adapted and utilized our recently developed hybrid ensemble model, which combines state-of-the-art lexicon rule--based and deep learning--based approaches, to analyze sentiment trends relating to the main vaccines available in the United Kingdom. Results: ?Our COVID-19 AEFI search strategy identified 46,762 unique Facebook posts by 14,346 users and 74,644 tweets (excluding retweets) by 36,446 users over the 4-month period. We identified an increasing trend in the number of mentions for each AEFI on social media over the study period. The most frequent AEFI mentions were found to be symptoms related to appetite (n=79,132, 14\%), allergy (n=53,924, 9\%), injection site (n=56,152, 10\%), and clots (n=43,907, 8\%). We also found some rarely reported AEFIs such as Bell palsy (n=11,909, 2\%) and Guillain-Barre syndrome (n=9576, 2\%) being discussed as frequently as more well-known side effects like headache (n=10,641, 2\%), fever (n=12,707, 2\%), and diarrhea (n=16,559, 3\%). Overall, we found public sentiment toward vaccines and their manufacturers to be largely positive (58\%), with a near equal split between negative (22\%) and neutral (19\%) sentiments. The sentiment trend was relatively steady over time and had minor variations, likely based on political and regulatory announcements and debates. Conclusions: ?The most frequently discussed COVID-19 AEFIs on social media were found to be broadly consistent with those reported in the literature and by government pharmacovigilance. We also detected potential safety signals from our analysis that have been detected elsewhere and are currently being investigated. As such, we believe our findings support the use of social media analysis to provide a complementary data source to conventional knowledge sources being used for pharmacovigilance purposes. ",
doi="10.2196/32543",
url="https://publichealth.jmir.org/2022/5/e32543",
url="http://www.ncbi.nlm.nih.gov/pubmed/35144240"
}


@Article{info:doi/10.2196/34715,
author="Suzuki, Yukio
and Sukegawa, Akiko
and Ueda, Yutaka
and Sekine, Masayuki
and Enomoto, Takayuki
and Melamed, Alexander
and Wright, D. Jason
and Miyagi, Etsuko",
title="The Effect of a Web-Based Cervical Cancer Survivor's Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="25",
volume="8",
number="5",
pages="e34715",
keywords="human papilloma virus vaccination",
keywords="vaccination",
keywords="vaccine",
keywords="vaccine hesitancy",
keywords="cancer survivor",
keywords="narrative story",
keywords="web based",
keywords="randomized controlled trial",
keywords="RCT",
keywords="HPV",
keywords="human papilloma virus",
keywords="virus",
keywords="hesitancy",
keywords="cancer",
keywords="willingness",
keywords="behavior",
keywords="parent",
abstract="Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor's story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2\%) were men and 909 (41.8\%) were women. A total of 191 (8.8\%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6\%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8\%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9\%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5\% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95\% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95\% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95\% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1\%) participants responded. Of these, 149 (8.2\%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9\%) in the intervention group and 72 (8.7\%) in the control group. Conclusions: A cervical cancer survivor's story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf ",
doi="10.2196/34715",
url="https://publichealth.jmir.org/2022/5/e34715",
url="http://www.ncbi.nlm.nih.gov/pubmed/35421848"
}


@Article{info:doi/10.2196/30426,
author="Zheng, Chengyi
and Duffy, Jonathan
and Liu, Amy In-Lu
and Sy, S. Lina
and Navarro, A. Ronald
and Kim, S. Sunhea
and Ryan, S. Denison
and Chen, Wansu
and Qian, Lei
and Mercado, Cheryl
and Jacobsen, J. Steven",
title="Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) in the United States: Development and Validation of a Natural Language Processing Method",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="24",
volume="8",
number="5",
pages="e30426",
keywords="health",
keywords="informatics",
keywords="shoulder injury related to vaccine administration",
keywords="SIRVA",
keywords="natural language processing",
keywords="NLP",
keywords="causal relation",
keywords="temporal relation",
keywords="pharmacovigilance",
keywords="electronic health records",
keywords="EHR",
keywords="vaccine safety",
keywords="artificial intelligence",
keywords="big data",
keywords="population health",
keywords="real-world data",
keywords="vaccines",
abstract="Background: Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, due to the difficulty of finding SIRVA cases in large health care databases, population-based studies are scarce. Objective: The goal of the research was to develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes. Methods: We conducted the study among members of a large integrated health care organization who were vaccinated between April 1, 2016, and December 31, 2017, and had subsequent diagnosis codes indicative of shoulder injury. Based on a training data set with a chart review reference standard of 164 cases, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified 3 groups of positive SIRVA cases (definite, probable, and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated cases. We then applied the final automated NLP algorithm to a broader cohort of vaccinated persons with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases. Results: In the validation sample, the NLP algorithm had 100\% accuracy for identifying 4 SIRVA cases and 96 cases without SIRVA. In the broader cohort of 53,585 vaccinations, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.5\% (278/291), 67.7\% (84/124), and 17.3\% (9/52), respectively. Conclusions: The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation. ",
doi="10.2196/30426",
url="https://publichealth.jmir.org/2022/5/e30426",
url="http://www.ncbi.nlm.nih.gov/pubmed/35608886"
}


@Article{info:doi/10.2196/35311,
author="Liu, Cong
and Lee, Junghwan
and Ta, Casey
and Soroush, Ali
and Rogers, R. James
and Kim, Hyun Jae
and Natarajan, Karthik
and Zucker, Jason
and Perl, Yehoshua
and Weng, Chunhua",
title="Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="24",
volume="8",
number="5",
pages="e35311",
keywords="COVID-19",
keywords="medical informatics",
keywords="real-word evidence",
keywords="vaccination",
keywords="electronic health records",
abstract="Background: COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported. Objective: This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals. Methods: We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors---including vaccine brand, demographics, and underlying conditions---while adjusting for calendar month, prior number of visits, and observational days in the EHR. Results: The overall estimated breakthrough infection rate was 0.16 (95\% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95\% CI 1.17-2.35) were male (IRR against female=1.47, 95\% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95\% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk. Conclusions: Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time. ",
doi="10.2196/35311",
url="https://publichealth.jmir.org/2022/5/e35311",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486806"
}


@Article{info:doi/10.2196/35054,
author="Rosero-Bixby, Luis",
title="The Effectiveness of Pfizer-BioNTech and Oxford-AstraZeneca Vaccines to Prevent Severe COVID-19 in Costa Rica: Nationwide, Ecological Study of Hospitalization Prevalence",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="20",
volume="8",
number="5",
pages="e35054",
keywords="COVID-19",
keywords="vaccine",
keywords="effectiveness",
keywords="hospitalization",
keywords="epidemiology",
keywords="prevention",
keywords="severity",
keywords="Costa Rica",
keywords="observational",
keywords="prevalence",
keywords="real-world",
keywords="virus",
keywords="variant",
keywords="policy",
keywords="monitoring",
keywords="surveillance",
abstract="Background: The Costa Rican COVID-19 vaccination program has used Pfizer-BioNTech and Oxford-AstraZeneca vaccines. Real-world estimates of the effectiveness of these vaccines to prevent hospitalizations range from 90\%-98\% for two doses and from 70\%-91\% for a single dose. Almost all of these estimates predate the Delta variant. Objective: The aim of this study is to estimate the dose-dependent effectiveness of COVID-19 vaccines to prevent severe illness in real-world conditions in Costa Rica, after the Delta variant became dominant. Methods: This observational study is a secondary analysis of hospitalization prevalence. The sample is all 3.67 million adult residents living in Costa Rica by mid-2021. The study is based on public aggregated data of 5978 COVID-19--related hospital records from September 14, 2021, to October 20, 2021, and 6.1 million vaccination doses administered to determine hospitalization prevalence by dose-specific vaccination status. The intervention retrospectively evaluated is vaccination with Pfizer-BioNTech (78\%) and Oxford-AstraZeneca (22\%). The main outcome studied is being hospitalized. Results: Vaccine effectiveness against hospitalization (VEH) was estimated as 93.4\% (95\% CI 93.0-93.9) for complete vaccination and 76.7\% (95\% CI 75.0-78.3) for single-dose vaccination among adults of all ages. VEH was lower and more uncertain among older adults aged ?58 years: 92\% (95\% CI 91\%-93\%) for those who had received full vaccination and 64\% (95\% CI 58\%-69\%) for those who had received partial vaccination. Single-dose VEH declined over time during the study period, especially in the older age group. Estimates were sensitive to possible errors in the population count used to determine the residual number of unvaccinated people when vaccine coverage is high. Conclusions: The Costa Rican COVID-19 vaccination program that administered Pfizer-BioNTech and Oxford-AstraZeneca vaccines seems to be highly effective at preventing COVID-19--related hospitalization after the Delta variant became dominant. Even a single dose seems to provide some degree of protection, which is good news for people whose second dose of the Pfizer-BioNTech vaccine was postponed several weeks to more rapidly increase the number of people vaccinated with a first dose. Timely monitoring of vaccine effectiveness is important to detect eventual failures and motivate the public to get vaccinated by providing information regarding the effectiveness of the vaccines. ",
doi="10.2196/35054",
url="https://publichealth.jmir.org/2022/5/e35054",
url="http://www.ncbi.nlm.nih.gov/pubmed/35483079"
}


@Article{info:doi/10.2196/37831,
author="Sauvayre, Romy
and Vernier, Jessica
and Chauvi{\`e}re, C{\'e}dric",
title="An Analysis of French-Language Tweets About COVID-19 Vaccines: Supervised Learning Approach",
journal="JMIR Med Inform",
year="2022",
month="May",
day="17",
volume="10",
number="5",
pages="e37831",
keywords="social media",
keywords="natural language processing",
keywords="public health",
keywords="vaccine",
keywords="machine learning",
keywords="CamemBERT language model",
keywords="method",
keywords="epistemology",
keywords="COVID-19",
keywords="disinformation",
keywords="language model",
abstract="Background: As the COVID-19 pandemic progressed, disinformation, fake news, and conspiracy theories spread through many parts of society. However, the disinformation spreading through social media is, according to the literature, one of the causes of increased COVID-19 vaccine hesitancy. In this context, the analysis of social media posts is particularly important, but the large amount of data exchanged on social media platforms requires specific methods. This is why machine learning and natural language processing models are increasingly applied to social media data. Objective: The aim of this study is to examine the capability of the CamemBERT French-language model to faithfully predict the elaborated categories, with the knowledge that tweets about vaccination are often ambiguous, sarcastic, or irrelevant to the studied topic. Methods: A total of 901,908 unique French-language tweets related to vaccination published between July 12, 2021, and August 11, 2021, were extracted using Twitter's application programming interface (version 2; Twitter Inc). Approximately 2000 randomly selected tweets were labeled with 2 types of categorizations: (1) arguments for (pros) or against (cons) vaccination (health measures included) and (2) type of content (scientific, political, social, or vaccination status). The CamemBERT model was fine-tuned and tested for the classification of French-language tweets. The model's performance was assessed by computing the F1-score, and confusion matrices were obtained. Results: The accuracy of the applied machine learning reached up to 70.6\% for the first classification (pro and con tweets) and up to 90\% for the second classification (scientific and political tweets). Furthermore, a tweet was 1.86 times more likely to be incorrectly classified by the model if it contained fewer than 170 characters (odds ratio 1.86; 95\% CI 1.20-2.86). Conclusions: The accuracy of the model is affected by the classification chosen and the topic of the message examined. When the vaccine debate is jostled by contested political decisions, tweet content becomes so heterogeneous that the accuracy of the model drops for less differentiated classes. However, our tests showed that it is possible to improve the accuracy by selecting tweets using a new method based on tweet length. ",
doi="10.2196/37831",
url="https://medinform.jmir.org/2022/5/e37831",
url="http://www.ncbi.nlm.nih.gov/pubmed/35512274"
}


@Article{info:doi/10.2196/34363,
author="Olusanya, A. Olufunto
and White, Brianna
and Melton, A. Chad
and Shaban-Nejad, Arash",
title="Examining the Implementation of Digital Health to Strengthen the COVID-19 Pandemic Response and Recovery and Scale up Equitable Vaccine Access in African Countries",
journal="JMIR Form Res",
year="2022",
month="May",
day="17",
volume="6",
number="5",
pages="e34363",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="Africa",
keywords="preparedness",
keywords="response",
keywords="recovery",
keywords="digital health",
keywords="artificial intelligence",
keywords="vaccine equity",
doi="10.2196/34363",
url="https://formative.jmir.org/2022/5/e34363",
url="http://www.ncbi.nlm.nih.gov/pubmed/35512271"
}


@Article{info:doi/10.2196/35115,
author="Portelli, Beatrice
and Scaboro, Simone
and Tonino, Roberto
and Chersoni, Emmanuele
and Santus, Enrico
and Serra, Giuseppe",
title="Monitoring User Opinions and Side Effects on COVID-19 Vaccines in the Twittersphere: Infodemiology Study of Tweets",
journal="J Med Internet Res",
year="2022",
month="May",
day="13",
volume="24",
number="5",
pages="e35115",
keywords="adverse drug events",
keywords="COVID-19",
keywords="digital pharmacovigilance",
keywords="opinion mining",
keywords="vaccines",
keywords="social media",
keywords="machine learning",
keywords="deep learning",
keywords="learning models",
keywords="sentiment analysis",
keywords="Twitter analysis",
keywords="Twitter",
keywords="web portal",
keywords="public health",
abstract="Background: In the current phase of the COVID-19 pandemic, we are witnessing the most massive vaccine rollout in human history. Like any other drug, vaccines may cause unexpected side effects, which need to be investigated in a timely manner to minimize harm in the population. If not properly dealt with, side effects may also impact public trust in the vaccination campaigns carried out by national governments. Objective: Monitoring social media for the early identification of side effects, and understanding the public opinion on the vaccines are of paramount importance to ensure a successful and harmless rollout. The objective of this study was to create a web portal to monitor the opinion of social media users on COVID-19 vaccines, which can offer a tool for journalists, scientists, and users alike to visualize how the general public is reacting to the vaccination campaign. Methods: We developed a tool to analyze the public opinion on COVID-19 vaccines from Twitter, exploiting, among other techniques, a state-of-the-art system for the identification of adverse drug events on social media; natural language processing models for sentiment analysis; statistical tools; and open-source databases to visualize the trending hashtags, news articles, and their factuality. All modules of the system are displayed through an open web portal. Results: A set of 650,000 tweets was collected and analyzed in an ongoing process that was initiated in December 2020. The results of the analysis are made public on a web portal (updated daily), together with the processing tools and data. The data provide insights on public opinion about the vaccines and its change over time. For example, users show a high tendency to only share news from reliable sources when discussing COVID-19 vaccines (98\% of the shared URLs). The general sentiment of Twitter users toward the vaccines is negative/neutral; however, the system is able to record fluctuations in the attitude toward specific vaccines in correspondence with specific events (eg, news about new outbreaks). The data also show how news coverage had a high impact on the set of discussed topics. To further investigate this point, we performed a more in-depth analysis of the data regarding the AstraZeneca vaccine. We observed how media coverage of blood clot--related side effects suddenly shifted the topic of public discussions regarding both the AstraZeneca and other vaccines. This became particularly evident when visualizing the most frequently discussed symptoms for the vaccines and comparing them month by month. Conclusions: We present a tool connected with a web portal to monitor and display some key aspects of the public's reaction to COVID-19 vaccines. The system also provides an overview of the opinions of the Twittersphere through graphic representations, offering a tool for the extraction of suspected adverse events from tweets with a deep learning model. ",
doi="10.2196/35115",
url="https://www.jmir.org/2022/5/e35115",
url="http://www.ncbi.nlm.nih.gov/pubmed/35446781"
}


@Article{info:doi/10.2196/33235,
author="Wang, Qiang
and Xiu, Shixin
and Yang, Liuqing
and Han, Ying
and Cui, Tingting
and Shi, Naiyang
and Liu, Minqi
and Yi, Youqin
and Liu, Chang
and Wang, Xuwen
and Yang, Guoping
and Ji, Lili
and Zhou, Weijie
and Jin, Hui
and Zhen, Shiqi
and Lin, Leesa",
title="Changes in Parental Attitudes Toward COVID-19 Vaccination and Routine Childhood Vaccination During the COVID-19 Pandemic: Repeated Cross-sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2022",
month="May",
day="13",
volume="8",
number="5",
pages="e33235",
keywords="childhood vaccination",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="repeated cross-section survey",
abstract="Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic. Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China. Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness. Results: Overall, 2881, 1038, and 1183 participants were included in the survey's three waves. Using the Vaccine Hesitancy Scale, 7.8\% (225/2881), 15.1\% (157/1038), and 5.5\% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3\% (1709/2881), 64.6\% (671/1038), and 92\% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, ``concerns about vaccine safety and side effects'' was the most common reason for refusal. Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety. ",
doi="10.2196/33235",
url="https://publichealth.jmir.org/2022/5/e33235",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486516"
}


@Article{info:doi/10.2196/32335,
author="Niu, Qian
and Liu, Junyu
and Kato, Masaya
and Shinohara, Yuki
and Matsumura, Natsuki
and Aoyama, Tomoki
and Nagai-Tanima, Momoko",
title="Public Opinion and Sentiment Before and at the Beginning of COVID-19 Vaccinations in Japan: Twitter Analysis",
journal="JMIR Infodemiology",
year="2022",
month="May",
day="9",
volume="2",
number="1",
pages="e32335",
keywords="COVID-19",
keywords="Japan",
keywords="vaccine",
keywords="Twitter",
keywords="sentiment",
keywords="latent dirichlet allocation",
keywords="natural language processing",
abstract="Background: COVID-19 vaccines are considered one of the most effective ways for containing the COVID-19 pandemic, but Japan lagged behind other countries in vaccination in the early stages. A deeper understanding of the slow progress of vaccination in Japan can be instructive for COVID-19 booster vaccination and vaccinations during future pandemics. Objective: This retrospective study aims to analyze the slow progress of early-stage vaccination in Japan by exploring opinions and sentiment toward the COVID-19 vaccine in Japanese tweets before and at the beginning of vaccination. Methods: We collected 144,101 Japanese tweets containing COVID-19 vaccine-related keywords between August 1, 2020, and June 30, 2021. We visualized the trend of the tweets and sentiments and identified the critical events that may have triggered the surges. Correlations between sentiments and the daily infection, death, and vaccination cases were calculated. The latent dirichlet allocation model was applied to identify topics of negative tweets from the beginning of vaccination. We also conducted an analysis of vaccine brands (Pfizer, Moderna, AstraZeneca) approved in Japan. Results: The daily number of tweets continued with accelerating growth after the start of large-scale vaccinations in Japan. The sentiments of around 85\% of the tweets were neutral, and negative sentiment overwhelmed the positive sentiment in the other tweets. We identified 6 public-concerned topics related to the negative sentiment at the beginning of the vaccination process. Among the vaccines from the 3 manufacturers, the attitude toward Moderna was the most positive, and the attitude toward AstraZeneca was the most negative. Conclusions: Negative sentiment toward vaccines dominated positive sentiment in Japan, and the concerns about side effects might have outweighed fears of infection at the beginning of the vaccination process. Topic modeling on negative tweets indicated that the government and policy makers should take prompt actions in building a safe and convenient vaccine reservation and rollout system, which requires both flexibility of the medical care system and the acceleration of digitalization in Japan. The public showed different attitudes toward vaccine brands. Policy makers should provide more evidence about the effectiveness and safety of vaccines and rebut fake news to build vaccine confidence. ",
doi="10.2196/32335",
url="https://infodemiology.jmir.org/2022/1/e32335",
url="http://www.ncbi.nlm.nih.gov/pubmed/35578643"
}


@Article{info:doi/10.2196/36830,
author="Chen, Yen-Pin
and Chen, Yi-Ying
and Yang, Kai-Chou
and Lai, Feipei
and Huang, Chien-Hua
and Chen, Yun-Nung
and Tu, Yi-Chin",
title="The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="26",
volume="24",
number="4",
pages="e36830",
keywords="misinformation",
keywords="vaccine hesitancy",
keywords="vaccination",
keywords="infodemic",
keywords="infodemiology",
keywords="COVID-19",
keywords="public immunity",
keywords="social media",
keywords="fake news",
abstract="Background: Vaccination is an important intervention to prevent the incidence and spread of serious diseases. Many factors including information obtained from the internet influence individuals' decisions to vaccinate. Misinformation is a critical issue and can be hard to detect, although it can change people's minds, opinions, and decisions. The impact of misinformation on public health and vaccination hesitancy is well documented, but little research has been conducted on the relationship between the size of the population reached by misinformation and the vaccination decisions made by that population. A number of fact-checking services are available on the web, including the Islander news analysis system, a free web service that provides individuals with real-time judgment on web news. In this study, we used such services to estimate the amount of fake news available and used Google Trends levels to model the spread of fake news. We quantified this relationship using official public data on COVID-19 vaccination in Taiwan. Objective: In this study, we aimed to quantify the impact of the magnitude of the propagation of fake news on vaccination decisions. Methods: We collected public data about COVID-19 infections and vaccination from Taiwan's official website and estimated the popularity of searches using Google Trends. We indirectly collected news from 26 digital media sources, using the news database of the Islander system. This system crawls the internet in real time, analyzes the news, and stores it. The incitement and suspicion scores of the Islander system were used to objectively judge news, and a fake news percentage variable was produced. We used multivariable linear regression, chi-square tests, and the Johnson-Neyman procedure to analyze this relationship, using weekly data. Results: A total of 791,183 news items were obtained over 43 weeks in 2021. There was a significant increase in the proportion of fake news in 11 of the 26 media sources during the public vaccination stage. The regression model revealed a positive adjusted coefficient ($\beta$=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient ($\beta$=--3.21, P=.04) of the interaction term on the fake news percentage with the Google Trends level. The Johnson-Neiman plot of the adjusted effect for the interaction term showed that the Google Trends level had a significant negative adjustment effect on vaccination doses for the following week when the proportion of fake news exceeded 39.3\%. Conclusions: There was a significant relationship between the amount of fake news to which the population was exposed and the number of vaccination doses administered. Reducing the amount of fake news and increasing public immunity to misinformation will be critical to maintain public health in the internet age. ",
doi="10.2196/36830",
url="https://www.jmir.org/2022/4/e36830",
url="http://www.ncbi.nlm.nih.gov/pubmed/35380546"
}


@Article{info:doi/10.2196/34070,
author="Shin, Hyunjeong
and Jeon, Songi
and Cho, Inhae
and Park, HyunJi",
title="Factors Affecting Human Papillomavirus Vaccination in Men: Systematic Review",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e34070",
keywords="health service use",
keywords="men",
keywords="papillomavirus",
keywords="papillomavirus vaccines",
keywords="systematic review",
keywords="vaccination",
keywords="vaccine",
keywords="HPV",
keywords="review",
keywords="gender",
abstract="Background: Despite the high risks associated with human papillomavirus (HPV), the HPV vaccination rate of men is far lower than women. Most previous review studies have focused on female vaccination and related affecting factors. However, previous studies have reported that the factors affecting HPV vaccination differ by gender. Objective: The aim of this review was to identify the factors affecting HPV vaccine initiation in men through a systematic review approach. Methods: A literature review was conducted across 3 central electronic databases for relevant articles. A total of 30 articles published between 2013 and 2019 met the inclusion criteria and were reviewed in this study. Results: In total, 50 factors affecting HPV vaccination in men were identified, including 13 sociodemographic factors and social structure factors, 12 belief-related variables, 4 family factors, 4 community factors, 14 variables related to needs, and 3 environmental factors. Conclusions: To increase HPV vaccination rates in men, strategies targeting young males and their families should consider frequent visits to or contact with health care providers so that health care professionals can provide recommendations for HPV vaccination. ",
doi="10.2196/34070",
url="https://publichealth.jmir.org/2022/4/e34070",
url="http://www.ncbi.nlm.nih.gov/pubmed/35471242"
}


@Article{info:doi/10.2196/32411,
author="Lee, An Hsiu
and Wu, Wei-Chen
and Kung, Hsin-Hua
and Udayasankaran, Ganesh Jai
and Wei, Yu-Chih
and Kijsanayotin, Boonchai
and Marcelo, B. Alvin
and Hsu, Chien-Yeh",
title="Design of a Vaccine Passport Validation System Using Blockchain-based Architecture: Development Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Apr",
day="26",
volume="8",
number="4",
pages="e32411",
keywords="COVID-19",
keywords="vaccine passport",
keywords="global border control",
keywords="health policy",
keywords="international infectious disease strategy",
keywords="vaccine",
keywords="policy",
keywords="strategy",
keywords="blockchain",
keywords="privacy",
keywords="security",
keywords="testing",
keywords="verification",
keywords="certification",
keywords="Fast Healthcare Interoperability Resource",
abstract="Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced. Conclusions: Blockchain architecture can be used to build a viable international VP authentication process with the advantages of low cost, high interoperability, effectiveness, security, and verifiability. ",
doi="10.2196/32411",
url="https://publichealth.jmir.org/2022/4/e32411",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377316"
}


@Article{info:doi/10.2196/32401,
author="Gupta, Ekta
and Mishra, Kumar Rupesh
and Kumar Niraj, Ranjan Ravi",
title="Identification of Potential Vaccine Candidates Against SARS-CoV-2 to Fight COVID-19: Reverse Vaccinology Approach",
journal="JMIR Bioinform Biotech",
year="2022",
month="Apr",
day="26",
volume="3",
number="1",
pages="e32401",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="reverse vaccinology",
keywords="molecular docking",
keywords="molecular dynamics simulation",
keywords="vaccine candidates",
keywords="vaccine",
keywords="simulation",
keywords="virus",
keywords="peptide",
keywords="antigen",
keywords="immunology",
keywords="biochemistry",
keywords="genetics",
abstract="Background: The recent emergence of COVID-19 has caused an immense global public health crisis. The etiological agent of COVID-19 is the novel coronavirus SARS-CoV-2. More research in the field of developing effective vaccines against this emergent viral disease is indeed a need of the hour. Objective: The aim of this study was to identify effective vaccine candidates that can offer a new milestone in the battle against COVID-19. Methods: We used a reverse vaccinology approach to explore the SARS-CoV-2 genome among strains prominent in India. Epitopes were predicted and then molecular docking and simulation were used to verify the molecular interaction of the candidate antigenic peptide with corresponding amino acid residues of the host protein. Results: A promising antigenic peptide, GVYFASTEK, from the surface glycoprotein of SARS-CoV-2 (protein accession number QIA98583.1) was predicted to interact with the human major histocompatibility complex (MHC) class I human leukocyte antigen (HLA)-A*11-01 allele, showing up to 90\% conservancy and a high antigenicity value. After vigorous analysis, this peptide was predicted to be a suitable epitope capable of inducing a strong cell-mediated immune response against SARS-CoV-2. Conclusions: These results could facilitate selecting SARS-CoV-2 epitopes for vaccine production pipelines in the immediate future. This novel research will certainly pave the way for a fast, reliable, and effective platform to provide a timely countermeasure against this dangerous virus responsible for the COVID-19 pandemic. ",
doi="10.2196/32401",
url="https://bioinform.jmir.org/2022/1/e32401",
url="http://www.ncbi.nlm.nih.gov/pubmed/35506029"
}


@Article{info:doi/10.2196/35356,
author="Rovetta, Alessandro",
title="Google Trends as a Predictive Tool for COVID-19 Vaccinations in Italy: Retrospective Infodemiological Analysis",
journal="JMIRx Med",
year="2022",
month="Apr",
day="19",
volume="3",
number="2",
pages="e35356",
keywords="COVID-19",
keywords="epidemiology",
keywords="Google Trends",
keywords="infodemiology",
keywords="infoveillance",
keywords="Italy",
keywords="public health",
keywords="SARS-CoV-2",
keywords="vaccinations",
keywords="vaccines",
keywords="social media analysis",
keywords="social media",
abstract="Background: Google Trends is an infoveillance tool widely used by the scientific community to investigate different user behaviors related to COVID-19. However, several limitations regarding its adoption are reported in the literature. Objective: This paper aims to provide an effective and efficient approach to investigating vaccine adherence against COVID-19 via Google Trends. Methods: Through the cross-correlational analysis of well-targeted hypotheses, we investigate the predictive capacity of web searches related to COVID-19 toward vaccinations in Italy from November 2020 to November 2021. The keyword ``vaccine reservation'' query (VRQ) was chosen as it reflects a real intention of being vaccinated (V). Furthermore, the impact of the second most read Italian newspaper (vaccine-related headlines [VRH]) on vaccine-related web searches was investigated to evaluate the role of the mass media as a confounding factor. Fisher r-to-z transformation (z) and percentage difference ($\delta$) were used to compare Spearman coefficients. A regression model V=f(VRH, VRQ) was built to validate the results found. The Holm-Bonferroni correction was adopted (P*). SEs are reported. Results: Simple and generic keywords are more likely to identify the actual web interest in COVID-19 vaccines than specific and elaborated keywords. Cross-correlations between VRQ and V were very strong and significant (min r{\texttwosuperior}=0.460, P*<.001, lag 0 weeks; max r{\texttwosuperior}=0.903, P*<.001, lag 6 weeks). The remaining cross-correlations have been markedly lower ($\delta$>55.8\%; z>5.8; P*<.001). The regression model confirmed the greater significance of VRQ versus VRH (P*<.001 vs P=.03, P*=.29). Conclusions: This research provides preliminary evidence in favor of using Google Trends as a surveillance and prediction tool for vaccine adherence against COVID-19 in Italy. Further research is needed to establish the appropriate use and limits of Google Trends for vaccination tracking. However, these findings prove that the search for suitable keywords is a fundamental step to reduce confounding factors. Additionally, targeting hypotheses helps diminish the likelihood of spurious correlations. It is recommended that Google Trends be leveraged as a complementary infoveillance tool by government agencies to monitor and predict vaccine adherence in this and future crises by following the methods proposed in this paper. ",
doi="10.2196/35356",
url="https://med.jmirx.org/2022/2/e35356",
url="http://www.ncbi.nlm.nih.gov/pubmed/35481982"
}


@Article{info:doi/10.2196/36928,
author="Nour, Radwa
and Powell, Leigh
and Alnakhi, K. Wafa
and Mamdouh, Heba
and Zidoun, Youness
and Hussain, Y. Hamid
and Al Suwaidi, Hanan
and Zary, Nabil",
title="Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for Translation and Validation in the World Health Organization Eastern Mediterranean Region",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="12",
volume="11",
number="4",
pages="e36928",
keywords="scale",
keywords="instrument",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="validation",
keywords="translation",
keywords="Arabic",
keywords="French",
keywords="EMRO",
abstract="Background: The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French. Objective: The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region. Methods: The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants' responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected. Results: As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022. Conclusions: This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation. International Registered Report Identifier (IRRID): PRR1-10.2196/36928 ",
doi="10.2196/36928",
url="https://www.researchprotocols.org/2022/4/e36928",
url="http://www.ncbi.nlm.nih.gov/pubmed/35247043"
}


@Article{info:doi/10.2196/28676,
author="Occa, Aurora
and Stahl, M. Hayley
and Julien-Bell, Sarah",
title="Helping Children to Participate in Human Papillomavirus--Related Discussions: Mixed Methods Study of Multimedia Messages",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="11",
volume="6",
number="4",
pages="e28676",
keywords="animation",
keywords="game",
keywords="HPV",
keywords="child-parent communication",
keywords="child-physician communication",
keywords="pilot study",
keywords="children",
keywords="health communication",
keywords="communication technologies",
keywords="vaccination",
keywords="health education",
abstract="Background: Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective: This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health---in particular when such conversations center around the HPV vaccination---and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children's knowledge and perceptions of HPV prevention. Methods: A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children's experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results: Both the animated video and a web-based game increased children's knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions: This study shows that both materials were effective for improving children's education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns. ",
doi="10.2196/28676",
url="https://formative.jmir.org/2022/4/e28676",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404265"
}


@Article{info:doi/10.2196/33982,
author="Budhwani, Henna
and Sharma, Vinita
and Long, Dustin
and Simpson, Tina",
title="Developing a Clinic-Based, Vaccine-Promoting Intervention for African American Youth in Rural Alabama: Protocol for a Pilot Cluster-Randomized Controlled Implementation Science Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="8",
volume="11",
number="4",
pages="e33982",
keywords="human papillomavirus",
keywords="COVID-19",
keywords="vaccine",
keywords="adolescents",
keywords="rural",
keywords="African American",
keywords="implementation science",
abstract="Background: African American youth in rural Alabama are clinically underserved and have limited knowledge about the human papillomavirus and the novel coronavirus 2019 (COVID-19) vaccines, including knowledge about the risk for developing cervical or oropharyngeal cancers or COVID-19. Objective: In this 30-month study, we propose to develop an in-clinic, youth-tailored, vaccine-promoting intervention for vaccine hesitancy reduction that can be seamlessly integrated into the existing environments of pediatric and family practice settings in rural Alabama. Methods: This exploratory, sequential mixed methods study will be conducted in 3 phases. In the first phase, we will assess stakeholders' knowledge, sentiments, and beliefs related to vaccination in general, COVID-19 vaccination, and human papillomavirus vaccination. We will also assess stakeholders' perceptions of barriers to vaccination that exist in rural Alabama. This will be followed by a second phase wherein we will use the data collected in the first phase to inform the development and finalization of a noninvasive, modular, synchronous counseling intervention that targets the behaviors of 15- to 26-year-old adolescents. In the third phase, we will conduct a pilot hybrid type 1 effectiveness-implementation cluster-randomized controlled trial to assess intervention acceptability and feasibility (clinics: N=4; African American youth: N=120) while assessing a ``clinical signal'' of effectiveness. We will document implementation contexts to provide real-world insight and support dissemination and scale-up. Results: The study was funded at the end of December 2020. Approval from the University of Alabama at Birmingham Institutional Review Board was obtained in May 2021, and the qualitative data collection process outlined in the first phase of this project concluded in November 2021. The entire study is expected to be complete at the end of December 2023. Conclusions: The results of the trial will provide much needed information on vaccine hesitancy in rural Alabama, and if found efficacious, the intervention could notably increase rates of vaccinations in one of the most underserved parts of the United States. The results from the trial will provide information that is valuable to public health practitioners and providers in rural settings to inform their efforts in increasing vaccination rates among 15- to 26-year-old African American youth in rural southern United States. Trial Registration: ClinicalTrials.gov NCT04604743; https://clinicaltrials.gov/ct2/show/NCT04604743 International Registered Report Identifier (IRRID): DERR1-10.2196/33982 ",
doi="10.2196/33982",
url="https://www.researchprotocols.org/2022/4/e33982",
url="http://www.ncbi.nlm.nih.gov/pubmed/35212640"
}


@Article{info:doi/10.2196/35910,
author="de la Cruz Herrera, Mercedes
and Fuster-Casanovas, A{\"i}na
and Mir{\'o} Catalina, Queralt
and Cigarr{\'a}n Mensa, Mireia
and Alc{\'a}ntara Pinillos, Pablo
and Vilanova Guitart, Isabel
and Grau Carri{\'o}n, Sergi
and Vidal-Alaball, Josep",
title="Use of Virtual Reality in the Reduction of Pain After the Administration of Vaccines Among Children in Primary Care Centers: Protocol for a Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="7",
volume="11",
number="4",
pages="e35910",
keywords="children",
keywords="virtual reality",
keywords="pain",
keywords="pain perception",
keywords="anxiety",
keywords="vaccination",
keywords="immunization schedule",
abstract="Background: Pain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions. Objective: We aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years. Methods: We will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system---a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age. Results: The study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination. Conclusions: VR can be a useful tool in pediatric procedures that generate pain and anxiety. International Registered Report Identifier (IRRID): PRR1-10.2196/35910 ",
doi="10.2196/35910",
url="https://www.researchprotocols.org/2022/4/e35910",
url="http://www.ncbi.nlm.nih.gov/pubmed/35388793"
}


@Article{info:doi/10.2196/35016,
author="Jang, Hyeju
and Rempel, Emily
and Roe, Ian
and Adu, Prince
and Carenini, Giuseppe
and Janjua, Zafar Naveed",
title="Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="29",
volume="24",
number="3",
pages="e35016",
keywords="COVID-19",
keywords="vaccination",
keywords="Twitter",
keywords="aspect-based sentiment analysis",
keywords="Canada",
keywords="social media",
keywords="pandemic",
keywords="content analysis",
keywords="vaccine rollout",
keywords="sentiment analysis",
keywords="public sentiment",
keywords="public health",
keywords="health promotion",
keywords="vaccination promotion",
abstract="Background: The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity. Objective: We aim to investigate Twitter users' attitudes toward COVID-19 vaccination in Canada after vaccine rollout. Methods: We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination--related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward ``vaccination'' changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects. Results: After applying the ABSA system, we obtained 170 aspect terms (eg, ``immunity'' and ``pfizer'') and 6775 opinion terms (eg, ``trustworthy'' for the positive sentiment and ``jeopardize'' for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to ``vaccine distribution,'' ``side effects,'' ``allergy,'' ``reactions,'' and ``anti-vaxxer,'' and positive sentiments related to ``vaccine campaign,'' ``vaccine candidates,'' and ``immune response.'' These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the ``anti-vaxxer'' population that used negative sentiments as a means to discourage vaccination and the ``Covid Zero'' population that used negative sentiments to encourage vaccinations while critiquing the public health response. Conclusions: Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination. ",
doi="10.2196/35016",
url="https://www.jmir.org/2022/3/e35016",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275835"
}


@Article{info:doi/10.2196/25803,
author="de Lusignan, Simon
and Tsang, M. Ruby S.
and Akinyemi, Oluwafunmi
and Lopez Bernal, Jamie
and Amirthalingam, Gayatri
and Sherlock, Julian
and Smith, Gillian
and Zambon, Maria
and Howsam, Gary
and Joy, Mark",
title="Adverse Events of Interest Following Influenza Vaccination in the First Season of Adjuvanted Trivalent Immunization: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="28",
volume="8",
number="3",
pages="e25803",
keywords="influenza",
keywords="influenza vaccines",
keywords="adverse events of interest",
keywords="computerized medical record systems",
keywords="sentinel surveillance",
abstract="Background: Vaccination is the most effective form of prevention of seasonal influenza; the United Kingdom has a national influenza vaccination program to cover targeted population groups. Influenza vaccines are known to be associated with some common minor adverse events of interest (AEIs), but it is not known if the adjuvanted trivalent influenza vaccine (aTIV), first offered in the 2018/2019 season, would be associated with more AEIs than other types of vaccines. Objective: We aim to compare the incidence of AEIs associated with different types of seasonal influenza vaccines offered in the 2018/2019 season. Methods: We carried out a retrospective cohort study using computerized medical record data from the Royal College of General Practitioners Research and Surveillance Centre sentinel network database. We extracted data on vaccine exposure and consultations for European Medicines Agency--specified AEIs for the 2018/2019 influenza season. We used a self-controlled case series design; computed relative incidence (RI) of AEIs following vaccination; and compared the incidence of AEIs associated with aTIV, the quadrivalent influenza vaccine, and the live attenuated influenza vaccine. We also compared the incidence of AEIs for vaccinations that took place in a practice with those that took place elsewhere. Results: A total of 1,024,160 individuals received a seasonal influenza vaccine, of which 165,723 individuals reported a total of 283,355 compatible symptoms in the 2018/2019 season. Most AEIs occurred within 7 days following vaccination, with a seasonal effect observed. Using aTIV as the reference group, the quadrivalent influenza vaccine was associated with a higher incidence of AEIs (RI 1.46, 95\% CI 1.41-1.52), whereas the live attenuated influenza vaccine was associated with a lower incidence of AEIs (RI 0.79, 95\% CI 0.73-0.83). No effect of vaccination setting on the incidence of AEIs was observed. Conclusions: Routine sentinel network data offer an opportunity to make comparisons between safety profiles of different vaccines. Evidence that supports the safety of newer types of vaccines may be reassuring for patients and could help improve uptake in the future. ",
doi="10.2196/25803",
url="https://publichealth.jmir.org/2022/3/e25803",
url="http://www.ncbi.nlm.nih.gov/pubmed/35343907"
}


@Article{info:doi/10.2196/25658,
author="Huang, Yun
and Luo, Chongliang
and Jiang, Ying
and Du, Jingcheng
and Tao, Cui
and Chen, Yong
and Hao, Yuantao",
title="A Bayesian Network to Predict the Risk of Post Influenza Vaccination Guillain-Barr{\'e} Syndrome: Development and Validation Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="25",
volume="8",
number="3",
pages="e25658",
keywords="adverse events",
keywords="Bayesian network",
keywords="Guillain-Barr{\'e} syndrome",
keywords="risk prediction",
keywords="trivalent influenza vaccine",
abstract="Background: Identifying the key factors of Guillain-Barr{\'e} syndrome (GBS) and predicting its occurrence are vital for improving the prognosis of patients with GBS. However, there are scarcely any publications on a forewarning model of GBS. A Bayesian network (BN) model, which is known to be an accurate, interpretable, and interaction-sensitive graph model in many similar domains, is worth trying in GBS risk prediction. Objective: The aim of this study is to determine the most significant factors of GBS and further develop and validate a BN model for predicting GBS risk. Methods: Large-scale influenza vaccine postmarketing surveillance data, including 79,165 US (obtained from the Vaccine Adverse Event Reporting System between 1990 and 2017) and 12,495 European (obtained from the EudraVigilance system between 2003 and 2016) adverse events (AEs) reports, were extracted for model development and validation. GBS, age, gender, and the top 50 prevalent AEs were included for initial BN construction using the R package bnlearn. Results: Age, gender, and 10 AEs were identified as the most significant factors of GBS. The posttest probability of GBS suggested that male vaccinees aged 50-64 years and without erythema should be on the alert or be warned by clinicians about an increased risk of GBS, especially when they also experience symptoms of asthenia, hypesthesia, muscular weakness, or paresthesia. The established BN model achieved an area under the receiver operating characteristic curve of 0.866 (95\% CI 0.865-0.867), sensitivity of 0.752 (95\% CI 0.749-0.756), specificity of 0.882 (95\% CI 0.879-0.885), and accuracy of 0.882 (95\% CI 0.879-0.884) for predicting GBS risk during the internal validation and obtained values of 0.829, 0.673, 0.854, and 0.843 for area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy, respectively, during the external validation. Conclusions: The findings of this study illustrated that a BN model can effectively identify the most significant factors of GBS, improve understanding of the complex interactions among different postvaccination symptoms through its graphical representation, and accurately predict the risk of GBS. The established BN model could further assist clinical decision-making by providing an estimated risk of GBS for a specific vaccinee or be developed into an open-access platform for vaccinees' self-monitoring. ",
doi="10.2196/25658",
url="https://publichealth.jmir.org/2022/3/e25658",
url="http://www.ncbi.nlm.nih.gov/pubmed/35333192"
}


@Article{info:doi/10.2196/35066,
author="Aronson, David Ian
and Bennett, S. Alex
and Ardouin-Guerrier, Mary-Andr{\'e}e
and Rivera-Castellar, German
and Gibson, Brent
and Santoscoy, Samantha
and Vargas-Estrella, Brittney",
title="How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="23",
volume="6",
number="3",
pages="e35066",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="people who inject drugs",
keywords="vaccine",
keywords="vaccine hesitancy",
keywords="barrier",
keywords="vaccination",
keywords="drugs",
keywords="hesitancy",
keywords="qualitative",
keywords="impact",
keywords="interview",
keywords="United States",
keywords="communication",
keywords="danger",
keywords="community",
abstract="Background: People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. Objective: This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. Methods: We conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55\%) or African American (22\%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants' understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. Results: Participants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. Conclusions: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines' ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective. ",
doi="10.2196/35066",
url="https://formative.jmir.org/2022/3/e35066",
url="http://www.ncbi.nlm.nih.gov/pubmed/35191841"
}


@Article{info:doi/10.2196/36610,
author="Mungmunpuntipantip, Rujittika
and Wiwanitkit, Viroj",
title="Ensuring Interrater Reliability When Evaluating Voice Assistants. Comment on ``Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment''",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="21",
volume="9",
number="1",
pages="e36610",
keywords="voice assistant",
keywords="natural user interface",
keywords="Portuguese language",
keywords="COVID-19",
keywords="vaccine",
doi="10.2196/36610",
url="https://humanfactors.jmir.org/2022/1/e36610",
url="http://www.ncbi.nlm.nih.gov/pubmed/35312626"
}


