|Year : 2022 | Volume
| Issue : 4 | Page : 364-371
Effects of Online Information and Social Media Platforms on Parents' Knowledge, Attitudes, and Practices toward Childhood Vaccinations in Saudi Arabia
Raniah Aldekhyyel1, Ali M Al-Hazmi2, Reem N Al-Qahtani3, Wejdan F Albadrani3, Felwah S Alsaawi3, Maha S Alqahtani3, Hayat Mohammed Alshammari3
1 Department of Medical Education, Medical Informatics and E-learning Unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Department of Medical Undergraduate Students, College of Medicine, King Saud University, Riyadh, Saudi Arabia
|Date of Submission||06-Feb-2022|
|Date of Decision||24-Jun-2022|
|Date of Acceptance||11-Sep-2022|
|Date of Web Publication||12-Oct-2022|
Department of Medical Education, Medical Informatics and E-learning Unit, College of Medicine, King Saud University, Riyadh 11362
Source of Support: None, Conflict of Interest: None
Objective: The aim is to measure the knowledge, attitudes, and practices (KAP) of parents towards childhood vaccinations. We also aim to explore if there is an association between parents' seeking vaccine information on the Internet and social media platforms, and vaccine hesitancy toward childhood vaccinations. Materials and Methods: Cross-sectional study was conducted in five mega malls in Riyadh by purposive sampling technique. Data collection lasted for 3 weeks from February 2020 using a self-developed questionnaire, which included: (1) sociodemographic information, (2) KAP, and (3) sources of information on childhood vaccination. Results: Five hundred and fourteen parents participated in our study, with most being mothers (79.4%). Most parents were informed about vaccination (94.7%), believed vaccines are safe (89.8%), and want their children to get the recommended vaccinations (92.4%). Forty-nine percent of parents use the internet as a source to seek vaccination information, while only 21% trust online information. As for social media, 27% mentioned that they use it to seek vaccine information but only 15% trust them as a source of information. 13.2% indicated that they changed their minds regarding vaccination because of information from the Internet, and 11.7% changed their minds from social media. We found a strong statistically significant association between vaccine hesitancy and information obtained from the internet and social media platforms (P = 0.000122, and 0.000025), respectively. Vaccine hesitancy, and information from family, and friends were statistically significant (P = 0.00003). Conclusions: We found a potential impact of internet health information and social media platforms on parents' hesitancy toward childhood vaccination.
Keywords: Childhood immunization, health information, Saudi Arabia, social media, vaccine hesitancy
|How to cite this article:|
Aldekhyyel R, Al-Hazmi AM, Al-Qahtani RN, Albadrani WF, Alsaawi FS, Alqahtani MS, Alshammari HM. Effects of Online Information and Social Media Platforms on Parents' Knowledge, Attitudes, and Practices toward Childhood Vaccinations in Saudi Arabia. J Nat Sci Med 2022;5:364-71
|How to cite this URL:|
Aldekhyyel R, Al-Hazmi AM, Al-Qahtani RN, Albadrani WF, Alsaawi FS, Alqahtani MS, Alshammari HM. Effects of Online Information and Social Media Platforms on Parents' Knowledge, Attitudes, and Practices toward Childhood Vaccinations in Saudi Arabia. J Nat Sci Med [serial online] 2022 [cited 2023 Feb 9];5:364-71. Available from: https://www.jnsmonline.org/text.asp?2022/5/4/364/358408
| Introduction|| |
End of 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rapidly spread across the globe resulting in millions of infections and deaths due to Coronavirus Disease 2019 (COVID-19). Different health organizations worked on developing adequate pharmaceutical therapies and vaccines to reduce community transmission of SARS-CoV-2. Vaccines are one of the most important medical achievements that are seen as an effective public health intervention. Vaccinations have substantially reduced childhood morbidity and mortality around the world, prevented the death of 6 million children under the age of five, and led to the global eradication of smallpox, and the elimination of polio.,
Continued surveillance is required given recent increase of vaccine-preventable diseases (VPDs) in Saudi Arabia. To prevent the spread of VPD in the community, adequate vaccination rates are required to achieve herd immunity. Despite the proven importance of vaccinations, the WHO has reported vaccine hesitancy as one of the top ten global issues threatening global health.