@Article{info:doi/10.2196/34674,
author="Ser{\'o}dio Figueiredo, Maur{\'i}cio Carlos
and de Melo, Tiago
and Goes, Raphaela",
title="Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="21",
volume="9",
number="1",
pages="e34674",
keywords="voice assistant",
keywords="natural user interface",
keywords="Portuguese language",
keywords="health information",
keywords="COVID-19",
keywords="vaccine",
keywords="immunization",
keywords="health device",
keywords="digital health",
abstract="Background: Voice assistants (VAs) are devices that respond to human voices and can be commanded to do a variety of tasks. Nowadays, VAs are being used to obtain health information, which has become a critical point of analysis for researchers in terms of question understanding and quality of response. Particularly, the COVID-19 pandemic has and still is severely affecting people worldwide, which demands studies on how VAs can be used as a tool to provide useful information. Objective: This work aimed to perform a quality analysis of different VAs' responses regarding the actual and important subject of COVID-19 vaccines. We focused on this important subject since vaccines are now available and society has urged for the population to be rapidly immunized. Methods: The proposed study was based on questions that were collected from the of?cial World Health Organization website. These questions were submitted to the 5 dominant VAs (Alexa, Bixby, Cortana, Google Assistant, and Siri), and responses were evaluated according to a rubric based on the literature. We focused this study on the Portuguese language as an additional contribution, since previous works are mainly focused on the English language, and we believe that VAs cannot be optimized to foreign languages. Results: Results showed that Google Assistant has a better overall performance, and only this VA and Samsung Bixby achieved high scores on question understanding in the Portuguese language. Regarding the obtained answers, the study also showed the best Google Assistant overall performance. Conclusions: Under the urgent context of COVID-19 vaccination, this work can help to understand how VAs must be improved to be more useful to the society and how careful people must be when considering VAs as a source of health information. VAs have been demonstrated to perform well regarding comprehension and user-friendliness. However, this work has found that they must be better integrated to their information sources to be useful as health information tools. ",
doi="10.2196/34674",
url="https://humanfactors.jmir.org/2022/1/e34674",
url="http://www.ncbi.nlm.nih.gov/pubmed/35041617"
}


@Article{info:doi/10.2196/34003,
author="Yeung, Kan Andy Wai
and Wochele-Thoma, Thomas
and Eibensteiner, Fabian
and Klager, Elisabeth
and Hribersek, Mojca
and Parvanov, D. Emil
and Hrg, Dalibor
and V{\"o}lkl-Kernstock, Sabine
and Kletecka-Pulker, Maria
and Schaden, Eva
and Willschke, Harald
and Atanasov, G. Atanas",
title="Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="15",
volume="8",
number="3",
pages="e34003",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="readability",
keywords="content quality",
keywords="online health information",
keywords="side effect",
keywords="public health",
keywords="medicine",
keywords="quality",
keywords="perception",
abstract="Background: Online information on COVID-19 vaccination may influence people's perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The ``frequently asked questions'' or ``questions and answers'' section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46\% (23/50) of the websites stated that they do not know, and another 40\% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82\%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78\%), headache (36/50, 72\%), fatigue (33/50, 66\%), and muscle/joint pain (31/50, 62\%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. ",
doi="10.2196/34003",
url="https://publichealth.jmir.org/2022/3/e34003",
url="http://www.ncbi.nlm.nih.gov/pubmed/35073276"
}


@Article{info:doi/10.2196/34040,
author="Blane, T. Janice
and Bellutta, Daniele
and Carley, M. Kathleen",
title="Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="7",
volume="24",
number="3",
pages="e34040",
keywords="social cybersecurity",
keywords="social-cyber maneuvers",
keywords="social network analysis",
keywords="disinformation",
keywords="BEND maneuvers",
keywords="COVID-19",
keywords="coronavirus",
keywords="social media",
keywords="vaccine",
keywords="anti-vaccine",
keywords="pro-vaccine",
keywords="ORA-PRO",
keywords="cybersecurity",
keywords="security",
keywords="Twitter",
keywords="community",
keywords="communication",
keywords="health information",
keywords="manipulation",
keywords="belief",
abstract="Background: During the time surrounding the approval and initial distribution of Pfizer-BioNTech's COVID-19 vaccine, large numbers of social media users took to using their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups toward the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences. Objective: This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole. Methods: COVID-19 Twitter vaccine data were collected using the Twitter application programming interface (API) for 1-week periods before, during, and 6 weeks after the initial Pfizer-BioNTech rollout (December 2020 to January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. Organization Risk Analyzer (ORA)-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network. Results: Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages. Conclusions: Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online. ",
doi="10.2196/34040",
url="https://www.jmir.org/2022/3/e34040",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044302"
}


@Article{info:doi/10.2196/32213,
author="Ateudjieu, J{\'e}r{\^o}me
and Tchio-Nighie, Hirma Ketina
and Goura, Pascal Andr{\'e}
and Ndinakie, Yakum Martin
and Dieffi Tchifou, Miltiade
and Amada, Lapia
and Tsafack, Marcelin
and Kiadjieu Dieumo, Forex Frank
and Guenou, Etienne
and Nangue, Charlette
and Kenfack, Bruno",
title="Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization: Field-Based Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2022",
month="Mar",
day="1",
volume="8",
number="3",
pages="e32213",
keywords="immunization status",
keywords="coverage",
keywords="completeness",
keywords="timeliness",
keywords="EPI vaccines",
keywords="children under five",
keywords="Foumban",
keywords="Cameroon",
keywords="mobile phone",
abstract="Background: Countries' Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective: We aim to assess whether involving community volunteers (CVs) to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children's vaccination timeliness, completeness, and coverage. Methods: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5\%) and 718 (98.4\%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6\%) and 636 (97.7\%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette--Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95\% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95\% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95\% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi\thinspace+Hb) dose 3 (aOR 2.0, 95\% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95\% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95\% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95\% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions: Findings support that involving CVs to track children's vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children's vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548 ",
doi="10.2196/32213",
url="https://publichealth.jmir.org/2022/3/e32213",
url="http://www.ncbi.nlm.nih.gov/pubmed/35230249"
}


@Article{info:doi/10.2196/31978,
author="Cummins, Alexander Jack",
title="Getting a Vaccine, Jab, or Vax Is More Than a Regular Expression. Comment on ``COVID-19 Vaccine-Related Discussion on Twitter: Topic Modeling and Sentiment Analysis''",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="23",
volume="24",
number="2",
pages="e31978",
keywords="COVID-19",
keywords="vaccine",
keywords="vaccination",
keywords="Twitter",
keywords="infodemiology",
keywords="infoveillance",
keywords="topic",
keywords="sentiment",
keywords="opinion",
keywords="discussion",
keywords="communication",
keywords="social media",
keywords="perception",
keywords="concern",
keywords="emotion",
keywords="natural language processing",
doi="10.2196/31978",
url="https://www.jmir.org/2022/2/e31978",
url="http://www.ncbi.nlm.nih.gov/pubmed/35195531"
}


@Article{info:doi/10.2196/30340,
author="Becker, RB Elisabeth
and Shegog, Ross
and Savas, S. Lara
and Frost, L. Erica
and Coan, P. Sharon
and Healy, Mary C.
and Spinner, W. Stanley
and Vernon, W. Sally",
title="Parents' Experience With a Mobile Health Intervention to Influence Human Papillomavirus Vaccination Decision Making: Mixed Methods Study",
journal="JMIR Pediatr Parent",
year="2022",
month="Feb",
day="21",
volume="5",
number="1",
pages="e30340",
keywords="human papillomavirus",
keywords="vaccination",
keywords="user experience",
keywords="parent",
keywords="mHealth",
keywords="HPV",
keywords="vaccine",
keywords="HPV vaccine",
keywords="parenting",
keywords="pediatrics",
keywords="sexual health",
keywords="cervical cancer",
keywords="adolescents",
keywords="app",
keywords="application",
abstract="Background: Human papillomavirus (HPV)-attributed cancers are preventable, yet HPV vaccination rates severely lag behind other adolescent vaccinations. HPVcancerFree (HPVCF) is a mobile health (mHealth) intervention developed to influence parental HPV vaccination decision making by raising awareness of HPV, reducing HPV vaccination barriers, and enabling HPV vaccination scheduling and reminders through a smartphone app. Evaluating the user experience of mHealth interventions is a vital component in assessing their quality and success but tends to be underreported in mHealth intervention evaluation. Objective: We aimed to evaluate the user experience of HPVCF, an HPV cancer prevention app designed for a pediatric clinic network, using mixed methods data collected from log files, survey measures, and qualitative feedback. Methods: Study data were evaluated from parents in a large US pediatric clinic network using HPVCF in the treatment study condition of a group randomized controlled trial. Log data captured HPVCF retention and use. Postintervention rating scales and items assessed HPVCF utility, usefulness, understandability, appeal, credibility, and perceived impact. Overall quality was evaluated using the user version of the Mobile Application Rating Scale (uMars). Open-ended responses assessed parent recommendations for HPVCF enhancement. Results: The 98 parents were mainly female (n=94, 96\%), 41 (5.67) years of age, college educated (n=55, 56\%), and White and non-Hispanic (n=55, 56\%) and had private health insurance for their children (n=75, 77\%). Parents used HPVCF 197 times, with the average visit duration approximating 3.5 minutes. The uMARS app quality score was positively skewed (4.2/5.0). Mean ratings were highest for information (4.46 [SD 0.53]) and lowest for engagement (3.74 [SD 0.69]). In addition, of 95 parents, 45 (47\%) rated HPVCF as helpful in HPV vaccination decision making and 16 (17\%) attributed HPV vaccine initiation to HPVCF. Parents reported that HPVCF increased their awareness (84/95, 88\%), knowledge (84/95, 88\%), and HPV vaccination intentions (64/95, 67\%). Most of the 98 parents rated the 4 HPVCF components as useful (72-92 [73\%-94\%]). Parents also agreed that HPVCF is clear (86/95, 91\%), accurate (86/95, 91\%), and more helpful than other HPV vaccine information they had received (89/95, 94\%) and that they would recommend it to others (81/95, 85\%). In addition, parents suggested ways to increase awareness and engagement with the app, along with opportunities to enhance the content and functionality. Conclusions: HPVCF was well received by parents and performed well on indicators of quality, usefulness, utility, credibility, and perceived impact. This study contributes a multimethod and multimeasure evaluation to the growing body of literature focused on assessing the user experience of patient-focused technology-mediated applications for HPV education. ",
doi="10.2196/30340",
url="https://pediatrics.jmir.org/2022/1/e30340",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188469"
}


@Article{info:doi/10.2196/32372,
author="Engel-Rebitzer, Eden
and Stokes, C. Daniel
and Meisel, F. Zachary
and Purtle, Jonathan
and Doyle, Rebecca
and Buttenheim, M. Alison",
title="Partisan Differences in Legislators' Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis",
journal="JMIR Infodemiology",
year="2022",
month="Feb",
day="18",
volume="2",
number="1",
pages="e32372",
keywords="social media",
keywords="Twitter",
keywords="vaccination",
keywords="partisanship",
keywords="COVID-19",
keywords="vaccine",
keywords="natural language processing",
keywords="NLP",
keywords="hesitancy",
keywords="politicization",
keywords="communication",
keywords="linguistic",
keywords="pattern",
abstract="Background: The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era. Objective: The aim of this study was to examine vaccine-related tweets produced by state and federal legislators during the COVID-19 era to (1) describe the content of vaccine-related tweets; (2) examine the differences in vaccine-related tweet content between Democrats and Republicans; and (3) quantify (and describe trends over time in) partisan differences in vaccine-related communication. Methods: We abstracted all vaccine-related tweets produced by state and federal legislators between February 01, 2020, and December 11, 2020. We used latent Dirichlet allocation to define the tweet topics and used descriptive statistics to describe differences by party in the use of topics and changes in political polarization over time. Results: We included 14,519 tweets generated by 1463 state legislators and 521 federal legislators. Republicans were more likely to use words (eg, ``record time,'' ``launched,'' and ``innovation'') and topics (eg, Operation Warp Speed success) that were focused on the successful development of a SARS-CoV-2 vaccine. Democrats used a broader range of words (eg, ``anti-vaxxers,'' ``flu,'' and ``free'') and topics (eg, vaccine prioritization, influenza, and antivaxxers) that were more aligned with public health messaging related to the vaccine. Polarization increased over most of the study period. Conclusions: Republican and Democratic legislators used different language in their Twitter conversations about vaccination during the COVID-19 era, leading to increased political polarization of vaccine-related tweets. These communication patterns have the potential to contribute to vaccine hesitancy. ",
doi="10.2196/32372",
url="https://infodemiology.jmir.org/2022/1/e32372",
url="http://www.ncbi.nlm.nih.gov/pubmed/35229075"
}


@Article{info:doi/10.2196/30738,
author="Lima, Araujo Isabela Dantas de
and Ponce de Leon, Martins Casandra Genoveva Rosales
and Ribeiro, Medeiros Laiane
and Silva, da Izabel Cristina Rodrigues
and Vilela, Monteiro Danielle
and Fonseca, Monti Luciana Mara
and G{\'o}es, de Fernanda dos Santos Nogueira
and Funghetto, Schwerz Silvana",
title="A Serious Game (Immunitates) About Immunization: Development and Validation Study",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="18",
volume="10",
number="1",
pages="e30738",
keywords="educational technology",
keywords="immunization",
keywords="nursing education",
keywords="validation",
keywords="methodological study",
keywords="vaccination",
keywords="public health",
keywords="nursing students",
keywords="teaching",
keywords="education",
keywords="support tool",
keywords="continuing education",
abstract="Background: Vaccination is a fundamental part of all levels---local to worldwide---of public health, and it can be considered one of humanity's greatest achievements in the control and elimination of infectious diseases. Teaching immunization and vaccination can be monotonous and tiring. It is necessary to develop new approaches for teaching these themes in nursing school. Objective: We aimed to develop and validate a serious game about immunization and vaccination for Brazilian nursing students. Methods: We developed a quiz-type game, Immunitates, using design and educational theoretical models and Brazilian National Health Guidelines. The game's heuristics and content were evaluated with 2 different instruments by a team of experts. A sample of nursing students evaluated the validity of the game's heuristics only. We calculated the content validity index (CVI) for each evaluation. Results: The study included 49 experts and 15 nursing students. All evaluations demonstrated high internal consistency (Cronbach $\alpha$?.86). The game's heuristics (experts: CVI 0.75-1.0; students: CVI 0.67-1.0) and the game's contents demonstrated validity (experts: CVI 0.73-1.0). Participants identified some specific areas for improvement in the next version. Conclusions: The serious game appears to be valid. It is intended as a support tool for nursing students in the teaching--learning process and as a tool for continuing education for nurses. ",
doi="10.2196/30738",
url="https://games.jmir.org/2022/1/e30738",
url="http://www.ncbi.nlm.nih.gov/pubmed/35179496"
}


@Article{info:doi/10.2196/34385,
author="Spitale, Giovanni
and Biller-Andorno, Nikola
and Germani, Federico",
title="Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="16",
volume="24",
number="2",
pages="e34385",
keywords="green pass",
keywords="COVID-19",
keywords="COVID-19 pandemic",
keywords="vaccines",
keywords="vaccination hesitancy",
keywords="freedom",
keywords="social listening",
keywords="social media",
keywords="infodemic",
keywords="bioethics",
keywords="telegram",
abstract="Background: The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places. Objective: This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization. Methods: We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach. Results: Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti--green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health. Conclusions: A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for public health. ",
doi="10.2196/34385",
url="https://www.jmir.org/2022/2/e34385",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156930"
}


@Article{info:doi/10.2196/31726,
author="Huangfu, Luwen
and Mo, Yiwen
and Zhang, Peijie
and Zeng, Dajun Daniel
and He, Saike",
title="COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment--Based Topic Modeling",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="8",
volume="24",
number="2",
pages="e31726",
keywords="COVID-19",
keywords="COVID-19 vaccine",
keywords="sentiment evolution",
keywords="topic modeling",
keywords="social media",
keywords="text mining",
abstract="Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public's conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public's vaccine awareness through sentiment--based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson \& Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter's application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment--based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51\%) were positive, 204,084 (23.81\%) were negative, 245,976 (28.70\%) were neutral, 6899 (0.80\%) were highly positive, and 1508 (0.18\%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13\%), getting vaccination (76,029/405,560, 18.75\%), and vaccine information and knowledge (21,127/405,560, 5.21\%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04\%), extreme side effects of the vaccines (19,690/205,592, 9.58\%), and vaccine supply and rollout (17,154/205,592, 8.34\%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment--based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. ",
doi="10.2196/31726",
url="https://www.jmir.org/2022/2/e31726",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783665"
}


@Article{info:doi/10.2196/35552,
author="Gisondi, A. Michael
and Barber, Rachel
and Faust, Samuel Jemery
and Raja, Ali
and Strehlow, C. Matthew
and Westafer, M. Lauren
and Gottlieb, Michael",
title="A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="1",
volume="24",
number="2",
pages="e35552",
keywords="COVID-19",
keywords="social media",
keywords="misinformation",
keywords="disinformation",
keywords="infodemic",
keywords="ethics",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="infoveillance",
keywords="vaccine",
doi="10.2196/35552",
url="https://www.jmir.org/2022/2/e35552",
url="http://www.ncbi.nlm.nih.gov/pubmed/35007204"
}


@Article{info:doi/10.2196/32455,
author="Secor, M. Andrew
and Mtenga, Hassan
and Richard, John
and Bulula, Ngwegwe
and Ferriss, Ellen
and Rathod, Mansi
and Ryman, K. Tove
and Werner, Laurie
and Carnahan, Emily",
title="Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="21",
volume="8",
number="1",
pages="e32455",
keywords="immunization",
keywords="immunization information system",
keywords="electronic immunization registry",
keywords="digital health",
keywords="eHealth",
abstract="Background: There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective: The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods: This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results: The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52\% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94\% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28\%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine--1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine--1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10\% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions: EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses. ",
doi="10.2196/32455",
url="https://publichealth.jmir.org/2022/1/e32455",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060919"
}


@Article{info:doi/10.2196/32394,
author="Zhang, Chunyan
and Xu, Songhua
and Li, Zongfang
and Liu, Ge
and Dai, Duwei
and Dong, Caixia",
title="The Evolution and Disparities of Online Attitudes Toward COVID-19 Vaccines: Year-long Longitudinal and Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="21",
volume="24",
number="1",
pages="e32394",
keywords="COVID-19",
keywords="vaccine",
keywords="attitude",
keywords="Twitter",
keywords="data mining",
keywords="pandemic",
keywords="population group",
keywords="evolution",
keywords="disparity",
abstract="Background: Due to the urgency caused by the COVID-19 pandemic worldwide, vaccine manufacturers have to shorten and parallel the development steps to accelerate COVID-19 vaccine production. Although all usual safety and efficacy monitoring mechanisms remain in place, varied attitudes toward the new vaccines have arisen among different population groups. Objective: This study aimed to discern the evolution and disparities of attitudes toward COVID-19 vaccines among various population groups through the study of large-scale tweets spanning over a whole year. Methods: We collected over 1.4 billion tweets from June 2020 to July 2021, which cover some critical phases concerning the development and inoculation of COVID-19 vaccines worldwide. We first developed a data mining model that incorporates a series of deep learning algorithms for inferring a range of individual characteristics, both in reality and in cyberspace, as well as sentiments and emotions expressed in tweets. We further conducted an observational study, including an overall analysis, a longitudinal study, and a cross-sectional study, to collectively explore the attitudes of major population groups. Results: Our study derived 3 main findings. First, the whole population's attentiveness toward vaccines was strongly correlated (Pearson r=0.9512) with official COVID-19 statistics, including confirmed cases and deaths. Such attentiveness was also noticeably influenced by major vaccine-related events. Second, after the beginning of large-scale vaccine inoculation, the sentiments of all population groups stabilized, followed by a considerably pessimistic trend after June 2021. Third, attitude disparities toward vaccines existed among population groups defined by 8 different demographic characteristics. By crossing the 2 dimensions of attitude, we found that among population groups carrying low sentiments, some had high attentiveness ratios, such as males and individuals aged ?40 years, while some had low attentiveness ratios, such as individuals aged ?18 years, those with occupations of the 3rd category, those with account age <5 years, and those with follower number <500. These findings can be used as a guide in deciding who should be given more attention and what kinds of help to give to alleviate the concerns about vaccines. Conclusions: This study tracked the year-long evolution of attitudes toward COVID-19 vaccines among various population groups defined by 8 demographic characteristics, through which significant disparities in attitudes along multiple dimensions were revealed. According to these findings, it is suggested that governments and public health organizations should provide targeted interventions to address different concerns, especially among males, older people, and other individuals with low levels of education, low awareness of news, low income, and light use of social media. Moreover, public health authorities may consider cooperating with Twitter users having high levels of social influence to promote the acceptance of COVID-19 vaccines among all population groups. ",
doi="10.2196/32394",
url="https://www.jmir.org/2022/1/e32394",
url="http://www.ncbi.nlm.nih.gov/pubmed/34878410"
}


@Article{info:doi/10.2196/32125,
author="Masselot, Camille
and Greshake Tzovaras, Bastian
and Graham, B. Chris L.
and Finnegan, Gary
and Jeyaram, Rathin
and Vitali, Isabelle
and Landrain, Thomas
and Santolini, Marc",
title="Implementing the Co-Immune Open Innovation Program to Address Vaccination Hesitancy and Access to Vaccines: Retrospective Study",
journal="J Particip Med",
year="2022",
month="Jan",
day="21",
volume="14",
number="1",
pages="e32125",
keywords="open science",
keywords="open innovation",
keywords="programmatic research",
keywords="collective intelligence",
keywords="web based",
keywords="immunization",
keywords="vaccination access",
keywords="vaccine hesitancy",
keywords="innovation",
keywords="vaccine",
keywords="public health",
keywords="access",
keywords="framework",
keywords="participatory",
keywords="design",
keywords="implementation",
abstract="Background: The rise of major complex public health problems, such as vaccination hesitancy and access to vaccination, requires innovative, open, and transdisciplinary approaches. Yet, institutional silos and lack of participation on the part of nonacademic citizens in the design of solutions hamper efforts to meet these challenges. Against this background, new solutions have been explored, with participatory research, citizen science, hackathons, and challenge-based approaches being applied in the context of public health. Objective: Our aim was to develop a program for creating citizen science and open innovation projects that address the contemporary challenges of vaccination in France and around the globe. Methods: We designed and implemented Co-Immune, a program created to tackle the question of vaccination hesitancy and access to vaccination through an online and offline challenge-based open innovation approach. The program was run on the open science platform Just One Giant Lab. Results: Over a 6-month period, the Co-Immune program gathered 234 participants of diverse backgrounds and 13 partners from the public and private sectors. The program comprised 10 events to facilitate the creation of 20 new projects, as well as the continuation of two existing projects, to address the issues of vaccination hesitancy and access, ranging from app development and data mining to analysis and game design. In an open framework, the projects made their data, code, and solutions publicly available. Conclusions: Co-Immune highlights how open innovation approaches and online platforms can help to gather and coordinate noninstitutional communities in a rapid, distributed, and global way toward solving public health issues. Such initiatives can lead to the production and transfer of knowledge, creating novel solutions in the public health sector. The example of Co-Immune contributes to paving the way for organizations and individuals to collaboratively tackle future global challenges. ",
doi="10.2196/32125",
url="https://jopm.jmir.org/2022/1/e32125",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060917"
}


@Article{info:doi/10.2196/32273,
author="Feldman, G. Amy
and Moore, Susan
and Bull, Sheana
and Morris, A. Megan
and Wilson, Kumanan
and Bell, Cameron
and Collins, M. Margaret
and Denize, M. Kathryn
and Kempe, Allison",
title="A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="13",
volume="6",
number="1",
pages="e32273",
keywords="vaccinations",
keywords="transplantation",
keywords="mobile app",
keywords="agile development",
keywords="immunization",
keywords="mHealth",
keywords="mobile health",
keywords="children",
keywords="transplant recipients",
keywords="pediatric transplant recipients",
keywords="pediatrics",
abstract="Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20\% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87\% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. ",
doi="10.2196/32273",
url="https://formative.jmir.org/2022/1/e32273",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023840"
}


@Article{info:doi/10.2196/32329,
author="Lee, Minjung
and You, Myoungsoon",
title="Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="6",
volume="24",
number="1",
pages="e32329",
keywords="COVID-19",
keywords="coronavirus",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="media use",
keywords="social media",
keywords="public health",
keywords="pandemic",
keywords="epidemiology",
keywords="online information",
keywords="health information",
abstract="Background: The battle against the 2019 novel coronavirus (COVID-19) has not concluded. Despite the availability of vaccines, the high prevalence of vaccine hesitancy represents a significant challenge to public health, and raising vaccine acceptance among the public is critical. Although media has become an increasingly popular source of COVID-19 vaccine-related information, the question of whether and how media use is related to the public's vaccine hesitancy warrants exploration. Objective: This study aimed to (1) examine the level of COVID-19 vaccine hesitancy, (2) identify factors associated with COVID-19 vaccine hesitancy, and (3) explore the direct and indirect relationship between media use and vaccine hesitancy through psychological factors. Methods: A month before COVID-19 vaccination was initiated in South Korea, we conducted a cross-sectional web-based survey over 6 days (January 20-25, 2021). This study included 1016 participants, and a logit model for regression analyzed associations between sociodemographic factors, health-related factors, psychological factors, and media use toward one's COVID-19 vaccine hesitancy. Additionally, we conducted a path analysis to examine the indirect effects of media use on vaccine hesitancy by using psychological factors (ie, perceived risk of COVID-19 infection, perceived benefits, and perceived barriers of COVID-19 vaccination). Results: Among the participants (N=1016), 53.3\% (541/1016) hesitated to take the COVID-19 vaccine, while 46.7\% (475/1016) agreed to accept the vaccine. Of the sociodemographic factors, female gender (odds ratio [OR] 1.967, 95\% CI 1.36-2.86; P<.001), age in 50s (OR 0.47, 95\% CI 0.23-0.96; P=.004), and age over 60s (OR 0.49, 95\% CI 0.24-0.99; P=.04) were significant individual predictors of COVID-19 vaccine hesitancy. Perceived susceptibility of infection (OR 0.69, 95\% CI 0.52-0.91; P=.01) and perceived benefits of vaccination (OR 0.69, 95\% CI 0.52-0.91; P=.01) were associated with lower vaccine hesitancy. Perceived barriers of vaccination (OR 1.63, 95\% CI 1.29-2.07; P<.001) and lower trust in government (OR 0.72, 95\% CI 0.53-0.98; P=.04) were related to vaccine hesitancy. The use of offline and online media as sources for the perceived benefits of vaccination was associated with vaccine hesitancy, resulting in lower vaccine hesitancy. Moreover, perceived susceptibility of the disease and perceived barriers of vaccination mediated the association between social media use and vaccine hesitancy. Conclusions: Our findings revealed a considerable level of COVID-19 vaccine hesitancy in South Korea. Gender-based and generation-based public health policies and communication are recommended. Efforts to lower the perceived risk of vaccine side effects and heighten perceived benefits of the vaccine are required. Although the use of media has a positive and negative effect on the population's vaccine hesitancy, efforts should be made to disseminate reliable and timely information on media while confronting misinformation or disinformation for successive implementation of vaccine programs during pandemics. ",
doi="10.2196/32329",
url="https://www.jmir.org/2022/1/e32329",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870605"
}


@Article{info:doi/10.2196/33792,
author="Klein, Z. Ari
and O'Connor, Karen
and Gonzalez-Hernandez, Graciela",
title="Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="6",
volume="6",
number="1",
pages="e33792",
keywords="natural language processing",
keywords="social media",
keywords="COVID-19",
keywords="data mining",
keywords="COVID-19 vaccine",
keywords="pregnancy outcomes",
abstract="Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75\%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. ",
doi="10.2196/33792",
url="https://formative.jmir.org/2022/1/e33792",
url="http://www.ncbi.nlm.nih.gov/pubmed/34870607"
}


@Article{info:doi/10.2196/29872,
author="Tsai, Richard
and Hervey, John
and Hoffman, Kathleen
and Wood, Jessica
and Johnson, Jennifer
and Deighton, Dana
and Clermont, Donald
and Loew, Brian
and Goldberg, L. Stuart",
title="COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="5",
volume="8",
number="1",
pages="e29872",
keywords="COVID-19",
keywords="vaccine",
keywords="hesitancy",
keywords="cancer",
keywords="autoimmune diseases",
keywords="vaccination",
keywords="comorbidities",
keywords="SARS-CoV-2",
keywords="survey",
keywords="cross-sectional",
keywords="incidence",
keywords="safety",
keywords="vulnerable",
keywords="perception",
keywords="attitude",
abstract="Background: Individuals with comorbid conditions have been disproportionately affected by COVID-19. Since regulatory trials of COVID-19 vaccines excluded those with immunocompromising conditions, few patients with cancer and autoimmune diseases were enrolled. With limited vaccine safety data available, vulnerable populations may have conflicted vaccine attitudes. Objective: We assessed the prevalence and independent predictors of COVID-19 vaccine hesitancy and acceptance among individuals with serious comorbidities and assessed self-reported side effects among those who had been vaccinated. Methods: We conducted a cross-sectional, 55-item, online survey, fielded January 15, 2021 through February 22, 2021, among a random sample of members of Inspire, an online health community of over 2.2 million individuals with comorbid conditions. Multivariable regression analysis was utilized to determine factors independently associated with vaccine hesitancy and acceptance. Results: Of the 996,500 members of the Inspire health community invited to participate, responses were received from 21,943 individuals (2.2\%). Respondents resided in 123 countries (United States: 16,277/21,943, 74.2\%), had a median age range of 56-65 years, were highly educated (college or postgraduate degree: 10,198/17,298, 58.9\%), and had diverse political leanings. All respondents self-reported at least one comorbidity: cancer, 27.3\% (5459/19,980); autoimmune diseases, 23.2\% (4946/21,294); chronic lung diseases: 35.4\% (7544/21,294). COVID-19 vaccine hesitancy was identified in 18.6\% (3960/21,294), with 10.3\% (2190/21,294) declaring that they would not, 3.5\% (742/21,294) stating that they probably would not, and 4.8\% (1028/21,294) not sure whether they would agree to be vaccinated. Hesitancy was expressed by the following patients: cancer, 13.4\% (731/5459); autoimmune diseases, 19.4\% (962/4947); chronic lung diseases: 17.8\% (1344/7544). Positive predictors of vaccine acceptance included routine influenza vaccination (odds ratio [OR] 1.53), trust in responsible vaccine development (OR 14.04), residing in the United States (OR 1.31), and never smoked (OR 1.06). Hesitancy increased with a history of prior COVID-19 (OR 0.86), conservative political leaning (OR 0.93), younger age (OR 0.83), and lower education level (OR 0.90). One-quarter (5501/21,294, 25.8\%) had received at least one COVID-19 vaccine injection, and 6.5\% (1390/21,294) completed a 2-dose series. Following the first injection, 69.0\% (3796/5501) self-reported local reactions, and 40.0\% (2200/5501) self-reported systemic reactions, which increased following the second injection to 77.0\% (1070/1390) and 67.0\% (931/1390), respectively. Conclusions: In this survey of individuals with serious comorbid conditions, significant vaccine hesitancy remained. Assumptions that the most vulnerable would automatically accept COVID-19 vaccination are erroneous and thus call for health care team members to initiate discussions focusing on the impact of the vaccine on an individual's underlying condition. Early self-reported side effect experiences among those who had already been vaccinated, as expressed by our population, should be reassuring and might be utilized to alleviate vaccine fears. Health care--related social media forums that rapidly disseminate accurate information about the COVID-19 vaccine may play an important role. ",
doi="10.2196/29872",
url="https://publichealth.jmir.org/2022/1/e29872",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709184"
}


@Article{info:doi/10.2196/26356,
author="Wynn, S. Chelsea
and Catallozzi, Marina
and Kolff, A. Chelsea
and Holleran, Stephen
and Meyer, Dodi
and Ramakrishnan, Rajasekhar
and Stockwell, S. Melissa",
title="Personalized Reminders for Immunization Using Short Messaging Systems to Improve Human Papillomavirus Vaccination Series Completion: Parallel-Group Randomized Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="27",
volume="9",
number="12",
pages="e26356",
keywords="text messaging",
keywords="mobile reminders",
keywords="human papillomavirus",
keywords="adolescent",
keywords="text reminders",
keywords="vaccine completion",
keywords="vaccine decision-making",
keywords="vaccine education",
keywords="transtheoretical model",
keywords="mobile phone",
keywords="smartphone",
keywords="mHealth",
keywords="mobile health",
keywords="minority health",
abstract="Background: Completion rates among adolescents who initiate the human papillomavirus (HPV) vaccine 3-dose series are low. SMS text message vaccine reminders are effective, but less is known about the best types for HPV series completion or the ability to assess and target vaccine decision-making stage. Objective: The aim of this study is to compare the effectiveness of HPV vaccine series completion in minority adolescents who received precision and educational versus conventional SMS text message reminders. Methods: Enrolled parents of adolescents aged 9-17 years who received the first HPV vaccine dose at 1 of the 4 academic-affiliated community health clinics in New York City were randomized 1:1 to 1 of the 2 parallel, unblinded arms: precision SMS text messages (which included stage-targeted educational information, next dose due date, and site-specific walk-in hours) or conventional SMS text messages without educational information. Randomization was stratified according to gender, age, and language. The primary outcome was series completion within 12 months. In post hoc analysis, enrollees were compared with concurrent nonenrollees and historical controls. Results: Overall, 956 parents were enrolled in the study. The precision (475 families) and conventional (481 families) SMS text message arms had similarly high series completion rates (344/475, 72.4\% vs 364/481, 75.7\%). A total of 42 days after the first dose, two-thirds of families, not initially in the preparation stage, moved to preparation or vaccinated stage. Those in either SMS text message arm had significantly higher completion rates than nonenrollees (708/1503, 47.1\% vs 679/1503, 45.17\%; P<.001). Even after removing those needing only 2 HPV doses, adolescents receiving any SMS text messages had higher completion rates than historical controls (337/2823, 11.93\% vs 981/2823, 34.75\%; P<.001). A population-wide effect was seen from 2014 to 2016, above historical trends. Conclusions: SMS text message reminders led to timely HPV vaccine series completion in a low-income, urban, minority study population and also led to population-wide effects. Educational information did not provide an added benefit to this population. Trial Registration: ClinicalTrials.gov NCT02236273; https://clinicaltrials.gov/ct2/show/NCT02236273 ",
doi="10.2196/26356",
url="https://mhealth.jmir.org/2021/12/e26356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34958306"
}


@Article{info:doi/10.2196/30424,
author="Benham, L. Jamie
and Atabati, Omid
and Oxoby, J. Robert
and Mourali, Mehdi
and Shaffer, Blake
and Sheikh, Hasan
and Boucher, Jean-Christophe
and Constantinescu, Cora
and Parsons Leigh, Jeanna
and Ivers, M. Noah
and Ratzan, C. Scott
and Fullerton, M. Madison
and Tang, Theresa
and Manns, J. Braden
and Marshall, A. Deborah
and Hu, Jia
and Lang, Raynell",
title="COVID-19 Vaccine--Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="23",
volume="7",
number="12",
pages="e30424",
keywords="coronavirus",
keywords="COVID-19",
keywords="public health",
keywords="marketing",
keywords="behavior",
keywords="risk reduction",
keywords="attitudes",
keywords="compliance",
keywords="vaccine",
keywords="hesitancy",
keywords="risk",
keywords="belief",
keywords="communication",
keywords="cross-sectional",
keywords="Canada",
keywords="gender",
keywords="education",
keywords="income",
keywords="race",
keywords="ethnicity",
abstract="Background: There are concerns that vaccine hesitancy may impede COVID-19 vaccine rollout and prevent the achievement of herd immunity. Vaccine hesitancy is a delay in acceptance or refusal of vaccines despite their availability. Objective: We aimed to identify which people are more and less likely to take a COVID-19 vaccine and factors associated with vaccine hesitancy to inform public health messaging. Methods: A Canadian cross-sectional survey was conducted in Canada in October and November 2020, prior to the regulatory approval of the COVID-19 vaccines. Vaccine hesitancy was measured by respondents answering the question ``what would you do if a COVID-19 vaccine were available to you?'' Negative binomial regression was used to identify the factors associated with vaccine hesitancy. Cluster analysis was performed to identify distinct clusters based on intention to take a COVID-19 vaccine, beliefs about COVID-19 and COVID-19 vaccines, and adherence to nonpharmaceutical interventions. Results: Of 4498 participants, 2876 (63.9\%) reported COVID-19 vaccine hesitancy. Vaccine hesitancy was significantly associated with (1) younger age (18-39 years), (2) lower education, and (3) non-Liberal political leaning. Participants that reported vaccine hesitancy were less likely to believe that a COVID-19 vaccine would end the pandemic or that the benefits of a COVID-19 vaccine outweighed the risks. Individuals with vaccine hesitancy had higher prevalence of being concerned about vaccine side effects, lower prevalence of being influenced by peers or health care professionals, and lower prevalence of trust in government institutions. Conclusions: These findings can be used to inform targeted public health messaging to combat vaccine hesitancy as COVID-19 vaccine administration continues. Messaging related to preventing COVID among friends and family, highlighting the benefits, emphasizing safety and efficacy of COVID-19 vaccination, and ensuring that health care workers are knowledgeable and supported in their vaccination counselling may be effective for vaccine-hesitant populations. ",
doi="10.2196/30424",
url="https://publichealth.jmir.org/2021/12/e30424",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779784"
}


@Article{info:doi/10.2196/33739,
author="Gurley, Stephen
and Bennett, Brady
and Sullivan, Sean Patrick
and Kiley, Maryellen
and Linde, Jamie
and Szczerbacki, David
and Guest, Jodie",
title="COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="15",
volume="7",
number="12",
pages="e33739",
keywords="COVID-19",
keywords="vaccine",
keywords="hesitancy",
keywords="college",
keywords="higher education",
keywords="race",
keywords="perception",
keywords="intention",
keywords="uptake",
keywords="prospective",
keywords="cohort",
keywords="demographic",
keywords="minority",
keywords="young adult",
abstract="Background: Uptake of the COVID-19 vaccine among US young adults, particularly those that belong to racial and ethnic minorities, remains low compared to their older peers. Understanding vaccine perceptions and their influence on vaccination uptake among this population remains crucial to achieving population herd immunity. Objective: We sought to study perceptions of COVID-19 vaccines as well as intended and actual vaccine uptake among one population of college students, faculty, and staff. Methods: As part of a larger study aimed at investigating the dynamics of COVID-19 transmission, serology, and perception on a college campus, participants were asked about their views on the COVID-19 vaccine in February 2021. Vaccination status was assessed by self-report in April 2021. Logistic regression was used to calculate prevalence ratios with marginal standardization. Results: We found that non-White participants were 25\% less likely to report COVID-19 vaccination compared to White participants. Among those who were unvaccinated, Black and other non-White participants were significantly more likely to indicate they were unwilling to receive a COVID-19 vaccine compared to White participants. The most common reason for unwillingness to receive the vaccine was belief that the vaccine approval process was rushed. Conclusions: There are racial differences in perceptions of the COVID-19 vaccine among young adults, and these differences might differentially impact vaccine uptake among young racial and ethnic minorities. Efforts to increase vaccine uptake among college populations might require campaigns specifically tailored to these minority groups. ",
doi="10.2196/33739",
url="https://publichealth.jmir.org/2021/12/e33739",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847054"
}


@Article{info:doi/10.2196/33330,
author="Brauer, Eden
and Choi, Kristen
and Chang, John
and Luo, Yi
and Lewin, Bruno
and Munoz-Plaza, Corrine
and Bronstein, David
and Bruxvoort, Katia",
title="Health Care Providers' Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study",
journal="JMIR Infodemiology",
year="2021",
month="Dec",
day="8",
volume="1",
number="1",
pages="e33330",
keywords="health information",
keywords="trust",
keywords="health care provider",
keywords="COVID-19",
keywords="vaccine",
keywords="mixed method",
keywords="communication",
abstract="Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. Results: The survey was completed by 2948 providers, of whom 91\% (n=2683) responded that they had received ?1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2\%); the least frequently trusted source was social media (n=691, 9.5\%). More physicians trusted government agencies (n=1226, 93\%) than nurses (n=927, 78\%) or pharmacists (n=203, 78\%; P<.001), and more physicians trusted their employer (n=1115, 84\%) than advanced practice providers (n=95, 67\%) and nurses (n=759, 64\%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a ``war zone'' during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19. Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources. ",
doi="10.2196/33330",
url="https://infodemiology.jmir.org/2021/1/e33330",
url="http://www.ncbi.nlm.nih.gov/pubmed/34926995"
}


@Article{info:doi/10.2196/32407,
author="Chow, PF Eric
and Fairley, K. Christopher
and Wigan, Rebecca
and Hocking, S. Jane
and Garland, M. Suzanne
and Cornall, M. Alyssa
and Tabrizi, N. Sepehr
and Chen, Y. Marcus",
title="Accuracy of Self-reported Human Papillomavirus Vaccination Status Among Gay and Bisexual Adolescent Males: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="6",
volume="7",
number="12",
pages="e32407",
keywords="human papillomavirus",
keywords="vaccination",
keywords="accuracy",
keywords="self-reported",
keywords="men who have sex with men",
keywords="immunisation",
keywords="public health",
keywords="immunization",
keywords="HPV vaccination",
keywords="bisexual adolescents",
keywords="bisexual men",
abstract="Background: Men who have sex with men are a risk group for anal human papillomavirus (HPV) and anal cancer. Australia introduced a universal school-based HPV vaccination program in 2013. Self-reported HPV vaccination status has been widely used in clinical and research settings, but its accuracy is understudied. Objective: We aimed to examine the accuracy of self-reported HPV vaccination status among gay and bisexual adolescent males. Methods: We included 192 gay and bisexual males aged 16-20 years from the Human Papillomavirus in Young People Epidemiological Research 2 (HYPER2) study in Melbourne, Australia. All participants had been eligible for the universal school-based HPV vaccination program implemented in 2013 and were asked to self-report their HPV vaccination status. Written informed consent was obtained to verify their HPV vaccination status using records at the National HPV Vaccination Program Register and the Australian Immunisation Register. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value of self-reported HPV vaccination status. Results: The median age of the 192 males was 19 (IQR 18-20) years. There were 128 males (67\%) who had HPV vaccination records documented on either registry. Self-reported HPV vaccination had a sensitivity of 47.7\% (95\% CI 38.8\%-56.7\%; 61/128), a specificity of 85.9\% (95\% CI 75.0\%-93.4\%; 55/64), a positive predictive value of 87.1\% (95\% CI 77.0\%-93.9\%; 61/70), and a negative predictive value of 45.1\% (95\% CI 36.1\%-54.3\%; 55/122). Conclusions: Self-reported HPV vaccination status among Australian gay and bisexual adolescent males underestimates actual vaccination and may be inaccurate for clinical and research purposes. ",
doi="10.2196/32407",
url="https://publichealth.jmir.org/2021/12/e32407",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874884"
}


@Article{info:doi/10.2196/29127,
author="Cruickshank, Iain
and Ginossar, Tamar
and Sulskis, Jason
and Zheleva, Elena
and Berger-Wolf, Tanya",
title="Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="3",
volume="23",
number="12",
pages="e29127",
keywords="COVID-19",
keywords="agenda setting",
keywords="antivaccination",
keywords="cross-platform",
keywords="data mining of social media",
keywords="misinformation",
keywords="social media",
keywords="Twitter",
keywords="vaccinations",
keywords="vaccine hesitancy",
abstract="Background: The onset of the COVID-19 pandemic and the consequent ``infodemic'' increased concerns about Twitter's role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. Objective: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. Methods: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. Results: Of 841,896 vaccination-related tweets identified, 185,994 (22.1\%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5\% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. Conclusions: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its ``bursty'' pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation. ",
doi="10.2196/29127",
url="https://www.jmir.org/2021/12/e29127",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665760"
}


@Article{info:doi/10.2196/33455,
author="Goldin, Shoshanna
and Kong, Joyce So Yeon
and Tokar, Anna
and Utunen, Heini
and Ndiaye, Ngouille
and Bahl, Jhilmil
and Appuhamy, Ranil
and Moen, Ann",
title="Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="3",
volume="7",
number="12",
pages="e33455",
keywords="COVID-19",
keywords="vaccination",
keywords="training",
keywords="massive open online course",
keywords="pandemic",
keywords="vaccine",
keywords="education",
keywords="online education",
keywords="preparation",
keywords="evaluation",
keywords="user experience",
keywords="challenge",
keywords="impact",
keywords="knowledge",
keywords="interest",
abstract="Background: To prepare key stakeholders for the global COVID-19 vaccination rollout, the World Health Organization and partners developed online vaccination training packages. The online course was launched in December 2020 on the OpenWHO learning platform. This paper presents the findings of an evaluation of this course. Objective: The aim of this evaluation was to provide insights into user experiences and challenges, measure the impact of the course in terms of knowledge gained, and anticipate potential interest in future online vaccination courses. Methods: The primary source of data was the anonymized information on course participants, enrollment, completion, and scores from the OpenWHO platform's statistical data and metric reporting system. Data from the OpenWHO platform were analyzed from the opening of the courses in mid-December 2020 to mid-April 2021. In addition, a learner feedback survey was sent by email to all course participants to complete within a 3-week period (March 19 to April 9, 2021). The survey was designed to determine the perceived strengths and weaknesses of the training packages and to understand barriers to access. Results: During the study period, 53,593 learners enrolled in the course. Of them, 30,034 (56.0\%) completed the course, which is substantially higher than the industry benchmark of 5\%-10\% for a massive open online course (MOOC). Overall, learners averaged 76.5\% on the prequiz compared to 85\% on the postquiz, resulting in an increase in average score of 9\%. A total of 2019 learners from the course participated in the survey. Nearly 98\% (n=1647 fully agree, n=308 somewhat agree; N=1986 survey respondents excluding missing values) of respondents fully or somewhat agreed that they had more confidence in their ability to support COVID-19 vaccination following completion of this course. Conclusions: The online vaccine training was well received by the target audience, with a measurable impact on knowledge gained. The key benefits of online training were the convenience, self-paced nature, access to downloadable material, and ability to replay material, as well as an increased ability to concentrate. Online training was identified as a timely, cost-effective way of delivering essential training to a large number of people to prepare for the COVID-19 vaccination rollout. ",
doi="10.2196/33455",
url="https://publichealth.jmir.org/2021/12/e33455",
url="http://www.ncbi.nlm.nih.gov/pubmed/34794116"
}