Parents who delay or refuse one or more childhood vaccinations are often referred to as “vaccine-hesitant” parents (VHPs). Factors that could hesitate parents toward vaccines are complex and may include their level of trust in the sources of information about vaccines, having past experience with vaccine side-effects,, and their sociodemographic characteristics, VHPs may have received misinformation about the risks, and benefits of childhood vaccines from a variety of sources including their social networks, social media, and the internet. Vaccine hesitancy has contributed to the reduction of vaccination rates around the world, resulting in an increase in VPD such as measles cases worldwide.
Studies on parents' perceptions toward vaccinations have been conducted in different parts of the world. Studies done in Turkey, and England showed positive perceptions, whereas studies done in Croatia, Egypt, and Libya showed negative perceptions including high vaccination refusal rates and misperceptions against childhood vaccinations. A study conducted in the United States showed that all parents regardless of their decision to vaccinate their children or not have a lot of misinformation, and questions about vaccines.
In Saudi Arabia, studies assessing the knowledge, attitude, and practice (KAP) of parents towards childhood vaccination have shown overall positive KAP scores. However, gaps in knowledge, and attitudes were identified especially among illiterate and less educated parents living in rural areas.,,,,, In a recent study published by Alshammari et al., the authors reported that a considerable percentage of parents believed there was an association between childhood vaccination and autism, or disabilities.
In our current day and age, individual health consumers rely on online resources and social media platforms, such as Twitter and Facebook to search for health-related information., While these platforms may provide health information related to a specific condition of interest, in some cases, they may become a source of misinformation. Then, This creates a challenge for consumers to distinguish relevant information from misleading health information,, which can negatively influence consumers' information-seeking behaviors, and may contribute to VHPs.,
Twitter in particular is a very popular platform in Saudi Arabia, where as of January 2021, the microblogging service had an audience reach of 12.45 million users, ranking KSA as eighth among other countries. In 2013, the Saudi Ministry of Communications and Information Technology reported that “41% of the online population in Saudi Arabia uses Twitter, a higher percentage than anywhere else in the world.” The popularity of using Twitter among the Saudi population was one of the drives for the Saudi government to utilize Twitter in sending different communication messages during the COVID-19 pandemic.
Research to address the factors that affect Saudi parents' perception toward vaccination is needed, considering the influence of social media and internet exposure. Our aim is to assess the KAP of Saudi parents living in Riyadh, toward childhood vaccination and understand how parents may be influenced by different factors such as internet exposure.
| Materials and Methods|| |
This is a cross-sectional study with 514 randomly recruited participants from selected shopping malls in Riyadh, Saudi Arabia. We collected the data by conducting a multistage random sampling technique, using the five regions of Riyadh; Central, Northern, Southern, Eastern, and Western Regions. We generated a list of 15 mega malls located in each region, and then, we randomly selected one mall representing each region using a random generator. We estimated the sample size to be 512 using “Daniels formula” with the assumption of a 75% response rate, a prevalence of 50% of parents who have vaccinated children with the recommended vaccines, a 95% confidence interval, and a 5% margin of error.
The survey questions were designed based on similar published studies by Alshammari et al. and Wallace et al.,, with the addition of eight questions exploring the role of information technology, and KAP. A pilot study was conducted, which resulted in the adjustment of the survey questions based on participants' comments, and feedback. The final version of the survey included 38 questions designed to collect demographic information, KAP toward childhood vaccination, and data on the use of the Internet, and social media platforms to seek vaccination information. The survey was divided into three sections. The first section included five multiple-choice questions regarding sociodemographic variables. The second section included 21 agree/disagree statements designed to assess the KAP of parents toward childhood vaccination. The third and last section included 11 agree/disagree statements designed to investigate the association between seeking vaccine information from the Internet, and parents' knowledge. The independent variables of the study were age, gender, birth order, education levels, household income, residence, and the source of information about childhood vaccines. While the dependent variables were KAP and the outcome was the association between seeking vaccines information from the Internet and parents' knowledge.