@Article{info:doi/10.2196/32814,
author="Zhang, Jueman
and Wang, Yi
and Shi, Molu
and Wang, Xiuli",
title="Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Dec",
day="3",
volume="7",
number="12",
pages="e32814",
keywords="COVID-19",
keywords="vaccine",
keywords="topic modeling",
keywords="LDA",
keywords="valence",
keywords="share",
keywords="viral",
keywords="Twitter",
keywords="social media",
abstract="Background: COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective: The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods: We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results: Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people's views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people's views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions: This study suggests the public interest in and demand for information about vaccine development and people's views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter. ",
doi="10.2196/32814",
url="https://publichealth.jmir.org/2021/12/e32814",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665761"
}


@Article{info:doi/10.2196/30529,
author="Jarynowski, Andrzej
and Semenov, Alexander
and Kami?ski, Miko?aj
and Belik, Vitaly",
title="Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="29",
volume="23",
number="11",
pages="e30529",
keywords="adverse events",
keywords="Sputnik V",
keywords="Gam-COVID-Vac",
keywords="social media",
keywords="Telegram",
keywords="COVID-19",
keywords="Sars-CoV-2",
keywords="deep learning",
keywords="vaccine safety",
abstract="Background: There is a limited amount of data on the safety profile of the COVID-19 vector vaccine Gam-COVID-Vac (Sputnik V). Previous infodemiology studies showed that social media discourse could be analyzed to assess the most concerning adverse events (AE) caused by drugs. Objective: We aimed to investigate mild AEs of Sputnik V based on a participatory trial conducted on Telegram in the Russian language. We compared AEs extracted from Telegram with other limited databases on Sputnik V and other COVID-19 vaccines. We explored symptom co-occurrence patterns and determined how counts of administered doses, age, gender, and sequence of shots could confound the reporting of AEs. Methods: We collected a unique dataset consisting of 11,515 self-reported Sputnik V vaccine AEs posted on the Telegram group, and we utilized natural language processing methods to extract AEs. Specifically, we performed multilabel classifications using the deep neural language model Bidirectional Encoder Representations from Transformers (BERT) ``DeepPavlov,'' which was pretrained on a Russian language corpus and applied to the Telegram messages. The resulting area under the curve score was 0.991. We chose symptom classes that represented the following AEs: fever, pain, chills, fatigue, nausea/vomiting, headache, insomnia, lymph node enlargement, erythema, pruritus, swelling, and diarrhea. Results: Telegram users complained mostly about pain (5461/11,515, 47.43\%), fever (5363/11,515, 46.57\%), fatigue (3862/11,515, 33.54\%), and headache (2855/11,515, 24.79\%). Women reported more AEs than men (1.2-fold, P<.001). In addition, there were more AEs from the first dose than from the second dose (1.1-fold, P<.001), and the number of AEs decreased with age ($\beta$=.05 per year, P<.001). The results also showed that Sputnik V AEs were more similar to other vector vaccines (132 units) than with messenger RNA vaccines (241 units) according to the average Euclidean distance between the vectors of AE frequencies. Elderly Telegram users reported significantly more (5.6-fold on average) systemic AEs than their peers, according to the results of the phase 3 clinical trials published in The Lancet. However, the AEs reported in Telegram posts were consistent (Pearson correlation r=0.94, P=.02) with those reported in the Argentinian postmarketing AE registry. Conclusions: After the Sputnik V vaccination, Russian Telegram users reported mostly pain, fever, and fatigue. The Sputnik V AE profile was comparable with other vector COVID-19 vaccines. Discussion on social media could provide meaningful information about the AE profile of novel vaccines. ",
doi="10.2196/30529",
url="https://www.jmir.org/2021/11/e30529",
url="http://www.ncbi.nlm.nih.gov/pubmed/34662291"
}


@Article{info:doi/10.2196/33231,
author="Cheong, Queena
and Au-yeung, Martin
and Quon, Stephanie
and Concepcion, Katsy
and Kong, Dzevela Jude",
title="Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning--Based Approach",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="25",
volume="23",
number="11",
pages="e33231",
keywords="COVID-19",
keywords="vaccine",
keywords="public health",
keywords="machine learning",
keywords="XGBoost",
keywords="SARS-CoV-2",
keywords="sociodemographic factors",
keywords="United States",
keywords="sociodemographic",
keywords="prediction",
keywords="model",
keywords="uptake",
abstract="Background: Although the COVID-19 pandemic has left an unprecedented impact worldwide, countries such as the United States have reported the most substantial incidence of COVID-19 cases worldwide. Within the United States, various sociodemographic factors have played a role in the creation of regional disparities. Regional disparities have resulted in the unequal spread of disease between US counties, underscoring the need for efficient and accurate predictive modeling strategies to inform public health officials and reduce the burden on health care systems. Furthermore, despite the widespread accessibility of COVID-19 vaccines across the United States, vaccination rates have become stagnant, necessitating predictive modeling to identify important factors impacting vaccination uptake. Objective: This study aims to determine the association between sociodemographic factors and vaccine uptake across counties in the United States. Methods: Sociodemographic data on fully vaccinated and unvaccinated individuals were sourced from several online databases such as the US Centers for Disease Control and Prevention and the US Census Bureau COVID-19 Site. Machine learning analysis was performed using XGBoost and sociodemographic data. Results: Our model predicted COVID-19 vaccination uptake across US counties with 62\% accuracy. In addition, it identified location, education, ethnicity, income, and household access to the internet as the most critical sociodemographic features in predicting vaccination uptake in US counties. Lastly, the model produced a choropleth demonstrating areas of low and high vaccination rates, which can be used by health care authorities in future pandemics to visualize and prioritize areas of low vaccination and design targeted vaccination campaigns. Conclusions: Our study reveals that sociodemographic characteristics are predictors of vaccine uptake rates across counties in the United States and, if leveraged appropriately, can assist policy makers and public health officials to understand vaccine uptake rates and craft policies to improve them. ",
doi="10.2196/33231",
url="https://www.jmir.org/2021/11/e33231",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751650"
}


@Article{info:doi/10.2196/28846,
author="Becker, RB Elisabeth
and Shegog, Ross
and Savas, S. Lara
and Frost, L. Erica
and Healy, Mary C.
and Spinner, W. Stanley
and Vernon, W. Sally",
title="Informing Content and Feature Design of a Parent-Focused Human Papillomavirus Vaccination Digital Behavior Change Intervention: Synchronous Text-Based Focus Group Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="19",
volume="5",
number="11",
pages="e28846",
keywords="human papillomavirus",
keywords="vaccination",
keywords="qualitative",
keywords="focus groups",
keywords="sexually transmitted infection",
abstract="Background: Human papillomavirus (HPV) is a common and preventable sexually transmitted infection; however, vaccination rates in the United States among the target age group, which is 11-12 years, are lower than national goals. Interventions that address the barriers to and facilitators of vaccination are important for improving HPV vaccination rates. Web-based, text-based focus groups are becoming a promising method that may be well suited for conducting formative research to inform the design of digital behavior change intervention (DBCI) content and features that address HPV vaccination decision-making. Objective: This study aims to explore parental HPV vaccination decision-making processes using a web-based, text-based focus group protocol to inform content and feature recommendations for an HPV prevention DBCI. Methods: We conducted 4 web-based, text-based synchronous focus groups via Skype with the parents of patients aged 11-13 years within a large urban US pediatric clinic network. Results: The 22 parents were mostly female, White, non-Hispanic college graduates, and they mostly had private health insurance for their children. Approximately half (14/25, 56\%) of the parents' 11-13 year old children had initiated HPV vaccination. Most parents had experience using Skype (19/22, 86\%). Approximately half (8/17, 47\%) of parents expressed no preference for the focus group format, whereas 47\% (8/17) requested a text-only chat format and 6\% (1/17) requested an audiovisual format. The three main themes from the qualitative data were barriers to HPV vaccination, facilitators of HPV vaccination, and suggestions for improving the HPV vaccination clinic experience. A total of 11 intervention content and feature recommendations emerged from the themes, including addressing HPV knowledge barriers using trusted sources, designing for a family audience, focusing on the framing of messages, reporting reputable HPV research in a comprehensible format, and expanding the clinic visit experience. Conclusions: Synchronous text-based focus groups are feasible for conducting formative research on HPV vaccination decision-making. Among well-educated and well-resourced parents, there are barriers such as misinformation and facilitators such as pediatrician recommendations that influence HPV vaccination decision-making. Parents want to conduct their own HPV research as well as receive relevant HPV vaccination advice from their child's pediatrician. In addition, parents want an enhanced clinic visit experience that lets them access and connect to tailored information before and after clinic visits. The results gathered provide guidance for content and features that may inform a more responsive DBCI to address HPV vaccination decision-making among parents. ",
doi="10.2196/28846",
url="https://formative.jmir.org/2021/11/e28846",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806991"
}


@Article{info:doi/10.2196/30642,
author="Muric, Goran
and Wu, Yusong
and Ferrara, Emilio",
title="COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="17",
volume="7",
number="11",
pages="e30642",
keywords="vaccine hesitancy",
keywords="COVID-19 vaccines",
keywords="dataset",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="social media",
keywords="network analysis",
keywords="hesitancy",
keywords="vaccine",
keywords="Twitter",
keywords="misinformation",
keywords="conspiracy",
keywords="trust",
keywords="public health",
keywords="utilization",
abstract="Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword--centered data collection with more than 1.8 million tweets, and (2) a historical account--level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. ",
doi="10.2196/30642",
url="https://publichealth.jmir.org/2021/11/e30642",
url="http://www.ncbi.nlm.nih.gov/pubmed/34653016"
}


@Article{info:doi/10.2196/32936,
author="Zhang, Zizheng
and Feng, Guanrui
and Xu, Jiahong
and Zhang, Yimin
and Li, Jinhui
and Huang, Jian
and Akinwunmi, Babatunde
and Zhang, P. Casper J.
and Ming, Wai-kit",
title="The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="9",
volume="7",
number="11",
pages="e32936",
keywords="COVID-19",
keywords="vaccine",
keywords="hesitancy",
keywords="social media",
keywords="China",
keywords="sentiment analysis",
keywords="infoveillance",
keywords="public health",
keywords="surveillance",
keywords="Weibo",
keywords="data mining",
keywords="sentiment",
keywords="attitude",
abstract="Background: The ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers. Objective: This study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported. Methods: A total of 340,783 vaccine-related posts were captured with the poster's information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine. Results: The positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7\% to 77.0\% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0\% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region. Conclusions: In China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance. ",
doi="10.2196/32936",
url="https://publichealth.jmir.org/2021/11/e32936",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591782"
}


@Article{info:doi/10.2196/31707,
author="Singh, Akansha
and Lai, Yan Angel Hor
and Wang, Jingxuan
and Asim, Saba
and Chan, Shing-Fong Paul
and Wang, Zixin
and Yeoh, Kiong Eng",
title="Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="9",
volume="7",
number="11",
pages="e31707",
keywords="COVID-19",
keywords="South Asian ethnic minorities",
keywords="COVID-19 vaccination",
keywords="uptake",
keywords="cultural and religious reasons for vaccine hesitancy",
keywords="perceptions",
keywords="information exposure on social media",
keywords="influence of peers",
keywords="socioecological model",
keywords="Hong Kong",
abstract="Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1\%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2\%; and both doses, 19/245, 7.9\%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95\% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95\% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95\% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95\% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95\% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95\% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95\% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. ",
doi="10.2196/31707",
url="https://publichealth.jmir.org/2021/11/e31707",
url="http://www.ncbi.nlm.nih.gov/pubmed/34653014"
}


@Article{info:doi/10.2196/30150,
author="Wawrzuta, Dominik
and Jaworski, Mariusz
and Gotlib, Joanna
and Panczyk, Mariusz",
title="Social Media Sharing of Articles About Measles in a European Context: Text Analysis Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="8",
volume="23",
number="11",
pages="e30150",
keywords="measles",
keywords="Facebook",
keywords="Twitter",
keywords="Pinterest",
keywords="social media",
keywords="vaccine",
keywords="infodemiology",
keywords="public health",
abstract="Background: Despite the existence of an effective vaccine, measles still threatens the health and lives of many Europeans. Notably, during the COVID-19 pandemic, measles vaccine uptake declined; as a result, after the pandemic, European countries will have to increase vaccination rates to restore the extent of vaccination coverage among the population. Because information obtained from social media are one of the main causes of vaccine hesitancy, knowledge of the nature of information pertaining to measles that is shared on social media may help create educational campaigns. Objective: In this study, we aim to define the characteristics of European news about measles shared on social media platforms (ie, Facebook, Twitter, and Pinterest) from 2017 to 2019. Methods: We downloaded and translated (into English) 10,305 articles on measles published in European Union countries. Using latent Dirichlet allocation, we identified main topics and estimated the sentiments expressed in these articles. Furthermore, we used linear regression to determine factors related to the number of times a given article was shared on social media. Results: We found that, in most European social media posts, measles is only discussed in the context of local European events. Articles containing educational information and describing world outbreaks appeared less frequently. The most common emotions identified from the study's news data set were fear and trust. Yet, it was found that readers were more likely to share information on educational topics and the situation in Germany, Ukraine, Italy, and Samoa. A high amount of anger, joy, and sadness expressed within the text was also associated with a higher number of shares. Conclusions: We identified which features of news articles were related to increased social media shares. We found that social media users prefer sharing educational news to sharing informational news. Appropriate emotional content can also increase the willingness of social media users to share an article. Effective media content that promotes measles vaccinations should contain educational or scientific information, as well as specific emotions (such as anger, joy, or sadness). Articles with this type of content may offer the best chance of disseminating vital messages to a broad social media audience. ",
doi="10.2196/30150",
url="https://www.jmir.org/2021/11/e30150",
url="http://www.ncbi.nlm.nih.gov/pubmed/34570715"
}


@Article{info:doi/10.2196/29789,
author="Liew, Ming Tau
and Lee, Sin Cia",
title="Examining the Utility of Social Media in COVID-19 Vaccination:  Unsupervised Learning of 672,133 Twitter Posts",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="3",
volume="7",
number="11",
pages="e29789",
keywords="social media",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="natural language processing",
keywords="machine learning",
keywords="infodemiology",
abstract="Background: Although COVID-19 vaccines have recently become available, efforts in global mass vaccination can be hampered by the widespread issue of vaccine hesitancy. Objective: The aim of this study was to use social media data to capture close-to-real-time public perspectives and sentiments regarding COVID-19 vaccines, with the intention to understand the key issues that have captured public attention, as well as the barriers and facilitators to successful COVID-19 vaccination. Methods: Twitter was searched for tweets related to ``COVID-19'' and ``vaccine'' over an 11-week period after November 18, 2020, following a press release regarding the first effective vaccine. An unsupervised machine learning approach (ie, structural topic modeling) was used to identify topics from tweets, with each topic further grouped into themes using manually conducted thematic analysis as well as guided by the theoretical framework of the COM-B (capability, opportunity, and motivation components of behavior) model.  Sentiment analysis of the tweets was also performed using the rule-based machine learning model VADER (Valence Aware Dictionary and Sentiment Reasoner). Results: Tweets related to COVID-19 vaccines were posted by individuals around the world (N=672,133).  Six overarching themes were identified: (1) emotional reactions related to COVID-19 vaccines (19.3\%), (2) public concerns related to COVID-19 vaccines (19.6\%), (3) discussions about news items related to COVID-19 vaccines (13.3\%), (4) public health communications about COVID-19 vaccines (10.3\%), (5) discussions about approaches to COVID-19 vaccination drives (17.1\%), and (6) discussions about the distribution of COVID-19 vaccines (20.3\%).  Tweets with negative sentiments largely fell within the themes of emotional reactions and public concerns related to COVID-19 vaccines.  Tweets related to facilitators of vaccination showed temporal variations over time, while tweets related to barriers remained largely constant throughout the study period. Conclusions: The findings from this study may facilitate the formulation of comprehensive strategies to improve COVID-19 vaccine uptake; they highlight the key processes that require attention in the planning of COVID-19 vaccination and provide feedback on evolving barriers and facilitators in ongoing vaccination drives to allow for further policy tweaks.  The findings also illustrate three key roles of social media in COVID-19 vaccination, as follows: surveillance and monitoring, a communication platform, and evaluation of government responses. ",
doi="10.2196/29789",
url="https://publichealth.jmir.org/2021/11/e29789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34583316"
}


@Article{info:doi/10.2196/28096,
author="Duong, Hong
and Dao, Sang
and Dang, Huyen
and Nguyen, Linh
and Ngo, Tuan
and Nguyen, Trung
and Tran, Anh Lan
and Nguyen, Doan
and Rivera, Maya
and Nguyen, Nga",
title="The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="25",
volume="5",
number="10",
pages="e28096",
keywords="immunizations",
keywords="immunization registry",
keywords="readiness assessment",
keywords="electronic immunization records",
keywords="Vietnam",
abstract="Background: Vietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted. Objective: This study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam---Ha Noi and Son La. Methods: All health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS. Results: Of the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7\%) and vaccine stocks (889/990, 90.8\%). Most had stable electricity (971/990, 98.1\%), at least 1 computer (986/990, 99.6\%), and ?2 trained NIIS end users (825/990, 83.3\%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5\%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4\%) and paper-based logbooks (254/269, 94.4\%). However, only 54.5\% (206/378) of immunization IDs matched, 57\% (13/23) of Bacillus Calmette-Gu{\'e}rin vaccination records were accurate, and 70\% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed. Conclusions: The readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data. ",
doi="10.2196/28096",
url="https://formative.jmir.org/2021/10/e28096",
url="http://www.ncbi.nlm.nih.gov/pubmed/34694232"
}


@Article{info:doi/10.2196/30765,
author="Monselise, Michal
and Chang, Chia-Hsuan
and Ferreira, Gustavo
and Yang, Rita
and Yang, C. Christopher",
title="Topics and Sentiments of Public Concerns Regarding COVID-19 Vaccines: Social Media Trend Analysis",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="21",
volume="23",
number="10",
pages="e30765",
keywords="health care informatics",
keywords="topic detection",
keywords="unsupervised sentiment analysis",
keywords="COVID-19",
keywords="vaccine hesitancy",
keywords="sentiment",
keywords="concern",
keywords="vaccine",
keywords="social media",
keywords="trend",
keywords="trust",
keywords="health information",
keywords="Twitter",
keywords="discussion",
keywords="communication",
keywords="hesitancy",
keywords="emotion",
keywords="fear",
abstract="Background: As a number of vaccines for COVID-19 are given emergency use authorization by local health agencies and are being administered in multiple countries, it is crucial to gain public trust in these vaccines to ensure herd immunity through vaccination. One way to gauge public sentiment regarding vaccines for the goal of increasing vaccination rates is by analyzing social media such as Twitter. Objective: The goal of this research was to understand public sentiment toward COVID-19 vaccines by analyzing discussions about the vaccines on social media for a period of 60 days when the vaccines were started in the United States. Using the combination of topic detection and sentiment analysis, we identified different types of concerns regarding vaccines that were expressed by different groups of the public on social media. Methods: To better understand public sentiment, we collected tweets for exactly 60 days starting from December 16, 2020 that contained hashtags or keywords related to COVID-19 vaccines. We detected and analyzed different topics of discussion of these tweets as well as their emotional content. Vaccine topics were identified by nonnegative matrix factorization, and emotional content was identified using the Valence Aware Dictionary and sEntiment Reasoner sentiment analysis library as well as by using sentence bidirectional encoder representations from transformer embeddings and comparing the embedding to different emotions using cosine similarity. Results: After removing all duplicates and retweets, 7,948,886 tweets were collected during the 60-day time period. Topic modeling resulted in 50 topics; of those, we selected 12 topics with the highest volume of tweets for analysis. Administration and access to vaccines were some of the major concerns of the public. Additionally, we classified the tweets in each topic into 1 of the 5 emotions and found fear to be the leading emotion in the tweets, followed by joy. Conclusions: This research focused not only on negative emotions that may have led to vaccine hesitancy but also on positive emotions toward the vaccine. By identifying both positive and negative emotions, we were able to identify the public's response to the vaccines overall and to news events related to the vaccines. These results are useful for developing plans for disseminating authoritative health information and for better communication to build understanding and trust. ",
doi="10.2196/30765",
url="https://www.jmir.org/2021/10/e30765",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581682"
}


@Article{info:doi/10.2196/31125,
author="Huang, Xiaojie
and Yu, Maohe
and Fu, Gengfeng
and Lan, Guanghua
and Li, Linghua
and Yang, Jianzhou
and Qiao, Ying
and Zhao, Jin
and Qian, Han-Zhu
and Zhang, Xiangjun
and Liu, Xinchao
and Jin, Xia
and Chen, Guohong
and Jiang, Hui
and Tang, Weiming
and Wang, Zixin
and Xu, Junjie",
title="Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Oct",
day="21",
volume="7",
number="10",
pages="e31125",
keywords="people living with HIV and AIDS",
keywords="COVID-19 vaccination",
keywords="willingness",
keywords="perceptions",
keywords="internet and social media influences",
keywords="interpersonal communication",
abstract="Background: HIV infection is a significant independent risk factor for both severe COVID-19 presentation at hospital admission and in-hospital mortality. Available information has suggested that people living with HIV and AIDS (PLWHA) could benefit from COVID-19 vaccination. However, there is a dearth of evidence on willingness to receive COVID-19 vaccination among PLWHA. Objective: The aim of this study was to investigate willingness to receive COVID-19 vaccination among a national sample of PLWHA in China. Methods: This cross-sectional online survey investigated factors associated with willingness to receive COVID-19 vaccination among PLWHA aged 18 to 65 years living in eight conveniently selected Chinese metropolitan cities between January and February 2021. Eight community-based organizations (CBOs) providing services to PLWHA facilitated the recruitment. Eligible PLWHA completed an online survey developed using a widely used encrypted web-based survey platform in China. We fitted a single logistic regression model to obtain adjusted odds ratios (aORs), which involved one of the independent variables of interest and all significant background variables. Path analysis was also used in the data analysis. Results: Out of 10,845 PLWHA approached by the CBOs, 2740 completed the survey, and 170 had received at least one dose of the COVID-19 vaccine. This analysis was performed among 2570 participants who had never received COVID-19 vaccination. Over half of the participants reported willingness to receive COVID-19 vaccination (1470/2570, 57.2\%). Perceptions related to COVID-19 vaccination were significantly associated with willingness to receive COVID-19 vaccination, including positive attitudes (aOR 1.11, 95\% CI 1.09-1.12; P<.001), negative attitudes (aOR 0.96, 95\% CI 0.94-0.97; P<.001), perceived support from significant others (perceived subjective norm; aOR 1.53, 95\% CI 1.46-1.61; P<.001), and perceived behavioral control (aOR 1.13, 95\% CI 1.11-1.14; P<.001). At the interpersonal level, receiving advice supportive of COVID-19 vaccination from doctors (aOR 1.99, 95\% CI 1.65-2.40; P<.001), CBO staff (aOR 1.89, 95\% CI 1.51-2.36; P<.001), friends and/or family members (aOR 3.22, 95\% CI 1.93-5.35; P<.001), and PLWHA peers (aOR 2.38, 95\% CI 1.85-3.08; P<.001) was associated with higher willingness to receive COVID-19 vaccination. The overall opinion supporting COVID-19 vaccination for PLWHA on the internet or social media was also positively associated with willingness to receive COVID-19 vaccination (aOR 1.59, 95\% CI 1.31-1.94; P<.001). Path analysis indicated that interpersonal-level variables were indirectly associated with willingness to receive COVID-19 vaccination through perceptions ($\beta$=.43, 95\% CI .37-.51; P<.001). Conclusions: As compared to PLWHA in other countries and the general population in most parts of the world, PLWHA in China reported a relatively low willingness to receive COVID-19 vaccination. The internet and social media as well as interpersonal communications may be major sources of influence on PLWHA's perceptions and willingness to receive COVID-19 vaccination. ",
doi="10.2196/31125",
url="https://publichealth.jmir.org/2021/10/e31125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34543223"
}


@Article{info:doi/10.2196/29584,
author="Kummervold, E. Per
and Martin, Sam
and Dada, Sara
and Kilich, Eliz
and Denny, Chermain
and Paterson, Pauline
and Larson, J. Heidi",
title="Categorizing Vaccine Confidence With a Transformer-Based Machine Learning Model: Analysis of Nuances of Vaccine Sentiment in Twitter Discourse",
journal="JMIR Med Inform",
year="2021",
month="Oct",
day="8",
volume="9",
number="10",
pages="e29584",
keywords="computer science",
keywords="information technology",
keywords="public health",
keywords="health humanities",
keywords="vaccines",
keywords="machine learning",
abstract="Background: Social media has become an established platform for individuals to discuss and debate various subjects, including vaccination. With growing conversations on the web and less than desired maternal vaccination uptake rates, these conversations could provide useful insights to inform future interventions. However, owing to the volume of web-based posts, manual annotation and analysis are difficult and time consuming. Automated processes for this type of analysis, such as natural language processing, have faced challenges in extracting complex stances such as attitudes toward vaccination from large amounts of text. Objective: The aim of this study is to build upon recent advances in transposer-based machine learning methods and test whether transformer-based machine learning could be used as a tool to assess the stance expressed in social media posts toward vaccination during pregnancy. Methods: A total of 16,604 tweets posted between November 1, 2018, and April 30, 2019, were selected using keyword searches related to maternal vaccination. After excluding irrelevant tweets, the remaining tweets were coded by 3 individual researchers into the categories Promotional, Discouraging, Ambiguous, and Neutral or No Stance. After creating a final data set of 2722 unique tweets, multiple machine learning techniques were trained on a part of this data set and then tested and compared with the human annotators. Results: We found the accuracy of the machine learning techniques to be 81.8\% (F score=0.78) compared with the agreed score among the 3 annotators. For comparison, the accuracies of the individual annotators compared with the final score were 83.3\%, 77.9\%, and 77.5\%. Conclusions: This study demonstrates that we are able to achieve close to the same accuracy in categorizing tweets using our machine learning models as could be expected from a single human coder. The potential to use this automated process, which is reliable and accurate, could free valuable time and resources for conducting this analysis, in addition to informing potentially effective and necessary interventions. ",
doi="10.2196/29584",
url="https://medinform.jmir.org/2021/10/e29584",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623312"
}


@Article{info:doi/10.2196/29885,
author="Li, Jinhui
and Zheng, Han
and Duan, Xu",
title="Factors Influencing the Popularity of a Health-Related Answer on a Chinese Question-and-Answer Website: Case Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e29885",
keywords="answer-response behaviors",
keywords="Zhihu",
keywords="HPV vaccine information",
keywords="content features",
keywords="context features",
keywords="contributor features",
abstract="Background: Social question-and-answer (Q\&A) sites have become an important venue for individuals to obtain and share human papillomavirus (HPV) vaccine knowledge. Objective: This study aims to examine how different features of an HPV vaccine--related answer are associated with users' response behaviors on social Q\&A websites. Methods: A total of 2953 answers and 270 corresponding questions regarding the HPV vaccine were collected from a leading Chinese social Q\&A platform, Zhihu. Three types of key features, including content, context, and contributor, were extracted and coded. Negative binomial regression models were used to examine their impact on the vote and comment count of an HPV vaccine--related answer. Results: The findings showed that both content length and vividness were positively related to the response behaviors of HPV vaccine--related answers. In addition, compared with answers under the question theme benefits and risks, answers under the question theme vaccination experience received fewer votes and answers under the theme news opinions received more votes but fewer comments. The effects of characteristics of contributors were also supported, suggesting that answers from a male contributor with more followers and no professional identity would attract more votes and comments from community members. The significant interaction effect between content and context features further showed that long and vivid answers about HPV vaccination experience were more likely to receive votes and comments of users than those about benefits and risks. Conclusions: The study provides a complete picture of the underlying mechanism behind response behaviors of users toward HPV vaccine--related answers on social Q\&A websites. The results help health community organizers develop better strategies for building and maintaining a vibrant web-based community for communicating HPV vaccine knowledge. ",
doi="10.2196/29885",
url="https://www.jmir.org/2021/9/e29885",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581675"
}


@Article{info:doi/10.2196/28355,
author="Suzuki, Yukio
and Sukegawa, Akiko
and Ueda, Yutaka
and Sekine, Masayuki
and Enomoto, Takayuki
and Miyagi, Etsuko",
title="Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="27",
volume="23",
number="9",
pages="e28355",
keywords="human papillomavirus",
keywords="human papillomavirus vaccination",
keywords="behavioral insights",
keywords="behavioral change",
keywords="web-based randomized controlled trial",
abstract="Background: The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events. Objective: This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons. Methods: We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format. Results: Only 484 (29.2\%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2\%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8\%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95\% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95\% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95\% CI 0.83-1.73). Conclusions: This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000049745 ",
doi="10.2196/28355",
url="https://www.jmir.org/2021/9/e28355",
url="http://www.ncbi.nlm.nih.gov/pubmed/34569941"
}


@Article{info:doi/10.2196/32685,
author="Yan, Cathy
and Law, Melanie
and Nguyen, Stephanie
and Cheung, Janelle
and Kong, Jude",
title="Comparing Public Sentiment Toward COVID-19 Vaccines Across Canadian Cities: Analysis of Comments on Reddit",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="24",
volume="23",
number="9",
pages="e32685",
keywords="COVID-19",
keywords="public sentiment",
keywords="social media",
keywords="Reddit",
keywords="Canada",
keywords="communication",
keywords="sentiment",
keywords="opinion",
keywords="emotion",
keywords="concern",
keywords="pandemic",
keywords="vaccine",
keywords="hesitancy",
abstract="Background: Social media enables the rapid consumption of news related to COVID-19 and serves as a platform for discussions. Its richness in text-based data in the form of posts and comments allows researchers to identify popular topics and assess public sentiment. Nonetheless, the vast majority of topic extraction and sentiment analysis based on social media is performed on the platform or country level and does not account for local culture and policies. Objective: The aim of this study is to use location-based subreddits on Reddit to study city-level variations in sentiments toward vaccine-related topics. Methods: Comments on posts providing regular updates on COVID-19 statistics in the Vancouver (r/vancouver, n=49,291), Toronto (r/toronto, n=20,764), and Calgary (r/calgary, n=21,277) subreddits between July 13, 2020, and June 14, 2021, were extracted. Latent Dirichlet allocation was used to identify frequently discussed topics. Sentiment (joy, sadness, fear, and anger) scores were assigned to comments through random forest regression. Results: The number of comments on the 250 posts from the Vancouver subreddit positively correlated with the number of new daily COVID-19 cases in British Columbia (R=0.51, 95\% CI for slope 0.18-0.29; P<.001). From the comments, 13 topics were identified. Two were related to vaccines, 1 regarding vaccine uptake and the other about vaccine supply. The levels of discussion for both topics were linked to the total number of vaccines administered (Granger test for causality, P<.001). Comments pertaining to either topic displayed higher scores for joy than for other topics (P<.001). Calgary and Toronto also discussed vaccine uptake. Sentiment scores for this topic differed across the 3 cities (P<.001). Conclusions: Our work demonstrates that data from city-specific subreddits can be used to better understand concerns and sentiments around COVID-19 vaccines at the local level. This can potentially lead to more targeted and publicly acceptable policies based on content on social media. ",
doi="10.2196/32685",
url="https://www.jmir.org/2021/9/e32685",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519654"
}


@Article{info:doi/10.2196/30010,
author="Glampson, Ben
and Brittain, James
and Kaura, Amit
and Mulla, Abdulrahim
and Mercuri, Luca
and Brett, J. Stephen
and Aylin, Paul
and Sandall, Tessa
and Goodman, Ian
and Redhead, Julian
and Saravanakumar, Kavitha
and Mayer, K. Erik",
title="Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="17",
volume="7",
number="9",
pages="e30010",
keywords="health informatics",
keywords="real-word evidence",
keywords="COVID-19",
keywords="medical informatics",
keywords="vaccine",
keywords="vaccination",
abstract="Background: On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. Objective: This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. Methods: A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. Results: In this study, 5.88\% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14\% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=--0.94; P=.002) with 13.5\% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98\% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09\%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13\% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74\% (hazard ratio 0.26, 95\% CI 0.19-0.35) and 78\% (hazard ratio 0.22, 95\% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07\% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. Conclusions: There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population. ",
doi="10.2196/30010",
url="https://publichealth.jmir.org/2021/9/e30010",
url="http://www.ncbi.nlm.nih.gov/pubmed/34265740"
}


@Article{info:doi/10.2196/25636,
author="Jiang, Crystal Li
and Chu, Hang Tsz
and Sun, Mengru",
title="Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis",
journal="JMIR Infodemiology",
year="2021",
month="Sep",
day="14",
volume="1",
number="1",
pages="e25636",
keywords="topic modeling",
keywords="social media",
keywords="infoveillance",
keywords="vaccine",
keywords="coronavirus",
keywords="COVID-19",
abstract="Background: During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions. Objective: This study aimed to uncover the emerging themes in Twitter users' perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak. Methods: This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, ``COVID'' AND ``vaccine'') to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms. Results: In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3\% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4\% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9\% (12,882/100,209) as Financial Concerns, 12.7\% (12,696/100,209) as Venting Negative Emotions, 9.9\% (9908/100,209) as Prayers and Calls for Positivity, 8.1\% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9\% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level---the extent to which a tweet being retweeted, quoted, liked, or replied by other users---was similar among different themes, but tweets venting negative emotions yielded the lowest engagement. Conclusions: This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence. ",
doi="10.2196/25636",
url="https://infodemiology.jmir.org/2021/1/e25636",
url="http://www.ncbi.nlm.nih.gov/pubmed/34604707"
}


@Article{info:doi/10.2196/30854,
author="Hu, Tao
and Wang, Siqin
and Luo, Wei
and Zhang, Mengxi
and Huang, Xiao
and Yan, Yingwei
and Liu, Regina
and Ly, Kelly
and Kacker, Viraj
and She, Bing
and Li, Zhenlong",
title="Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e30854",
keywords="Twitter",
keywords="public opinion",
keywords="COVID-19 vaccines",
keywords="sentiment analysis",
keywords="emotion analysis",
keywords="topic modeling",
keywords="COVID-19",
abstract="Background: The COVID-19 pandemic has imposed a large, initially uncontrollable, public health crisis both in the United States and across the world, with experts looking to vaccines as the ultimate mechanism of defense. The development and deployment of COVID-19 vaccines have been rapidly advancing via global efforts. Hence, it is crucial for governments, public health officials, and policy makers to understand public attitudes and opinions towards vaccines, such that effective interventions and educational campaigns can be designed to promote vaccine acceptance. Objective: The aim of this study was to investigate public opinion and perception on COVID-19 vaccines in the United States. We investigated the spatiotemporal trends of public sentiment and emotion towards COVID-19 vaccines and analyzed how such trends relate to popular topics found on Twitter. Methods: We collected over 300,000 geotagged tweets in the United States from March 1, 2020 to February 28, 2021. We examined the spatiotemporal patterns of public sentiment and emotion over time at both national and state scales and identified 3 phases along the pandemic timeline with sharp changes in public sentiment and emotion. Using sentiment analysis, emotion analysis (with cloud mapping of keywords), and topic modeling, we further identified 11 key events and major topics as the potential drivers to such changes. Results: An increasing trend in positive sentiment in conjunction with a decrease in negative sentiment were generally observed in most states, reflecting the rising confidence and anticipation of the public towards vaccines. The overall tendency of the 8 types of emotion implies that the public trusts and anticipates the vaccine. This is accompanied by a mixture of fear, sadness, and anger. Critical social or international events or announcements by political leaders and authorities may have potential impacts on public opinion towards vaccines. These factors help identify underlying themes and validate insights from the analysis. Conclusions: The analyses of near real-time social media big data benefit public health authorities by enabling them to monitor public attitudes and opinions towards vaccine-related information in a geo-aware manner, address the concerns of vaccine skeptics, and promote the confidence that individuals within a certain region or community have towards vaccines. ",
doi="10.2196/30854",
url="https://www.jmir.org/2021/9/e30854",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346888"
}


@Article{info:doi/10.2196/30451,
author="Tomaszewski, Tre
and Morales, Alex
and Lourentzou, Ismini
and Caskey, Rachel
and Liu, Bing
and Schwartz, Alan
and Chin, Jessie",
title="Identifying False Human Papillomavirus (HPV) Vaccine Information and Corresponding Risk Perceptions From Twitter: Advanced Predictive Models",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e30451",
keywords="misinformation",
keywords="disinformation",
keywords="social media",
keywords="HPV",
keywords="human papillomavirus vaccination",
keywords="vaccination",
keywords="causality mining",
keywords="cause",
keywords="effect",
keywords="risk perceptions",
keywords="vaccine",
keywords="perception",
keywords="risk",
keywords="Twitter",
keywords="machine learning",
keywords="natural language processing",
keywords="cervical cancer",
abstract="Background: The vaccination uptake rates of the human papillomavirus (HPV) vaccine remain low despite the fact that the effectiveness of HPV vaccines has been established for more than a decade. Vaccine hesitancy is in part due to false information about HPV vaccines on social media. Combating false HPV vaccine information is a reasonable step to addressing vaccine hesitancy. Objective: Given the substantial harm of false HPV vaccine information, there is an urgent need to identify false social media messages before it goes viral. The goal of the study is to develop a systematic and generalizable approach to identifying false HPV vaccine information on social media. Methods: This study used machine learning and natural language processing to develop a series of classification models and causality mining methods to identify and examine true and false HPV vaccine--related information on Twitter. Results: We found that the convolutional neural network model outperformed all other models in identifying tweets containing false HPV vaccine--related information (F score=91.95). We also developed completely unsupervised causality mining models to identify HPV vaccine candidate effects for capturing risk perceptions of HPV vaccines. Furthermore, we found that false information contained mostly loss-framed messages focusing on the potential risk of vaccines covering a variety of topics using more diverse vocabulary, while true information contained both gain- and loss-framed messages focusing on the effectiveness of vaccines covering fewer topics using relatively limited vocabulary. Conclusions: Our research demonstrated the feasibility and effectiveness of using predictive models to identify false HPV vaccine information and its risk perceptions on social media. ",
doi="10.2196/30451",
url="https://www.jmir.org/2021/9/e30451",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499043"
}


@Article{info:doi/10.2196/31409,
author="Lee, Hocheol
and Noh, Bi Eun
and Park, Jong Sung
and Nam, Kweun Hae
and Lee, Ho Tae
and Lee, Ram Ga
and Nam, Woo Eun",
title="COVID-19 Vaccine Perception in South Korea: Web Crawling Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="8",
volume="7",
number="9",
pages="e31409",
keywords="COVID-19 vaccine",
keywords="COVID-19",
keywords="instagram",
keywords="social media",
keywords="infodemiology",
keywords="sentiment analysis",
keywords="vaccine perception",
keywords="South Korea",
keywords="web crawling",
keywords="AstraZeneca",
keywords="Pfizer",
abstract="Background: The US Centers for Disease Control and Prevention and the World Health Organization emphasized vaccination against COVID-19 because physical distancing proved inadequate to mitigate death, illness, and massive economic loss. Objective: This study aimed to investigate Korean citizens' perceptions of vaccines by examining their views on COVID-19 vaccines, their positive and negative perceptions of each vaccine, and ways to enhance policies to increase vaccine acceptance. Methods: This cross-sectional study analyzed posts on NAVER and Instagram to examine Korean citizens' perception of COVID-19 vaccines. The keywords searched were ``vaccine,'' ``AstraZeneca,'' and ``Pfizer.'' In total 8100 posts in NAVER and 5291 posts in Instagram were sampled through web crawling. Morphology analysis was performed, overlapping or meaningless words were removed, sentiment analysis was implemented, and 3 public health professionals reviewed the results. Results: The findings revealed a negative perception of COVID-19 vaccines; of the words crawled, the proportion of negative words for AstraZeneca was 71.0\% (476/670) and for Pfizer was 56.3\% (498/885). Among words crawled with ``vaccine,'' ``good'' ranked first, with a frequency of 13.43\% (312/2323). Meanwhile, ``side effect'' ranked highest, with a frequency of 29.2\% (163/559) for ``AstraZeneca,'' but 0.6\% (4/673) for ``Pfizer.'' With ``vaccine,'' positive words were more frequently used, whereas with ``AstraZeneca'' and ``Pfizer'' negative words were prevalent. Conclusions: There is a negative perception of AstraZeneca and Pfizer vaccines in Korea, with 1 in 4 people refusing vaccination. To address this, accurate information needs to be shared about vaccines including AstraZeneca, and the experiences of those vaccinated. Furthermore, government communication about risk management is required to increase the AstraZeneca vaccination rate for herd immunity before the vaccine expires. ",
doi="10.2196/31409",
url="https://publichealth.jmir.org/2021/9/e31409",
url="http://www.ncbi.nlm.nih.gov/pubmed/34348890"
}


@Article{info:doi/10.2196/29329,
author="Chen, Hao
and Li, Xiaomei
and Gao, Junling
and Liu, Xiaoxi
and Mao, Yimeng
and Wang, Ruru
and Zheng, Pinpin
and Xiao, Qianyi
and Jia, Yingnan
and Fu, Hua
and Dai, Junming",
title="Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="6",
volume="23",
number="9",
pages="e29329",
keywords="COVID-19 pandemic",
keywords="vaccination behavior",
keywords="vaccine hesitancy",
keywords="health belief model",
abstract="Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3\% (95\% CI 42.3\%-46.2\%), and the vaccination rate was 10.4\% (9.2\%-11.6\%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95\% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95\% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95\% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95\% CI 1.36-1.95) and perceived benefits (OR 0.51, 95\% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=?0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=?0.45, P<.001) via vaccine hesitancy (SSC=?0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function. ",
doi="10.2196/29329",
url="https://www.jmir.org/2021/9/e29329",
url="http://www.ncbi.nlm.nih.gov/pubmed/34280115"
}


@Article{info:doi/10.2196/30715,
author="Luo, Chen
and Ji, Kaiyuan
and Tang, Yulong
and Du, Zhiyuan",
title="Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e30715",
keywords="COVID-19",
keywords="vaccine",
keywords="Zhihu",
keywords="structural topic modeling",
keywords="medical professional",
keywords="laypeople",
keywords="adverse reactions",
keywords="vaccination",
keywords="vaccine effectiveness",
keywords="vaccine development",
abstract="Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine--related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the ``safety of Chinese-made vaccine'' topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as ``qualitatively different'' in perspective rather than ``quantitatively different'' in scientific knowledge. Among those questions closely associated with medical expertise, the ``qualitatively different'' characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. ",
doi="10.2196/30715",
url="https://www.jmir.org/2021/8/e30715",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346885"
}


@Article{info:doi/10.2196/29324,
author="Roghani, Ali",
title="The Influence of COVID-19 Vaccination on Daily Cases, Hospitalization, and Death Rate in Tennessee, United States: Case Study",
journal="JMIRx Med",
year="2021",
month="Aug",
day="12",
volume="2",
number="3",
pages="e29324",
keywords="COVID-19",
keywords="pandemic",
keywords="vaccination",
keywords="vaccine",
keywords="strategy",
keywords="vaccination strategy",
keywords="hospitalization",
keywords="mortality rates",
keywords="older adults",
keywords="mortality",
abstract="Background: The COVID-19 outbreak highlights our vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the immediate vaccination of the whole population. Therefore, policies have adopted a strategy to vaccinate older adults and vulnerable populations while delaying vaccination for others. Objective: This study aimed to understand how age-specific vaccination strategies reduce daily cases, hospitalizations, and death rates using official statistics for Tennessee, United States. Methods: This study used publicly available data on COVID-19, including vaccination rates, positive cases, hospitalizations, and deaths from the Tennessee Department of Health. Data from the first date of vaccination (December 17, 2020) to March 3, 2021, were retrieved. The rates were adjusted by 2019 data from the US Census Bureau, and age groups were stratified into 10-year intervals starting with 21 years of age. Results: The findings showed that vaccination strategy can reduce the numbers of patients with COVID-19 in all age groups, with lower hospitalization and death rates in older populations. Older adults had a 95\% lower death rate from December to March; no change in the death rate of other age groups was observed. The hospitalization rate was reduced by 80\% for people aged ?80 years, while people who were 50 to 70 years old had nearly the same hospitalization rate as prior to vaccination. Conclusions: This research indicates that targeting older age groups for vaccination is the optimal way to avoid higher transmissions and reduce hospitalization and death rates. ",
doi="10.2196/29324",
url="https://med.jmirx.org/2021/3/e29324",
url="http://www.ncbi.nlm.nih.gov/pubmed/34424255"
}


@Article{info:doi/10.2196/28800,
author="Boucher, Jean-Christophe
and Cornelson, Kirsten
and Benham, L. Jamie
and Fullerton, M. Madison
and Tang, Theresa
and Constantinescu, Cora
and Mourali, Mehdi
and Oxoby, J. Robert
and Marshall, A. Deborah
and Hemmati, Hadi
and Badami, Abbas
and Hu, Jia
and Lang, Raynell",
title="Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study",
journal="JMIR Infodemiology",
year="2021",
month="Aug",
day="12",
volume="1",
number="1",
pages="e28800",
keywords="coronavirus",
keywords="COVID-19",
keywords="public health",
keywords="social media",
keywords="Twitter",
keywords="behavior",
keywords="risk reduction",
keywords="attitudes",
keywords="social network analysis",
keywords="machine learning",
abstract="Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2\%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8\%) expressed criticism toward the government's handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. ",
doi="10.2196/28800",
url="https://infodemiology.jmir.org/2021/1/e28800",
url="http://www.ncbi.nlm.nih.gov/pubmed/34447924"
}


@Article{info:doi/10.2196/30251,
author="Liu, Siru
and Li, Jili
and Liu, Jialin",
title="Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="10",
volume="23",
number="8",
pages="e30251",
keywords="vaccine",
keywords="COVID-19",
keywords="leveraging transfer learning",
keywords="pandemic",
keywords="infodemiology",
keywords="infoveillance",
keywords="public health",
keywords="social media",
keywords="content analysis",
keywords="machine learning",
keywords="online health",
abstract="Background: The COVID-19 vaccine is considered to be the most promising approach to alleviate the pandemic. However, in recent surveys, acceptance of the COVID-19 vaccine has been low. To design more effective outreach interventions, there is an urgent need to understand public perceptions of COVID-19 vaccines. Objective: Our objective was to analyze the potential of leveraging transfer learning to detect tweets containing opinions, attitudes, and behavioral intentions toward COVID-19 vaccines, and to explore temporal trends as well as automatically extract topics across a large number of tweets. Methods: We developed machine learning and transfer learning models to classify tweets, followed by temporal analysis and topic modeling on a dataset of COVID-19 vaccine--related tweets posted from November 1, 2020 to January 31, 2021. We used the F1 values as the primary outcome to compare the performance of machine learning and transfer learning models. The statistical values and P values from the Augmented Dickey-Fuller test were used to assess whether users' perceptions changed over time. The main topics in tweets were extracted by latent Dirichlet allocation analysis. Results: We collected 2,678,372 tweets related to COVID-19 vaccines from 841,978 unique users and annotated 5000 tweets. The F1 values of transfer learning models were 0.792 (95\% CI 0.789-0.795), 0.578 (95\% CI 0.572-0.584), and 0.614 (95\% CI 0.606-0.622) for these three tasks, which significantly outperformed the machine learning models (logistic regression, random forest, and support vector machine). The prevalence of tweets containing attitudes and behavioral intentions varied significantly over time. Specifically, tweets containing positive behavioral intentions increased significantly in December 2020. In addition, we selected tweets in the following categories: positive attitudes, negative attitudes, positive behavioral intentions, and negative behavioral intentions. We then identified 10 main topics and relevant terms for each category. Conclusions: Overall, we provided a method to automatically analyze the public understanding of COVID-19 vaccines from real-time data in social media, which can be used to tailor educational programs and other interventions to effectively promote the public acceptance of COVID-19 vaccines. ",
doi="10.2196/30251",
url="https://www.jmir.org/2021/8/e30251",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254942"
}


@Article{info:doi/10.2196/28573,
author="Zola Matuvanga, Tr{\'e}sor
and Johnson, Ginger
and Larivi{\`e}re, Ynke
and Esanga Longomo, Emmanuel
and Matangila, Junior
and Maketa, Vivi
and Lapika, Bruno
and Mitashi, Patrick
and Mc Kenna, Paula
and De Bie, Jessie
and Van Geertruyden, Jean-Pierre
and Van Damme, Pierre
and Muhindo Mavoko, Hypolite",
title="Use of Iris Scanning for Biometric Recognition of Healthy Adults Participating in an Ebola Vaccine Trial in the Democratic Republic of the Congo: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="9",
volume="23",
number="8",
pages="e28573",
keywords="biometric identification",
keywords="iris recognition",
keywords="vaccine trial",
keywords="participants' visits",
keywords="acceptability",
keywords="feasibility",
keywords="Democratic Republic of the Congo",
keywords="mixed methods",
keywords="Ebola",
abstract="Background: A partnership between the University of Antwerp and the University of Kinshasa implemented the EBOVAC3 clinical trial with an Ebola vaccine regimen administered to health care provider participants in Tshuapa Province, Democratic Republic of the Congo. This randomized controlled trial was part of an Ebola outbreak preparedness initiative financed through Innovative Medicines Initiative-European Union. The EBOVAC3 clinical trial used iris scan technology to identify all health care provider participants enrolled in the vaccine trial, to ensure that the right participant received the right vaccine at the right visit. Objective: We aimed to assess the acceptability, accuracy, and feasibility of iris scan technology as an identification method within a population of health care provider participants in a vaccine trial in a remote setting. Methods: We used a mixed methods study. The acceptability was assessed prior to the trial through 12 focus group discussions (FGDs) and was assessed at enrollment. Feasibility and accuracy research was conducted using a longitudinal trial study design, where iris scanning was compared with the unique study ID card to identify health care provider participants at enrollment and at their follow-up visits. Results: During the FGDs, health care provider participants were mainly concerned about the iris scan technology causing physical problems to their eyes or exposing them to spiritual problems through sorcery. However, 99\% (85/86; 95\% CI 97.1-100.0) of health care provider participants in the FGDs agreed to be identified by the iris scan. Also, at enrollment, 99.0\% (692/699; 95\% CI 98.2-99.7) of health care provider participants accepted to be identified by iris scan. Iris scan technology correctly identified 93.1\% (636/683; 95\% CI 91.2-95.0) of the participants returning for scheduled follow-up visits. The iris scanning operation lasted 2 minutes or less for 96.0\% (656/683; 95\% CI 94.6-97.5), and 1 attempt was enough to identify the majority of study participants (475/683, 69.5\%; 95\% CI 66.1-73.0). Conclusions: Iris scans are highly acceptable as an identification tool in a clinical trial for health care provider participants in a remote setting. Its operationalization during the trial demonstrated a high level of accuracy that can reliably identify individuals. Iris scanning is found to be feasible in clinical trials but requires a trained operator to reduce the duration and the number of attempts to identify a participant. Trial Registration: ClinicalTrials.gov NCT04186000; https://clinicaltrials.gov/ct2/show/NCT04186000 ",
doi="10.2196/28573",
url="https://www.jmir.org/2021/8/e28573",
url="http://www.ncbi.nlm.nih.gov/pubmed/34378545"
}


@Article{info:doi/10.2196/26478,
author="Du, Jingcheng
and Preston, Sharice
and Sun, Hanxiao
and Shegog, Ross
and Cunningham, Rachel
and Boom, Julie
and Savas, Lara
and Amith, Muhammad
and Tao, Cui",
title="Using Machine Learning--Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="5",
volume="23",
number="8",
pages="e26478",
keywords="HPV vaccine",
keywords="social media",
keywords="misinformation",
keywords="infodemiology",
keywords="infoveillance",
keywords="deep learning",
keywords="Reddit",
keywords="machine learning",
abstract="Background: The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion. Objective: The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)--based methods. Methods: Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82\%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation. Results: A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63\%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99\%). Conclusions: ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion. ",
doi="10.2196/26478",
url="https://www.jmir.org/2021/8/e26478",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383667"
}


@Article{info:doi/10.2196/28740,
author="Sajjadi, B. Nicholas
and Shepard, Samuel
and Ottwell, Ryan
and Murray, Kelly
and Chronister, Justin
and Hartwell, Micah
and Vassar, Matt",
title="Examining the Public's Most Frequently Asked Questions Regarding COVID-19 Vaccines Using Search Engine Analytics in the United States: Observational Study",
journal="JMIR Infodemiology",
year="2021",
month="Aug",
day="4",
volume="1",
number="1",
pages="e28740",
keywords="content",
keywords="COVID-19",
keywords="frequently asked questions",
keywords="internet",
keywords="machine learning",
keywords="natural language processing",
keywords="quality",
keywords="question",
keywords="SARS-CoV-2",
keywords="search analytics",
keywords="search engine",
keywords="transparency",
keywords="vaccine hesitancy",
keywords="vaccine",
keywords="web-based health information",
abstract="Background: The emergency authorization of COVID-19 vaccines has offered the first means of long-term protection against COVID-19--related illness since the pandemic began. It is important for health care professionals to understand commonly held COVID-19 vaccine concerns and to be equipped with quality information that can be used to assist in medical decision-making. Objective: Using Google's RankBrain machine learning algorithm, we sought to characterize the content of the most frequently asked questions (FAQs) about COVID-19 vaccines evidenced by internet searches. Secondarily, we sought to examine the information transparency and quality of sources used by Google to answer FAQs on COVID-19 vaccines. Methods: We searched COVID-19 vaccine terms on Google and used the ``People also ask'' box to obtain FAQs generated by Google's machine learning algorithms. FAQs are assigned an ``answer'' source by Google. We extracted FAQs and answer sources related to COVID-19 vaccines. We used the Rothwell Classification of Questions to categorize questions on the basis of content. We classified answer sources as either academic, commercial, government, media outlet, or medical practice. We used the Journal of the American Medical Association's (JAMA's) benchmark criteria to assess information transparency and Brief DISCERN to assess information quality for answer sources. FAQ and answer source type frequencies were calculated. Chi-square tests were used to determine associations between information transparency by source type. One-way analysis of variance was used to assess differences in mean Brief DISCERN scores by source type. Results: Our search yielded 28 unique FAQs about COVID-19 vaccines. Most COVID-19 vaccine--related FAQs were seeking factual information (22/28, 78.6\%), specifically about safety and efficacy (9/22, 40.9\%). The most common source type was media outlets (12/28, 42.9\%), followed by government sources (11/28, 39.3\%). Nineteen sources met 3 or more JAMA benchmark criteria with government sources as the majority (10/19, 52.6\%). JAMA benchmark criteria performance did not significantly differ among source types ($\chi$24=7.40; P=.12). One-way analysis of variance revealed a significant difference in mean Brief DISCERN scores by source type (F4,23=10.27; P<.001). Conclusions: The most frequently asked COVID-19 vaccine--related questions pertained to vaccine safety and efficacy. We found that government sources provided the most transparent and highest-quality web-based COVID-19 vaccine--related information. Recognizing common questions and concerns about COVID-19 vaccines may assist in improving vaccination efforts. ",
doi="10.2196/28740",
url="https://infodemiology.jmir.org/2021/1/e28740",
url="http://www.ncbi.nlm.nih.gov/pubmed/34458683"
}


@Article{info:doi/10.2196/26111,
author="Su, Zhaohui
and McDonnell, Dean
and Cheshmehzangi, Ali
and Li, Xiaoshan
and Maestro, Daniel
and {\vS}egalo, Sabina
and Ahmad, Junaid
and Hao, Xiaoning",
title="With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="4",
volume="7",
number="8",
pages="e26111",
keywords="COVID-19",
keywords="coronavirus",
keywords="COVID-19 vaccine",
keywords="made in China",
keywords="vaccine efficacy",
keywords="vaccine safety",
keywords="vaccine",
keywords="China",
keywords="expectation",
keywords="safety",
keywords="efficacy",
keywords="infectious disease",
keywords="public health",
keywords="consequence",
keywords="standard",
doi="10.2196/26111",
url="https://publichealth.jmir.org/2021/8/e26111",
url="http://www.ncbi.nlm.nih.gov/pubmed/33560997"
}


@Article{info:doi/10.2196/28568,
author="Hajduczok, G. Alexander
and DiJoseph, M. Kara
and Bent, Brinnae
and Thorp, K. Audrey
and Mullholand, B. Jon
and MacKay, A. Stuart
and Barik, Sabrina
and Coleman, J. Jamie
and Paules, I. Catharine
and Tinsley, Andrew",
title="Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="4",
volume="5",
number="8",
pages="e28568",
keywords="COVID-19",
keywords="wearable devices",
keywords="remote physiologic monitoring",
keywords="heart rate",
keywords="heart rate variability",
keywords="respiratory rate",
keywords="sleep",
keywords="REM sleep",
keywords="deep sleep",
keywords="wearable",
keywords="vaccine",
keywords="monitoring",
keywords="respiratory",
keywords="physiological",
keywords="cohort",
abstract="Background: The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective: We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods: In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results: In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53\% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean --13.44\%, SD 13.62\%) and second vaccine dose (mean --9.25\%, SD 22.6\%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions: This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration: ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703 ",
doi="10.2196/28568",
url="https://formative.jmir.org/2021/8/e28568",
url="http://www.ncbi.nlm.nih.gov/pubmed/34236995"
}


@Article{info:doi/10.2196/29759,
author="Chaney, Cunard Sarah
and Mechael, Patricia
and Thu, Myo Nay
and Diallo, S. Mamadou
and Gachen, Carine",
title="Every Child on the Map: A Theory of Change Framework for Improving Childhood Immunization Coverage and Equity Using Geospatial Data and Technologies",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="3",
volume="23",
number="8",
pages="e29759",
keywords="geospatial data",
keywords="immunization",
keywords="health information systems",
keywords="service delivery",
keywords="equity mapping",
keywords="theory",
keywords="framework",
keywords="children",
keywords="vaccine",
keywords="equity",
keywords="geospatial",
keywords="data",
keywords="outcome",
keywords="coverage",
keywords="low- and middle-income",
keywords="LMIC",
doi="10.2196/29759",
url="https://www.jmir.org/2021/8/e29759",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342584"
}


@Article{info:doi/10.2196/29942,
author="Chan, Calvin
and Sounderajah, Viknesh
and Daniels, Elisabeth
and Acharya, Amish
and Clarke, Jonathan
and Yalamanchili, Seema
and Normahani, Pasha
and Markar, Sheraz
and Ashrafian, Hutan
and Darzi, Ara",
title="The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jul",
day="8",
volume="7",
number="7",
pages="e29942",
keywords="COVID-19",
keywords="infodemiology",
keywords="public health",
keywords="quality",
keywords="reliability",
keywords="social media",
keywords="vaccination",
keywords="vaccine",
keywords="video",
keywords="web-based health information",
keywords="YouTube",
abstract="Background: Recent emergency authorization and rollout of COVID-19 vaccines by regulatory bodies has generated global attention. As the most popular video-sharing platform globally, YouTube is a potent medium for the dissemination of key public health information. Understanding the nature of available content regarding COVID-19 vaccination on this widely used platform is of substantial public health interest. Objective: This study aimed to evaluate the reliability and quality of information on COVID-19 vaccination in YouTube videos. Methods: In this cross-sectional study, the phrases ``coronavirus vaccine'' and ``COVID-19 vaccine'' were searched on the UK version of YouTube on December 10, 2020. The 200 most viewed videos of each search were extracted and screened for relevance and English language. Video content and characteristics were extracted and independently rated against Health on the Net Foundation Code of Conduct and DISCERN quality criteria for consumer health information by 2 authors. Results: Forty-eight videos, with a combined total view count of 30,100,561, were included in the analysis. Topics addressed comprised the following: vaccine science (n=18, 58\%), vaccine trials (n=28, 58\%), side effects (n=23, 48\%), efficacy (n=17, 35\%), and manufacturing (n=8, 17\%). Ten (21\%) videos encouraged continued public health measures. Only 2 (4.2\%) videos made nonfactual claims. The content of 47 (98\%) videos was scored to have low (n=27, 56\%) or moderate (n=20, 42\%) adherence to Health on the Net Foundation Code of Conduct principles. Median overall DISCERN score per channel type ranged from 40.3 (IQR 34.8-47.0) to 64.3 (IQR 58.5-66.3). Educational channels produced by both medical and nonmedical professionals achieved significantly higher DISCERN scores than those of other categories. The highest median DISCERN scores were achieved by educational videos produced by medical professionals (64.3, IQR 58.5-66.3) and the lowest median scores by independent users (18, IQR 18-20). Conclusions: The overall quality and reliability of information on COVID-19 vaccines on YouTube remains poor. Videos produced by educational channels, especially by medical professionals, were higher in quality and reliability than those produced by other sources, including health-related organizations. Collaboration between health-related organizations and established medical and educational YouTube content producers provides an opportunity for the dissemination of high-quality information on COVID-19 vaccination. Such collaboration holds potential as a rapidly implementable public health intervention aiming to engage a wide audience and increase public vaccination awareness and knowledge. ",
doi="10.2196/29942",
url="https://publichealth.jmir.org/2021/7/e29942",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081599"
}


@Article{info:doi/10.2196/24435,
author="Lyu, Chen Joanne
and Han, Le Eileen
and Luli, K. Garving",
title="COVID-19 Vaccine--Related Discussion on Twitter: Topic Modeling and Sentiment Analysis",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="29",
volume="23",
number="6",
pages="e24435",
keywords="COVID-19",
keywords="vaccine",
keywords="vaccination",
keywords="Twitter",
keywords="infodemiology",
keywords="infoveillance",
keywords="topic",
keywords="sentiment",
keywords="opinion",
keywords="discussion",
keywords="communication",
keywords="social media",
keywords="perception",
keywords="concern",
keywords="emotion",
abstract="Background: Vaccination is a cornerstone of the prevention of communicable infectious diseases; however, vaccines have traditionally met with public fear and hesitancy, and COVID-19 vaccines are no exception. Social media use has been demonstrated to play a role in the low acceptance of vaccines. Objective: The aim of this study is to identify the topics and sentiments in the public COVID-19 vaccine--related discussion on social media and discern the salient changes in topics and sentiments over time to better understand the public perceptions, concerns, and emotions that may influence the achievement of herd immunity goals. Methods: Tweets were downloaded from a large-scale COVID-19 Twitter chatter data set from March 11, 2020, the day the World Health Organization declared COVID-19 a pandemic, to January 31, 2021. We used R software to clean the tweets and retain tweets that contained the keywords vaccination, vaccinations, vaccine, vaccines, immunization, vaccinate, and vaccinated. The final data set included in the analysis consisted of 1,499,421 unique tweets from 583,499 different users. We used R to perform latent Dirichlet allocation for topic modeling as well as sentiment and emotion analysis using the National Research Council of Canada Emotion Lexicon. Results: Topic modeling of tweets related to COVID-19 vaccines yielded 16 topics, which were grouped into 5 overarching themes. Opinions about vaccination (227,840/1,499,421 tweets, 15.2\%) was the most tweeted topic and remained a highly discussed topic during the majority of the period of our examination. Vaccine progress around the world became the most discussed topic around August 11, 2020, when Russia approved the world's first COVID-19 vaccine. With the advancement of vaccine administration, the topic of instruction on getting vaccines gradually became more salient and became the most discussed topic after the first week of January 2021. Weekly mean sentiment scores showed that despite fluctuations, the sentiment was increasingly positive in general. Emotion analysis further showed that trust was the most predominant emotion, followed by anticipation, fear, sadness, etc. The trust emotion reached its peak on November 9, 2020, when Pfizer announced that its vaccine is 90\% effective. Conclusions: Public COVID-19 vaccine--related discussion on Twitter was largely driven by major events about COVID-19 vaccines and mirrored the active news topics in mainstream media. The discussion also demonstrated a global perspective. The increasingly positive sentiment around COVID-19 vaccines and the dominant emotion of trust shown in the social media discussion may imply higher acceptance of COVID-19 vaccines compared with previous vaccines. ",
doi="10.2196/24435",
url="https://www.jmir.org/2021/6/e24435",
url="http://www.ncbi.nlm.nih.gov/pubmed/34115608"
}


@Article{info:doi/10.2196/29733,
author="Surapaneni, Mohan Krishna
and Kaur, Mahima
and Kaur, Ritika
and Grover, Ashoo
and Joshi, Ashish",
title="The Impact of COVID-19 Vaccine Communication, Acceptance, and Practices (CO-VIN-CAP) on Vaccine Hesitancy in an Indian Setting: Protocol for a Cross-sectional Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e29733",
keywords="COVID-19 vaccine",
keywords="vaccine hesitancy",
keywords="vaccine acceptance",
keywords="unintended consequences",
keywords="vaccination",
keywords="COVID-19",
keywords="pandemic",
keywords="coronavirus",
keywords="infectious disease",
keywords="protocol",
keywords="vaccine",
abstract="Background: COVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. Objective: This study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19--related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. Methods: A cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. Results: A pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95\% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. Conclusions: The proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID): DERR1-10.2196/29733 ",
doi="10.2196/29733",
url="https://www.researchprotocols.org/2021/6/e29733/"
}


@Article{info:doi/10.2196/28925,
author="Lutrick, Karen
and Ellingson, D. Katherine
and Baccam, Zoe
and Rivers, Patrick
and Beitel, Shawn
and Parker, Joel
and Hollister, James
and Sun, Xiaoxiao
and Gerald, K. Joe
and Komatsu, Kenneth
and Kim, Elizabeth
and LaFleur, Bonnie
and Grant, Lauren
and Yoo, M. Young
and Kumar, Archana
and Mayo Lamberte, Julie
and Cowling, J. Benjamin
and Cobey, Sarah
and Thornburg, J. Natalie
and Meece, K. Jennifer
and Kutty, Preeta
and Nikolich-Zugich, Janko
and Thompson, G. Mark
and Burgess, L. Jefferey",
title="COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="24",
volume="10",
number="6",
pages="e28925",
keywords="SARS-CoV-2",
keywords="COVID-19",
keywords="health care personnel",
keywords="first responders",
keywords="essential workers",
abstract="Background: COVID-19 has spread worldwide since late 2019, with an unprecedented case count and death toll globally. Health care personnel (HCP), first responders, and other essential and frontline workers (OEWs) are at increased risk of SARS-CoV-2 infection because of frequent close contact with others. Objective: The Arizona Healthcare, Emergency Response, and Other Essential Workers Study (AZ HEROES) aims to examine the epidemiology of SARS-CoV-2 infection and COVID-19 illness among adults with high occupational exposure risk. Study objectives include estimating the incidence of SARS-CoV-2 infection in essential workers by symptom presentation and demographic factors, determining independent effects of occupational and community exposures on incidence of SARS-CoV-2 infection, establishing molecular and immunologic characteristics of SARS-CoV-2 infection in essential workers, describing the duration and patterns of real-time reverse transcription--polymerase chain reaction (rRT-PCR) positivity, and examining postvaccine immunologic response. Methods: Eligible participants include Arizona residents aged 18 to 85 years who work at least 20 hours per week in an occupation involving regular direct contact (ie, within 3 feet) with others. Recruitment goals are stratified by demographic characteristics (50\% aged 40 years or older, 50\% women, and 50\% Hispanic or American Indian), by occupation (40\% HCP, 30\% first responders, and 30\% OEWs), and by prior SARS-CoV-2 infection (with up to 50\% seropositive at baseline). Information on sociodemographics, health and medical history, vaccination status, exposures to individuals with suspected or confirmed SARS-CoV-2 infection, use of personal protective equipment, and perceived risks are collected at enrollment and updated through quarterly surveys. Every week, participants complete active surveillance for COVID-like illness (CLI) and self-collect nasal swabs. Additional self-collected nasal swab and saliva specimens are collected in the event of CLI onset. Respiratory specimens are sent to Marshfield Laboratories and tested for SARS-CoV-2 by rRT-PCR assay. CLI symptoms and impact on work and productivity are followed through illness resolution. Serum specimens are collected every 3 months and additional sera are collected following incident rRT-PCR positivity and after each COVID-19 vaccine dose. Incidence of SARS-CoV-2 infections will be calculated by person-weeks at risk and compared by occupation and demographic characteristics as well as by seropositivity status and infection and vaccination history. Results: The AZ HEROES study was funded by the US Centers for Disease Control and Prevention. Enrollment began on July 27, 2020; as of May 1, 2021, a total of 3165 participants have been enrolled in the study. Enrollment is expected to continue through December 1, 2021, with data collection continuing through at least April 2022, contingent upon funding. Conclusions: AZ HEROES is unique in aiming to recruit a diverse sample of essential workers and to prospectively follow strata of SARS-CoV-2 seronegative and seropositive adults. Survey results combined with active surveillance data on exposure, CLI, weekly molecular diagnostic testing, and periodic serology will be used to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, assess the intensity and durability of immune responses to natural infection and COVID-19 vaccination, and contribute to the evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/28925 ",
doi="10.2196/28925",
url="https://www.researchprotocols.org/2021/6/e28925/"
}


@Article{info:doi/10.2196/23105,
author="Argyris, Anna Young
and Monu, Kafui
and Tan, Pang-Ning
and Aarts, Colton
and Jiang, Fan
and Wiseley, Anne Kaleigh",
title="Using Machine Learning to Compare Provaccine and Antivaccine Discourse Among the Public on Social Media: Algorithm Development Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="24",
volume="7",
number="6",
pages="e23105",
keywords="antivaccination movement",
keywords="Twitter messaging",
keywords="public health informatics",
keywords="supervised machine learning algorithm",
keywords="unsupervised machine learning algorithm",
keywords="qualitative content analysis",
keywords="data visualization",
keywords="infodemiology",
keywords="infodemic",
keywords="health misinformation",
keywords="infoveillance",
keywords="social listening",
abstract="Background: Despite numerous counteracting efforts, antivaccine content linked to delays and refusals to vaccinate has grown persistently on social media, while only a few provaccine campaigns have succeeded in engaging with or persuading the public to accept immunization. Many prior studies have associated the diversity of topics discussed by antivaccine advocates with the public's higher engagement with such content. Nonetheless, a comprehensive comparison of discursive topics in pro- and antivaccine content in the engagement-persuasion spectrum remains unexplored. Objective: We aimed to compare discursive topics chosen by pro- and antivaccine advocates in their attempts to influence the public to accept or reject immunization in the engagement-persuasion spectrum. Our overall objective was pursued through three specific aims as follows: (1) we classified vaccine-related tweets into provaccine, antivaccine, and neutral categories; (2) we extracted and visualized discursive topics from these tweets to explain disparities in engagement between pro- and antivaccine content; and (3) we identified how those topics frame vaccines using Entman's four framing dimensions. Methods: We adopted a multimethod approach to analyze discursive topics in the vaccine debate on public social media sites. Our approach combined (1) large-scale balanced data collection from a public social media site (ie, 39,962 tweets from Twitter); (2) the development of a supervised classification algorithm for categorizing tweets into provaccine, antivaccine, and neutral groups; (3) the application of an unsupervised clustering algorithm for identifying prominent topics discussed on both sides; and (4) a multistep qualitative content analysis for identifying the prominent discursive topics and how vaccines are framed in these topics. In so doing, we alleviated methodological challenges that have hindered previous analyses of pro- and antivaccine discursive topics. Results: Our results indicated that antivaccine topics have greater intertopic distinctiveness (ie, the degree to which discursive topics are distinct from one another) than their provaccine counterparts (t122=2.30, P=.02). In addition, while antivaccine advocates use all four message frames known to make narratives persuasive and influential, provaccine advocates have neglected having a clear problem statement. Conclusions: Based on our results, we attribute higher engagement among antivaccine advocates to the distinctiveness of the topics they discuss, and we ascribe the influence of the vaccine debate on uptake rates to the comprehensiveness of the message frames. These results show the urgency of developing clear problem statements for provaccine content to counteract the negative impact of antivaccine content on uptake rates. ",
doi="10.2196/23105",
url="https://publichealth.jmir.org/2021/6/e23105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34185004"
}


@Article{info:doi/10.2196/27603,
author="Mekonnen, Abebaw Zeleke
and Gelaye, Alemu Kassahun
and Were, Martin
and Tilahun, Binyam",
title="Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="15",
volume="9",
number="6",
pages="e27603",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
keywords="text message",
keywords="short message service",
keywords="reminder",
keywords="immunization",
keywords="vaccination",
keywords="Ethiopia",
abstract="Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message--based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8\% vs 185/213, 86.9\%, respectively; P<.001), measles (195/213, 91.5\% vs 169/213, 79.3\%, respectively; P<.001), and full vaccination (176/213, 82.6\% vs 151/213, 70.9\%, respectively; P=.002; risk ratio 1.17, 95\% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7\% vs 128/185, 69.2\%, respectively; P<.001), measles (170/195, 87.1\% vs 116/169, 68.6\%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3\% vs 85/213, 39.9\%, respectively; P<.001; risk ratio 1.59, 95\% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7\%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 ",
doi="10.2196/27603",
url="https://mhealth.jmir.org/2021/6/e27603",
url="http://www.ncbi.nlm.nih.gov/pubmed/34128813"
}


@Article{info:doi/10.2196/27632,
author="Hou, Zhiyuan
and Tong, Yixin
and Du, Fanxing
and Lu, Linyao
and Zhao, Sihong
and Yu, Kexin
and Piatek, J. Simon
and Larson, J. Heidi
and Lin, Leesa",
title="Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="11",
volume="23",
number="6",
pages="e27632",
keywords="COVID-19 vaccine",
keywords="hesitancy",
keywords="infoveillance",
keywords="infodemiology",
keywords="confidence",
keywords="acceptance",
keywords="engagement",
keywords="social media",
keywords="COVID-19",
abstract="Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions. Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination. Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization's Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media. Results: Among social media users, 36.4\% (571/1568) in New York, 51.3\% (738/1440) in London, 67.3\% (144/214) in Sao Paulo, 69.8\% (726/1040) in Mumbai, and 76.8\% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online. Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts. ",
doi="10.2196/27632",
url="https://www.jmir.org/2021/6/e27632",
url="http://www.ncbi.nlm.nih.gov/pubmed/34061757"
}


@Article{info:doi/10.2196/24564,
author="Wawrzuta, Dominik
and Jaworski, Mariusz
and Gotlib, Joanna
and Panczyk, Mariusz",
title="Characteristics of Antivaccine Messages on Social Media: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="4",
volume="23",
number="6",
pages="e24564",
keywords="vaccination",
keywords="social media",
keywords="antivaccination movement",
keywords="vaccination refusal",
keywords="health communication",
keywords="public health",
keywords="vaccines",
abstract="Background: Supporters of the antivaccination movement can easily spread information that is not scientifically proven on social media. Therefore, learning more about their posts and activities is instrumental in effectively reacting and responding to the false information they publish, which is aimed at discouraging people from taking vaccines. Objective: This study aims to gather, assess, and synthesize evidence related to the current state of knowledge about antivaccine social media users' web-based activities. Methods: We systematically reviewed English-language papers from 3 databases (Scopus, Web of Science, and PubMed). A data extraction form was established, which included authors, year of publication, specific objectives, study design, comparison, and outcomes of significance. We performed an aggregative narrative synthesis of the included studies. Results: The search strategy retrieved 731 records in total. After screening for duplicates and eligibility, 18 articles were included in the qualitative synthesis. Although most of the authors analyzed text messages, some of them studied images or videos. In addition, although most of the studies examined vaccines in general, 5 focused specifically on human papillomavirus vaccines, 2 on measles vaccines, and 1 on influenza vaccines. The synthesized studies dealt with the popularity of provaccination and antivaccination content, the style and manner in which messages about vaccines were formulated for the users, a range of topics concerning vaccines (harmful action, limited freedom of choice, and conspiracy theories), and the role and activity of bots in the dissemination of these messages in social media. Conclusions: Proponents of the antivaccine movement use a limited number of arguments in their messages; therefore, it is possible to prepare publications clarifying doubts and debunking the most common lies. Public health authorities should continuously monitor social media to quickly find new antivaccine arguments and then create information campaigns for both health professionals and other users. ",
doi="10.2196/24564",
url="https://www.jmir.org/2021/6/e24564",
url="http://www.ncbi.nlm.nih.gov/pubmed/34085943"
}


@Article{info:doi/10.2196/27590,
author="Moghalles, Ameen Suaad
and Aboasba, Ahmed Basher
and Alamad, Abdullah Mohammed
and Khader, Saleh Yousef",
title="Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="2",
volume="7",
number="6",
pages="e27590",
keywords="diphtheria",
keywords="epidemiology",
keywords="incidence",
keywords="case fatality rate",
abstract="Background: As a consequence of war and the collapse of the health system in Yemen, which prevented many people from accessing health facilities to obtain primary health care, vaccination coverage was affected, leading to a deadly diphtheria epidemic at the end of 2017. Objective: This study aimed to describe the epidemiology of diphtheria in Yemen and determine its incidence and case fatality rate. Methods: Data were obtained from the diphtheria surveillance program 2017-2018, using case definitions of the World Health Organization. A probable case was defined as a case involving a person having laryngitis, pharyngitis, or tonsillitis and an adherent membrane of the tonsils, pharynx, and/or nose. A confirmed case was defined as a probable case that was laboratory confirmed or linked epidemiologically to a laboratory-confirmed case. Data from the Central Statistical Organization was used to calculate the incidence per 100,000 population. A P value <.05 was considered significant. Results: A total of 2243 cases were reported during the period between July 2017 and August 2018. About 49\% (1090/2243, 48.6\%) of the cases were males. About 44\% (978/2243, 43.6\%) of the cases involved children aged 5 to 15 years. Respiratory tract infection was the predominant symptom (2044/2243, 91.1\%), followed by pseudomembrane (1822/2243, 81.2\%). Based on the vaccination status, the percentages of partially vaccinated, vaccinated, unvaccinated, and unknown status patients were 6.6\% (148/2243), 30.8\% (690/2243), 48.6\% (10902243), and 14.0\% (315/2243), respectively. The overall incidence of diphtheria was 8 per 100,000 population. The highest incidence was among the age group <15 years (11 per 100,000 population), and the lowest incidence was among the age group ?15 years (5 per 100,000 population). The overall case fatality rate among all age groups was 5\%, and it was higher (10\%) in the age group <5 years. Five governorates that were difficult to access (Raymah, Abyan, Sa'ada, Lahj, and Al Jawf) had a very high case fatality rate (22\%). Conclusions: Diphtheria affected a large number of people in Yemen in 2017-2018. The majority of patients were partially or not vaccinated. Children aged ?15 years were more affected, with higher fatality among children aged <5 years. Five governorates that were difficult to access had a case fatality rate twice that of the World Health Organization estimate (5\%-10\%). To control the diphtheria epidemic in Yemen, it is recommended to increase routine vaccination coverage and booster immunizations, increase public health awareness toward diphtheria, and strengthen the surveillance system for early detection and immediate response. ",
doi="10.2196/27590",
url="https://publichealth.jmir.org/2021/6/e27590",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076583"
}


@Article{info:doi/10.2196/26372,
author="Hou, Zhiyuan
and Song, Suhang
and Du, Fanxing
and Shi, Lu
and Zhang, Donglan
and Lin, Leesa
and Yu, Hongjie",
title="The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="26",
volume="7",
number="5",
pages="e26372",
keywords="COVID-19",
keywords="prevention",
keywords="vaccination",
keywords="behavior",
keywords="children",
keywords="China",
abstract="Background: The COVID-19 epidemic and the related containment strategies may affect parental and pediatric health behaviors. Objective: The goal of this study was to assess the change in children's and adolescents' prevention and vaccination behaviors amid China's COVID-19 epidemic. Methods: We conducted a cross-sectional online survey in mid-March 2020 using proportional quota sampling in Wuhan (the epidemic epicenter) and Shanghai (a nonepicenter). Data were collected from 1655 parents with children aged 3 to 17 years. Children's and adolescents' prevention behaviors and regular vaccination behaviors before and during the epidemic were assessed. Descriptive analyses were used to investigate respondents' characteristics, public health prevention behaviors, unproven protection behaviors, and vaccination behaviors before and during the COVID-19 epidemic. Univariate analyses were performed to compare differences in outcome measures between cities and family characteristics, using chi-square tests or Fisher exact tests (if expected frequency was <5) and analyses of variance. Multivariate logistic regressions were used to identify the factors and disparities associated with prevention and vaccination behaviors. Results: Parent-reported prevention behaviors increased among children and adolescents during the COVID-19 epidemic compared with those before the epidemic. During the epidemic, 82.2\% (638/776) of children or adolescents always wore masks when going out compared with 31.5\% (521/1655) before the epidemic; in addition, 25.0\% (414/1655) and 79.8\% (1321/1655) had increased their frequency and duration of handwashing, respectively, although only 46.9\% (776/1655) went out during the epidemic. Meanwhile, 56.1\% (928/1655) of the families took unproven remedies against COVID-19. Parent-reported vaccination behaviors showed mixed results, with 74.8\% (468/626) delaying scheduled vaccinations and 80.9\% (1339/1655) planning to have their children get the influenza vaccination after the epidemic. Regarding socioeconomic status, children and adolescents from larger families and whose parents had lower education levels were less likely to improve prevention behaviors but more likely to take unproven remedies. Girls were less likely than boys to always wear a mask when going out and wash their hands. Conclusions: Prevention behaviors and attitudes toward influenza vaccination have improved during the COVID-19 epidemic. Public health prevention measures should be continuously promoted, particularly among girls, parents with lower education levels, and larger families. Meanwhile, misinformation about COVID-19 remains a serious challenge and needs to be addressed by public health stakeholders. ",
doi="10.2196/26372",
url="https://publichealth.jmir.org/2021/5/e26372",
url="http://www.ncbi.nlm.nih.gov/pubmed/33882450"
}


@Article{info:doi/10.2196/26953,
author="Kwok, Hang Stephen Wai
and Vadde, Kumar Sai
and Wang, Guanjin",
title="Tweet Topics and Sentiments Relating to COVID-19 Vaccination Among Australian Twitter Users: Machine Learning Analysis",
journal="J Med Internet Res",
year="2021",
month="May",
day="19",
volume="23",
number="5",
pages="e26953",
keywords="COVID-19",
keywords="vaccination",
keywords="public topics",
keywords="public sentiments",
keywords="Twitter",
keywords="infodemiology",
keywords="infoveillance",
keywords="social listening",
keywords="infodemic",
keywords="social media",
keywords="natural language processing",
keywords="machine learning",
keywords="latent Dirichlet allocation",
abstract="Background: COVID-19 is one of the greatest threats to human beings in terms of health care, economy, and society in recent history. Up to this moment, there have been no signs of remission, and there is no proven effective cure. Vaccination is the primary biomedical preventive measure against the novel coronavirus. However, public bias or sentiments, as reflected on social media, may have a significant impact on the progression toward achieving herd immunity. Objective: This study aimed to use machine learning methods to extract topics and sentiments relating to COVID-19 vaccination on Twitter. Methods: We collected 31,100 English tweets containing COVID-19 vaccine--related keywords between January and October 2020 from Australian Twitter users. Specifically, we analyzed tweets by visualizing high-frequency word clouds and correlations between word tokens. We built a latent Dirichlet allocation (LDA) topic model to identify commonly discussed topics in a large sample of tweets. We also performed sentiment analysis to understand the overall sentiments and emotions related to COVID-19 vaccination in Australia. Results: Our analysis identified 3 LDA topics: (1) attitudes toward COVID-19 and its vaccination, (2) advocating infection control measures against COVID-19, and (3) misconceptions and complaints about COVID-19 control. Nearly two-thirds of the sentiments of all tweets expressed a positive public opinion about the COVID-19 vaccine; around one-third were negative. Among the 8 basic emotions, trust and anticipation were the two prominent positive emotions observed in the tweets, while fear was the top negative emotion. Conclusions: Our findings indicate that some Twitter users in Australia supported infection control measures against COVID-19 and refuted misinformation. However, those who underestimated the risks and severity of COVID-19 may have rationalized their position on COVID-19 vaccination with conspiracy theories. We also noticed that the level of positive sentiment among the public may not be sufficient to increase vaccination coverage to a level high enough to achieve vaccination-induced herd immunity. Governments should explore public opinion and sentiments toward COVID-19 and COVID-19 vaccination, and implement an effective vaccination promotion scheme in addition to supporting the development and clinical administration of COVID-19 vaccines. ",
doi="10.2196/26953",
url="https://www.jmir.org/2021/5/e26953",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886492"
}


@Article{info:doi/10.2196/28118,
author="Liu, Siru
and Liu, Jialin",
title="Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets",
journal="J Med Internet Res",
year="2021",
month="May",
day="12",
volume="23",
number="5",
pages="e28118",
keywords="vaccine",
keywords="COVID-19",
keywords="behavior",
keywords="tweet",
keywords="intention",
keywords="content analysis",
keywords="Twitter",
keywords="social media",
keywords="acceptance",
keywords="threshold",
keywords="willing",
keywords="theory",
keywords="model",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: Acceptance rates of COVID-19 vaccines have still not reached the required threshold to achieve herd immunity. Understanding why some people are willing to be vaccinated and others are not is a critical step to develop efficient implementation strategies to promote COVID-19 vaccines. Objective: We conducted a theory-based content analysis based on the capability, opportunity, motivation--behavior (COM-B) model to characterize the factors influencing behavioral intentions toward COVID-19 vaccines mentioned on the Twitter platform. Methods: We collected tweets posted in English from November 1-22, 2020, using a combination of relevant keywords and hashtags. After excluding retweets, we randomly selected 5000 tweets for manual coding and content analysis. We performed a content analysis informed by the adapted COM-B model. Results: Of the 5000 COVID-19 vaccine--related tweets that were coded, 4796 (95.9\%) were posted by unique users. A total of 97 tweets carried positive behavioral intent, while 182 tweets contained negative behavioral intent. Of these, 28 tweets were mapped to capability factors, 155 tweets were related to motivation, 23 tweets were related to opportunities, and 74 tweets did not contain any useful information about the reasons for their behavioral intentions ($\kappa$=0.73). Some tweets mentioned two or more constructs at the same time. Tweets that were mapped to capability (P<.001), motivation (P<.001), and opportunity (P=.03) factors were more likely to indicate negative behavioral intentions. Conclusions: Most behavioral intentions regarding COVID-19 vaccines were related to the motivation construct. The themes identified in this study could be used to inform theory-based and evidence-based interventions to improve acceptance of COVID-19 vaccines. ",
doi="10.2196/28118",
url="https://www.jmir.org/2021/5/e28118",
url="http://www.ncbi.nlm.nih.gov/pubmed/33939625"
}


@Article{info:doi/10.2196/26289,
author="Nguyen, H. Minh Tam
and Krause, G{\'e}rard
and Keller-Stanislawski, Brigitte
and Gl{\"o}ckner, Stephan
and Mentzer, Dirk
and Ott, J. J{\"o}rdis",
title="Postmarketing Safety Monitoring After Influenza Vaccination Using a Mobile Health App: Prospective Longitudinal Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="May",
day="7",
volume="9",
number="5",
pages="e26289",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="adverse event",
keywords="adverse event following immunization",
keywords="active reporting",
keywords="pharmacovigilance",
keywords="therapeutic use",
keywords="adverse effect",
abstract="Background: For the safety monitoring of vaccinations postlicensure, reports of adverse events after immunization (AEFIs) are crucial. New technologies such as digital mobile apps can be used as an active approach to capture these events. We therefore conducted a feasibility study among recipients of the influenza vaccination using an app for assessment of the reporting of AEFIs. Objective: The goal of the research was to determine factors influencing adherence to and correct use of a newly developed app for individuals to report AEFI for 3 months using regular reminder functions, to identify determinants of AEFI occurrence and define reported AEFI types. Methods: We developed the app (SafeVac) and offered it to recipients of the influenza vaccination in 3 occupational settings in fall 2018. In this prospective longitudinal feasibility study, data on AEFIs were generated through SafeVac for 3 months. Using logistic and Cox regression, we assessed associations between app adherence, correct app entry, AEFIs, and sociodemographic parameters. Results: Of the individuals who logged into SafeVac, 61.4\% (207/337) used the app throughout a 3-month period. App use adherence was negatively associated with female sex (odds ratio [OR] 0.47; CI 0.25-0.91) and correct app entry was negatively associated with older age (OR 0.96; CI 0.93-0.99) and lower education (OR 0.31; CI 0.13-0.76). AEFI occurrence was associated with female sex (hazard ratio 1.41; CI 1.01-1.96) and negatively with older age (hazard ratio 0.98; CI 0.97-0.99). The most common AEFIs reported were injection site pain (106/337), pain in extremity (103/337), and fatigue/asthenia (73/337). Conclusions: Digital AEFI reporting was feasible with SafeVac and generated plausible results for this observation period and setting. Studies directly comparing SafeVac with conventional passive reporting schemes could determine whether such digital approaches improve completeness, timeliness, and sensitivity of vaccine vigilance. Further studies should evaluate if these results are transferable to other vaccinations and populations and if introduction of such a tool has an influence on vaccination readiness and therefore vaccine safety. ",
doi="10.2196/26289",
url="https://mhealth.jmir.org/2021/5/e26289",
url="http://www.ncbi.nlm.nih.gov/pubmed/33960950"
}