After obtaining Institutional Review Board Approval from King Saud University, data collection started in February 2020 and lasted for 3 weeks. Parents were surveyed using convenience sampling in the selected malls. Five data collectors from the research team approached potential parents, confirmed they matched the inclusion criteria of being a Saudi parent and having at least one child, explained the research to them, and then received their informed consent before administrating the survey. The survey was administered either orally by one of the data collectors or was self-administered by the participant using a web-based handheld device. To avoid bias, and to create a representative sample of the population, researchers responsible for data collection visited the selected malls on different days of the week, and during different times of the day. Snack/refreshments were provided to establish a bond with participants, with no obligation to participate.
Data analysis was carried out using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). Descriptive statistics (frequencies, and percentages) were calculated to characterize the sociodemographic and KAP variables. A response for each variable included in the scale was scored as either a 0 (nonhesitant response), 1 (partially hesitant response), or 2 (hesitant response). Statements, which were negatively framed, were converted to the same direction scoring-wise as items that were positively framed. For each participant, an average score was calculated for the KAP separately. Scale score was constructed so that the scores lower than average were considered the nonhesitant parents and the scores higher than average were the most hesitant parents. Chi-square tests were performed to analyze the categorical data and to assess whether the association between the study variables, and the outcome variables were statistically significant. A P < 0.05 was used to report the statistical significance and the precision of the results.
| Results|| |
A total of 514 parents accepted to participate in the survey with most of the participants being mothers n = 408 (79.4%). The most frequent age group among the participants was between 30 and 39 years n = 207 (40.3%). Less than half of the participants n = 164 (31.9%) reported a monthly income <5000 SAR. The education status of the participants ranged between illiterate to postgraduate, with most mothers reporting a bachelor's degree n = 278 (54.1%). Detailed descriptive results regarding the participant characteristics are shown in [Table 1].
Responses to research items generally showed positive KAP scores. However, some responses reflect insufficient knowledge and negative attitude. A high percentage of the participants were informed, and aware of vaccination, as (94,7%) of the participants answered with agreement to the statement “I am completely informed about vaccination,” and no less than (80%) of participants responded with agreement to the following statements “I know the location where I can have my child vaccinated,” “I know the days, and times when vaccination services are offered in my community,” and “The first vaccination dose is given at birth.”
Results measuring the level of awareness toward vaccines safety, benefits, and side effects were positive. Parents showed acceptance, and good knowledge toward vaccines efficacy, and benefits for their children, and the community, as they were highly supportive with over (85%) agreement on all of the following statements “vaccinations have more benefit than harm,” “I know how vaccination protects against disease,” “I believe vaccines protect my child from VPDs,” “many of the illness which vaccinations prevent are severe,” “I want my child to get all the recommended vaccinations,” and “when a parent refuses to vaccinate a child, it harms the entire community through the risk of disease.”
The majority of parents also showed a positive attitude toward vaccine safety (89.8%) and showed a positive practice toward childhood vaccinations, where 86% denied that they have refused a vaccine for their child. On the other hand, less than half of the parents (30.3%) thought vaccines were not necessary as shown in the statements: “It is better for a child to develop immunity by getting sick than to get a vaccine,” and “healthy children do not need vaccines.” Thirty-three percent thought that children get more vaccinations than what is good for them, and about 10% thought vaccines can cause autism. Knowledge toward vaccinations was measured using the statement “It is better for a child to receive two injectable vaccinations in 1 visit rather than, 1 injectable vaccination in 2 visits,” where 42% of the parents disagreed with the statement.
A total of 252 participants (49%) indicated the use of the Internet as a source to seek vaccination information, while only 21% trusted the information on the Internet. As for social media platforms, 27% indicated that they use it to seek vaccine information; however, only 15% trust social media platforms as a source of information. A minority of the parents indicated that they changed their minds regarding vaccination because of information from the Internet (13.2%) and social media sources (11.7%) [Table 2].
[Table 3] displays the results of variables associated with vaccine hesitancy using Chi-square test. Hesitancy percentage was higher among younger age groups and among males compared to females. However, this association was not statistically significant with a weak association (Cramer's V = 0.07). Monthly income and parent's education levels showed statistical significance and strong association with vaccine hesitancy but there was no specific pattern of correlation. Our analysis suggests statistical significance, and a strong association between vaccine hesitancy, and information obtained from the internet, and social media with (P = 0.000122, and 0.000025), respectively, and (Cramer's V values of 0.187, and 0.2). Vaccine hesitancy, and information from family, and friends were statistically significant with a (P = 0.00003)
|Table 3: Association between sociodemographic, source of information, and hesitancy towards vaccination|
Click here to view
| Discussion|| |
Our study aimed to measure Saudi parents' KAP toward childhood vaccinations and explored the role of online information and social media platforms on parents' vaccine hesitancy. Our findings suggest that the overall knowledge of parents toward childhood vaccination is relatively good resulting in positive attitudes and practices. These findings were similar to what has been reported by other studies conducted in Saudi Arabia., In line with what has been reported by Getman et al. on the online community of VHPs, we found that online information and social media platforms played a role in parents' hesitancy toward childhood vaccination.
While most participants in our study were mothers, we found no evidence of an effect of gender or age on vaccine hesitancy. Instead, our findings demonstrated that a parent's educational level and income could influence the child's vaccination status. This is in line with similar studies reported by Omer et al. and Torun and Bakirci.
To the best of our knowledge, this is the first study to explore the role of online information and social media platforms on the hesitancy of parents toward childhood vaccinations in Saudi Arabia. We found a negative influence of the internet and social networks on the perceptions of childhood vaccination. Many communities are formed in an online environment utilizing social media platforms. This environment may become a source of misinformation for many parents, hindering the efforts of scientific communities and health-care providers in spreading awareness on the importance of childhood vaccines in preventing diseases. It is crucial for health-care authorities responsible for setting communication strategies to invest in targeting specific social media platforms to spread scientific information related to childhood vaccines.
Interestingly, while few participants stated that their family and friends had an influence on their decision-making practices and knowledge toward childhood vaccination, this influence was found to be a factor in their overall practice. Different from western communities and societies, Saudi families are usually large families that share a familial bond, which can be an influential factor. These findings were similarly reported in other studies, which share a similar family structure.
Factors that influence parents' perceptions toward childhood vaccination have slightly changed with the existence of online information and social media platforms. Understanding how this may impact parents' hesitancy toward childhood vaccination is the first step in fighting misinformation. A continuous assessment of parents' KAP is required as minor changes in peoples' KAP related to vaccinations can lead to the reemergence of VPD. With the spread of different social media accounts and the reliance of people on the Internet as a source of information, studies that explore the effects of Internet exposure on parents' KAP toward childhood vaccinations are needed. These studies may highlight the type of communication messages that healthcare officials on social media platforms should focus on to correct misinformation, and tailor targeted interventions to change perceptions, which may have the potential to create a successful vaccination program. Such efforts need to be collaborative in nature bringing together decision-makers, health-care providers, and researchers to develop continuous assessment, and evidence-based communication strategies targeting social networks.