@Article{info:doi/10.2196/28352,
author="Basch, E. Charles
and Basch, H. Corey
and Hillyer, C. Grace
and Meleo-Erwin, C. Zoe
and Zagnit, A. Emily",
title="YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study",
journal="JMIR Public Health Surveill",
year="2021",
month="May",
day="6",
volume="7",
number="5",
pages="e28352",
keywords="YouTube",
keywords="vaccination",
keywords="COVID-19",
keywords="social media",
keywords="communication",
keywords="misinformation",
keywords="disinformation",
keywords="adverse reactions",
abstract="Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords ``coronavirus vaccination,'' we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6\% (1,449,915 views) to 16.6\% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7\% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2\% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. ",
doi="10.2196/28352",
url="https://publichealth.jmir.org/2021/5/e28352",
url="http://www.ncbi.nlm.nih.gov/pubmed/33886487"
}


@Article{info:doi/10.2196/26734,
author="Bachtiger, Patrik
and Adamson, Alexander
and Chow, Ji-Jian
and Sisodia, Rupa
and Quint, K. Jennifer
and Peters, S. Nicholas",
title="The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Apr",
day="14",
volume="7",
number="4",
pages="e26734",
keywords="COVID-19",
keywords="influenza",
keywords="vaccination",
keywords="COVID",
keywords="Pandemic",
keywords="National Health Service",
keywords="Health Service",
keywords="flu",
keywords="virus",
keywords="vaccine",
keywords="impact",
keywords="uptake",
keywords="observational",
keywords="United Kingdom",
keywords="public health",
keywords="intention",
keywords="electronic health record",
abstract="Background: In the face of the COVID-19 pandemic, the UK National Health Service (NHS) extended eligibility for influenza vaccination this season to approximately 32.4 million people (48.8\% of the population). Knowing the intended uptake of the vaccine will inform supply and public health messaging to maximize vaccination. Objective: The objective of this study was to measure the impact of the COVID-19 pandemic on the acceptance of influenza vaccination in the 2020-2021 season, specifically focusing on people who were previously eligible but routinely declined vaccination and newly eligible people. Methods: Intention to receive the influenza vaccine in 2020-2021 was asked of all registrants of the largest electronic personal health record in the NHS by a web-based questionnaire on July 31, 2020. Of those who were either newly or previously eligible but had not previously received an influenza vaccination, multivariable logistic regression and network diagrams were used to examine their reasons to undergo or decline vaccination. Results: Among 6641 respondents, 945 (14.2\%) were previously eligible but were not vaccinated; of these, 536 (56.7\%) intended to receive an influenza vaccination in 2020-2021, as did 466 (68.6\%) of the newly eligible respondents. Intention to receive the influenza vaccine was associated with increased age, index of multiple deprivation quintile, and considering oneself to be at high risk from COVID-19. Among those who were eligible but not intending to be vaccinated in 2020-2021, 164/543 (30.2\%) gave reasons based on misinformation. Of the previously unvaccinated health care workers, 47/96 (49\%) stated they would decline vaccination in 2020-2021. Conclusions: In this sample, COVID-19 has increased acceptance of influenza vaccination in previously eligible but unvaccinated people and has motivated substantial uptake in newly eligible people. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, which is also necessary for COVID-19 vaccination programs. ",
doi="10.2196/26734",
url="https://publichealth.jmir.org/2021/4/e26734",
url="http://www.ncbi.nlm.nih.gov/pubmed/33651708"
}


@Article{info:doi/10.2196/26874,
author="Griffith, Janessa
and Marani, Husayn
and Monkman, Helen",
title="COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="13",
volume="23",
number="4",
pages="e26874",
keywords="vaccine hesitancy",
keywords="vaccine",
keywords="COVID-19",
keywords="immunization",
keywords="Twitter",
keywords="infodemiology",
keywords="infoveillance",
keywords="social media",
keywords="behavioral science",
keywords="behavior",
keywords="Canada",
keywords="content analysis",
keywords="framework",
keywords="hesitancy",
abstract="Background: With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75\% of people in Canada plan to receive one of the vaccines. Objective: The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods: We screened 3915 tweets from public Twitter profiles in Canada by using the search words ``vaccine'' and ``COVID.'' The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results: Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions: With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines. ",
doi="10.2196/26874",
url="https://www.jmir.org/2021/4/e26874",
url="http://www.ncbi.nlm.nih.gov/pubmed/33769946"
}


@Article{info:doi/10.2196/26627,
author="Hussain, Amir
and Tahir, Ahsen
and Hussain, Zain
and Sheikh, Zakariya
and Gogate, Mandar
and Dashtipour, Kia
and Ali, Azhar
and Sheikh, Aziz",
title="Artificial Intelligence--Enabled Analysis of Public Attitudes on Facebook and Twitter Toward COVID-19 Vaccines in the United Kingdom and the United States: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="5",
volume="23",
number="4",
pages="e26627",
keywords="artificial intelligence",
keywords="COVID-19",
keywords="deep learning",
keywords="Facebook",
keywords="health informatics",
keywords="natural language processing",
keywords="public health",
keywords="sentiment analysis",
keywords="social media",
keywords="Twitter",
keywords="infodemiology",
keywords="vaccination",
abstract="Background: Global efforts toward the development and deployment of a vaccine for COVID-19 are rapidly advancing. To achieve herd immunity, widespread administration of vaccines is required, which necessitates significant cooperation from the general public. As such, it is crucial that governments and public health agencies understand public sentiments toward vaccines, which can help guide educational campaigns and other targeted policy interventions. Objective: The aim of this study was to develop and apply an artificial intelligence--based approach to analyze public sentiments on social media in the United Kingdom and the United States toward COVID-19 vaccines to better understand the public attitude and concerns regarding COVID-19 vaccines. Methods: Over 300,000 social media posts related to COVID-19 vaccines were extracted, including 23,571 Facebook posts from the United Kingdom and 144,864 from the United States, along with 40,268 tweets from the United Kingdom and 98,385 from the United States from March 1 to November 22, 2020. We used natural language processing and deep learning--based techniques to predict average sentiments, sentiment trends, and topics of discussion. These factors were analyzed longitudinally and geospatially, and manual reading of randomly selected posts on points of interest helped identify underlying themes and validated insights from the analysis. Results: Overall averaged positive, negative, and neutral sentiments were at 58\%, 22\%, and 17\% in the United Kingdom, compared to 56\%, 24\%, and 18\% in the United States, respectively. Public optimism over vaccine development, effectiveness, and trials as well as concerns over their safety, economic viability, and corporation control were identified. We compared our findings to those of nationwide surveys in both countries and found them to correlate broadly. Conclusions: Artificial intelligence--enabled social media analysis should be considered for adoption by institutions and governments alongside surveys and other conventional methods of assessing public attitude. Such analyses could enable real-time assessment, at scale, of public confidence and trust in COVID-19 vaccines, help address the concerns of vaccine sceptics, and help develop more effective policies and communication strategies to maximize uptake. ",
doi="10.2196/26627",
url="https://www.jmir.org/2021/4/e26627",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724919"
}


@Article{info:doi/10.2196/25610,
author="Bonner, Carissa
and Cvejic, Erin
and Ayre, Julie
and Isautier, Jennifer
and Semsarian, Christopher
and Nickel, Brooke
and Batcup, Carys
and Pickles, Kristen
and Dodd, Rachael
and Cornell, Samuel
and Copp, Tessa
and McCaffery, J. Kirsten",
title="The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study",
journal="JMIRx Med",
year="2021",
month="Mar",
day="30",
volume="2",
number="1",
pages="e25610",
keywords="public health",
keywords="global health",
keywords="COVID-19",
keywords="hypertension",
keywords="risk",
keywords="strategy",
keywords="mental health",
keywords="behavior",
keywords="response",
keywords="anxiety",
keywords="vaccine",
keywords="retrospective",
keywords="perception",
keywords="prevention",
keywords="intention",
abstract="Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7\%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7\%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80\%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. ",
doi="10.2196/25610",
url="https://xmed.jmir.org/2021/1/e25610",
url="http://www.ncbi.nlm.nih.gov/pubmed/34076628"
}


@Article{info:doi/10.5210/ojphi.v13i1.11621,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2021",
volume="13",
number="1",
pages="e11621",
doi="10.5210/ojphi.v13i1.11621",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/33936526"
}


@Article{info:doi/10.2196/22916,
author="Gbashi, Sefater
and Adebo, Ayodeji Oluwafemi
and Doorsamy, Wesley
and Njobeh, Berka Patrick",
title="Systematic Delineation of Media Polarity on COVID-19 Vaccines in Africa: Computational Linguistic Modeling Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="16",
volume="9",
number="3",
pages="e22916",
keywords="COVID-19",
keywords="coronavirus",
keywords="vaccine",
keywords="infodemiology",
keywords="infoveillance",
keywords="infodemic",
keywords="sentiment analysis",
keywords="natural language processing",
keywords="media",
keywords="computation",
keywords="linguistic",
keywords="model",
keywords="communication",
abstract="Background: The global onset of COVID-19 has resulted in substantial public health and socioeconomic impacts. An immediate medical breakthrough is needed. However, parallel to the emergence of the COVID-19 pandemic is the proliferation of information regarding the pandemic, which, if uncontrolled, cannot only mislead the public but also hinder the concerted efforts of relevant stakeholders in mitigating the effect of this pandemic. It is known that media communications can affect public perception and attitude toward medical treatment, vaccination, or subject matter, particularly when the population has limited knowledge on the subject. Objective: This study attempts to systematically scrutinize media communications (Google News headlines or snippets and Twitter posts) to understand the prevailing sentiments regarding COVID-19 vaccines in Africa. Methods: A total of 637 Twitter posts and 569 Google News headlines or descriptions, retrieved between February 2 and May 5, 2020, were analyzed using three standard computational linguistics models (ie, TextBlob, Valence Aware Dictionary and Sentiment Reasoner, and Word2Vec combined with a bidirectional long short-term memory neural network). Results: Our findings revealed that, contrary to general perceptions, Google News headlines or snippets and Twitter posts within the stated period were generally passive or positive toward COVID-19 vaccines in Africa. It was possible to understand these patterns in light of increasingly sustained efforts by various media and health actors in ensuring the availability of factual information about the pandemic. Conclusions: This type of analysis could contribute to understanding predominant polarities and associated potential attitudinal inclinations. Such knowledge could be critical in informing relevant public health and media engagement policies. ",
doi="10.2196/22916",
url="https://medinform.jmir.org/2021/3/e22916",
url="http://www.ncbi.nlm.nih.gov/pubmed/33667172"
}


@Article{info:doi/10.2196/24673,
author="Zhang, Chun Ke
and Fang, Yuan
and Cao, He
and Chen, Hongbiao
and Hu, Tian
and Chen, Yaqi
and Zhou, Xiaofeng
and Wang, Zixin",
title="Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="9",
volume="23",
number="3",
pages="e24673",
keywords="COVID-19",
keywords="vaccination",
keywords="behavioral intention",
keywords="perception",
keywords="social media influence",
keywords="personal preventive behaviors",
keywords="factory workers",
keywords="China",
keywords="social media",
keywords="vaccine",
keywords="behavior",
keywords="intention",
keywords="risk",
abstract="Background: COVID-19 vaccines will become available in China soon. Understanding communities' responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective: This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods: Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4\%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results: The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6\% (n=1368, conditional on 80\% vaccine efficacy and market rate) and 80.6\% (n=1655, conditional on 80\% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95\% CI 1.15-1.25 and AOR 1.24, 95\% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95\% CI 1.32-1.55 and AOR 1.37, 95\% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95\% CI 1.32-1.73 and AOR 1.28, 95\% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80\% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95\% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95\% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95\% CI 1.02-1.58 and AOR 1.67, 95\% CI 1.24-2.27) and other public spaces (AOR 1.80, 95\% CI 1.42-2.29 and AOR 1.34, 95\% CI 1.01-1.77), hand hygiene (AOR 1.21, 95\% CI 1.00-1.47 and AOR 1.52, 95\% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95\% CI 1.01-1.47 and AOR 1.55, 95\% CI 1.23-1.95) and crowded places (AOR 1.24, 95\% CI 1.02-1.51 and AOR 1.73, 95\% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95\% CI 1.04-1.12 and AOR 1.06, 95\% CI 1.01-1.11). Conclusions: Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination. ",
doi="10.2196/24673",
url="https://www.jmir.org/2021/3/e24673",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646966"
}


@Article{info:doi/10.2196/22483,
author="Cabral, Pereira Bernardo
and Braga, Luiza
and Mota, Fabio",
title="Expert Opinions on the Most Promising Treatments and Vaccine Candidates for COVID-19: Global Cross-sectional Survey of Virus Researchers in the Early Months of the Pandemic",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="26",
volume="7",
number="2",
pages="e22483",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="treatment",
keywords="survey",
keywords="public health",
keywords="drug",
keywords="clinical trial",
abstract="Background: The COVID-19 pandemic presents a great public health challenge worldwide, especially given the urgent need to identify effective drugs and develop a vaccine in a short period of time. Globally, several drugs and vaccine candidates are in clinical trials. However, because these drugs and vaccines are still being tested, there is still no definition of which ones will succeed. Objective: This study aimed to assess the opinions of over 1000 virus researchers with knowledge on the prevention and treatment of coronavirus-related human diseases to determine the most promising drug and vaccine candidates to address COVID-19. Methods: We mapped the clinical trials related to COVID-19 registered at ClinicalTrials.gov. These data were used to prepare a survey questionnaire about treatments and vaccine candidates for COVID-19. In May 2020, a global survey was conducted with authors of recent scientific publications indexed in the Web of Science Core Collection related to viruses, severe acute respiratory syndrome coronavirus, coronaviruses, and COVID-19. Results: Remdesivir, immunoglobulin from cured patients, and plasma were considered to be the most promising treatments in May 2020, while ChAdOx1 and mRNA-1273 were considered to be the most promising vaccine candidates. Almost two-thirds of the respondents (766/1219, 62.8\%) believed that vaccines for COVID-19 were likely to be available in the next 18 months. Slightly fewer than 25\% (289/1219, 23.7\%) believed that a vaccine was feasible, but probably not within 18 months. Conclusions: The issues addressed in this study are constantly evolving; therefore, the current state of knowledge has changed since the survey was conducted. However, for several months after the survey, the respondents' expectations were in line with recent results related to treatments and vaccine candidates for COVID-19. ",
doi="10.2196/22483",
url="https://publichealth.jmir.org/2021/2/e22483",
url="http://www.ncbi.nlm.nih.gov/pubmed/33635275"
}


@Article{info:doi/10.2196/17262,
author="Ehlman, C. Daniel
and Magoola, Joseph
and Tanifum, Patricia
and Wallace, S. Aaron
and Behumbiize, Prosper
and Mayanja, Robert
and Luzze, Henry
and Yukich, Joshua
and Daniels, Danni
and Mugenyi, Kevin
and Baryarama, Fulgentius
and Ayebazibwe, Nicholas
and Conklin, Laura",
title="Evaluating a Mobile Phone--Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="24",
volume="10",
number="2",
pages="e17262",
keywords="immunization",
keywords="vaccination",
keywords="reminder system",
keywords="mHealth",
keywords="short message service",
keywords="text messages",
keywords="cell phone",
keywords="mobile phone",
keywords="vaccination dropout",
keywords="vaccination timeliness",
abstract="Background: Globally, suboptimal vaccine coverage is a public health concern. According to Uganda's 2016 Demographic and Health Survey, only 49\% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective: This study evaluates a personalized, automated caregiver mobile phone--delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods: A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children's measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results: Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children's vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions: Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration: ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID): DERR1-10.2196/17262 ",
doi="10.2196/17262",
url="https://www.researchprotocols.org/2021/2/e17262",
url="http://www.ncbi.nlm.nih.gov/pubmed/33625372"
}


@Article{info:doi/10.2196/22222,
author="Morrow, L. Ardythe
and Staat, A. Mary
and DeFranco, A. Emily
and McNeal, M. Monica
and Cline, R. Allison
and Conrey, C. Shannon
and Schlaudecker, P. Elizabeth
and Piasecki, M. Alexandra
and Burke, M. Rachel
and Niu, Liang
and Hall, J. Aron
and Bowen, D. Michael
and Gerber, I. Susan
and Langley, E. Gayle
and Thornburg, J. Natalie
and Campbell, P. Angela
and Vinj{\'e}, Jan
and Parashar, D. Umesh
and Payne, C. Daniel",
title="Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis in US Mothers and Children Aged 0-2: PREVAIL Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="12",
volume="10",
number="2",
pages="e22222",
keywords="birth cohort",
keywords="RSV",
keywords="influenza",
keywords="rotavirus",
keywords="norovirus",
keywords="vaccines",
keywords="vaccine effectiveness",
keywords="immunology",
keywords="pediatrics",
abstract="Background: Acute gastroenteritis (AGE) and acute respiratory infections (ARIs) cause significant pediatric morbidity and mortality. Developing childhood vaccines against major enteric and respiratory pathogens should be guided by the natural history of infection and acquired immunity. The United States currently lacks contemporary birth cohort data to guide vaccine development. Objective: The PREVAIL (Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal) Cohort study was undertaken to define the natural history of infection and immune response to major pathogens causing AGE and ARI in US children. Methods: Mothers in Cincinnati, Ohio, were enrolled in their third trimester of pregnancy, with intensive child follow-up to 2 years. Blood samples were obtained from children at birth (cord), 6 weeks, and 6, 12, 18, and 24 months. Whole stool specimens and midturbinate nasal swabs were collected weekly and tested by multipathogen molecular assays. Saliva, meconium, maternal blood, and milk samples were also collected. AGE (?3 loose or watery stools or ?1 vomiting episode within 24 hours) and ARI (cough or fever) cases were documented by weekly cell phone surveys to mothers via automated SMS text messaging and review of medical records. Immunization records were obtained from registries and providers. follow-up ended in October 2020. Pathogen-specific infections are defined by a PCR-positive sample or rise in serum antibody. Results: Of the 245 enrolled mother--child pairs, 51.8\% (n=127) were White, 43.3\% (n=106) Black, 55.9\% (n=137) publicly insured, and 86.5\% (n=212) initiated breastfeeding. Blood collection was 100.0\% for mothers (n=245) and 85.7\% for umbilical cord (n=210). A total of 194/245 (79.2\%) mother--child pairs were compliant based on participation in at least 70\% (?71/102 study weeks) of child-weeks and providing 70\% or more of weekly samples during that time, or blood samples at 18 or 24 months. Compliant participants (n=194) had 71.0\% median nasal swab collection (IQR 30.0\%-90.5\%), with 98.5\% (191/194) providing either an 18- or 24-month blood sample; median response to weekly SMS text message surveys was 95.1\% (IQR 76.5\%-100\%). Compliant mothers reported 2.0 AGE and 4.5 ARI cases per child-year, of which 25.5\% (160/627) and 38.06\% (486/1277) of cases, respectively, were medically attended; 0.5\% of AGE (3/627) and 0.55\% of ARI (7/1277) cases were hospitalized. Conclusions: The PREVAIL Cohort demonstrates intensive follow-up to document the natural history of enteric and respiratory infections and immunity in children 0-2 years of age in the United States and will contribute unique data to guide vaccine recommendations. Testing for pathogens and antibodies is ongoing. International Registered Report Identifier (IRRID): RR1-10.2196/22222 ",
doi="10.2196/22222",
url="http://www.researchprotocols.org/2021/2/e22222/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33576746"
}


@Article{info:doi/10.2196/21734,
author="Ateudjieu, J{\'e}r{\^o}me
and Yakum, Martin Ndinakie
and Goura, Pascal Andr{\'e}
and Guenou, Etienne
and Beyala, Bita'a Landry
and Amada, Lapia
and Ngoche, Isabelle
and Kiadjieu, Forex Frank
and Nangue, Charlette
and Djosseu, Soukep Elvis Briand
and Kenfack, Bruno",
title="Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="8",
volume="10",
number="2",
pages="e21734",
keywords="immunization status",
keywords="coverage: completeness",
keywords="timeliness",
keywords="EPI vaccines",
keywords="children under five",
keywords="Foumban",
keywords="Cameroon",
keywords="vaccines",
keywords="infectious",
keywords="immunization",
abstract="Background: In Cameroon, the coverage, completeness, and timeliness of the Expanded Programme on Immunization (EPI) vaccines administration in children have remained heterogeneous and below the national and districts targets in several districts. In an effort to solve this problem, many interventions have been tested but none has shown significant improvement of the situation. Objective: This trial aims to test whether involving Community Volunteers to assess children vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children vaccination timeliness, completeness and coverage. Methods: Communities of the Foumban Health district, West region of Cameroon will be selected and assigned to either intervention or control groups using a restricted randomization of 2. In the intervention group, one Community Volunteer per community will be trained to visit households and record EPI-targeted children in a register, record their demographic movements, and assess their immunization status monthly for a year. The information recorded will be snapped and sent to the competent health center immunization team through WhatsApp. These will be used to plan and implement monthly community catch up immunization sessions in collaboration with the community volunteer. In the control group, the routine immunization sessions will be conducted with health centers organizing either weekly vaccination sessions for communities situated not farther than 5 kilometers away from the health facility or monthly vaccination sessions in communities situated more than 5 kilometers away from the health center. Baseline, mid-term and end-line surveys will be conducted to assess and compare immunization coverage, timeliness, and completeness. Results: Funded in 2018, data collection started in 2018 and has been completed. Data analysis and reporting are ongoing. Conclusions: This trial is expecting to test an innovative approach to improving children's immunization timeliness, completeness and coverage of immunization by tracking EPI targeted population vaccination status and denominator at household level and building collaboration between the community and health facilities vaccination teams to organize monthly community-based response vaccination sessions. This intervention is expected to improve children sustainable access to EPI vaccination as it offers assessing and responding to their immunization needs at monthly basis using low cost local human resources. Trial Registration: Pan African Clinical Trials Registry ID PACTR201808527428720; tinyurl.com/u058qnse International Registered Report Identifier (IRRID): DERR1-10.2196/21734 ",
doi="10.2196/21734",
url="https://www.researchprotocols.org/2021/2/e21734",
url="http://www.ncbi.nlm.nih.gov/pubmed/33555269"
}


@Article{info:doi/10.2196/17149,
author="Karafillakis, Emilie
and Martin, Sam
and Simas, Clarissa
and Olsson, Kate
and Takacs, Judit
and Dada, Sara
and Larson, Jane Heidi",
title="Methods for Social Media Monitoring Related to Vaccination: Systematic Scoping Review",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="8",
volume="7",
number="2",
pages="e17149",
keywords="vaccination",
keywords="antivaccination movement",
keywords="vaccination refusal",
keywords="social media",
keywords="internet",
keywords="research design",
keywords="review",
keywords="media monitoring",
keywords="social listening",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: Social media has changed the communication landscape, exposing individuals to an ever-growing amount of information while also allowing them to create and share content. Although vaccine skepticism is not new, social media has amplified public concerns and facilitated their spread globally. Multiple studies have been conducted to monitor vaccination discussions on social media. However, there is currently insufficient evidence on the best methods to perform social media monitoring. Objective: The aim of this study was to identify the methods most commonly used for monitoring vaccination-related topics on different social media platforms, along with their effectiveness and limitations. Methods: A systematic scoping review was conducted by applying a comprehensive search strategy to multiple databases in December 2018. The articles' titles, abstracts, and full texts were screened by two reviewers using inclusion and exclusion criteria. After data extraction, a descriptive analysis was performed to summarize the methods used to monitor and analyze social media, including data extraction tools; ethical considerations; search strategies; periods monitored; geolocalization of content; and sentiments, content, and reach analyses. Results: This review identified 86 articles on social media monitoring of vaccination, most of which were published after 2015. Although 35 out of the 86 studies used manual browser search tools to collect data from social media, this was time-consuming and only allowed for the analysis of small samples compared to social media application program interfaces or automated monitoring tools. Although simple search strategies were considered less precise, only 10 out of the 86 studies used comprehensive lists of keywords (eg, with hashtags or words related to specific events or concerns). Partly due to privacy settings, geolocalization of data was extremely difficult to obtain, limiting the possibility of performing country-specific analyses. Finally, 20 out of the 86 studies performed trend or content analyses, whereas most of the studies (70\%, 60/86) analyzed sentiments toward vaccination. Automated sentiment analyses, performed using leverage, supervised machine learning, or automated software, were fast and provided strong and accurate results. Most studies focused on negative (n=33) and positive (n=31) sentiments toward vaccination, and may have failed to capture the nuances and complexity of emotions around vaccination. Finally, 49 out of the 86 studies determined the reach of social media posts by looking at numbers of followers and engagement (eg, retweets, shares, likes). Conclusions: Social media monitoring still constitutes a new means to research and understand public sentiments around vaccination. A wide range of methods are currently used by researchers. Future research should focus on evaluating these methods to offer more evidence and support the development of social media monitoring as a valuable research design. ",
doi="10.2196/17149",
url="http://publichealth.jmir.org/2021/2/e17149/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33555267"
}


@Article{info:doi/10.2196/21465,
author="Wang, Zixin
and Lau, F. Joseph T.
and Ip, Mary Tsun Kwan
and Yu, Yebo
and Fong, Francois
and Fang, Yuan
and Mo, H. Phoenix K.",
title="Two Web-Based and Theory-Based Interventions With and Without Brief Motivational Interviewing in the Promotion of Human Papillomavirus Vaccination Among Chinese Men Who Have Sex With Men: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Feb",
day="2",
volume="23",
number="2",
pages="e21465",
keywords="HPV vaccination",
keywords="web-based health promotion",
keywords="randomized controlled trial",
keywords="men who have sex with men",
keywords="China",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) vaccination is effective in the prevention of vaccine-type genital warts and cancers among men who have sex with men (MSM). Objective: The primary objective of this randomized controlled trial (RCT) is to evaluate the efficacies of 2 web- and theory--based interventions with and without brief motivational interviewing (MI) over the phone to increase the completion of HPV vaccination among unvaccinated participants within a 24-month follow-up period compared with the control group. Methods: A 3-arm parallel-group RCT was conducted between July 2017 and December 2019. Five telephone surveys were conducted at baseline and at 3, 6, 9, and 24 months by blinded interviewers. Participants were Hong Kong Chinese--speaking MSM aged between 18 and 45 years with regular internet access who were recruited from outreaching at venues, web-based recruitment, and peer referral. Those who had ever received HPV vaccination were excluded. A total of 624 participants were randomized into either the online tutorial (OT) only group (n=208), the OT plus MI group (OT-MI; n=208), or the control group (n=208). In total, 459 (459/624, 73.6\%) completed the follow-up evaluation at 24 months. Participants in the OT group received a fully automated OT developed based on the health belief model. On top of the same OT, the OT-MI group received brief MI over the phone. Reminders were sent to the participants of the OT and OT-MI groups after 1, 2, 4, 6, and 8 months. Participants in the control group received web-based health communication messages unrelated to HPV or HPV vaccination. The research team validated the self-reported HPV vaccination uptake. Intention-to-treat analysis was used for outcome analyses. Logistic regression models and multivariable linear regression models were used to test the between-group differences in primary and secondary outcomes. Baron and Kenny's methods were used to test the mediation hypothesis. Results: The participants in the OT-MI group reported a significantly higher validated completion of HPV vaccination at 24 months than the control group (36/208, 17.3\% vs 15/208, 7.2\%; P=.006). However, the difference in HPV vaccination completion between the OT and the control groups (24/208, 11.5\% vs 15/208, 7.2\%; P=.17), or between OT-MI and OT groups (P=.13), was not statistically significant. The association between randomization status (OT-MI group vs control group) and HPV vaccination completion became statistically nonsignificant after controlling for changes in the perceived susceptibility to HPV (24 months vs baseline), whereas perceived susceptibility remained strongly associated with HPV vaccination uptake in the model (P<.001). Changes in perceived susceptibility fully mediated the intervention effect. Conclusions: Theory-based OT with brief MI over the phone was effective in increasing HPV vaccination completion among Chinese MSM. Perceived susceptibility is an active theoretical component that causes behavioral changes. Trial Registration: ClinicalTrials.gov NCT03286907; https://clinicaltrials.gov/ct2/show/NCT03286907 ",
doi="10.2196/21465",
url="https://www.jmir.org/2021/2/e21465",
url="http://www.ncbi.nlm.nih.gov/pubmed/33528372"
}


@Article{info:doi/10.2196/21303,
author="Darville, Gabrielle
and Burns, Jade
and Chavanduka, Tanaka
and Anderson-Lewis, Charkarra",
title="Utilizing Theories and Evaluation in Digital Gaming Interventions to Increase Human Papillomavirus Vaccination Among Young Males: Qualitative Study",
journal="JMIR Serious Games",
year="2021",
month="Jan",
day="22",
volume="9",
number="1",
pages="e21303",
keywords="digital games",
keywords="behavior change",
keywords="theory",
keywords="evaluation",
keywords="game design",
keywords="health care providers",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. HPV attributes to most cancers including anal, oral, cervical, and penile. Despite infection rates in the United States, recommendations and communication campaigns have traditionally focused on females. Because of this, males lack knowledge about reasons for vaccination, the benefits of being vaccinated, and their HPV risk, overall. Gaming as a health education strategy can be beneficial as mechanism that can promote behavior change for this key demographic because of the popularity of gaming. Objective: We sought to explore the relationship between gamification and HPV vaccine uptake. Methods: Interviews were conducted with experts (n=22) in the fields of cancer prevention, sexual and reproductive health, public health, game design, technology, and health communication on how a game should be developed to increase HPV vaccination rates among males. Results: Overwhelmingly, theoretical models such as the health belief model were identified with key constructs such as self-efficacy and risk perception. Experts also suggested using intervention mapping and logic models as planning tools for health promotion interventions utilizing a digital game as a medium. In game and out of game measures were discussed as assessments for quality and impact by our expert panel. Conclusions: This study shows that interventions should focus on whether greater utilization of serious games, and the incorporation of theory and standardized methods, can encourage young men to get vaccinated and to complete the series of HPV vaccinations. ",
doi="10.2196/21303",
url="http://games.jmir.org/2021/1/e21303/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33480856"
}


@Article{info:doi/10.2196/26089,
author="Yin, Fulian
and Wu, Zhaoliang
and Xia, Xinyu
and Ji, Meiqi
and Wang, Yanyan
and Hu, Zhiwen",
title="Unfolding the Determinants of COVID-19 Vaccine Acceptance in China",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="15",
volume="23",
number="1",
pages="e26089",
keywords="COVID-19 vaccines",
keywords="COVID-19 vaccination",
keywords="affordability",
keywords="efficacy",
keywords="risk communication",
keywords="evidence communication",
keywords="social media",
keywords="COVID-19",
keywords="vaccine",
keywords="communication",
keywords="risk",
keywords="acceptance",
keywords="China",
keywords="opinion",
keywords="strategy",
keywords="promotion",
abstract="Background: China is at the forefront of global efforts to develop COVID-19 vaccines and has five fast-tracked candidates at the final-stage, large-scale human clinical trials testing phase. Vaccine-promoting policymaking for public engagement is a prerequisite for social mobilization. However, making an informed and judicious choice is a dilemma for the Chinese government in the vaccine promotion context. Objective: In this study, public opinions in China were analyzed via dialogues on Chinese social media, based on which Chinese netizens' views on COVID-19 vaccines and vaccination were investigated. We also aimed to develop strategies for promoting vaccination programs in China based on an in-depth understanding of the challenges in risk communication and social mobilization. Methods: We proposed a novel behavioral dynamics model, SRS/I (susceptible-reading-susceptible/immune), to analyze opinion transmission paradigms on Chinese social media. Coupled with a meta-analysis and natural language processing techniques, the emotion polarity of individual opinions was examined in their given context. Results: We collected more than 1.75 million Weibo messages about COVID-19 vaccines from January to October 2020. According to the public opinion reproduction ratio (R0), the dynamic propagation of those messages can be classified into three periods: the ferment period (R01=1.1360), the revolution period (R02=2.8278), and the transmission period (R03=3.0729). Topics on COVID-19 vaccine acceptance in China include price and side effects. From September to October, Weibo users claimed that the vaccine was overpriced, making up 18.3\% (n=899) of messages; 38.1\% (n=81,909) of relevant topics on Weibo received likes. On the contrary, the number of messages that considered the vaccine to be reasonably priced was twice as high but received fewer likes, accounting for 25.0\% (n=53,693). In addition, we obtained 441 (47.7\%) positive and 295 (31.9\%) negative Weibo messages about side effects. Interestingly, inactivated vaccines instigated more heated discussions than any other vaccine type. The discussions, forwards, comments, and likes associated with topics related to inactivated vaccines accounted for 53\% (n=588), 42\% (n=3072), 56\% (n=3671), and 49\% (n=17,940), respectively, of the total activity associated with the five types of vaccines in China. Conclusions: Most Chinese netizens believe that the vaccine is less expensive than previously thought, while some claim they cannot afford it for their entire family. The findings demonstrate that Chinese individuals are inclined to be positive about side effects over time and are proud of China's involvement with vaccine development. Nevertheless, they have a collective misunderstanding about inactivated vaccines, insisting that inactivated vaccines are safer than other vaccines. Reflecting on netizens' collective responses, the unfolding determinants of COVID-19 vaccine acceptance provide illuminating benchmarks for vaccine-promoting policies. ",
doi="10.2196/26089",
url="http://www.jmir.org/2021/1/e26089/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33400682"
}


@Article{info:doi/10.2196/23262,
author="Tang, Lu
and Fujimoto, Kayo
and Amith, (Tuan) Muhammad
and Cunningham, Rachel
and Costantini, A. Rebecca
and York, Felicia
and Xiong, Grace
and Boom, A. Julie
and Tao, Cui",
title="``Down the Rabbit Hole'' of Vaccine Misinformation on YouTube: Network Exposure Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="5",
volume="23",
number="1",
pages="e23262",
keywords="vaccine",
keywords="misinformation",
keywords="infodemiology",
keywords="infodemic",
keywords="YouTube",
keywords="network analysis",
abstract="Background: Social media platforms such as YouTube are hotbeds for the spread of misinformation about vaccines. Objective: The aim of this study was to explore how individuals are exposed to antivaccine misinformation on YouTube based on whether they start their viewing from a keyword-based search or from antivaccine seed videos. Methods: Four networks of videos based on YouTube recommendations were collected in November 2019. Two search networks were created from provaccine and antivaccine keywords to resemble goal-oriented browsing. Two seed networks were constructed from conspiracy and antivaccine expert seed videos to resemble direct navigation. Video contents and network structures were analyzed using the network exposure model. Results: Viewers are more likely to encounter antivaccine videos through direct navigation starting from an antivaccine video than through goal-oriented browsing. In the two seed networks, provaccine videos, antivaccine videos, and videos containing health misinformation were all found to be more likely to lead to more antivaccine videos. Conclusions: YouTube has boosted the search rankings of provaccine videos to combat the influence of antivaccine information. However, when viewers are directed to antivaccine videos on YouTube from another site, the recommendation algorithm is still likely to expose them to additional antivaccine information. ",
doi="10.2196/23262",
url="https://www.jmir.org/2021/1/e23262",
url="http://www.ncbi.nlm.nih.gov/pubmed/33399543"
}


@Article{info:doi/10.2196/24827,
author="Zhang, Chun Ke
and Fang, Yuan
and Cao, He
and Chen, Hongbiao
and Hu, Tian
and Chen, Qi Ya
and Zhou, Xiaofeng
and Wang, Zixin",
title="Parental Acceptability of COVID-19 Vaccination for Children Under the Age of 18 Years: Cross-Sectional Online Survey",
journal="JMIR Pediatr Parent",
year="2020",
month="Dec",
day="30",
volume="3",
number="2",
pages="e24827",
keywords="parental acceptability",
keywords="COVID-19 vaccination",
keywords="children under the age of 18 years",
keywords="theory of planned behavior",
keywords="social media influence",
keywords="China",
abstract="Background: It is expected that COVID-19 vaccines will become available in China by the end of 2020. Vaccinating children against COVID-19 would contribute to the control of the pandemic and the recovery of the global economy. For children under the age of 18 years, parents are usually the decision makers regarding their children's vaccination. Objective: The goal of this study was to investigate parental acceptability of free COVID-19 vaccination for children under the age of 18 years in China. Methods: This is a secondary analysis of a cross-sectional, closed online survey among 2053 factory workers in Shenzhen, China, implemented from September 1 to 7, 2020.  Participants of the online survey were full-time employees aged 18 years or over who had resumed work in factories in Shenzhen. Factory workers in Shenzhen are required to receive physical examinations once a year. Eligible workers attending six designated physical examination sites were invited to complete an online survey. This study was based on a subsample of those who had at least one child under the age of 18 years (N=1052). After being briefed that COVID-19 vaccines developed by China are likely to be available by the end of 2020, participants were asked about their likelihood of having their children under the age of 18 years take up free COVID-19 vaccination provided by the government, if it existed. Multivariate logistic regression models were fitted to examine the associations of perceptions related to COVID-19 vaccination based on the theory of planned behavior (TPB) and exposure to information related to COVID-19 through social media with parental acceptability, after controlling for significant background characteristics. Results: The prevalence of parents' acceptability of COVID-19 vaccination for their children was 72.6\% (764/1052). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.70, 95\% CI 1.50-1.91), the perception that a family member would support them in having their children take up COVID-19 vaccination (ie, perceived subjective norm) (AOR 4.18, 95\% CI 3.21-5.43), and perceived behavioral control to have the children take up COVID-19 vaccination (AOR 1.84, 95\% CI 1.49-2.26) were associated with higher parental acceptability of COVID-19 vaccination. Regarding social media influence, higher exposure to positive information related to COVID-19 vaccination was associated with higher parental acceptability of COVID-19 vaccination (AOR 1.35, 95\% CI 1.17-1.56). Higher exposure to negative information related to COVID-19 vaccination was negatively associated with the dependent variable (AOR 0.85, 95\% CI 0.74-0.99). Conclusions: Parents' acceptability of COVID-19 vaccination for their children under 18 years of age was high in China. The TPB is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination targeting parents. Transparency in communicating about the vaccine development process and vaccine safety testing is important. Public health authorities should also address misinformation in a timely manner. ",
doi="10.2196/24827",
url="http://pediatrics.jmir.org/2020/2/e24827/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33326406"
}


@Article{info:doi/10.2196/19504,
author="Gallagher, John
and Lawrence, Y. Heidi",
title="Rhetorical Appeals and Tactics in New York Times Comments About Vaccines: Qualitative Analysis",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="4",
volume="22",
number="12",
pages="e19504",
keywords="vaccination",
keywords="qualitative research",
keywords="quantitative research",
keywords="rhetoric",
keywords="online comments",
keywords="anti-vaccination",
keywords="pro-vaccination",
abstract="Background: Improving persuasion in response to vaccine skepticism is a long-standing problem. Elective nonvaccination emerging from skepticism about vaccine safety and efficacy jeopardizes herd immunity, exposing those who are most vulnerable to the risk of serious diseases. Objective: This article analyzes vaccine sentiments in the New York Times as a way of improving understanding of why existing persuasive approaches may be ineffective and offers insight into how existing methods might be improved. We categorize pro-vaccine and anti-vaccine arguments, offering an in-depth analysis of pro-vaccine appeals and tactics in particular to enhance current understanding of arguments that support vaccines. Methods: Qualitative thematic analyses were used to analyze themes in rhetorical appeals across 808 vaccine-specific comments. Pro-vaccine and anti-vaccine comments were categorized to provide a broad analysis of the overall context of vaccine comments across viewpoints, with in-depth rhetorical analysis of pro-vaccine comments to address current gaps in understanding of pro-vaccine arguments in particular. Results: Appeals across 808 anti-vaccine and pro-vaccine comments were similar, though these appeals diverged in tactics and conclusions. Anti-vaccine arguments were more heterogeneous, deploying a wide range of arguments against vaccines. Additional analysis of pro-vaccine comments reveals that these comments use rhetorical strategies that could be counterproductive to producing persuasion. Pro-vaccine comments more frequently used tactics such as ad hominem arguments levied at those who refuse vaccines or used appeals to science to correct beliefs in vaccine skepticism, both of which can be ineffective when attempting to persuade a skeptical audience. Conclusions: Further study of pro-vaccine argumentation appeals and tactics could illuminate how persuasiveness could be improved in online forums. ",
doi="10.2196/19504",
url="http://www.jmir.org/2020/12/e19504/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33275110"
}


@Article{info:doi/10.2196/22996,
author="Kazi, Momin Abdul
and Qazi, Ahmed Saad
and Khawaja, Sadori
and Ahsan, Nazia
and Ahmed, Moueed Rao
and Sameen, Fareeha
and Khan Mughal, Ayub Muhammad
and Saqib, Muhammad
and Ali, Sikander
and Kaleemuddin, Hussain
and Rauf, Yasir
and Raza, Mehreen
and Jamal, Saima
and Abbasi, Munir
and Stergioulas, K. Lampros",
title="An Artificial Intelligence--Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="4",
volume="9",
number="12",
pages="e22996",
keywords="artificial intelligence",
keywords="AI",
keywords="routine childhood immunization",
keywords="EPI",
keywords="LMICs",
keywords="mHealth",
keywords="Pakistan",
keywords="personalized messages",
keywords="routine immunization",
keywords="smartphone apps",
keywords="vaccine-preventable illnesses",
abstract="Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective: The primary objectives of this study are to evaluate whether a personalized mobile app can improve children's on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone--based app on vaccination improvement. Methods: A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children's 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers' perceptions about RCI and a mobile phone--based app in improving RCI coverage. Results: Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions: This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs. Trial Registration: ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107 International Registered Report Identifier (IRRID): DERR1-10.2196/22996 ",
doi="10.2196/22996",
url="https://www.researchprotocols.org/2020/12/e22996",
url="http://www.ncbi.nlm.nih.gov/pubmed/33274726"
}


@Article{info:doi/10.2196/21451,
author="Massey, M. Philip
and Kearney, D. Matthew
and Hauer, K. Michael
and Selvan, Preethi
and Koku, Emmanuel
and Leader, E. Amy",
title="Dimensions of Misinformation About the HPV Vaccine on Instagram: Content and Network Analysis of Social Media Characteristics",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="3",
volume="22",
number="12",
pages="e21451",
keywords="social media",
keywords="cancer",
keywords="vaccination",
keywords="health communication",
keywords="public health",
keywords="HPV, human papillomavirus",
abstract="Background: The human papillomavirus (HPV) vaccine is a major advancement in cancer prevention and this primary prevention tool has the potential to reduce and eliminate HPV-associated cancers; however, the safety and efficacy of vaccines in general and the HPV vaccine specifically have come under attack, particularly through the spread of misinformation on social media. The popular social media platform Instagram represents a significant source of exposure to health (mis)information; 1 in 3 US adults use Instagram. Objective: The objective of this analysis was to characterize pro- and anti-HPV vaccine networks on Instagram, and to describe misinformation within the anti-HPV vaccine network. Methods: From April 2018 to December 2018, we collected publicly available English-language Instagram posts containing hashtags \#HPV, \#HPVVaccine, or \#Gardasil using Netlytic software (n=16,607). We randomly selected 10\% of the sample and content analyzed relevant posts (n=580) for text, image, and social media features as well as holistic attributes (eg, sentiments, personal stories). Among antivaccine posts, we organized elements of misinformation within four broad dimensions: 1) misinformation theoretical domains, 2) vaccine debate topics, 3) evidence base, and 4) health beliefs. We conducted univariate, bivariate, and network analyses on the subsample of posts to quantify the role and position of individual posts in the network. Results: Compared to provaccine posts (324/580, 55.9\%), antivaccine posts (256/580, 44.1\%) were more likely to originate from individuals (64.1\% antivaccine vs 25.0\% provaccine; P<.001) and include personal narratives (37.1\% vs 25.6\%; P=.003). In the antivaccine network, core misinformation characteristics included mentioning \#Gardasil, purporting to reveal a lie (ie, concealment), conspiracy theories, unsubstantiated claims, and risk of vaccine injury. Information/resource posts clustered around misinformation domains including falsification, nanopublications, and vaccine-preventable disease, whereas personal narrative posts clustered around different domains of misinformation, including concealment, injury, and conspiracy theories. The most liked post (6634 likes) in our full subsample was a positive personal narrative post, created by a non-health individual; the most liked post (5604 likes) in our antivaccine subsample was an informational post created by a health individual. Conclusions: Identifying characteristics of misinformation related to HPV vaccine on social media will inform targeted interventions (eg, network opinion leaders) and help sow corrective information and stories tailored to different falsehoods. ",
doi="10.2196/21451",
url="https://www.jmir.org/2020/12/e21451",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270038"
}