Just as in similar epidemiological studies, there were certain limitations that need to be considered. First, our study was conducted in Riyadh, the capital, and the largest city in Saudi Arabia. While Riyadh is both a metropolitan and cosmopolitan city with a population of about seven million people, the results may not necessarily be generalizable to the other regions. Different regions of the country have shown to have unique traditions, cultures, and beliefs. Adopting a multi-center, multi-city approach in future studies may better be representative of the population. Second, this study included only Saudi parents. Future studies should take into consideration other nationalities living in Saudi Arabia as their knowledge and practices may influence the health of the public, especially when it comes to communicable diseases. Finally, although an anonymous self-administered questionnaire was used in collecting the data, which allowed the parents to respond freely, recall and reporting bias may have occurred. In addition, a tendency to agree or disagree with some statements whether due to fear of judgment or being uncertain when it comes to answering some points in the questionnaire could increase the reporting bias.
| Conclusions|| |
We found a potential impact of internet health information and social media platforms on parents' hesitancy toward childhood vaccination. Other factors such as sociodemographic and family influence may impact parents' perception and knowledge, which need to be further explored. Evidence-based interventions and continuous monitoring are needed to overcome the negative effects of social media and their role in spreading misinformation, as minor changes in parents' perception against vaccines can lead to public health and economic consequences, especially during pandemics. Findings of this study can serve as an important step in beginning to understand the emerging influences of social media platforms and online information within the public health communication environment to adapt our communication strategies and efforts in promoting vaccinations among parents in Saudi Arabia, especially during pandemics such as COVID-19.
This study was approved by the Institutional Review Board at King Saud University, College of Medicine (Research Project Number E-19-4454, December 8, 2019). Study procedures adhered to the ethical guidelines of the Declaration of Helsinki.
The authors thank King Saud University for their scientific support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Keni R, Alexander A, Nayak PG, Mudgal J, Nandakumar K. COVID-19: Emergence, spread, possible treatments, and global burden. Front Public Health 2020;8:216.
Greenwood B. The contribution of vaccination to global health: Past, present and future. Philos Trans R Soc Lond B Biol Sci 2014;369:20130433.
Fine P, Eames K, Heymann DL. “Herd immunity”: A rough guide. Clin Infect Dis 2011;52:911-6.
Williams SE. What are the factors that contribute to parental vaccine-hesitancy and what can we do about it? Hum Vaccin Immunother 2014;10:2584-96.
Hussain A, Ali S, Ahmed M, Hussain S. The anti-vaccination movement: A regression in modern medicine. Cureus 2018;10:e2919.
Kara SS, Polat M, Yayla BC, Demirdag TB, Tapisiz A, Tezer H, et al.
Parental vaccine knowledge and behaviours: A survey of Turkish families. East Mediterr Health J 2018;24:451-8.
Chung Y, Schamel J, Fisher A, Frew PM. Influences on immunization decision-making among US parents of young children. Matern Child Health J 2017;21:2178-87.
Prislin R, Dyer JA, Blakely CH, Johnson CD. Immunization status and sociodemographic characteristics: The mediating role of beliefs, attitudes, and perceived control. Am J Public Health 1998;88:1821-6.
Habib RF, Alsubhi RA, Saadawi DW, Faisa R, Hatim LA, Saleh A, et al.
Assessment of knowledge, attitude and practice of parents towards immunization of children in Saudi Arabia. Egypt J Hosp Med 2018;71:2585-9.
Campbell H, Edwards A, Letley L, Bedford H, Ramsay M, Yarwood J. Changing attitudes to childhood immunisation in English parents. Vaccine 2017;35:2979-85.
Lovrić Makarić Z, Kolarić B, Tomljenović M, Posavec M. Attitudes and beliefs related to childhood vaccinations among parents of 6 years old children in Zagreb, Croatia. Vaccine 2018;36:7530-5.
Ramadan H, Soliman S, Abd El-kader R. Knowledge, Attitude and practice of mothers toward children's obligatory vaccination. IOSR J Nurs Health Sci 2016;5:22-8. [doi.org/10.9790/1959-0504022228].
Bofarraj MA. Knowledge, attitude and practices of mothers regarding immunization of infants and preschool children at Al-Beida City, Libya 2008. Egypt J Pediatr Allergy Immunol 2011;9:29-34. [doi.org/10.4314/ejpai.v9i1].