@Article{info:doi/10.2196/22878,
author="Fontenot, B. Holly
and White, Patrick Bradley
and Rosenberger, G. Joshua
and Lacasse, Hailee
and Rutirasiri, Chokdee
and Mayer, H. Kenneth
and Zimet, Gregory",
title="Mobile App Strategy to Facilitate Human Papillomavirus Vaccination Among Young Men Who Have Sex With Men: Pilot Intervention Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="4",
volume="22",
number="11",
pages="e22878",
keywords="human papillomavirus",
keywords="men who have sex with men",
keywords="vaccination",
keywords="mobile health tool",
keywords="mHealth",
abstract="Background: Mobile app-based interventions have been identified as potential facilitators for vaccination among young men who have sex with men (MSM). Objective: This pilot study aimed to test the feasibility of a theoretically informed mobile health (mHealth) tool designed to reduce health disparities and facilitate human papillomavirus (HPV) vaccination among a sample of young MSM. Methods: The development of the mHealth tool was guided by previous research, implementation intention theory, and design thinking. We recruited MSM aged 18-26 years through a popular online dating app and linked participants to our mHealth tool, which provided HPV vaccine information and fostered access to care. Results: A total of 42 young MSM participated in this pilot study in Boston, Massachusetts. Participants reported variable HPV knowledge (ie, high knowledge of HPV risk factors and low knowledge of HPV-related cancer risks for men) and positive vaccine beliefs and attitudes. Of those who were either unvaccinated, not up to date, or did not report vaccine status, 23\% (8/35) utilized the mHealth tool to obtain HPV vaccination. Participants primarily utilized the tool's (1) educational components and (2) capabilities facilitating concrete vaccine action plans. Conclusions: We recruited an underserved at-risk population of youth via an online dating app for our mHealth intervention that resulted in in-person health care delivery. This study was limited by enrollment challenges, including low willingness to download the mHealth tool to mobile devices. ",
doi="10.2196/22878",
url="https://www.jmir.org/2020/11/e22878",
url="http://www.ncbi.nlm.nih.gov/pubmed/33146621"
}


@Article{info:doi/10.2196/20113,
author="Hakim, Hina
and Bettinger, A. Julie
and Chambers, T. Christine
and Driedger, Michelle S.
and Dub{\'e}, Eve
and Gavaruzzi, Teresa
and Giguere, C. Anik M.
and Kavanagh, {\'E}ric
and Leask, Julie
and MacDonald, E. Shannon
and Orji, Rita
and Parent, Elizabeth
and Paquette, Jean-S{\'e}bastien
and Roberge, Jacynthe
and Sander, Beate
and Scherer, M. Aaron
and Tremblay-Breault, Martin
and Wilson, Kumanan
and Reinharz, Daniel
and Witteman, O. Holly",
title="A Web Application About Herd Immunity Using Personalized Avatars: Development Study",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="30",
volume="22",
number="10",
pages="e20113",
keywords="community immunity",
keywords="herd immunity",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="avatar",
keywords="web application",
abstract="Background: Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. Objective: This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. Methods: Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. Results: Among 110 participants across all four cycles, 68 (61.8\%) were women and 38 (34.5\%) were men (4/110, 3.6\%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0\%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. Conclusions: Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity. ",
doi="10.2196/20113",
url="https://www.jmir.org/2020/10/e20113",
url="http://www.ncbi.nlm.nih.gov/pubmed/33124994"
}


@Article{info:doi/10.2196/19503,
author="Teitelman, M. Anne
and Gregory, F. Emily
and Jayasinghe, Joshua
and Wermers, Zara
and Koo, H. Ja
and Morone, F. Jennifer
and Leri, C. Damien
and Davis, Annet
and Feemster, A. Kristen",
title="Vaccipack, A Mobile App to Promote Human Papillomavirus Vaccine Uptake Among Adolescents Aged 11 to 14 Years: Development and Usability Study",
journal="JMIR Nursing",
year="2020",
month="Oct",
day="29",
volume="3",
number="1",
pages="e19503",
keywords="cervical cancer",
keywords="prevention",
keywords="mobile health",
keywords="parents",
keywords="adolescent health",
keywords="vaccine",
keywords="human papillomavirus",
abstract="Background: More than 90\% of human papillomavirus (HPV)-related cancers could be prevented by widespread uptake of the HPV vaccine, yet vaccine use in the United States falls short of public health goals. Objective: The purpose of this study was to describe the development, acceptability, and intention to use the mobile app Vaccipack, which was designed to promote uptake and completion of the adolescent HPV vaccine series. Methods: Development of the mobile health (mHealth) content was based on the integrated behavioral model (IBM). The technology acceptance model (TAM) was used to guide the app usability evaluation. App design utilized an iterative process involving providers and potential users who were parents and adolescents. App features include a vaccine-tracking function, a discussion forum, and stories with embedded messages to promote intention to vaccinate. Parents and adolescents completed surveys before and after introducing the app in a pediatric primary care setting with low HPV vaccination rates. Results: Surveys were completed by 54 participants (20 adolescents aged 11 to 14 years and 34 parents). Notably, 75\% (15/20) of adolescents and 88\% (30/34) of parents intended to use the app in the next 2 weeks. Acceptability of the app was high among both groups: 88\% (30/34) of parents and 75\% (15/20) of adolescents indicated that Vaccipack was easy to use, and 82\% (28/34) of parents and 85\% (17/20) of adolescents perceived the app to be beneficial. Higher levels of app acceptability were found among parents with strong intentions to use the app (P=.09; 95\% CI --2.15 to 0.15). Conclusions: mHealth technology, such as Vaccipack, may be an acceptable and nimble platform for providing information to parents and adolescents and advancing the uptake of important vaccines. ",
doi="10.2196/19503",
url="https://nursing.jmir.org/2020/1/e19503/",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345789"
}


@Article{info:doi/10.2196/18878,
author="Dhaliwal, Dhamanpreet
and Mannion, Cynthia",
title="Antivaccine Messages on Facebook: Preliminary Audit",
journal="JMIR Public Health Surveill",
year="2020",
month="Oct",
day="20",
volume="6",
number="4",
pages="e18878",
keywords="antivaccine",
keywords="vaccines",
keywords="vaccination",
keywords="immunization",
keywords="communicable disease",
abstract="Background: The World Health Organization lists vaccine hesitancy as one of 10 threats to global health. The antivaccine movement uses Facebook to promote messages on the alleged dangers and consequences of vaccinating, leading to a reluctance to immunize against preventable communicable diseases. Objective: We would like to know more about the messages these websites are sharing via social media that can influence readers and consumers. What messages is the public receiving on Facebook about immunization? What content (news articles, testimonials, videos, scientific studies) is being promoted? Methods: We proposed using a social media audit tool and 3 categorical lists to capture information on websites and posts, respectively. The keywords ``vaccine,'' ``vaccine truth,'' and ``anti-vax'' were entered in the Facebook search bar. A Facebook page was examined if it had between 2500 and 150,000 likes. Data about beliefs, calls to action, and testimonials were recorded from posts and listed under the categories Myths, Truths, and Consequences. Website data were entered in a social media audit template. Results: Users' posts reflected fear and vaccine hesitancy resulting from the alleged dangers of immunization featured on the website links. Vaccines were blamed for afflictions such as autism, cancer, and infertility. Mothers shared testimonies on alleged consequences their children suffered due to immunization, which have influenced other parents to not vaccinate their children. Users denied the current measles outbreaks in the United States to be true, retaliating against the government in protests for fabricating news. Conclusions: Some Facebook messages encourage prevailing myths about the safety and consequences of vaccines and likely contribute to parents' vaccine hesitancy. Deeply concerning is the mistrust social media has the potential to cast upon the relationship between health care providers and the public. A grasp of common misconceptions can help support health care provider practice. ",
doi="10.2196/18878",
url="http://publichealth.jmir.org/2020/4/e18878/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33079072"
}


@Article{info:doi/10.2196/20002,
author="Ashfield, Sarah
and Donelle, Lorie",
title="Parental Online Information Access and Childhood Vaccination Decisions in North America: Scoping Review",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="13",
volume="22",
number="10",
pages="e20002",
keywords="childhood vaccination",
keywords="parental vaccine decisions",
keywords="online vaccine information",
keywords="social media",
keywords="vaccine hesitancy",
keywords="digital health literacy",
abstract="Background: Immunizing children throughout their early years prevents the spread of communicable disease and decreases the morbidity and mortality associated with many vaccine-preventable diseases. Searching online allows individuals rapid access to health information. Objective: The purpose of this review was to develop an understanding of the existing literature of parents' online health information-seeking behaviors to inform their vaccination choices for their children and to identify gaps in the literature around parents' use of online health information and their vaccination choices. Methods: A scoping review of peer-reviewed literature from Canada and the United States was performed. The following databases were utilized to perform the search: PubMed, CINAHL, Nursing \& Allied Health Database, Scopus, and PsycINFO. The purpose of this review was to examine parents' use of online information seeking related to vaccine information and to understand how parents utilize this information to inform decisions about vaccinating their children. Of the 34 papers included in the review, 4 relevant themes and subthemes were identified: information seeking, online information resources, online vaccine content, and trust in health care providers. Results: Examination of the literature revealed conflicting information regarding parents' use of social media and online resources to inform decisions around vaccinating their children. There is evidence of significant misinformation regarding vaccine risks online. Parents' digital health literacy levels are unknown and may affect their ability to appraise online vaccination information. Conclusions: Parents are seeking vaccine information from online sources. However, the influence of online vaccine information on parental vaccine practices remains uncertain. ",
doi="10.2196/20002",
url="http://www.jmir.org/2020/10/e20002/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33048055"
}


@Article{info:doi/10.2196/16672,
author="Ndwandwe, Duduzile
and Ngcobo, J. Ntombenhle
and Adamu, A. Abdu
and Nnaji, Chukwudi
and Mashunye, Thandiwe
and Leufak, M. Arlette
and Cooper, Sara
and Uthman, A. Olalekan
and Wiysonge, S. Charles",
title="Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="28",
volume="9",
number="9",
pages="e16672",
keywords="South Africa",
keywords="vaccination coverage",
keywords="missed opportunities for vaccination",
keywords="implementation science",
abstract="Background: Vaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination. Objective: This study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa. Methods: The 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa. Results: Ethical review submission is planned for October 2020. Data collection is expected to be underway in January 2021. Conclusions: The extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage. International Registered Report Identifier (IRRID): PRR1-10.2196/16672 ",
doi="10.2196/16672",
url="http://www.researchprotocols.org/2020/9/e16672/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985990"
}


@Article{info:doi/10.2196/16373,
author="Wijesundara, G. Jessica
and Ito Fukunaga, Mayuko
and Ogarek, Jessica
and Barton, Bruce
and Fisher, Lloyd
and Preusse, Peggy
and Sundaresan, Devi
and Garber, Lawrence
and Mazor, M. Kathleen
and Cutrona, L. Sarah",
title="Electronic Health Record Portal Messages and Interactive Voice Response Calls to Improve Rates of Early Season Influenza Vaccination: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="25",
volume="22",
number="9",
pages="e16373",
keywords="electronic health records",
keywords="influenza vaccination",
keywords="patient care",
keywords="patient engagement",
abstract="Background: Patient reminders for influenza vaccination, delivered via an electronic health record patient portal and interactive voice response calls, offer an innovative approach to engaging patients and improving patient care. Objective: The goal of this study was to test the effectiveness of portal and interactive voice response outreach in improving rates of influenza vaccination by targeting patients in early September, shortly after vaccinations became available. Methods: Using electronic health record portal messages and interactive voice response calls promoting influenza vaccination, outreach was conducted in September 2015. Participants included adult patients within a large multispecialty group practice in central Massachusetts. Our main outcome was electronic health record--documented early influenza vaccination during the 2015-2016 influenza season, measured in November 2015. We randomly assigned all active portal users to 1 of 2 groups: (1) receiving a portal message promoting influenza vaccinations, listing upcoming clinics, and offering online scheduling of vaccination appointments (n=19,506) or (2) receiving usual care (n=19,505). We randomly assigned all portal nonusers to 1 of 2 groups: (1) receiving interactive voice response call (n=15,000) or (2) receiving usual care (n=43,596). The intervention also solicited patient self-reports on influenza vaccinations completed outside the clinic. Self-reported influenza vaccination data were uploaded into the electronic health records to increase the accuracy of existing provider-directed electronic health record clinical decision support (vaccination alerts) but were excluded from main analyses. Results: Among portal users, 28.4\% (5549/19,506) of those randomized to receive messages and 27.1\% (5294/19,505) of the usual care group had influenza vaccinations documented by November 2015 (P=.004). In multivariate analysis of portal users, message recipients were slightly more likely to have documented vaccinations when compared to the usual care group (OR 1.07, 95\% CI 1.02-1.12). Among portal nonusers, 8.4\% (1262/15,000) of those randomized to receive calls and 8.2\% (3586/43,596) of usual care had documented vaccinations (P=.47), and multivariate analysis showed nonsignificant differences. Over half of portal messages sent were opened (10,112/19,479; 51.9\%), and over half of interactive voice response calls placed (7599/14,984; 50.7\%) reached their intended target, thus we attained similar levels of exposure to the messaging for both interventions. Among portal message recipients, 25.4\% of message openers (2570/10,112) responded to a subsequent question on receipt of influenza vaccination; among interactive voice response recipients, 72.5\% of those reached (5513/7599) responded to a similar question. Conclusions: Portal message outreach to a general primary care population achieved a small but statistically significant improvement in rates of influenza vaccination (OR 1.07, 95\% CI 1.02-1.12). Interactive voice response calls did not significantly improve vaccination rates among portal nonusers (OR 1.03, 95\% CI 0.96-1.10). Rates of patient engagement with both modalities were favorable. Trial Registration: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277 ",
doi="10.2196/16373",
url="http://www.jmir.org/2020/9/e16373/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32975529"
}


@Article{info:doi/10.2196/19923,
author="Dang, Huyen
and Dao, Sang
and Carnahan, Emily
and Kawakyu, Nami
and Duong, Hong
and Nguyen, Trung
and Nguyen, Doan
and Nguyen, Linh
and Rivera, Maya
and Ngo, Tuan
and Werner, Laurie
and Nguyen, Nga",
title="Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="22",
volume="22",
number="9",
pages="e19923",
keywords="immunization",
keywords="immunization information system",
keywords="electronic immunization registry",
keywords="scale-up",
keywords="digital health intervention",
keywords="mHealth",
keywords="eHealth",
abstract="Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam's National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the ``axes of scale,'' to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. ",
doi="10.2196/19923",
url="http://www.jmir.org/2020/9/e19923/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960184"
}


@Article{info:doi/10.2196/20356,
author="Johri, Mira
and Chandra, Dinesh
and Kone, Georges Karna
and Sylvestre, Marie-Pierre
and Mathur, K. Alok
and Harper, Sam
and Nandi, Arijit",
title="Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e20356",
keywords="randomized controlled trial",
keywords="immunization programs",
keywords="child health",
keywords="mHealth",
keywords="health promotion",
keywords="health services accessibility",
keywords="implementation science",
keywords="pilot projects",
keywords="developing countries",
keywords="global health",
abstract="Background: In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding the coverage of effective interventions. In India, childhood immunization is a priority health strategy with suboptimal uptake. Objective: To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health. Methods: A cluster-randomized pilot trial with a 1:1 allocation ratio was conducted in rural Uttar Pradesh, India, from January to September 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify eligible households and requested participation before randomization. Interventions were designed through formative research using a social marketing approach and delivered over 3 months using strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities, including 3 small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomization, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized logistic regression and ordered logistic regression to assess coverage, and generalized estimating equation models to assess changes in intermediate outcomes. Results: All villages consented to participate. Gaps in administrative data hampered recruitment; 14.0\% (79/565) of recorded households were nonresident. Only 1.4\% (8/565) of households did not consent. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. The end line survey occurred during the flood season; 17.6\% (68/387) of the households were absent. Contamination was less than 1\%. Participation in one or more interventions was 94.0\% (173/184), 78.3\% (144/184) for the face-to-face strategy, and 67.4\% (124/184) for the mHealth strategy. Determinants including place of residence, mobile phone access, education, and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesized causal mechanisms. Conclusions: A future trial of a new intervention model is feasible. The interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 44840759; https://doi.org/10.1186/ISRCTN44840759 ",
doi="10.2196/20356",
url="http://mhealth.jmir.org/2020/9/e20356/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955455"
}


@Article{info:doi/10.2196/17154,
author="Wigfall, Tisdale Lisa",
title="eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2020",
month="Sep",
day="9",
volume="4",
number="9",
pages="e17154",
keywords="eHealth",
keywords="communication",
keywords="HIV",
keywords="disparities",
keywords="inequalities",
abstract="Background: Providing HIV/STD testing and prevention education, medical and nonmedical case management, housing assistance, transportation services, and patient navigation are just a few examples of how community-based HIV/AIDS service organizations will help the United States realize the goals of the updated National HIV/AIDS Strategy. Objective: In this study, the aim was to assess electronic data security confidence level, electronic communication behaviors, and interest in using eHealth communication tools with clients of staff at community-based HIV/AIDS service organizations. Methods: Staff were recruited from 7 community-based HIV/AIDS service organizations in the southern United States (3 in South Carolina and 4 in Texas). The principal investigator used state department of health websites to identify community-based HIV/AIDS service organizations. Staff were included if they provided HIV/STD prevention education to clients. A recruitment letter was sent to community-based HIV/AIDS service organization leaders who then used snowball sampling to recruit eligible staff. Chi-square tests were used. Results: Among staff (n=59) who participated in the study, 66\% (39/59) were very or completely confident that safeguards are in place to keep electronically shared information from being seen by other people; 68\% (40/59) used email, 58\% (34/59) used text messages, 25\% (15/59) used social media, 15\% (9/59) used a mobile app, 8\% (5/59) used web-enabled videoconferencing, and 3\% (2/59) used other tools (eg, electronic medical record, healthnavigator.com website) to communicate electronically with their clients. More than half were very interested in using eHealth communication tools in the future for sharing appointment reminders (67\%, 38/59) and general health tips (61\%, 34/59) with their clients. Half were very interested in using eHealth communication tools in the future to share HIV medication reminders with their clients (50\%, 29/59). Forty percent (23/59) were very interested in using eHealth communication tools to share vaccination reminders with their clients. Conclusions: Community-based HIV/AIDS service organization staff had some level of confidence that safeguards were in place to keep electronically shared information from being seen by other people. This is critically important given the sensitivity of the information shared between community-based HIV/AIDS service organization staff and their clients, and because many staff were very interested in using eHealth communication tools with their clients in the future. It is very likely that eHealth communication tools can be used in community settings to improve health outcomes across the HIV care continuum; in the interim, more research is needed to better understand factors that may facilitate or impede community-based HIV/AIDS service organization staff use and client acceptability. ",
doi="10.2196/17154",
url="http://formative.jmir.org/2020/9/e17154/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902395"
}


@Article{info:doi/10.2196/14822,
author="Pot, Mirjam
and Paulussen, GWM Theo
and Ruiter, AC Robert
and Mollema, Liesbeth
and Hofstra, Miranda
and Van Keulen, M. Hilde",
title="Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="17",
volume="22",
number="7",
pages="e14822",
keywords="HPV vaccination",
keywords="web-based tailored intervention",
keywords="process evaluation",
keywords="intervention use",
keywords="dose-response relationship",
keywords="randomized controlled trial",
keywords="informed decision making",
abstract="Background: In the Netherlands, human papillomavirus (HPV) vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, web-based tailored intervention to which mothers of Dutch girls were invited to participate. Objective: The aim of this study was to provide insight into the intervention's working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with program acceptability and intervention effects (ie, dose-response relationship). Methods: Only mothers from the intervention arm of a randomized controlled trial that assessed the effectiveness of the web-based, tailored intervention were included in this study. They were invited to visit the website of the web-based intervention between baseline (January 2015, just before access to the intervention) and follow up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (ie, duration of intervention exposure) and completeness (ie, proportion of all available web pages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were IDM, decisional conflict, and social-psychological determinants of HPV vaccination uptake. Results: Among the 3995 invited mothers, 2509 (62.80\%) logged on to the website, 2239 of whom (89.24\%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes (SD 12.41) on the website and completed 50.04\% (SD 26.18\%) of the website components. Participants rated the website 7.64 (SD 1.39) on a 10-point scale. Program acceptability was significantly associated with completeness ($\beta$=4.36, P<.001), but not with time of website use ($\beta$=--.07, P=.77). Intention-to-treat analysis (N=3995) showed a significant positive effect of completeness on all outcome measures (all P<.003; Bonferroni-corrected $\alpha$=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (all P<.003), except for uptake (P=.20), risk perception when not vaccinated (P=.14), subjective norms (P=.03), and habit (P=.01). Conclusions: Program use and acceptability of the intervention were adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (ie, dose-response effects) were found for completeness and time of website use on the mothers' IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters' vaccination uptake. This indicates that the web-based, tailored intervention fits well with the mothers' needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. Trial Registration: Netherlands Trial Register NTR4795; https://www.trialregister.nl/trial/4795 ",
doi="10.2196/14822",
url="https://www.jmir.org/2020/7/e14822",
url="http://www.ncbi.nlm.nih.gov/pubmed/32520718"
}


@Article{info:doi/10.2196/10959,
author="Alqahtani, S. Amani
and Alsharif, A. Saeed
and Garnan, A. Mohammad
and Tashani, Mohamed
and BinDhim, F. Nasser
and Heywood, E. Anita
and Booy, Robert
and Wiley, E. Kerrie
and Rashid, Harunor
and ",
title="The Impact of Receiving Pretravel Health Advice on the Prevention of Hajj-Related Illnesses Among Australian Pilgrims: Cohort Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Jul",
day="14",
volume="6",
number="3",
pages="e10959",
keywords="Hajj",
keywords="health behavior",
keywords="mass gathering",
keywords="pretravel health advice",
keywords="travelers",
abstract="Background: Pretravel health advice can play a crucial role in improving both travelers' awareness about disease risk and compliance with preventive measures. General practitioners (GPs) and the internet have been reported internationally to be the main sources of health advice for travelers to non--mass gathering (MG) destinations. However, few studies have attempted to investigate the sources of health advice among travelers to MGs including the Hajj pilgrimage, and none of these studies further investigated the impact of pretravel advice on pilgrims' health behaviors. Objective: The objective of this study was to investigate the impact of the source of pretravel health advice (from GPs and specialized Hajj travel agents) on Hajj pilgrims' awareness of and compliance with health recommendations, and the incidence of Hajj-associated illnesses. Methods: A prospective cohort study (before and during Hajj) was conducted among Australian pilgrims aged ?18 years in 2015. Results: A total of 421 pilgrims participated prior to Hajj, and 391 (93\%) provided follow-up data during Hajj. All participants obtained pretravel health advice from one or more sources, with Hajj travel agents (46\%) and general practitioners (GPs; 40\%) the most commonly reported sources. In total, 288 (74\%) participants reported Hajj-related symptoms, of which 86\% (248/288) were respiratory symptoms. Participants who obtained pretravel health advice from travel agents were more likely to be aware of the official Saudi recommendations (adjusted odds ratio [aOR] 2.1, 95\% CI 1.2-3.8; P=.01), receive recommended vaccines before travel (aOR 2.4, 95\% CI 1.4-3.9; P=.01), use hand sanitizers including soap (aOR 2.5, 95\% CI 1.1-6.1; P=.03), and wash their hands after touching an ill person during Hajj (aOR 2.9, 95\% CI 1.1-7.1; P=.01), compared to those who sought advice from GPs. However, neither advice from travel agents nor GPs was associated with a lower incidence of Hajj-related illnesses. Conclusions: Advice from travel agents appeared to be accessed by more travelers than that from GPs, and was associated with an increased likelihood of positive travel health behaviors. ",
doi="10.2196/10959",
url="https://publichealth.jmir.org/2020/3/e10959",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673259"
}


@Article{info:doi/10.2196/17446,
author="Liu, Zhike
and Zhang, Liang
and Yang, Yu
and Meng, Ruogu
and Fang, Ting
and Dong, Ying
and Li, Ning
and Xu, Guozhang
and Zhan, Siyan",
title="Active Surveillance of Adverse Events Following Human Papillomavirus Vaccination: Feasibility Pilot Study Based on the Regional Health Care Information Platform in the City of Ningbo, China",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="1",
volume="22",
number="6",
pages="e17446",
keywords="safety",
keywords="HPV",
keywords="human papillomavirus",
keywords="vaccine",
keywords="active surveillance",
abstract="Background: Comprehensive safety data for vaccines from post-licensure surveillance, especially active surveillance, could guide administrations and individuals to make reasonable decisions on vaccination. Therefore, we designed a pilot study to assess the capability of a regional health care information platform to actively monitor the safety of a newly licensed vaccine. Objective: This study aimed to conduct active surveillance of human papillomavirus (HPV) vaccine safety based on this information platform. Methods: In 2017, one of China's most mature information platforms with superior data linkage was selected. A structured questionnaire and open-ended interview guidelines were developed to investigate the feasibility of active surveillance following HPV vaccination using the regional health care information platform in Ningbo. The questionnaire was sent to participants via email, and a face-to-face interview was conducted to confirm details or resolve discrepancies. Results: Five databases that could be considered essential to active surveillance of vaccine safety were integrated into the platform starting in 2015. Except for residents' health records, which had a coverage rate of 87\%, the data sources covered more than 95\% of the records that were documented in Ningbo. All the data could be inherently linked using the national identity card. There were 19,328 women who received the HPV vaccine, and 37,988 doses were administered in 2017 and 2018. Women aged 30-40 years accounted for the largest proportion. Quadrivalent vaccination accounted for 73.1\% of total vaccination, a much higher proportion than that of bivalent vaccination. Of the first doses, 60 (60/19,328, 0.31\%) occurred outside Ningbo. There were no missing data for vaccination-relevant variables, such as identity card, vaccine name, vaccination doses, vaccination date, and manufacturer. ICD-10 coding could be used to identify 9,180 cases using a predefined list of the outcomes of interest, and 1.88\% of these cases were missing the identity card. During the 90 days following HPV vaccination, 4 incident cases were found through the linked vaccination history and electronic medical records. The combined incident rate of rheumatoid arthritis, optic neuritis, and Henoch-Schonlein purpura was 8.84/100,000 doses of bivalent HPV, and the incidence rate of rheumatoid arthritis was 3.75/100,000 doses of quadrivalent HPV. Conclusions: This study presents an available approach to initiate an active surveillance system for adverse events following HPV vaccination, based on a regional health care information platform in China. An extended observation period or the inclusion of additional functional sites is warranted to conduct future hypothesis-generating and hypothesis-confirming studies for vaccine safety concerns. ",
doi="10.2196/17446",
url="https://www.jmir.org/2020/6/e17446",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234696"
}


@Article{info:doi/10.2196/17371,
author="de Cock, Caroline
and van Velthoven, Michelle
and Milne-Ives, Madison
and Mooney, Mary
and Meinert, Edward",
title="Use of Apps to Promote Childhood Vaccination: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="18",
volume="8",
number="5",
pages="e17371",
keywords="vaccination",
keywords="vaccination coverage",
keywords="mobile apps",
keywords="infant",
keywords="childhood vaccination",
keywords="immunization",
keywords="smartphone technology",
keywords="mobile phone",
abstract="Background: Vaccination is a critical step in reducing child mortality; however, vaccination rates have declined in many countries in recent years. This decrease has been associated with an increase in the outbreak of vaccine-preventable diseases. The potential for leveraging mobile platforms to promote vaccination coverage has been investigated in the development of numerous mobile apps. Although many are available for public use, there is little robust evaluation of these apps. Objective: This systematic review aimed to assess the effectiveness of apps supporting childhood vaccinations in improving vaccination uptake, knowledge, and decision making as well as the usability and user perceptions of these apps. Methods: PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and Education Resources Information Center (ERIC) databases were systematically searched for studies published between 2008 and 2019 that evaluated childhood vaccination apps. Two authors screened and selected studies according to the inclusion and exclusion criteria. Data were extracted and analyzed, and the studies were assessed for risk of bias. Results: A total of 28 studies evaluating 25 apps met the inclusion criteria and were included in this analysis. Overall, 9 studies assessed vaccination uptake, of which 4 reported significant benefits (P<.001 or P=.03) of the implementation of the app. Similarly, 4 studies indicated a significant (P?.054) impact on knowledge and on vaccination decision making. Patient perceptions, usability, and acceptability were generally positive. The quality of the included studies was found to be moderate to poor, with many aspects of the methodology being unclear. Conclusions: There is little evidence to support the use of childhood vaccination apps to improve vaccination uptake, knowledge, or decision making. Further research is required to understand the dichotomous effects of vaccination-related information provision and the evaluation of these apps in larger, more robust studies. The methodology of studies must be reported more comprehensively to accurately assess the effectiveness of childhood vaccination apps and the risk of bias of studies. International Registered Report Identifier (IRRID): RR2-10.2196/16929 ",
doi="10.2196/17371",
url="https://mhealth.jmir.org/2020/5/e17371",
url="http://www.ncbi.nlm.nih.gov/pubmed/32421684"
}


@Article{info:doi/10.2196/16983,
author="Montagni, Ilaria
and Mabchour, Inass
and Tzourio, Christophe",
title="Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review",
journal="JMIR Serious Games",
year="2020",
month="May",
day="18",
volume="8",
number="2",
pages="e16983",
keywords="gamification",
keywords="vaccination",
keywords="vaccine hesitancy",
keywords="digital tools",
keywords="scoping review",
abstract="Background: Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective: The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods: We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results: A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions: Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage. ",
doi="10.2196/16983",
url="http://games.jmir.org/2020/2/e16983/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32348271"
}


@Article{info:doi/10.5210/ojphi.v12i1.10576,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2020",
volume="12",
number="1",
pages="e10576",
doi="10.5210/ojphi.v12i1.10576",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/32577153"
}


@Article{info:doi/10.2196/16848,
author="Chen, Ji
and Chokshi, Sara
and Hegde, Roshini
and Gonzalez, Javier
and Iturrate, Eduardo
and Aphinyanaphongs, Yin
and Mann, Devin",
title="Development, Implementation, and Evaluation of a Personalized Machine Learning Algorithm for Clinical Decision Support: Case Study With Shingles Vaccination",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="29",
volume="22",
number="4",
pages="e16848",
keywords="clinical decision support",
keywords="machine learning",
keywords="alert fatigue",
keywords="implementation science",
abstract="Background: Although clinical decision support (CDS) alerts are effective reminders of best practices, their effectiveness is blunted by clinicians who fail to respond to an overabundance of inappropriate alerts. An electronic health record (EHR)--integrated machine learning (ML) algorithm is a potentially powerful tool to increase the signal-to-noise ratio of CDS alerts and positively impact the clinician's interaction with these alerts in general. Objective: This study aimed to describe the development and implementation of an ML-based signal-to-noise optimization system (SmartCDS) to increase the signal of alerts by decreasing the volume of low-value herpes zoster (shingles) vaccination alerts. Methods: We built and deployed SmartCDS, which builds personalized user activity profiles to suppress shingles vaccination alerts unlikely to yield a clinician's interaction. We extracted all records of shingles alerts from January 2017 to March 2019 from our EHR system, including 327,737 encounters, 780 providers, and 144,438 patients. Results: During the 6 weeks of pilot deployment, the SmartCDS system suppressed an average of 43.67\% (15,425/35,315) potential shingles alerts (appointments) and maintained stable counts of weekly shingles vaccination orders (326.3 with system active vs 331.3 in the control group; P=.38) and weekly user-alert interactions (1118.3 with system active vs 1166.3 in the control group; P=.20). Conclusions: All key statistics remained stable while the system was turned on. Although the results are promising, the characteristics of the system can be subject to future data shifts, which require automated logging and monitoring. We demonstrated that an automated, ML-based method and data architecture to suppress alerts are feasible without detriment to overall order rates. This work is the first alert suppression ML-based model deployed in practice and serves as foundational work in encounter-level customization of alert display to maximize effectiveness. ",
doi="10.2196/16848",
url="http://www.jmir.org/2020/4/e16848/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347813"
}


@Article{info:doi/10.2196/15800,
author="Dempsey, Amanda
and Kwan, M. Bethany
and Wagner, M. Nicole
and Pyrzanowski, Jennifer
and Brewer, E. Sarah
and Sevick, Carter
and Narwaney, Komal
and Resnicow, Kenneth
and Glanz, Jason",
title="A Values-Tailored Web-Based Intervention for New Mothers to Increase Infant Vaccine Uptake: Development and Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="5",
volume="22",
number="3",
pages="e15800",
keywords="immunization",
keywords="parents",
abstract="Background: Vaccine hesitancy among parents leads to childhood undervaccination and outbreaks of vaccine-preventable disease. As the reasons for vaccine hesitancy are diverse, there is often not enough time during regular clinical visits for medical providers to adequately address all the concerns that parents have. Providing individually tailored vaccine information via the internet before a clinical visit may be a good mechanism for effectively allaying parents' vaccination concerns while also being time efficient. Including tailoring based on values is a promising, but untested, approach to message creation. Objective: This study aimed to describe the process by which we developed a Web-based intervention that is being used in an ongoing randomized controlled trial aimed at improving the timeliness of infant vaccination by reducing parental vaccine hesitancy. Methods: Development of the intervention incorporated evidence-based health behavior theories. A series of interviews, surveys, and feedback sessions were used to iteratively develop the intervention in collaboration with vaccination experts and potential end users. Results: In all, 41 specific content areas were identified to be included in the intervention. User feedback elucidated preferences for specific design elements to be incorporated throughout the website. The tile-based architecture chosen for the website was perceived as easy to use. Creating messages that were two-sided was generally preferred over other message formats. Quantitative surveys identified associations between specific vaccine values and vaccination beliefs, suggesting that values tailoring should vary, depending on the specific belief being endorsed. Conclusions: Using health behavior theories, qualitative and quantitative data, and significant expert and end user input, we created a novel, Web-based intervention to improve infant vaccination timeliness. The intervention is based on tailoring messages according to each individual's values and beliefs. This intervention is currently being tested in a controlled randomized clinical trial. ",
doi="10.2196/15800",
url="https://www.jmir.org/2020/3/e15800",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134394"
}


@Article{info:doi/10.2196/13552,
author="Chambers, T. Christine
and Dol, Justine
and Parker, A. Jennifer
and Caes, Line
and Birnie, A. Kathryn
and Taddio, Anna
and Campbell-Yeo, Marsha
and Halperin, A. Scott
and Langille, Jennifer",
title="Implementation Effectiveness of a Parent-Directed YouTube Video (``It Doesn't Have To Hurt'') on Evidence-Based Strategies to Manage Needle Pain: Descriptive Survey Study",
journal="JMIR Pediatr Parent",
year="2020",
month="Mar",
day="4",
volume="3",
number="1",
pages="e13552",
keywords="pain management",
keywords="child",
keywords="knowledge translation",
keywords="social media",
abstract="Background: Despite the availability of high-quality evidence and clinical practice guidelines for the effective management of pediatric pain, this evidence is rarely used in practice for managing children's pain from needle procedures such as vaccinations. Parents are generally unaware of pain management strategies they can use with their children. Objective: This study aimed to develop, implement, and evaluate the implementation effectiveness of a parent-directed YouTube video on evidence-based strategies to manage needle pain in children. Methods: This was a descriptive study. Analytics were extracted from YouTube to describe video reach. A Web-based survey was used to seek parent and health care professional (HCP) feedback about the video. The 2-minute 18-second video was launched on YouTube on November 4, 2013. In the video, a 4-year-old girl tells parents what they should and should not do to help needles hurt less. The key evidence-based messages shared in the video were distraction, deep breathing, and topical anesthetic creams. A group of parents (n=163) and HCPs (n=278) completed the Web-based survey. Measures of reach included number of unique views, country where the video was viewed, sex of the viewer, and length of watch time. The Web-based survey assessed implementation outcomes of the video, such as acceptability, appropriateness, penetration, and adoption. Results: As of November 4, 2018 (5 years after launch), the video had 237,132 unique views from 182 countries, with most viewers watching an average of 55.1\% (76/138 seconds) of the video. Overall, both parents and HCPs reported strong acceptance of the video (ie, they liked the video, found it helpful, and felt more confident) and reported significant improvements in plans to use distraction, deep breathing, and topical anesthetic creams. Conclusions: This parent-directed YouTube video was an acceptable and appropriate way to disseminate evidence about the procedure of pain management to a large number of parents. ",
doi="10.2196/13552",
url="http://pediatrics.jmir.org/2020/1/e13552/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130190"
}


@Article{info:doi/10.2196/16427,
author="Liao, Qiuyan
and Fielding, Richard
and Cheung, Derek Yee Tak
and Lian, Jinxiao
and Yuan, Jiehu
and Lam, Tak Wendy Wing",
title="Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="28",
volume="22",
number="2",
pages="e16427",
keywords="influenza vaccination",
keywords="social media",
keywords="intervention",
keywords="children",
abstract="Background: Seasonal influenza vaccination (SIV) coverage among young children remains low worldwide. Mobile social networking apps such as WhatsApp Messenger are promising tools for health interventions. Objective: This was a preliminary study to test the effectiveness and parental acceptability of a social networking intervention that sends weekly vaccination reminders and encourages exchange of SIV-related views and experiences among mothers via WhatsApp discussion groups for promoting childhood SIV. The second objective was to examine the effect of introducing time pressure on mothers' decision making for childhood SIV for vaccination decision making. This was done using countdowns of the recommended vaccination timing. Methods: Mothers of child(ren) aged 6 to 72 months were randomly allocated to control or to one of two social networking intervention groups receiving vaccination reminders with (SNI+TP) or without (SNI--TP) a time pressure component via WhatsApp discussion groups at a ratio of 5:2:2. All participants first completed a baseline assessment. Both the SNI--TP and SNI+TP groups subsequently received weekly vaccination reminders from October to December 2017 and participated in WhatsApp discussions about SIV moderated by a health professional. All participants completed a follow-up assessment from April to May 2018. Results: A total of 84.9\% (174/205), 71\% (57/80), and 75\% (60/80) who were allocated to the control, SNI--TP, and SNI+TP groups, respectively, completed the outcome assessment. The social networking intervention significantly promoted mothers' self-efficacy for taking children for SIV (SNI--TP: odds ratio [OR] 2.69 [1.07-6.79]; SNI+TP: OR 2.50 [1.13-5.55]), but did not result in significantly improved children's SIV uptake. Moreover, after adjusting for mothers' working status, introducing additional time pressure reduced the overall SIV uptake in children of working mothers (OR 0.27 [0.10-0.77]) but significantly increased the SIV uptake among children of mothers without a full-time job (OR 6.53 [1.87-22.82]). Most participants' WhatsApp posts were about sharing experience or views (226/434, 52.1\%) of which 44.7\% (101/226) were categorized as negative, such as their concerns over vaccine safety, side effects and effectiveness. Although participants shared predominantly negative experience or views about SIV at the beginning of the discussion, the moderator was able to encourage the discussion of more positive experience or views and more knowledge and information. Most intervention group participants indicated willingness to receive the same interventions (110/117, 94.0\%) and recommend the interventions to other mothers (102/117, 87.2\%) in future Conclusions: Online information support can effectively promote mothers' self-efficacy for taking children for SIV but alone it may not sufficient to address maternal concerns over SIV to achieve a positive vaccination decision. However, the active involvement of health professionals in online discussions can shape positive discussions about vaccination. Time pressure on decision making interacts with maternal work status, facilitating vaccination uptake among mothers who may have more free time, but having the opposite effect among busier working mothers. Trial Registration: Hong Kong University Clinical Trials Registry HKUCTR-2250; https://tinyurl.com/vejv276 ",
doi="10.2196/16427",
url="http://www.jmir.org/2020/2/e16427/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130136"
}


@Article{info:doi/10.2196/16294,
author="Reiter, L. Paul
and Gower, L. Amy
and Kiss, E. Dale
and Malone, A. Molly
and Katz, L. Mira
and Bauermeister, A. Jose
and Shoben, B. Abigail
and Paskett, D. Electra
and McRee, Annie-Laurie",
title="A Web-Based Human Papillomavirus Vaccination Intervention for Young Gay, Bisexual, and Other Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="24",
volume="9",
number="2",
pages="e16294",
keywords="human papillomavirus",
keywords="human papillomavirus vaccination",
keywords="gay or bisexual",
keywords="men who have sex with men",
keywords="intervention",
keywords="young adult",
abstract="Background: Gay, bisexual, and other men who have sex with men experience several disparities related to human papillomavirus (HPV) infection, including high incidence rates of anal cancer. Although the HPV vaccine is currently recommended for young adults, HPV vaccine coverage is modest among young gay, bisexual, and other men who have sex with men (YGBMSM). Objective: We describe the design and methods for a randomized controlled trial (RCT) to rigorously evaluate Outsmart HPV, a population-targeted, individually tailored, Web-based HPV vaccination intervention for YGBMSM. The RCT is designed to determine the efficacy of the intervention, the mechanism by which the intervention has an effect (ie, mediation), and whether efficacy varies by participant characteristics (ie, moderation). Methods: Outsmart HPV was previously developed and pilot-tested. This study is a 3-arm prospective RCT that will enroll a projected 1995 YGBMSM who are aged 18 to 25 years, live in the United States, and have not received any doses of the HPV vaccine. Participants will be recruited by means of paid advertisements on social media sites and randomized to receive (1) standard information on the Web about HPV vaccine (control group), (2) Outsmart HPV content on the Web with monthly unidirectional vaccination reminders sent via text messages, or (3) Outsmart HPV content on the Web with monthly interactive vaccination reminders sent via text messages. Participants will complete Web-based surveys at 4 time points during the study: baseline, immediately after engaging with Web-based content, 3 months after randomization, and 9 months after randomization. Primary outcomes will include both HPV vaccine initiation (ie, receipt of 1 or more doses of the HPV vaccine) and completion (receipt of all 3 doses recommended for this age range). We will examine constructs from the intervention's theoretical framework as potential mediators and demographic and health-related characteristics as potential moderators of intervention effects. Results: The institutional review board at The Ohio State University has approved the study. Materials have been developed and finalized for all study groups. Recruitment for the RCT began in fall 2019. Conclusions: If shown to be efficacious, Outsmart HPV has the potential to fill an important gap by promoting HPV vaccination among a population at increased risk of HPV infection and HPV-related disease. Trial Registration: ClinicalTrials.gov NCT04032106; http://clinicaltrials.gov/show/NCT04032106 International Registered Report Identifier (IRRID): PRR1-10.2196/16294 ",
doi="10.2196/16294",
url="http://www.researchprotocols.org/2020/2/e16294/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130192"
}


@Article{info:doi/10.2196/16081,
author="Zaidi, Shehla
and Shaikh, Ali Saqib
and Sayani, Saleem
and Kazi, Momin Abdul
and Khoja, Adeel
and Hussain, Shahzad Syed
and Najmi, Rabia",
title="Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Feb",
day="13",
volume="8",
number="2",
pages="e16081",
keywords="mHealth",
keywords="immunization",
keywords="digital technology",
keywords="experience",
keywords="health workers",
abstract="Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers. ",
doi="10.2196/16081",
url="https://mhealth.jmir.org/2020/2/e16081",
url="http://www.ncbi.nlm.nih.gov/pubmed/32053115"
}


@Article{info:doi/10.2196/16929,
author="Van Velthoven, Helena Michelle
and Milne-Ives, Madison
and de Cock, Caroline
and Mooney, Mary
and Meinert, Edward",
title="Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="5",
volume="9",
number="2",
pages="e16929",
keywords="app",
keywords="smartphone technology",
keywords="vaccination",
keywords="vaccines",
keywords="immunization",
keywords="children",
keywords="mobile phone",
abstract="Background: The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective: The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods: We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100\% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and  health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results: This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions: This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID): PRR1-10.2196/16929 ",
doi="10.2196/16929",
url="https://www.researchprotocols.org/2020/2/e16929",
url="http://www.ncbi.nlm.nih.gov/pubmed/32022694"
}


@Article{info:doi/10.2196/16487,
author="Oliveira, R. Carlos
and Avni-Singer, Lital
and Badaro, Geovanna
and Sullivan, L. Erin
and Sheth, S. Sangini
and Shapiro, D. Eugene
and Niccolai, M. Linda",
title="Feasibility and Accuracy of a Computer-Assisted Self-Interviewing Instrument to Ascertain Prior Immunization With Human Papillomavirus Vaccine by Self-Report: Cross-Sectional Analysis",
journal="JMIR Med Inform",
year="2020",
month="Jan",
day="22",
volume="8",
number="1",
pages="e16487",
keywords="human papillomavirus vaccine",
keywords="self-report",
keywords="accuracy",
keywords="computer-assisted self-interviewing",
abstract="Background: Ascertaining history of prior immunization with human papillomavirus (HPV) vaccine can be challenging and resource-intensive. Computer-assisted self-interviewing instruments have the potential to address some of the challenges of self-reporting, and may also reduce the time, costs, and efforts associated with ascertaining immunization status. Objective: This study assesses both the feasibility and the accuracy of a computer-assisted self-interviewing instrument to ascertain a patient's history of immunization with the HPV vaccine. Methods: We developed both a survey and a Web-based data collection system using computer-assisted self-interviewing to ascertain self-reported HPV vaccine immunization history. We implemented the instrument in a sample of adult women enrolled in an ongoing study of the HPV vaccine. Vaccine records from prior sources of care were reviewed to verify reported immunization history. Results: Among the 312 participants who provided HPV vaccine immunization history by self-report, almost all (99\%) were able to do so using the computer-assisted self-interviewing instrument. The median survey completion time was 10 minutes (IQR 7-17). The accuracy of self-report was 84\%, sensitivity was 89\%, specificity was 80\%, and the negative predictive value was 92\%. Conclusions: We found that it is feasible to collect a history of immunization with the HPV vaccine using a computer-assisted self-interviewing instrument. This approach is likely to be acceptable to adult women and is reasonably accurate in a clinical research setting. ",
doi="10.2196/16487",
url="http://medinform.jmir.org/2020/1/e16487/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012073"
}


@Article{info:doi/10.2196/14007,
author="Shah, Zubair
and Surian, Didi
and Dyda, Amalie
and Coiera, Enrico
and Mandl, D. Kenneth
and Dunn, G. Adam",
title="Automatically Appraising the Credibility of Vaccine-Related Web Pages Shared on Social Media: A Twitter Surveillance Study",
journal="J Med Internet Res",
year="2019",
month="Nov",
day="4",
volume="21",
number="11",
pages="e14007",
keywords="health misinformation",
keywords="credibility appraisal",
keywords="machine learning",
keywords="social media",
abstract="Background: Tools used to appraise the credibility of health information are time-consuming to apply and require context-specific expertise, limiting their use for quickly identifying and mitigating the spread of misinformation as it emerges. Objective: The aim of this study was to estimate the proportion of vaccine-related Twitter posts linked to Web pages of low credibility and measure the potential reach of those posts. Methods: Sampling from 143,003 unique vaccine-related Web pages shared on Twitter between January 2017 and March 2018, we used a 7-point checklist adapted from validated tools and guidelines to manually appraise the credibility of 474 Web pages. These were used to train several classifiers (random forests, support vector machines, and recurrent neural networks) using the text from a Web page to predict whether the information satisfies each of the 7 criteria. Estimating the credibility of all other Web pages, we used the follower network to estimate potential exposures relative to a credibility score defined by the 7-point checklist. Results: The best-performing classifiers were able to distinguish between low, medium, and high credibility with an accuracy of 78\% and labeled low-credibility Web pages with a precision of over 96\%. Across the set of unique Web pages, 11.86\% (16,961 of 143,003) were estimated as low credibility and they generated 9.34\% (1.64 billion of 17.6 billion) of potential exposures. The 100 most popular links to low credibility Web pages were each potentially seen by an estimated 2 million to 80 million Twitter users globally. Conclusions: The results indicate that although a small minority of low-credibility Web pages reach a large audience, low-credibility Web pages tend to reach fewer users than other Web pages overall and are more commonly shared within certain subpopulations. An automatic credibility appraisal tool may be useful for finding communities of users at higher risk of exposure to low-credibility vaccine communications. ",
doi="10.2196/14007",
url="https://www.jmir.org/2019/11/e14007",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682571"
}


@Article{info:doi/10.2196/14791,
author="Munnoch, Sally-Anne
and Cashman, Patrick
and Peel, Roseanne
and Attia, John
and Hure, Alexis
and Durrheim, N. David",
title="Participant-Centered Online Active Surveillance for Adverse Events Following Vaccination in a Large Clinical Trial: Feasibility and Usability Study",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="23",
volume="21",
number="10",
pages="e14791",
keywords="clinical trials",
keywords="active surveillance",
keywords="adverse events following immunization",
keywords="technology",
keywords="vaccination",
abstract="Background: Active participant monitoring of adverse events following immunization (AEFI) is a recent development to improve the speed and transparency of vaccine safety postmarketing. Vaxtracker, an online tool used to monitor vaccine safety, has successfully demonstrated its usefulness in postmarketing surveillance of newly introduced childhood vaccines. However, its use in older participants, or for monitoring patients participating in large clinical trials, has not been evaluated. Objective: The objective of this study was to monitor AEFIs in older participants enrolled in the Australian Study for the Prevention through the Immunisation of Cardiovascular Events (AUSPICE) trial, and to evaluate the usefulness and effectiveness of Vaxtracker in this research setting. Methods: AUSPICE is a multicenter, randomized, placebo-controlled, double-blinded trial in which participants aged 55 to 61 years were given either the pneumococcal polysaccharide vaccine (23vPPV) or 0.9\% saline placebo. Vaxtracker was used to monitor AEFIs in participants in either treatment arm through the administration of two online questionnaires. A link to each questionnaire was sent to participants via email or short message service (SMS) text message 7 and 28 days following vaccination. Data were collated and analyzed in near-real time to identify any possible safety signals indicating problems with the vaccine or placebo. Results: All 4725 AUSPICE participants were enrolled in Vaxtracker. Participant response rates for the first and final survey were 96.47\% (n=4558) and 96.65\% (n=4525), respectively. The online survey was completed by 90.23\% (4083/4525) of Vaxtracker participants within 3 days of receiving the link. AEFIs were reported by 34.40\% (805/2340) of 23vPPV recipients and 10.29\% (240/2332) of placebo recipients in the 7 days following vaccination. Dominant symptoms for vaccine and placebo recipients were pain at the injection site (587/2340, 25.09\%) and fatigue (103/2332, 4.42\%), respectively. Females were more likely to report symptoms following vaccination with 23vPPV compared with males (433/1138, 38.05\% versus 372/1202, 30.95\%; P<.001). Conclusions: Vaxtracker is an effective tool for monitoring AEFIs in the 55 to 61 years age group. Participant response rates were high for both surveys, in both treatment arms and for each method of sending the survey. This study indicates that administration of 23vPPV was well-tolerated in this cohort. Vaxtracker has successfully demonstrated its application in the monitoring of adverse events in near-real time following vaccination in people participating in a national clinical trial. Trial Registration: Australian New Zealand Trial Registry Number (ACTRN) 12615000536561; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368506 ",
doi="10.2196/14791",
url="https://www.jmir.org/2019/10/e14791",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647470"
}


@Article{info:doi/10.2196/14461,
author="Torbosh, Amr
and Al Amad, Abdulla Mohammed
and Al Serouri, Abdulwahed
and Khader, Yousef",
title="The Impact of War in Yemen on Immunization Coverage of Children Under One Year of Age: Descriptive Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Oct",
day="23",
volume="5",
number="4",
pages="e14461",
keywords="immunization coverage",
keywords="2015 war",
keywords="impact",
keywords="Y-FETP",
keywords="Yemen",
abstract="Background: After 2 years of war that crippled the capacity of the Yemeni National Health System and left only 45\% of health facilities functioning, Yemen faced increasing vaccine-preventable disease (VPD) outbreaks and may be at high risk of polio importation. Objective: The aim of this study was to determine the impact of the 2015 war on the immunization coverage of children under 1 year. Methods: Data on vaccination coverage for 2012-2015 were obtained from the national Expanded Program on Immunization (EPI). The vaccination coverage was calculated at the national and governorate levels by dividing the number of actually vaccinated children by the estimated population of children under 1 year. Results: Although there was an increase from 2012 to 2014 in the national coverage for penta-3 vaccine (82\% in 2012 vs 88\% in 2014) and measles vaccine (70\% in 2012 vs 75\% in 2014), the coverage was still below the national target (?95\%). Furthermore, the year 2015 witnessed a marked drop in the national coverage compared with 2014 for the measles vaccine (66\% in 2015 vs 75\% in 2014), but a slight drop in penta-3 vaccine coverage (84\% in 2015 vs 88\% in 2014). Bacillus Calmette--Gu{\'e}rin vaccine also showed a marked drop from 73\% in 2014 to 49\% in 2015. These reductions were more marked in governorates that witnessed armed confrontations (eg, Taiz, Lahj, and Sa'dah governorates). On the other hand, governorates that did not witness armed confrontations showed an increase in coverage (eg, Raymah and Ibb), owing to an increase in their population because of displacement from less secure and confrontation-prone governorates. Conclusions: This analysis demonstrated the marked negative impact of the 2015 war on immunization coverage, especially in the governorates that witnessed armed confrontations. This could put Yemen at more risk of VPD outbreaks and polio importation. Besides the ongoing efforts to stop the Yemeni war, strategies for more innovative vaccine delivery or provision and fulfilling the increasing demands are needed, especially in governorates with confrontations. Enhancing EPI performance through supportable investments in infrastructure that was destroyed by the war and providing decentralized funds are a prerequisite. ",
doi="10.2196/14461",
url="http://publichealth.jmir.org/2019/4/e14461/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31647465"
}


@Article{info:doi/10.2196/14451,
author="Amily, Sadiq Ali
and Lami, Faris
and Khader, Yousef",
title="Impact of Training of Primary Health Care Centers' Vaccinators on Immunization Session Practices in Wasit Governorate, Iraq: Interventional Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Oct",
day="7",
volume="5",
number="4",
pages="e14451",
keywords="immunization",
keywords="primary health care",
keywords="intervention",
keywords="practices",
keywords="Iraq",
abstract="Background: Immunization averts more than 2.5 million deaths of children annually. The World Health Organization (WHO) and the United Nations Children's Fund estimates of immunization coverage in Iraq in 2015 revealed a 58\% coverage for the third dose of the diphtheria-tetanus-pertussis vaccine and a 57\% coverage for the measles vaccine. High-quality immunization session practices (ISPs) can ensure safer, more effective vaccination and higher coverage rates. Objective: The goal of this study was to assess the impact of training of primary health care centers' (PHCs) vaccinators on the quality of ISPs. Methods: This was an interventional study conducted on 10 (18\%) PHCs in Wasit Governorate. Two PHCs were randomly selected from each health district. ISPs were assessed by direct on-job observation, using modified WHO immunization session checklists. Findings were grouped into seven domains: vaccine and diluent management, cold chain management, session equipment, registration, communication, vaccine preparation and administration, and waste management. The vaccinators were enrolled in a one-day training session using the WHO module, ``Managing an Immunization Session'', and one month later a second assessment was conducted using the same tools and techniques. We then calculated the median differences of the domains' scores. Results: A total of 42 vaccinators were trained, with 25 (60\%) of them having graduated from technical health institutes, but only 15 (36\%) having had previous training on standard ISPs. Following training, a significant improvement was noticed in three domains: vaccines and diluents management (P=.01), cold chain management (P=.01) and vaccine preparation and administration (P=.02). Conclusions: The training of the PHCs' vaccinators for a single day was effective in improving some ISPs. We would recommend using this training module, or a more in-depth one, for other PHCs to improve utilization of immunization services. ",
doi="10.2196/14451",
url="https://publichealth.jmir.org/2019/4/e14451",
url="http://www.ncbi.nlm.nih.gov/pubmed/31593540"
}


@Article{info:doi/10.2196/13557,
author="Khader, S. Yousef
and Laflamme, Lucie
and Schmid, Daniela
and El-Halabi, Soha
and Abu Khdair, Mohammad
and Sengoelge, Mathilde
and Atkins, Salla
and Tahtamouni, Manal
and Derrough, Tarik
and El-Khatib, Ziad",
title="Children Immunization App (CImA) Among Syrian Refugees in Zaatari Camp, Jordan: Protocol for a Cluster Randomized Controlled Pilot Trial Intervention Study ",
journal="JMIR Res Protoc",
year="2019",
month="Oct",
day="7",
volume="8",
number="10",
pages="e13557",
keywords="mHealth",
keywords="refugees",
keywords="vaccines",
keywords="Jordan",
keywords="Syria",
abstract="Background: There are up to 19.4 million children who are still unvaccinated and face unnecessary deaths, especially among refugees. However, growing access to smartphones, among refugees, can be a leading factor to improve vaccination rates. Objective: This study aims to determine whether a smartphone app can improve the vaccination uptake among refugees and determine the app's effectiveness in improving the documentation of vaccination records. Methods: We developed and planned to test an app through a cluster randomized trial that will be carried out at the Zaatari refugee camp in Jordan. The study will be open to all parents who carry Android smartphones, have at least one child, and agree to participate in the study. The parents will be recruited to the study by trained volunteers at the vaccination sites around the Zaatari camp. Inclusion criteria will be the following: having at least one child of 0 to 5 years, being a local resident of the camp, and having an Android smartphone. Results: The intervention includes an app that will allow storing Jordanian vaccination records, per child, on the parents' smartphones in Arabic and English (in an interchangeable fashion). Every record will have a set of automated reminders before the appointment of each child. The app will summarize immunization records in form of due, taken, or overdue appointments, labeled in orange, green, and red, respectively. Baseline will include the collection of our primary and secondary outcomes that are needed for the pre and postdata measurements. This includes social demographic data, any previous vaccination history, and electronic health literacy. Participants, in both study arms, will be monitored for their follow-up visits to the clinic for vaccination doses. For the study outcome measures, we will measure any differences in the uptake of vaccinations. The secondary outcome is to analyze the effect of the children immunization app on visits for follow-up doses. Conclusions: Owing to the limited evidence of effective interventions for childhood vaccination among refugees, research in this area is greatly needed. The project will have a significant impact on the health of refugees and the public health system. In Jordan and the Middle East, the vaccination level is low. Given the influx of refugees from the area, it is crucial to ensure a high vaccination level among the children. International Registered Report Identifier (IRRID): PRR1-10.2196/13557 ",
doi="10.2196/13557",
url="https://www.researchprotocols.org/2019/10/e13557",
url="http://www.ncbi.nlm.nih.gov/pubmed/31593549"
}


@Article{info:doi/10.5210/ojphi.v11i2.10244,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2019",
volume="11",
number="2",
pages="e10244",
doi="10.5210/ojphi.v11i2.10244",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/31632609"
}


@Article{info:doi/10.2196/13221,
author="Gibson, G. Dustin
and Kagucia, Wangeci E.
and Were, Joyce
and Obor, David
and Hayford, Kyla
and Ochieng, Benard",
title="Text Message Reminders and Unconditional Monetary Incentives to Improve Measles Vaccination in Western Kenya: Study Protocol for the Mobile and Scalable Innovations for Measles Immunization Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Jul",
day="09",
volume="8",
number="7",
pages="e13221",
keywords="measles vaccine",
keywords="text messaging",
keywords="Kenya",
keywords="vaccination coverage",
abstract="Background: Globally, 21 million children do not receive the measles vaccine each year. With high levels of mobile phone access and ownership, opportunities exist to leverage mobile health technologies to generate demand for immunization. Objective: The aim of the Mobile and Scalable Innovations for Measles Immunization trial is to determine if text message (short message service, SMS) reminders, either with or without mobile phone--based incentives, can improve measles immunization coverage and timeliness in rural western Kenya. Methods: This is a 3-arm, parallel, randomized controlled trial (RCT). Using simple randomization, caregivers in Siaya County, Kenya, will be randomized and evenly allocated to 1 of 3 study arms: (1) control, (2) SMS reminders only, and (3) SMS reminders plus a 150 Kenyan Shilling (KES) incentive. Participants assigned to the SMS group will be sent SMS reminders 3 days before and on the day before the measles immunization visit scheduled for when the child is 9 months of age. Participants in the incentive arm will, in addition to SMS reminders as above, be sent an unconditional 150 KES mobile-money incentive to their mobile phone 3 days before the child becomes 9 months of age. Children will be followed up to the age of 12 months to assess the primary outcome, a measles vaccination by 10 months of age. Log-binomial regressions will be used to calculate relative risks. Results: Enrollment was completed in March 2017. We enrolled 537 caregivers and their infants into the following groups: control (n=179), SMS reminders only (n=179), and SMS reminders plus 150 KES (n=179). Results will be made publicly available in 2020. Conclusions: Few RCTs have examined the effect of text message reminders to improve measles immunization coverage. This is the first study to assess the effect of SMS reminders with and without unconditionally provided mobile-money incentives to improve measles immunization coverage. Trial Registration: ClinicalTrials.gov NCT02904642; https://clinicaltrials.gov/ct2/show/NCT02904642 (Archived by WebCite? at http://www.webcitation.org/78r7AzD2X). International Registered Report Identifier (IRRID): RR1-10.2196/13221 ",
doi="10.2196/13221",
url="http://www.researchprotocols.org/2019/7/e13221/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290405"
}


@Article{info:doi/10.2196/13832,
author="Cunningham-Erves, Jennifer
and Koyama, Tatsuki
and Huang, Yi
and Jones, Jessica
and Wilkins, H. Consuelo
and Harnack, Lora
and McAfee, Caree
and Hull, C. Pamela",
title="Providers' Perceptions of Parental Human Papillomavirus Vaccine Hesitancy: Cross-Sectional Study",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="02",
volume="5",
number="2",
pages="e13832",
keywords="neoplasms",
keywords="papillomavirus infections",
keywords="papillomavirus vaccines",
keywords="primary prevention",
keywords="health care provider",
keywords="vaccine hesitancy",
keywords="provider barriers to HPV vaccination",
abstract="Background: Human papillomavirus (HPV) vaccine hesitancy among parents contributes to low vaccination coverage in adolescents. To improve health care provider communication and vaccine recommendation practices with hesitant parents, it is important to understand how providers perceive parental HPV vaccine hesitancy. Objective: This study aimed to characterize perceived reasons for parental HPV vaccine hesitancy and identify factors associated with perceived parental hesitancy among providers at community-based pediatric clinics. Methods: In 2018, providers in 23 community-based pediatric clinics in Tennessee were invited to complete a Web-based baseline survey as part of a larger quality improvement study focused on HPV vaccine uptake. These survey data were used for a cross-sectional, secondary data analysis. Scale scores ranging from 0 to 100 were calculated for provider self-efficacy (confidence in ability to recommend HPV vaccine), provider outcome expectations (expectations that recommendation will influence parents' decisions), and perceived parental HPV vaccine hesitancy. Provider confidence in HPV vaccine safety and effectiveness were categorized as high versus low. Clinic-level exposures examined were clinic size and rural-urban location. Descriptive analyses were used to characterize perceived parental barriers by provider type. Mixed-effects linear regression models were fit taking one exposure variable at a time, whereas controlling for provider type, age, gender, and race to identify provider- and clinic-level factors associated with perceived parental barriers to HPV vaccination. Results: Of the 187 providers located in the 23 clinics, 137 completed the survey. The majority of physician providers were white and female, with a higher percentage of females among nurse practitioners (NPs) and physician assistants (PAs). The most common parental barriers to HPV vaccination perceived by providers were concerns about HPV vaccine safety (88\%), child being too young (78\%), low risk of HPV infection for child through sexual activity (70\%), and mistrust in vaccines (59\%). In adjusted mixed models, perceived parental HPV vaccine hesitancy was significantly associated with several provider-level factors: self-efficacy (P=.001), outcome expectations (P<.001), and confidence in HPV vaccine safety (P=.009). No significant associations were observed between perceived parental HPV vaccine hesitancy and clinic-level factors clinic size nor location. Conclusions: Researchers developing provider-focused interventions to reduce parental HPV vaccine hesitancy should consider addressing providers' self-efficacy, outcome expectations, and confidence in HPV vaccine safety to help providers communicate more effectively with HPV vaccine hesitant parents. ",
doi="10.2196/13832",
url="https://cancer.jmir.org/2019/2/e13832/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31267976"
}


@Article{info:doi/10.2196/13456,
author="On, Jeongah
and Park, Hyeoun-Ae
and Song, Tae-Min",
title="Sentiment Analysis of Social Media on Childhood Vaccination: Development of an Ontology",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="7",
volume="21",
number="6",
pages="e13456",
keywords="social media",
keywords="vaccination",
keywords="health information interoperability",
keywords="semantics",
abstract="Background: Although vaccination rates are above the threshold for herd immunity in South Korea, a growing number of parents have expressed concerns about the safety of vaccines. It is important to understand these concerns so that we can maintain high vaccination rates. Objective: The aim of this study was to develop a childhood vaccination ontology to serve as a framework for collecting and analyzing social data on childhood vaccination and to use this ontology for identifying concerns about and sentiments toward childhood vaccination from social data. Methods: The domain and scope of the ontology were determined by developing competency questions. We checked if existing ontologies and conceptual frameworks related to vaccination can be reused for the childhood vaccination ontology. Terms were collected from clinical practice guidelines, research papers, and posts on social media platforms. Class concepts were extracted from these terms. A class hierarchy was developed using a top-down approach. The ontology was evaluated in terms of description logics, face and content validity, and coverage. In total, 40,359 Korean posts on childhood vaccination were collected from 27 social media channels between January and December 2015. Vaccination issues were identified and classified using the second-level class concepts of the ontology. The sentiments were classified in 3 ways: positive, negative or neutral. Posts were analyzed using frequency, trend, logistic regression, and association rules. Results: Our childhood vaccination ontology comprised 9 superclasses with 137 subclasses and 431 synonyms for class, attribute, and value concepts. Parent's health belief appeared in 53.21\% (15,709/29,521) of posts and positive sentiments appeared in 64.08\% (17,454/27,236) of posts. Trends in sentiments toward vaccination were affected by news about vaccinations. Posts with parents' health belief, vaccination availability, and vaccination policy were associated with positive sentiments, whereas posts with experience of vaccine adverse events were associated with negative sentiments. Conclusions: The childhood vaccination ontology developed in this study was useful for collecting and analyzing social data on childhood vaccination. We expect that practitioners and researchers in the field of childhood vaccination could use our ontology to identify concerns about and sentiments toward childhood vaccination from social data. ",
doi="10.2196/13456",
url="http://www.jmir.org/2019/6/e13456/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199290"
}


@Article{info:doi/10.2196/13256,
author="Lee, Yun Hee
and Lee, Hwa Mi
and Sharratt, Monica
and Lee, Sohye
and Blaes, Anne",
title="Development of a Mobile Health Intervention to Promote Papanicolaou Tests and Human Papillomavirus Vaccination in an Underserved Immigrant Population: A Culturally Targeted and Individually Tailored Text Messaging Approach",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="6",
volume="7",
number="6",
pages="e13256",
keywords="uterine cervical cancer",
keywords="papanicolaou test",
keywords="papillomavirus infections",
keywords="papillomavirus vaccines",
keywords="text messaging",
keywords="Asian American",
keywords="immigrants",
abstract="Background: Disparities in cervical cancer incidence and mortality signify the need for intervention efforts targeting Korean American immigrant women. Objective: The purpose of this study was to demonstrate how a culturally targeted and tailored mobile text messaging intervention, mobile screening (mScreening), was developed to promote the uptake of Papanicolaou tests and human papillomavirus vaccine among young Korean American immigrant women. Methods: Guided by the Fogg behavior model, the mScreening intervention was developed through a series of focus groups. Braun and Clarke's thematic analysis was used to identify core themes. Results: Overall, 4 themes were identified: (1) tailored message content (ie, basic knowledge about cervical cancer), (2) an interactive and visual message format (ie, age-appropriate and friendly messages using emoticons), (3) brief message delivery formats to promote participant engagement, and (4) use of an incentive to motivate participation (ie, gift cards). Conclusions: This study demonstrated the processes of gathering culturally relevant information to develop a mobile phone text messaging intervention and incorporating the target population's perspectives into the development of the intervention. The findings of the study could help guide future intervention development targeting different types of cancer screening in other underserved racial or ethnic groups. ",
doi="10.2196/13256",
url="https://mhealth.jmir.org/2019/6/e13256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199340"
}


@Article{info:doi/10.2196/12851,
author="Kazi, Momin Abdul
and Ahsan, Nazia
and Khan, Ayub
and Jamal, Saima
and Kalimuddin, Hussain
and Ghulamhussain, Naveera
and Wajidali, Zabin
and Muqeet, Abdul
and Zaidi, Fabiha
and Subzlani, Meraj
and McKellin, William
and Ali, Asad
and Collet, Jean-Paul",
title="Personalized Text Messages and Automated Calls for Improving Vaccine Coverage Among Children in Pakistan: Protocol for a Community-Based Cluster Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2019",
month="May",
day="30",
volume="8",
number="5",
pages="e12851",
keywords="routine immunization",
keywords="SMS messages",
keywords="automated call messages",
keywords="cluster randomized clinical trial",
keywords="vaccine barriers",
keywords="personalized intervention",
keywords="cell phones",
keywords="vaccination coverage",
keywords="mobile health",
keywords="text messaging",
keywords="developing countries",
keywords="parents",
abstract="Background: A major reason for poor childhood vaccine coverage in developing countries is the lack of awareness among parents and caregivers regarding the need for immunization and the importance of completing the entire series of vaccines. Short message service (SMS)--based interventions have been quite effective in different programs such as smoking cessation, treatment adherence, health care scheduled appointment attendance, antenatal care attendance, and compliance to immunization. However, there are limited data from low- and middle-income countries on the role of SMS and automated call--based messages and interventions to improve routine immunization (RI) coverage. Objective: The primary objective of this study is to evaluate whether automated mobile phone--based personalized messages (SMS or automated call) can improve RI uptake at 6, 10, and 14 weeks of age per the expanded program immunization schedule, compared with a usual care control group. Secondary objectives include assessing the effects of different types of automated SMS text or calls on RI coverage at 20 weeks of age. Methods: This is a mixed methods study using a clustered randomized controlled trial with 4 intervention arms and 1 control arm, augmented by qualitative interviews for personalizing the message. The study is being conducted in Pakistan (an urban site in Karachi and a rural site Matiari). In Karachi, 250 administrative structures are taken as 1 cluster, whereas in Matiari, a catchment area of 4 Lady Health Workers is considered as 1 cluster. The intervention targets families to receive weekly 1-way or 2-way (interactive) personalized automated SMS or automated phone call messages regarding vaccination. Possible barriers to vaccination are assessed in each family at the time of inclusion to determine the type of personalized messages that should be sent to the family to increase the chance of a positive response. Finally, in-depth interviews using purposive sampling are conducted before and after the trial to determine the family's vaccination experience and related factors. Results: All study participants for the cluster randomized trial were enrolled by January 14, 2019. Study exit interviews at 20-weeks follow-up visits will be completed by June 2019. Conclusions: The results of this study will be useful to understand the respective effects of SMS text messages versus automated phone--based communication to improve RI coverage and timelines. Moreover, information regarding families' perceptions of vaccination and the daily life challenges for timely visits to the vaccine clinic will be used for developing more complex interventions that use mobile phone messages and possibly other approaches to overcome barriers in the uptake of correct and timely immunization practices. Trial Registration: ClinicalTrials.gov NCT03341195; https://clinicaltrials.gov/ct2/show/NCT03341195 (Archived by WebCite at http://www.webcitation.org/78EWA56Uo) International Registered Report Identifier (IRRID): DERR1-10.2196/12851 ",
doi="10.2196/12851",
url="http://www.researchprotocols.org/2019/5/e12851/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31148544"
}


@Article{info:doi/10.2196/12223,
author="Ahn, Hyun Sang
and Zhiang, Jooho
and Kim, Hyery
and Chang, Seyun
and Shin, Jaewon
and Kim, Myeongchan
and Lee, Yura
and Lee, Jae-Ho
and Park, Rang Yu",
title="Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="22",
volume="7",
number="4",
pages="e12223",
keywords="patient-generated health data",
keywords="vaccination",
keywords="postvaccination fever",
keywords="digital health care",
keywords="mobile app",
abstract="Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ?39{\textdegree}C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05\%) children had taken antipyretic drugs, and 3238 (89.15\%) children took antibiotics at body temperatures above 38{\textdegree}C. The number of children taking antipyretics at a body temperature of 38{\textdegree}C was more than four times that of those taking antipyretics at 37.9{\textdegree}C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9{\textdegree}C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. ",
doi="10.2196/12223",
url="http://mhealth.jmir.org/2019/4/e12223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008712"
}


@Article{info:doi/10.2196/11419,
author="Blomberg, Karin
and Eriksson, Mats
and B{\"o}{\"o}, Rickard
and Gr{\"o}nlund, {\AA}ke",
title="Using a Facebook Forum to Cope With Narcolepsy After Pandemrix Vaccination: Infodemiology Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="16",
volume="21",
number="4",
pages="e11419",
keywords="narcolepsy",
keywords="mass vaccination",
keywords="social media",
abstract="Background: In 2010, newly diagnosed narcolepsy cases among children and adolescents were seen in several European countries as a consequence of comprehensive national vaccination campaigns with Pandemrix against H1N1 influenza. Since then, a large number of people have had to live with narcolepsy and its consequences in daily life, such as effects on school life, social relationships, and activities. Initially, the adverse effects were not well understood and there was uncertainty about whether there would be any financial compensation. The situation remained unresolved until 2016, and during these years affected people sought various ways to join forces to handle the many issues involved, including setting up a social media forum. Objective: Our aim was to examine how information was shared, and how opinions and beliefs about narcolepsy as a consequence of Pandemrix vaccination were formed through discussions on social media. Methods: We used quantitative and qualitative methods to investigate a series of messages posted in a social media forum for people affected by narcolepsy after vaccination. Results: Group activity was high throughout the years 2010 to 2016, with peaks corresponding to major narcolepsy-related events, such as the appearance of the first cases in 2010, the first payment of compensation in 2011, and passage of a law on compensation in July 2016. Unusually, most (462/774, 59.7\%) of the group took part in discussions and only 312 of 774 (40.3\%) were lurkers (compared with the usual 90\% rule of thumb for participation in an online community). The conversation in the group was largely factual and had a civil tone, even though there was a long struggle for the link between the vaccine and narcolepsy to be acknowledged and regarding the compensation issue. Radical, nonscientific views, such as those expounded by the antivaccination movement, did not shape the discussions in the group but were being actively expressed elsewhere on the internet. At the outset of the pandemic, there were 18 active Swedish discussion groups on the topic, but most dissolved quickly and only one Facebook group remained active throughout the period. Conclusions: The group studied is a good example of social media use for self-help through a difficult situation among people affected by illness and disease. This shows that social media do not by themselves induce trench warfare but, given a good group composition, can provide a necessary forum for managing an emergency situation where health care and government have failed or are mistrusted, and patients have to organize themselves so as to cope. ",
doi="10.2196/11419",
url="http://www.jmir.org/2019/4/e11419/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30990457"
}


@Article{info:doi/10.2196/12307,
author="Dodd, H. Rachael
and Obermair, M. Helena
and McCaffery, J. Kirsten",
title="A Thematic Analysis of Attitudes Toward Changes to Cervical Screening in Australia",
journal="JMIR Cancer",
year="2019",
month="Apr",
day="11",
volume="5",
number="1",
pages="e12307",
keywords="screening",
keywords="attitudes",
keywords="cervical cancer",
keywords="knowledge",
abstract="Background: In December 2017, the Australian National Cervical Screening Program (NCSP) was changed to encompass a 5-yearly human papillomavirus (HPV) primary test for women aged 25 to 74 years. Public concerns about changes to screening programs has been demonstrated in other countries previously. Objective: The aim of the study was to explore in depth women's understanding of and concerns about the specific changes to the Australian NCSP implemented in December 2017. Methods: A Web-based petition (Change.org) opposing the changes received over 70,000 signatures and nearly 20,000 comments from February to March 2017. Of 19,633 comments, a random sample of 10\% (2000/19,633) were analyzed using content analysis (reported elsewhere). Comments relating directly to the specific changes to the program were further analyzed using qualitative thematic analysis. Results: Around one-third (34.55\%; 691/2000) of the total comments were related to concerns about specific changes to the program. The greatest concern was that screening intervals would be too long and that cancer may not be detected in time for successful treatment. Missing cancer in younger women (aged <25 years) was also an important concern, perceiving younger women to remain at significant risk. Notably, concern was rarely expressed about the new test (the HPV test). Conclusions: Gaps in knowledge and understanding about changes to the program and the rationale behind these have caused health concerns among women. Worry about the extended screening interval indicates little understanding of the slow progression of the HPV infection to cervical cancer or the high rates of regression. Identification of these knowledge gaps can inform both deintensification of other cancer screening programs and practitioners, so that they are able to address these concerns with their patients. ",
doi="10.2196/12307",
url="http://cancer.jmir.org/2019/1/e12307/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30973340"
}


@Article{info:doi/10.2196/games.8540,
author="Ruiz-L{\'o}pez, Tom{\'a}s
and Sen, Sagar
and Jakobsen, Elisabeth
and Trop{\'e}, Ameli
and Castle, E. Philip
and Hansen, Terning Bo
and Nyg{\aa}rd, Mari",
title="FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer",
journal="JMIR Serious Games",
year="2019",
month="Apr",
day="08",
volume="7",
number="2",
pages="e8540",
keywords="papillomavirus vaccines",
keywords="educational technology",
keywords="uterine cervical neoplasms",
keywords="papillomavirus infections",
keywords="primary prevention",
keywords="secondary prevention",
keywords="early detection of cancer",
keywords="mobile applications",
keywords="health education",
keywords="learning",
abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69\% (18/26) reported that they liked the game, and 81\% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. ",
doi="10.2196/games.8540",
url="https://games.jmir.org/2019/2/e8540/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30958271"
}


@Article{info:doi/10.2196/12480,
author="Lama, Yuki
and Hu, Dian
and Jamison, Amelia
and Quinn, Crouse Sandra
and Broniatowski, A. David",
title="Characterizing Trends in Human Papillomavirus Vaccine Discourse on Reddit (2007-2015): An Observational Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Mar",
day="18",
volume="5",
number="1",
pages="e12480",
keywords="papillomavirus infections",
keywords="prevention \& control",
keywords="cancer prevention",
keywords="cervical cancer",
keywords="HPV",
keywords="vaccination",
keywords="papillomavirus vaccines",
keywords="immunology",
keywords="administration \& dosage",
keywords="social media",
keywords="health communication",
keywords="infodemiology",
abstract="Background: Despite the introduction of the human papillomavirus (HPV) vaccination as a preventive measure in 2006 for cervical and other cancers, uptake rates remain suboptimal, resulting in preventable cancer mortality. Social media, widely used for information seeking, can influence users' knowledge and attitudes regarding HPV vaccination. Little is known regarding attitudes related to HPV vaccination on Reddit (a popular news aggregation site and online community), particularly related to cancer risk and sexual activity. Examining HPV vaccine--related messages on Reddit may provide insight into how HPV discussions are characterized on forums online and influence decision making related to vaccination. Objective: We observed how the HPV vaccine is characterized on Reddit over time and by user gender. Specifically, this study aimed to determine (1) if Reddit messages are more related to cancer risks or sexual behavior and (2) what other HPV vaccine--related discussion topics appear on Reddit. Methods: We gathered all public Reddit comments from January 2007 to September 2015. We manually annotated 400 messages to generate keywords and identify salient themes. We then measured the similarity between each comment and lists of keywords associated with sexual behavior and cancer risk using Latent Semantic Analysis (LSA). Next, we used Latent Dirichlet Allocation (LDA) to characterize remaining topics within the Reddit data. Results: We analyzed 22,729 messages containing the strings hpv or human papillomavirus and vaccin. LSA findings show that HPV vaccine discussions are significantly more related to cancer compared with sexual behavior from 2008 to 2015 (P<.001). We did not find a significant difference between genders in discussions of cancer and sexual activity (P>.05). LDA analyses demonstrated that although topics related to cancer risk and sexual activity were both frequently discussed (16.1\% and 14.5\% of word tokens, respectively), the majority of online discussions featured other topics. The most frequently discussed topic was politics associated with the vaccine (17.2\%). Other topics included HPV disease and/or immunity (13.5\%), the HPV vaccine schedule (11.5\%), HPV vaccine side effects (9.7\%), hyperlinks to outside sources (9.1\%), and the risks and benefit of HPV vaccination (8.5\%). Conclusions: Reddit discourse on HPV vaccine encompasses a broad range of topics among men and women, with HPV political debates and cancer risk making up the plurality of the discussion. Our findings demonstrated that women and men both discussed HPV, highlighting that Reddit users do not perceive HPV as an issue that only pertains to women. Given the increasing use of social media as a source of health information, these results can inform the development of targeted online health communication strategies to promote HPV vaccination to young adult users of Reddit. Analyzing online discussions on Reddit can inform health communication efforts by identifying relevant, important HPV-related topics among online communities. ",
doi="10.2196/12480",
url="http://publichealth.jmir.org/2019/1/e12480/"
}


@Article{info:doi/10.2196/10915,
author="Eley, Victoria Charlotte
and Young, Louise Vicki
and Hayes, Victoria Catherine
and Verlander, Q. Neville
and McNulty, Miriam Cliodna Ann",
title="Young People's Knowledge of Antibiotics and Vaccinations and Increasing This Knowledge Through Gaming: Mixed-Methods Study Using e-Bug",
journal="JMIR Serious Games",
year="2019",
month="Feb",
day="01",
volume="7",
number="1",
pages="e10915",
keywords="education",
keywords="children",
keywords="knowledge",
keywords="antibiotics",
keywords="vaccines",
abstract="Background: e-Bug, led by Public Health England, educates young people about important topics: microbes, infection prevention, and antibiotics. Body Busters and Stop the Spread are 2 new e-Bug educational games. Objective: This study aimed to determine students' baseline knowledge, views on the games, and knowledge improvement. Methods: Students in 5 UK educational provisions were observed playing 2 e-Bug games. Before and after knowledge and evaluation questionnaires were completed, and student focus groups were conducted. Results: A total of 123 junior and 350 senior students completed the questionnaires. Vaccination baseline knowledge was high. Knowledge increased significantly about antibiotic use, appropriate sneezing behaviors, and vaccinations. In total, 26 student focus groups were conducted. Body Busters was engaging and enjoyable, whereas Stop the Spread was fast-paced and challenging but increased vaccination and health behavior intentions. Conclusions: e-Bug games are an effective learning tool for students to enhance knowledge about microbes, infection prevention, and antibiotics. Game-suggested improvements should help increase enjoyment. ",
doi="10.2196/10915",
url="https://games.jmir.org/2019/1/e10915/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30707096"
}


@Article{info:doi/10.2196/publichealth.9544,
author="Hansen, Dalum Niels
and M{\o}lbak, K{\aa}re
and Cox, Johansson Ingemar
and Lioma, Christina",
title="Relationship Between Media Coverage and Measles-Mumps-Rubella (MMR) Vaccination Uptake in Denmark: Retrospective Study",
journal="JMIR Public Health Surveill",
year="2019",
month="Jan",
day="23",
volume="5",
number="1",
pages="e9544",
keywords="online news media",
keywords="vaccination uptake",
keywords="media influence on vaccination uptake",
keywords="MMR",
keywords="autism",
abstract="Background: Understanding the influence of media coverage upon vaccination activity is valuable when designing outreach campaigns to increase vaccination uptake. Objective: To study the relationship between media coverage and vaccination activity of the measles-mumps-rubella (MMR) vaccine in Denmark. Methods: We retrieved data on media coverage (1622 articles), vaccination activity (2 million individual registrations), and incidence of measles for the period 1997-2014. All 1622 news media articles were annotated as being provaccination, antivaccination, or neutral. Seasonal and serial dependencies were removed from the data, after which cross-correlations were analyzed to determine the relationship between the different signals. Results: Most (65\%) of the anti-vaccination media coverage was observed in the period 1997-2004, immediately before and following the 1998 publication of the falsely claimed link between autism and the MMR vaccine. There was a statistically significant positive correlation between the first MMR vaccine (targeting children aged 15 months) and provaccination media coverage (r=.49, P=.004) in the period 1998-2004. In this period the first MMR vaccine and neutral media coverage also correlated (r=.45, P=.003). However, looking at the whole period, 1997-2014, we found no significant correlations between vaccination activity and media coverage. Conclusions: Following the falsely claimed link between autism and the MMR vaccine, provaccination and neutral media coverage correlated with vaccination activity. This correlation was only observed during a period of controversy which indicates that the population is more susceptible to media influence when presented with diverging opinions. Additionally, our findings suggest that the influence of media is stronger on parents when they are deciding on the first vaccine of their children, than on the subsequent vaccine because correlations were only found for the first MMR vaccine. ",
doi="10.2196/publichealth.9544",
url="https://publichealth.jmir.org/2019/1/e9544/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30672743"
}


@Article{info:doi/10.2196/10347,
author="Zafar, Sidra
and Habboush, Yacob
and Beidas, Sary",
title="Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy",
journal="JMIR Med Educ",
year="2018",
month="Nov",
day="07",
volume="4",
number="2",
pages="e10347",
keywords="GRADE",
keywords="influenza",
keywords="vaccination",
keywords="spontaneous abortion",
keywords="miscarriage",
abstract="Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians' decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1--containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95\% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95\% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE. ",
doi="10.2196/10347",
url="http://mededu.jmir.org/2018/2/e10347/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30404772"
}


@Article{info:doi/10.2196/10090,
author="Tustin, Lee Jordan
and Crowcroft, Sarah Natasha
and Gesink, Dionne
and Johnson, Ian
and Keelan, Jennifer
and Lachapelle, Barbara",
title="User-Driven Comments on a Facebook Advertisement Recruiting Canadian Parents in a Study on Immunization: Content Analysis",
journal="JMIR Public Health Surveill",
year="2018",
month="Sep",
day="20",
volume="4",
number="3",
pages="e10090",
keywords="Facebook",
keywords="immunization",
keywords="vaccination",
keywords="antivaccination movement",
keywords="social media",
abstract="Background: More people are searching for immunization information online and potentially being exposed to misinformation and antivaccination sentiment in content and discussions on social media platforms. As vaccination coverage rates remain suboptimal in several developed countries, and outbreaks of vaccine-preventable diseases become more prevalent, it is important that we build on previous research by analyzing themes in online vaccination discussions, including those that individuals may see without actively searching for information on immunization. Objective: The study aimed to explore the sentiments and themes behind an unsolicited debate on immunization in order to better inform public health interventions countering antivaccination sentiment. Methods: We analyzed and quantified 117 user-driven open-ended comments on immunization posted in the Comments section of a Facebook advertisement that targeted Canadian parents for recruitment into a larger study on immunization. Then, 2 raters coded all comments using content analysis. Results: Of 117 comments, 85 were posted by unique commentators, with most being female (65/85, 77\%). The largest proportion of the immunization comments were positive (51/117, 43.6\%), followed by negative (41/117, 35.0\%), ambiguous (20/117, 17.1\%), and hesitant (5/117, 4.3\%). Inaccurate knowledge (27/130, 20.8\%) and misperceptions of risk (23/130, 17.7\%) were most prevalent in the 130 nonpositive comments. Other claims included distrust of pharmaceutical companies or government agencies (18/130, 13.8\%), distrust of the health care system or providers (15/130, 11.5\%), past negative experiences with vaccination or beliefs (10/130, 7.7\%), and attitudes about health and prevention (10/130, 7.7\%). Almost 40\% (29/74, 39\%) of the positive comments communicated the risks of not vaccinating, followed by judgments on the knowledge level of nonvaccinators (13/74, 18\%). A total of 10 positive comments (10/74, 14\%) specifically refuted the link between autism and vaccination. Conclusions: The presence of more than 100 unsolicited user-driven comments on a platform not intended for discussion, nor providing any information on immunization, illustrates the strong sentiments associated with immunization and the arbitrariness of the online platforms used for immunization debates. Health authorities should be more proactive in finding mechanisms to refute misinformation and misperceptions that are propagating uncontested online. Online debates and communications on immunization need to be identified by continuous monitoring in order for health authorities to understand the current themes and trends, and to engage in the discussion. ",
doi="10.2196/10090",
url="http://publichealth.jmir.org/2018/3/e10090/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249585"
}


@Article{info:doi/10.2196/publichealth.9681,
author="Chandir, Subhash
and Siddiqi, Arif Danya
and Hussain, Ahmed Owais
and Niazi, Tahira
and Shah, Taighoon Mubarak
and Dharma, Kumar Vijay
and Habib, Ali
and Khan, Javed Aamir",
title="Using Predictive Analytics to Identify Children at High Risk of Defaulting From a Routine Immunization Program: Feasibility Study",
journal="JMIR Public Health Surveill",
year="2018",
month="Sep",
day="04",
volume="4",
number="3",
pages="e63",
keywords="machine learning",
keywords="artificial intelligence",
keywords="immunizations",
keywords="dropouts",
keywords="predictive analytics",
abstract="Background: Despite the availability of free routine immunizations in low- and middle-income countries, many children are not completely vaccinated, vaccinated late for age, or drop out from the course of the immunization schedule. Without the technology to model and visualize risk of large datasets, vaccinators and policy makers are unable to identify target groups and individuals at high risk of dropping out; thus default rates remain high, preventing universal immunization coverage. Predictive analytics algorithm leverages artificial intelligence and uses statistical modeling, machine learning, and multidimensional data mining to accurately identify children who are most likely to delay or miss their follow-up immunization visits. Objective: This study aimed to conduct feasibility testing and validation of a predictive analytics algorithm to identify the children who are likely to default on subsequent immunization visits for any vaccine included in the routine immunization schedule. Methods: The algorithm was developed using 47,554 longitudinal immunization records, which were classified into the training and validation cohorts. Four machine learning models (random forest; recursive partitioning; support vector machines, SVMs; and C-forest) were used to generate the algorithm that predicts the likelihood of each child defaulting from the follow-up immunization visit. The following variables were used in the models as predictors of defaulting: gender of the child, language spoken at the child's house, place of residence of the child (town or city), enrollment vaccine, timeliness of vaccination, enrolling staff (vaccinator or others), date of birth (accurate or estimated), and age group of the child. The models were encapsulated in the predictive engine, which identified the most appropriate method to use in a given case. Each of the models was assessed in terms of accuracy, precision (positive predictive value), sensitivity, specificity and negative predictive value, and area under the curve (AUC). Results: Out of 11,889 cases in the validation dataset, the random forest model correctly predicted 8994 cases, yielding 94.9\% sensitivity and 54.9\% specificity. The C-forest model, SVMs, and recursive partitioning models improved prediction by achieving 352, 376, and 389 correctly predicted cases, respectively, above the predictions made by the random forest model. All models had a C-statistic of 0.750 or above, whereas the highest statistic (AUC 0.791, 95\% CI 0.784-0.798) was observed in the recursive partitioning algorithm. Conclusions: This feasibility study demonstrates that predictive analytics can accurately identify children who are at a higher risk for defaulting on follow-up immunization visits. Correct identification of potential defaulters opens a window for evidence-based targeted interventions in resource limited settings to achieve optimal immunization coverage and timeliness. ",
doi="10.2196/publichealth.9681",
url="http://publichealth.jmir.org/2018/3/e63/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30181112"
}