Tustin JL, Crowcroft NS, Gesink D, Johnson I, Keelan J. Internet exposure associated with canadian parents' perception of risk on childhood immunization: Cross-sectional study. JMIR Public Health Surveill 2018;4:e7.
Alfahl SO, Alharbi KM. Parents' knowledge, attitude and practice towards childhood vaccination, medina, Saudi Arabia 2017. Neonatal Pediatr Med 2017;3:1-9.
Alyami A, Alhashan G, Nasser I. Knowledge, beliefs and practices of parents towards childhood vaccination in Najran City, Saudi Arabia. Egypt J Hosp Med 2018;70:1-7. [doi.org/10.12816/0042954].
Al-Zahrani J. Knowledge, Attitude and practice of parents towards childhood vaccination Majmaah J Health Sci 2013;1:23-32.
Alshammari TM, Subaiea GM, Hussain T, Moin A, Yusuff KB. Parental perceptions, attitudes and acceptance of childhood immunization in Saudi Arabia: A cross sectional study. Vaccine 2018;36:23-8.
Yousif M, Albarraq A, Abdallah M, Elbur A. Parents′ knowledge and attitudes on childhood immunization, Taif, Saudi Arabia. J Vaccines Vaccin 2013;5. [doi.org/10.4172/2157-7560.1000215].
Alshammari SZ, AlFayyad I, Altannir Y, Al-Tannir M. Parental awareness and attitude about childhood immunization in Riyadh, Saudi Arabia: A cross-sectional study. Int J Environ Res Public Health 2021;18:8455.
AlGhamdi KM, Moussa NA. Internet use by the public to search for health-related information. Int J Med Inform 2012;81:363-73.
Starcevic V, Berle D. Cyberchondria: Towards a better understanding of excessive health-related internet use. Expert Rev Neurother 2013;13:205-13.
Rowlands IJ, Loxton D, Dobson A, Mishra GD. Seeking health information online: Association with young australian women's physical, mental, and reproductive health. J Med Internet Res 2015;17:e120.
Bawden D, Robinson L. The dark side of information: Overload, anxiety and other paradoxes and pathologies. J Inform Sci 2008;35:180-91. [doi.org/10.1177/0165551508095781].
Boroon L, Abedin B, Erfani E. The dark side of using online social networks: A review of individuals' negative experiences. J Glob Inf Manag 2021;29:1-21. [doi.org/10.4018/JGIM.20211101.oa34].
Mckay D, Makri S, Gutierrez-Lopez M, MacFarlane A, Missaoui S, Porlezza C et al
. We are the change that we seek. In: CHIIR '20: proceedings of the 2020 Conf Hum Inf Interact Retr (pp. 173-182). New York: ACM. ISBN 978-1-4503-6892-6.
Zarocostas J. How to fight an infodemic. Lancet 2020;395:676.
Stahl JP, Cohen R, Denis F, Gaudelus J, Martinot A, Lery T, et al.
The impact of the web and social networks on vaccination. New challenges and opportunities offered to fight against vaccine hesitancy. Med Mal Infect 2016;46:117-22.
Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Arch Orofac Sci 2006;1:9-14.
Wallace AS, Wannemuehler K, Bonsu G, Wardle M, Nyaku M, Amponsah-Achiano K, et al.
Development of a valid and reliable scale to assess parents' beliefs and attitudes about childhood vaccines and their association with vaccination uptake and delay in Ghana. Vaccine 2019;37:848-56.
Getman R, Helmi M, Roberts H, Yansane A, Cutler D, Seymour B. Vaccine hesitancy and online information: The influence of digital networks. Health Educ Behav 2018;45:599-606.
Omer SB, Salmon DA, Orenstein WA, deHart MP, Halsey N. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. N Engl J Med 2009;360:1981-8.
Torun SD, Bakirci N. Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health 2006;6:125.
Khalil MK, Al-Eidi S, Al-Qaed M, AlSanad S. The future of integrative health and medicine in Saudi Arabia. Integr Med Res 2018;7:316-21.
[Table 1], [Table 2], [Table 3]