@Article{info:doi/10.2196/10180,
author="Berlinberg, J. Elyse
and Deiner, S. Michael
and Porco, C. Travis
and Acharya, R. Nisha",
title="Monitoring Interest in Herpes Zoster Vaccination: Analysis of Google Search Data",
journal="JMIR Public Health Surveill",
year="2018",
month="May",
day="02",
volume="4",
number="2",
pages="e10180",
keywords="herpes zoster",
keywords="vaccination",
keywords="Internet",
keywords="periodicity",
keywords="Google Trends",
keywords="infodemiology",
abstract="Background: A new recombinant subunit vaccine for herpes zoster (HZ or shingles) was approved by the United States Food and Drug Administration on October 20, 2017 and is expected to replace the previous live attenuated vaccine. There have been low coverage rates with the live attenuated vaccine (Zostavax), ranging from 12-32\% of eligible patients receiving the HZ vaccine. Objective: This study aimed to provide insight into trends and potential reasons for interest in HZ vaccination. Methods: Internet search data were queried from the Google Health application programming interface from 2004-2017. Seasonality of normalized search volume was analyzed using wavelets and Fisher's g test. Results: The search terms ``shingles vaccine,'' ``zoster vaccine,'' and ``zostavax'' all exhibited significant periodicity in the fall months (P<.001), with sharp increases after recommendations for vaccination by public health-related organizations. Although the terms ``shingles blisters,'' ``shingles itch,'' ``shingles rash,'' ``skin rash,'' and ``shingles medicine'' exhibited statistically significant periodicities with a seasonal peak in the summer (P<.001), the terms ``shingles contagious,'' ``shingles pain,'' ``shingles treatment,'' and ``shingles symptoms'' did not reveal an annual trend. Conclusions: There may be increased interest in HZ vaccination during the fall and after public health organization recommendations are broadcast. This finding points to the possibility that increased awareness of the vaccine through public health announcements could be evaluated as a potential intervention for increasing vaccine coverage. ",
doi="10.2196/10180",
url="http://publichealth.jmir.org/2018/2/e10180/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29720364"
}


@Article{info:doi/10.2196/jmir.8221,
author="Chen, Tao
and Dredze, Mark",
title="Vaccine Images on Twitter: Analysis of What Images are Shared",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="03",
volume="20",
number="4",
pages="e130",
keywords="vaccine",
keywords="visual communication",
keywords="image tweet",
keywords="Twitter",
keywords="retweet prediction",
keywords="social media",
abstract="Background: Visual imagery plays a key role in health communication; however, there is little understanding of what aspects of vaccine-related images make them effective communication aids. Twitter, a popular venue for discussions related to vaccination, provides numerous images that are shared with tweets. Objective: The objectives of this study were to understand how images are used in vaccine-related tweets and provide guidance with respect to the characteristics of vaccine-related images that correlate with the higher likelihood of being retweeted. Methods: We collected more than one million vaccine image messages from Twitter and characterized various properties of these images using automated image analytics. We fit a logistic regression model to predict whether or not a vaccine image tweet was retweeted, thus identifying characteristics that correlate with a higher likelihood of being shared. For comparison, we built similar models for the sharing of vaccine news on Facebook and for general image tweets. Results: Most vaccine-related images are duplicates (125,916/237,478; 53.02\%) or taken from other sources, not necessarily created by the author of the tweet. Almost half of the images contain embedded text, and many include images of people and syringes. The visual content is highly correlated with a tweet's textual topics. Vaccine image tweets are twice as likely to be shared as nonimage tweets. The sentiment of an image and the objects shown in the image were the predictive factors in determining whether an image was retweeted. Conclusions: We are the first to study vaccine images on Twitter. Our findings suggest future directions for the study and use of vaccine imagery and may inform communication strategies around vaccination. Furthermore, our study demonstrates an effective study methodology for image analysis. ",
doi="10.2196/jmir.8221",
url="http://www.jmir.org/2018/4/e130/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29615386"
}


@Article{info:doi/10.2196/publichealth.7026,
author="Kazi, Momin Abdul
and Ali, Murtaza
and Zubair, Khurram
and Kalimuddin, Hussain
and Kazi, Nafey Abdul
and Iqbal, Perwaiz Saleem
and Collet, Jean-Paul
and Ali, Asad Syed",
title="Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial",
journal="JMIR Public Health Surveill",
year="2018",
month="Mar",
day="07",
volume="4",
number="1",
pages="e20",
keywords="SMS",
keywords="mobile phone",
keywords="reminders",
keywords="low- and middle-income countries",
keywords="routine immunization",
keywords="children",
abstract="Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3\% (300/356) of the participants were eligible for enrollment and 94.1\% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0\%, 86/90 vs 86.4\%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0\% vs 71.3\%, P=.36). The 10 weeks scheduled visit (58.7\% vs 52.7\%, P=.30) and the 14 weeks scheduled visit (31.3\% vs 26.0\%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) ",
doi="10.2196/publichealth.7026",
url="http://publichealth.jmir.org/2018/1/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514773"
}


@Article{info:doi/10.2196/mhealth.8263,
author="Fadda, Marta
and Galimberti, Elisa
and Fiordelli, Maddalena
and Schulz, Johannes Peter",
title="Evaluation of a Mobile Phone--Based Intervention to Increase Parents' Knowledge About the Measles-Mumps-Rubella Vaccination and Their Psychological Empowerment: Mixed-Method Approach",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="07",
volume="6",
number="3",
pages="e59",
keywords="qualitative research",
keywords="measles-mumps-rubella vaccine",
keywords="surveys and questionnaires",
keywords="mobile applications",
keywords="knowledge",
keywords="patient participation",
abstract="Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most intervention studies is that they do not apply randomized controlled trials (RCTs), the method that, over the last 2 decades, has increasingly been considered as the only method to provide proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. This study, however, holds that methods other than RCTs also can produce meaningful results. Objective: The aim of this study was to evaluate 2 mobile phone--based interventions aimed at increasing parents' knowledge of the measles-mumps-rubella (MMR) vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The 2 interventions were part of an RCT. Methods: We conducted 2 studies with the RCT participants: a Web-based survey aimed at assessing their rating of the tool regarding a number of qualities such as usability and usefulness (N=140), and qualitative telephonic interviews to explore participants' experiences with the app (N=60). Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment intervention) liked the app significantly better compared with the group that only received the empowerment intervention (F2,137=15.335; P<.001). Parents who were exposed to the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that efforts to empower patients should always be accompanied by the provision of factual information. Using a narrative format that promotes parents' identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time. Trial Registration: International Standard Randomized Controlled Trial Number 30768813; http://www.isrctn.com/ ISRCTN30768813 (Archived by WebCite at http://www.webcitation.org/6xOQSJ3w8) ",
doi="10.2196/mhealth.8263",
url="http://mhealth.jmir.org/2018/3/e59/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514772"
}


@Article{info:doi/10.2196/publichealth.8921,
author="Tustin, Lee Jordan
and Crowcroft, Sarah Natasha
and Gesink, Dionne
and Johnson, Ian
and Keelan, Jennifer",
title="Internet Exposure Associated With Canadian Parents' Perception of Risk on Childhood Immunization: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2018",
month="Jan",
day="19",
volume="4",
number="1",
pages="e7",
keywords="Canadian parents",
keywords="vaccination",
keywords="immunization",
keywords="Internet",
keywords="vaccine safety",
abstract="Background: There is a large presence of provaccination and antivaccination content on the Internet. The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment. No other studies have investigated the association between seeking vaccine information online and Canadian parents' perception of risk on childhood immunization. Objective: We aimed to investigate the potential association between seeking vaccine information on the Internet and Canadian parents' perception of risk on childhood immunization in order to quantify the perceived association and increase our understanding on the impact of the Internet to help guide public health interventions. Methods: We analyzed this association in two population samples: a self-selecting Web-based sample of Canadian parents recruited through Facebook (n=966) and a population-based sample of parents recruited by random digit dialing (RDD; n=951). The outcome was parental perception of vaccine safety on a seven-point ordinal scale from ``not safe'' to ``extremely safe.'' An ordinal regression model was used to investigate if Internet information seeking on childhood vaccination predicted parental perception of vaccine safety. Results: After adjusting for income level, Internet reliability, age of parent, and region, the odds of perceiving vaccines as less safe rather than more safe were 1.6 times higher (95\% CI 1.3-2.1) for parents who used the Internet to search for vaccination information compared to parents who did not search the Internet in the Web-based sample, and 2.0 times higher (95\% CI 1.6-2.5) in the population-based RDD sample. Conclusions: The results suggest the Internet is significantly associated with Canadian parents' negative perception of vaccine risk. Governmental and scientific sectors should consider the development and implementation of Web-based vaccine interventions to promote confidence in immunization. ",
doi="10.2196/publichealth.8921",
url="http://publichealth.jmir.org/2018/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29351896"
}


@Article{info:doi/10.2196/jmir.8184,
author="Wagner, Moritz
and Lampos, Vasileios
and Yom-Tov, Elad
and Pebody, Richard
and Cox, J. Ingemar",
title="Estimating the Population Impact of a New Pediatric Influenza Vaccination Program in England Using Social Media Content",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="21",
volume="19",
number="12",
pages="e416",
keywords="health intervention",
keywords="influenza",
keywords="vaccination",
keywords="social media",
keywords="Twitter",
abstract="Background: The rollout of a new childhood live attenuated influenza vaccine program was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locations offering the vaccine to primary school-age children (4-11 years of age) during the influenza season. The 2014/2015 influenza season saw the national program extended to include additional pilot regions, some of which offered the vaccine to secondary school children (11-13 years of age) as well. Objective: We utilized social media content to obtain a complementary assessment of the population impact of the programs that were launched in England during the 2013/2014 and 2014/2015 flu seasons. The overall community-wide impact on transmission in pilot areas was estimated for the different age groups that were targeted for vaccination. Methods: A previously developed statistical framework was applied, which consisted of a nonlinear regression model that was trained to infer influenza-like illness (ILI) rates from Twitter posts originating in pilot (school-age vaccinated) and control (unvaccinated) areas. The control areas were then used to estimate ILI rates in pilot areas, had the intervention not taken place. These predictions were compared with their corresponding Twitter-based ILI estimates. Results: Results suggest a reduction in ILI rates of 14\% (1-25\%) and 17\% (2-30\%) across all ages in only the primary school-age vaccine pilot areas during the 2013/2014 and 2014/2015 influenza seasons, respectively. No significant impact was observed in areas where two age cohorts of secondary school children were vaccinated. Conclusions: These findings corroborate independent assessments from traditional surveillance data, thereby supporting the ongoing rollout of the program to primary school-age children and providing evidence of the value of social media content as an additional syndromic surveillance tool. ",
doi="10.2196/jmir.8184",
url="http://www.jmir.org/2017/12/e416/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29269339"
}


@Article{info:doi/10.2196/publichealth.8237,
author="Ueda, Nao
and Yokouchi, Ryoki
and Onoda, Taro
and Ogihara, Atsushi",
title="Characteristics of Articles About Human Papillomavirus Vaccination in Japanese Newspapers: Time-Series Analysis Study",
journal="JMIR Public Health Surveill",
year="2017",
month="Dec",
day="19",
volume="3",
number="4",
pages="e97",
keywords="papillomavirus vaccines",
keywords="immunization programs",
keywords="uterine cervical neoplasms",
keywords="newspapers as topic",
keywords="mass media",
keywords="data mining",
keywords="Japan",
abstract="Background: Media coverage and reports have a major influence on individual vaccination and other health-related activities. People use the media to seek information and knowledge on health-related behaviors. They obtain health-related information from media such as television and newspapers, and they trust such information. While several studies have examined the relation between media coverage and individual health, there is a lack of studies that have analyzed media reports of health information. In particular, we have found no analyses related to cervical cancer (human papillomavirus [HPV]) vaccine. Objective: This study aimed to identify mentions of cervical cancer vaccine in Japan's printed news media and to determine their characteristics. Methods: We used the archival databases of 2 Japanese newspapers, Yomiuri Shimbun (Yomidasu Rekishikan) and Asahi Shimbun (Kikuzo II Visual), for text mining. First, we created a database by extracting articles published between January 1, 2007, and December 31, 2014, that matched the terms ``cervical cancer'' AND ``vaccination'' in a keyword search. Then, we tallied the extracted articles based on the month of publication and number of characters in order to conduct a time-series analysis. Results: We extracted a total of 219 articles. Of these, 154 (70.3\%) were positive and 51 (23.3\%) were negative toward HPV vaccination. Of the 51 negative articles, 4 (7.8\%) were published before June 2013, when routine vaccination was temporarily discontinued due to concerns regarding side effects, and 47 (92.2\%) were published since then. The negative reports commonly cited side effects, although prior to June 2013, these issues were hardly mentioned. Although foreign media reports mentioned side effects before routine vaccination was temporarily discontinued, fewer articles mentioned side effects than recommendations for vaccination. Furthermore, on June 13, 2013, the World Health Organization's advisory body Global Advisory Committee on Vaccine Safety issued a statement regarding the safety of HPV vaccines, but hardly any articles reported this statement. Rather, several articles were published about the side effects after June 2013. Conclusions: Since we consider media coverage to be a factor affecting human health behavior, the media should extensively report on the cost of not receiving cervical cancer vaccination, global trends concerning cervical cancer vaccination, and statements released by various agencies on the subject. ",
doi="10.2196/publichealth.8237",
url="http://publichealth.jmir.org/2017/4/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258972"
}


@Article{info:doi/10.2196/mhealth.7792,
author="Oliver-Williams, Clare
and Brown, Elizabeth
and Devereux, Sara
and Fairhead, Cassandra
and Holeman, Isaac",
title="Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="04",
volume="5",
number="10",
pages="e148",
keywords="cell phones",
keywords="vaccination",
keywords="communication",
keywords="telemedicine",
keywords="mHealth",
keywords="global health",
abstract="Background: The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective: The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods: In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites---Communication Initiative Network, TechNet-21, and PATH---were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results: Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions: Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. ",
doi="10.2196/mhealth.7792",
url="http://mhealth.jmir.org/2017/10/e148/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28978495"
}


@Article{info:doi/10.2196/jmir.7449,
author="Pot, Mirjam
and Paulussen, GWM Theo
and Ruiter, AC Robert
and Eekhout, Iris
and de Melker, E. Hester
and Spoelstra, EA Maxine
and van Keulen, M. Hilde",
title="Effectiveness of a Web-Based Tailored Intervention With Virtual Assistants Promoting the Acceptability of HPV Vaccination Among Mothers of Invited Girls: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="06",
volume="19",
number="9",
pages="e312",
keywords="vaccination",
keywords="health promotion",
keywords="web-based intervention computer-tailoring",
keywords="randomized controlled trial",
abstract="Background: In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61\% versus 70\%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective: The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods: Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers' degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P<.001). No effect was found on uptake (P=.60). This may be attributed to the overall high uptake rates in both conditions. Mothers evaluated the intervention as highly positive, including the website as well as the virtual assistants that were used to deliver the tailored feedback. Conclusions: This computer-tailored intervention has the potential to improve HPV vaccination acceptability and IDM and to decrease decisional conflict among mothers of invited girls. Implications for future research are discussed. Trial Registration: Trialregister.nl NTR4935; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4935 (Archived by WebCite at http://www.webcitation.org/6srT7l9EM) ",
doi="10.2196/jmir.7449",
url="http://www.jmir.org/2017/9/e312/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28877862"
}


@Article{info:doi/10.2196/cancer.7345,
author="Warner, L. Echo
and Ding, Qian
and Pappas, Lisa
and Bodson, Julia
and Fowler, Brynn
and Mooney, Ryan
and Kirchhoff, C. Anne
and Kepka, Deanna",
title="Health Care Providers' Knowledge of HPV Vaccination, Barriers, and Strategies in a State With Low HPV Vaccine Receipt: Mixed-Methods Study",
journal="JMIR Cancer",
year="2017",
month="Aug",
day="11",
volume="3",
number="2",
pages="e12",
keywords="health care provider",
keywords="human papillomavirus",
keywords="human papillomavirus vaccine",
keywords="mixed methods",
keywords="knowledge",
abstract="Background: Human papillomavirus (HPV) vaccination is below national goals in the United States. Health care providers are at the forefront of improving vaccination in the United States, given their close interactions with patients and parents. Objective: The objective of this study was to assess the associations between demographic and practice characteristics of the health care providers with the knowledge of HPV vaccination and HPV vaccine guidelines. Furthermore, our aim was to contextualize the providers' perceptions of barriers to HPV vaccination and strategies for improving vaccination in a state with low HPV vaccine receipt. Methods: In this mixed-methods study, participating providers (N=254) were recruited from statewide pediatric, family medicine, and nursing organizations in Utah. Participants completed a Web-based survey of demographics, practice characteristics, HPV vaccine knowledge (?10 correct vs 11-12 correct answers), and knowledge of HPV vaccine guidelines (correct vs incorrect). Demographic and practice characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes. Four open-ended questions pertaining to the barriers and strategies for improving HPV vaccination were content analyzed. Results: Family practice providers (52.2\%, 71/136; P=.001), institutional or university clinics (54.0\%, 20/37; P=.001), and busier clinics seeing 20 to 29 patients per day (50.0\%, 28/56; P=.04) had the highest proportion of respondents with high HPV vaccination knowledge. Older providers aged 40 to 49 years (85.1\%, 57/67; P=.04) and those who were a Vaccines for Children provider (78.7\%, 133/169; P=.03) had the highest proportion of respondents with high knowledge of HPV vaccine recommendations. Providers perceived the lack of parental education to be the main barrier to HPV vaccination. They endorsed stronger, consistent, and more direct provider recommendations for HPV vaccination delivered to parents through printed materials available in clinical settings and public health campaigns. Hesitancy to recommend the HPV vaccine to patients persisted among some providers. Conclusions: Providers require support to eliminate barriers to recommending HPV vaccination in clinical settings. Additionally, providers endorsed the need for parental educational materials and instructions on framing HPV vaccination as a priority cancer prevention mechanism for all adolescents. ",
doi="10.2196/cancer.7345",
url="http://cancer.jmir.org/2017/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28801303"
}


@Article{info:doi/10.2196/publichealth.7545,
author="Reiter, L. Paul
and Katz, L. Mira
and Bauermeister, A. Jose
and Shoben, B. Abigail
and Paskett, D. Electra
and McRee, Annie-Laurie",
title="Recruiting Young Gay and Bisexual Men for a Human Papillomavirus Vaccination Intervention Through Social Media: The Effects of Advertisement Content",
journal="JMIR Public Health Surveill",
year="2017",
month="Jun",
day="02",
volume="3",
number="2",
pages="e33",
keywords="HPV",
keywords="HPV vaccine",
keywords="gay and bisexual men",
keywords="social media",
abstract="Background: Web-based approaches, specifically social media sites, represent a promising approach for recruiting young gay and bisexual men for research studies. Little is known, however, about how the performance of social media advertisements (ads) used to recruit this population is affected by ad content (ie, image and text). Objective: The aim of this study was to evaluate the effects of different images and text included in social media ads used to recruit young gay and bisexual men for the pilot test of a Web-based human papillomavirus (HPV) vaccination intervention. Methods: In July and September 2016, we used paid Facebook advertisements to recruit men who were aged 18-25 years, self-identified as gay or bisexual, US resident, and had not received HPV vaccine. A 4x2x2 factorial experiment varied ad image (a single young adult male, a young adult male couple, a group of young adult men, or a young adult male talking to a doctor), content focus (text mentioning HPV or HPV vaccine), and disease framing (text mentioning cancer or a sexually transmitted disease [STD]). Poisson regression determined whether these experimental factors affected ad performance. Results: The recruitment campaign reached a total of 35,646 users who viewed ads for 36,395 times. This resulted in an overall unique click-through rate of 2.01\% (717/35,646) and an overall conversion rate of 0.66\% (241/36,395). Reach was higher for ads that included an image of a couple (incidence rate ratio, IRR=4.91, 95\% CI 2.68-8.97, P<.001) or a group (IRR=2.65, 95\% CI 1.08-6.50, P=.03) compared with those that included an image of a single person. Ads that included an image of a couple also had a higher conversion rate (IRR=2.56, 95\% CI 1.13-5.77, P=.02) than ads that included an image of a single person. Ads with text mentioning an STD had a higher unique click-through rate compared with ads with text mentioning cancer (IRR=1.34, 95\% CI 1.06-1.69, P=.01). The campaign cost a total of US \$413.72 and resulted in 150 eligible and enrolled individuals (US \$2.76 per enrolled participant). Conclusions: Facebook ads are a convenient and cost-efficient strategy for reaching and recruiting young gay and bisexual men for a Web-based HPV vaccination intervention. To help optimize ad performance among this population, researchers should consider the importance of the text and image included in the social media recruitment ads. ",
doi="10.2196/publichealth.7545",
url="http://publichealth.jmir.org/2017/2/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28576758"
}


@Article{info:doi/10.2196/publichealth.6586,
author="Tangherlini, R. Timothy
and Roychowdhury, Vwani
and Glenn, Beth
and Crespi, M. Catherine
and Bandari, Roja
and Wadia, Akshay
and Falahi, Misagh
and Ebrahimzadeh, Ehsan
and Bastani, Roshan",
title="``Mommy Blogs'' and the Vaccination Exemption Narrative: Results From A Machine-Learning Approach for Story Aggregation on Parenting Social Media Sites",
journal="JMIR Public Health Surveill",
year="2016",
month="Nov",
day="22",
volume="2",
number="2",
pages="e166",
keywords="vaccination",
keywords="social media",
keywords="machine learning",
keywords="personal narratives",
keywords="Internet",
keywords="health knowledge",
keywords="attitudes",
keywords="practice",
abstract="Background: Social media offer an unprecedented opportunity to explore how people talk about health care at a very large scale. Numerous studies have shown the importance of websites with user forums for people seeking information related to health. Parents turn to some of these sites, colloquially referred to as ``mommy blogs,'' to share concerns about children's health care, including vaccination. Although substantial work has considered the role of social media, particularly Twitter, in discussions of vaccination and other health care--related issues, there has been little work on describing the underlying structure of these discussions and the role of persuasive storytelling, particularly on sites with no limits on post length. Understanding the role of persuasive storytelling at Internet scale provides useful insight into how people discuss vaccinations, including exemption-seeking behavior, which has been tied to a recent diminution of herd immunity in some communities. Objective: To develop an automated and scalable machine-learning method for story aggregation on social media sites dedicated to discussions of parenting. We wanted to discover the aggregate narrative frameworks to which individuals, through their exchange of experiences and commentary, contribute over time in a particular topic domain. We also wanted to characterize temporal trends in these narrative frameworks on the sites over the study period. Methods: To ensure that our data capture long-term discussions and not short-term reactions to recent events, we developed a dataset of 1.99 million posts contributed by 40,056 users and viewed 20.12 million times indexed from 2 parenting sites over a period of 105 months. Using probabilistic methods, we determined the topics of discussion on these parenting sites. We developed a generative statistical-mechanical narrative model to automatically extract the underlying stories and story fragments from millions of posts. We aggregated the stories into an overarching narrative framework graph. In our model, stories were represented as network graphs with actants as nodes and their various relationships as edges. We estimated the latent stories circulating on these sites by modeling the posts as a sampling of the hidden narrative framework graph. Temporal trends were examined based on monthly user-poststatistics. Results: We discovered that discussions of exemption from vaccination requirements are highly represented. We found a strong narrative framework related to exemption seeking and a culture of distrust of government and medical institutions. Various posts reinforced part of the narrative framework graph in which parents, medical professionals, and religious institutions emerged as key nodes, and exemption seeking emerged as an important edge. In the aggregate story, parents used religion or belief to acquire exemptions to protect their children from vaccines that are required by schools or government institutions, but (allegedly) cause adverse reactions such as autism, pain, compromised immunity, and even death. Although parents joined and left the discussion forums over time, discussions and stories about exemptions were persistent and robust to these membership changes. Conclusions: Analyzing parent forums about health care using an automated analytic approach, such as the one presented here, allows the detection of widespread narrative frameworks that structure and inform discussions. In most vaccination stories from the sites we analyzed, it is taken for granted that vaccines and not vaccine preventable diseases (VPDs) pose a threat to children. Because vaccines are seen as a threat, parents focus on sharing successful strategies for avoiding them, with exemption being the foremost among these strategies. When new parents join such sites, they may be exposed to this endemic narrative framework in the threads they read and to which they contribute, which may influence their health care decision making. ",
doi="10.2196/publichealth.6586",
url="http://publichealth.jmir.org/2016/2/e166/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27876690"
}


@Article{info:doi/10.2196/jmir.5430,
author="Ludolph, Ramona
and Allam, Ahmed
and Schulz, J. Peter",
title="Manipulating Google's Knowledge Graph Box to Counter Biased Information Processing During an Online Search on Vaccination: Application of a Technological Debiasing Strategy",
journal="J Med Internet Res",
year="2016",
month="Jun",
day="02",
volume="18",
number="6",
pages="e137",
keywords="search engine",
keywords="online health information search",
keywords="vaccination",
keywords="debiasing",
keywords="search behavior",
keywords="health communication",
keywords="information processing",
keywords="information seeking",
abstract="Background: One of people's major motives for going online is the search for health-related information. Most consumers start their search with a general search engine but are unaware of the fact that its sorting and ranking criteria do not mirror information quality. This misconception can lead to distorted search outcomes, especially when the information processing is characterized by heuristic principles and resulting cognitive biases instead of a systematic elaboration. As vaccination opponents are vocal on the Web, the chance of encountering their non?evidence-based views on immunization is high. Therefore, biased information processing in this context can cause subsequent impaired judgment and decision making. A technological debiasing strategy could counter this by changing people's search environment. Objective: This study aims at testing a technological debiasing strategy to reduce the negative effects of biased information processing when using a general search engine on people's vaccination-related knowledge and attitudes. This strategy is to manipulate the content of Google's knowledge graph box, which is integrated in the search interface and provides basic information about the search topic. Methods: A full 3x2 factorial, posttest-only design was employed with availability of basic factual information (comprehensible vs hardly comprehensible vs not present) as the first factor and a warning message as the second factor of experimental manipulation. Outcome variables were the evaluation of the knowledge graph box, vaccination-related knowledge, as well as beliefs and attitudes toward vaccination, as represented by three latent variables emerged from an exploratory factor analysis. Results: Two-way analysis of variance revealed a significant main effect of availability of basic information in the knowledge graph box on participants' vaccination knowledge scores (F2,273=4.86, P=.01), skepticism/fear of vaccination side effects (F2,273=3.5, P=.03), and perceived information quality (F2,273=3.73, P=.02). More specifically, respondents receiving comprehensible information appeared to be more knowledgeable, less skeptical of vaccination, and more critical of information quality compared to participants exposed to hardly comprehensible information. Although, there was no significant interaction effect between the availability of information and the presence of the warning, there was a dominant pattern in which the presence of the warning appeared to have a positive influence on the group receiving comprehensible information while the opposite was true for the groups exposed to hardly comprehensible information and no information at all. Participants evaluated the knowledge graph box as moderately to highly useful, with no significant differences among the experimental groups. Conclusion: Overall, the results suggest that comprehensible information in the knowledge graph box positively affects participants' vaccination-related knowledge and attitudes. A small change in the content retrieval procedure currently used by Google could already make a valuable difference in the pursuit of an unbiased online information search. Further research is needed to gain insights into the knowledge graph box's entire potential. ",
doi="10.2196/jmir.5430",
url="http://www.jmir.org/2016/6/e137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27255736"
}


@Article{info:doi/10.2196/resprot.5478,
author="Cutrona, L. Sarah
and Sreedhara, Meera
and Goff, L. Sarah
and Fisher, D. Lloyd
and Preusse, Peggy
and Jackson, Madeline
and Sundaresan, Devi
and Garber, D. Lawrence
and Mazor, M. Kathleen",
title="Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2016",
month="May",
day="06",
volume="5",
number="2",
pages="e56",
keywords="electronic health records",
keywords="influenza vaccines",
keywords="clinical decision support",
keywords="Internet",
keywords="Telephone",
keywords="Electronic Mail",
keywords="Health Records, Personal",
keywords="Medical Informatics Applications",
abstract="Background: Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care. Objective: To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts. Methods: We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts). Results: With our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80\% power to detect a 3\% improvement in influenza vaccination rates between groups ($\alpha$=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016. Conclusions: If successful, this study's intervention may be adapted by other large health care organizations to increase vaccination rates among their eligible patients. ClinicalTrial: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277 (Archived by WebCite at http://www.webcitation.org/6fbLviHLH). ",
doi="10.2196/resprot.5478",
url="http://www.researchprotocols.org/2016/2/e56/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27153752"
}


@Article{info:doi/10.2196/resprot.5092,
author="Tiro, A. Jasmin
and Lee, Craddock Simon
and Marks, G. Emily
and Persaud, Donna
and Skinner, Sugg Celette
and Street, L. Richard
and Wiebe, J. Deborah
and Farrell, David
and Bishop, Pechero Wendy
and Fuller, Sobha
and Baldwin, S. Austin",
title="Developing a Tablet-Based Self-Persuasion Intervention Promoting Adolescent HPV Vaccination: Protocol for a Three-Stage Mixed-Methods Study",
journal="JMIR Res Protoc",
year="2016",
month="Jan",
day="29",
volume="5",
number="1",
pages="e19",
keywords="adolescents",
keywords="intervention development",
keywords="HPV vaccination",
keywords="self-persuasion",
abstract="Background: Human papillomavirus (HPV)-related cancers are a significant burden on the US health care system that can be prevented through adolescent HPV vaccination. Despite guidelines recommending vaccination, coverage among US adolescents is suboptimal particularly among underserved patients (uninsured, low income, racial, and ethnic minorities) seen in safety-net health care settings.  Many parents are ambivalent about the vaccine and delay making a decision or talking with a provider about it. Self-persuasion---generating one's own arguments for a health behavior---may be particularly effective for parents who are undecided or not motivated to make a vaccine decision. Objective: Through a 3-stage mixed-methods protocol, we will identify an optimal and feasible self-persuasion intervention strategy to promote adolescent HPV vaccination in safety-net clinics. Methods: In Stage 1, we will define content for a tablet-based self-persuasion app by characterizing (1) parents' self-generated arguments through cognitive interviews conducted with parents (n=50) of patients and (2) parent-provider HPV vaccine discussions through audio recordings of clinic visits (n=50). In Stage 2, we will compare the effects of the four self-persuasion intervention conditions that vary by cognitive processing level (parents verbalize vs listen to arguments) and choice of argument topics (parents choose vs are assigned topics) on parental vaccine intentions in a 2 {\texttimes} 2 factorial design randomized controlled trial (n=160). This proof-of-concept trial design will identify which intervention condition is optimal by quantitatively examining basic self-persuasion mechanisms (cognitive processing and choice) and qualitatively exploring parent experiences with intervention tasks. In Stage 3, we will conduct a pilot trial (n=90) in the safety-net clinics to assess feasibility of the optimal intervention condition identified in Stage 2. We will also assess its impact on parent-provider discussions. Results: This paper describes the study protocol and activities to date. Currently, we have developed the initial prototype of the tablet app for English- and Spanish-speaking populations, and completed Stage 1 data collection. Conclusions: Our systematic collaboration between basic and applied behavioral scientists accelerates translation of promising basic psychological research into innovative interventions suitable for underserved, safety-net populations. At project's end, we plan to have a feasible and acceptable self-persuasion intervention that can affect key cancer disparities in the United States through prevention of HPV-related cancers. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02537756 and http://clinicaltrials.gov/ct2/show/NCT02535845 (Archived by WebCite at http://www.webcitation.org/6e5XcOGXz and http://www.webcitation.org/6e5XfHoic, respectively). ",
doi="10.2196/resprot.5092",
url="http://www.researchprotocols.org/2016/1/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26825137"
}


@Article{info:doi/10.2196/publichealth.5059,
author="Radzikowski, Jacek
and Stefanidis, Anthony
and Jacobsen, H. Kathryn
and Croitoru, Arie
and Crooks, Andrew
and Delamater, L. Paul",
title="The Measles Vaccination Narrative in Twitter: A Quantitative Analysis",
journal="JMIR Public Health Surveill",
year="2016",
month="Jan",
day="04",
volume="2",
number="1",
pages="e1",
keywords="social media",
keywords="health narrative",
keywords="geographic characteristics",
keywords="data analysis",
keywords="health informatics",
keywords="GIS (geographic information systems)",
abstract="Background: The emergence of social media is providing an alternative avenue for information exchange and opinion formation on health-related issues. Collective discourse in such media leads to the formation of a complex narrative, conveying public views and perceptions. Objective: This paper presents a study of Twitter narrative regarding vaccination in the aftermath of the 2015 measles outbreak, both in terms of its cyber and physical characteristics. We aimed to contribute to the analysis of the data, as well as presenting a quantitative interdisciplinary approach to analyze such open-source data in the context of health narratives. Methods: We collected 669,136 tweets referring to vaccination from February 1 to March 9, 2015. These tweets were analyzed to identify key terms, connections among such terms, retweet patterns, the structure of the narrative, and connections to the geographical space. Results: The data analysis captures the anatomy of the themes and relations that make up the discussion about vaccination in Twitter. The results highlight the higher impact of stories contributed by news organizations compared to direct tweets by health organizations in communicating health-related information. They also capture the structure of the antivaccination narrative and its terms of reference. Analysis also revealed the relationship between community engagement in Twitter and state policies regarding child vaccination. Residents of Vermont and Oregon, the two states with the highest rates of non-medical exemption from school-entry vaccines nationwide, are leading the social media discussion in terms of participation. Conclusions: The interdisciplinary study of health-related debates in social media across the cyber-physical debate nexus leads to a greater understanding of public concerns, views, and responses to health-related issues. Further coalescing such capabilities shows promise towards advancing health communication, thus supporting the design of more effective strategies that take into account the complex and evolving public views of health issues. ",
doi="10.2196/publichealth.5059",
url="http://publichealth.jmir.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27227144"
}


@Article{info:doi/10.2196/jmir.4153,
author="Grant, Lenny
and Hausman, L. Bernice
and Cashion, Margaret
and Lucchesi, Nicholas
and Patel, Kelsey
and Roberts, Jonathan",
title="Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites",
journal="J Med Internet Res",
year="2015",
month="May",
day="29",
volume="17",
number="5",
pages="e133",
keywords="vaccination",
keywords="communication",
keywords="Internet",
keywords="social networking",
keywords="Web 2.0",
keywords="qualitative research",
abstract="Background: Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites. Objective: The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices. Methods: This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity. Results: The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites, including government websites. They leveraged the affordances of Web 2.0 with their interactive features and digital media. Conclusions: By employing a rhetorical framework, this study found that the provaccine websites analyzed concentrate on the accurate transmission of evidence-based scientific research about vaccines and government-endorsed vaccination-related practices, whereas the vaccine-skeptical websites focus on creating communities of people affected by vaccines and vaccine-related practices. From this personal framework, these websites then challenge the information presented in scientific literature and government documents. At the same time, the vaccine-skeptical websites in this study are repositories of vaccine information and vaccination-related resources. Future studies on vaccination and the Internet should take into consideration the rhetorical features of provaccine and vaccine-skeptical websites and further investigate the influence of Web 2.0 community-building features on people seeking information about vaccine-related practices. ",
doi="10.2196/jmir.4153",
url="http://www.jmir.org/2015/5/e133/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26024907"
}


@Article{info:doi/10.2196/publichealth.3310,
author="Mahoney, Meghan L.
and Tang, Tang
and Ji, Kai
and Ulrich-Schad, Jessica",
title="The Digital Distribution of Public Health News Surrounding the Human Papillomavirus Vaccination: A Longitudinal Infodemiology Study",
journal="JMIR Public Health Surveill",
year="2015",
month="Mar",
day="18",
volume="1",
number="1",
pages="e2",
keywords="new media",
keywords="public health dissemination",
keywords="health communication",
keywords="social media",
keywords="HPV vaccination",
keywords="infodemiology",
keywords="infoveillance",
abstract="Background: New media changes the dissemination of public health information and misinformation. During a guest appearance on the Today Show, US Representative Michele Bachmann claimed that human papillomavirus (HPV) vaccines could cause ``mental retardation''. Objective: The purpose of this study is to explore how new media influences the type of public health information users access, as well as the impact to these platforms after a major controversy. Specifically, this study aims to examine the similarities and differences in the dissemination of news articles related to the HPV vaccination between Google News and Twitter, as well as how the content of news changed after Michele Bachmann's controversial comment. Methods: This study used a purposive sampling to draw the first 100 news articles that appeared on Google News and the first 100 articles that appeared on Twitter from August 1-October 31, 2011. Article tone, source, topics, concerns, references, publication date, and interactive features were coded. The intercoder reliability had a total agreement of .90. Results: Results indicate that 44.0\% of the articles (88/200) about the HPV vaccination had a positive tone, 32.5\% (65/200) maintained a neutral tone, while 23.5\% (47/200) presented a negative tone. Protection against diseases 82.0\% (164/200), vaccine eligibility for females 75.5\% (151/200), and side effects 59.0\% (118/200) were the top three topics covered by these articles. Google News and Twitter articles significantly differed in article tone, source, topics, concerns covered, types of sources referenced in the article, and uses of interactive features. Most notably, topic focus changed from public health information towards political conversation after Bachmann's comment. Before the comment, the HPV vaccine news talked more often about vaccine dosing (P<.001), duration (P=.005), vaccine eligibility for females (P=.03), and protection against diseases (P=.04) than did the later pieces. After the controversy, the news topic shifted towards politics (P=.01) and talked more about HPV vaccine eligibility for males (P=.01). Conclusions: This longitudinal infodemiology study suggests that new media influences public health communication, knowledge transaction, and poses potential problems in the amount of misinformation disseminated during public health campaigns. In addition, the study calls for more research to adopt an infodemiology approach to explore relationships between online information supply and public health decisions. ",
doi="10.2196/publichealth.3310",
url="http://publichealth.jmir.org/2015/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27227125"
}


@Article{info:doi/10.2196/jmir.2846,
author="Nakada, Haruka
and Yuji, Koichiro
and Tsubokura, Masaharu
and Ohsawa, Yukio
and Kami, Masahiro",
title="Development of a National Agreement on Human Papillomavirus Vaccination in Japan: An Infodemiology Study",
journal="J Med Internet Res",
year="2014",
month="May",
day="15",
volume="16",
number="5",
pages="e129",
keywords="cervical cancer",
keywords="health policy",
keywords="human papillomavirus",
keywords="public health",
keywords="vaccination",
abstract="Background: A national agreement on human papillomavirus (HPV) vaccination was achieved relatively quickly in Japan as compared to the United States and India. Objective: The objective was to identify the role of print and online media references, including references to celebrities or other informants, as factors potentially responsible for the relatively rapid national acceptance of HPV vaccination in Japan. Methods: A method of text mining was performed to select keywords, representing the context of the target documents, from articles relevant to the promotion of HPV vaccination appearing in major Japanese newspapers and Web pages between January 2009 and July 2010. The selected keywords were classified as positive, negative, or neutral, and the transition of the frequency of their appearance was analyzed. Results: The number of positive and neutral keywords appearing in newspaper articles increased sharply in early 2010 while the number of negative keywords remained low. The numbers of positive, neutral, and negative keywords appearing in Web pages increased gradually and did not significantly differ by category. Neutral keywords, such as ``vaccine'' and ``prevention,'' appeared more frequently in newspaper articles, whereas negative keywords, such as ``infertility'' and ``side effect,'' appeared more frequently in Web pages. The extraction of the positive keyword ``signature campaign'' suggests that vaccine beneficiaries cooperated with providers in promoting HPV vaccination. Conclusions: The rapid development of a national agreement regarding HPV vaccination in Japan may be primarily attributed to the advocacy of vaccine beneficiaries, supported by advocacy by celebrities and positive reporting by print and online media. ",
doi="10.2196/jmir.2846",
url="http://www.jmir.org/2014/5/e129/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24834471"
}


@Article{info:doi/10.2196/jmir.2642,
author="Allam, Ahmed
and Schulz, Johannes Peter
and Nakamoto, Kent",
title="The Impact of Search Engine Selection and Sorting Criteria on Vaccination Beliefs and Attitudes: Two Experiments Manipulating Google Output",
journal="J Med Internet Res",
year="2014",
month="Apr",
day="02",
volume="16",
number="4",
pages="e100",
keywords="consumer health information",
keywords="search engine",
keywords="searching behavior",
keywords="Internet",
keywords="information storage and retrieval",
keywords="online systems",
keywords="public health informatics",
keywords="vaccination",
keywords="health communication",
abstract="Background: During the past 2 decades, the Internet has evolved to become a necessity in our daily lives. The selection and sorting algorithms of search engines exert tremendous influence over the global spread of information and other communication processes. Objective: This study is concerned with demonstrating the influence of selection and sorting/ranking criteria operating in search engines on users' knowledge, beliefs, and attitudes of websites about vaccination. In particular, it is to compare the effects of search engines that deliver websites emphasizing on the pro side of vaccination with those focusing on the con side and with normal Google as a control group. Method: We conducted 2 online experiments using manipulated search engines. A pilot study was to verify the existence of dangerous health literacy in connection with searching and using health information on the Internet by exploring the effect of 2 manipulated search engines that yielded either pro or con vaccination sites only, with a group receiving normal Google as control. A pre-post test design was used; participants were American marketing students enrolled in a study-abroad program in Lugano, Switzerland. The second experiment manipulated the search engine by applying different ratios of con versus pro vaccination webpages displayed in the search results. Participants were recruited from Amazon's Mechanical Turk platform where it was published as a human intelligence task (HIT). Results: Both experiments showed knowledge highest in the group offered only pro vaccination sites (Z=--2.088, P=.03; Kruskal-Wallis H test [H5]=11.30, P=.04). They acknowledged the importance/benefits (Z=--2.326, P=.02; H5=11.34, P=.04) and effectiveness (Z=--2.230, P=.03) of vaccination more, whereas groups offered antivaccination sites only showed increased concern about effects (Z=--2.582, P=.01; H5=16.88, P=.005) and harmful health outcomes (Z=--2.200, P=.02) of vaccination. Normal Google users perceived information quality to be positive despite a small effect on knowledge and a negative effect on their beliefs and attitudes toward vaccination and willingness to recommend the information ($\chi$25=14.1, P=.01). More exposure to antivaccination websites lowered participants' knowledge (J=4783.5, z=?2.142, P=.03) increased their fear of side effects (J=6496, z=2.724, P=.006), and lowered their acknowledgment of benefits (J=4805, z=--2.067, P=.03). Conclusion: The selection and sorting/ranking criteria of search engines play a vital role in online health information seeking. Search engines delivering websites containing credible and evidence-based medical information impact positively Internet users seeking health information. Whereas sites retrieved by biased search engines create some opinion change in users. These effects are apparently independent of users' site credibility and evaluation judgments. Users are affected beneficially or detrimentally but are unaware, suggesting they are not consciously perceptive of indicators that steer them toward the credible sources or away from the dangerous ones. In this sense, the online health information seeker is flying blind. ",
doi="10.2196/jmir.2642",
url="http://www.jmir.org/2014/4/e100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24694866"
}


@Article{info:doi/10.5210/ojphi.v4i3.4238,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2012",
volume="4",
number="3",
pages="e4238",
doi="10.5210/ojphi.v4i3.4238",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569640"
}


@Article{info:doi/10.5210/ojphi.v4i3.4290,
title="Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review",
journal="Online J Public Health Inform",
year="2012",
volume="4",
number="3",
pages="e4290",
doi="10.5210/ojphi.v4i3.4290",
url="",
url="http://www.ncbi.nlm.nih.gov/pubmed/23569651"
}