An Evaluation of an Interactive Social Media Web site for Parents who are Concerned about Immunizing their Children

Widespread use of immunizations in the United States has led to the eradication or control of numerous vaccine-preventable diseases including smallpox, polio, diphtheria, and measles. However, as the incidence of vaccine-preventable diseases has declined, public concern has shifted from disease transmission to vaccine safety. Many Web sites – both pro- and anti-vaccination – use social media to convey the benefits and risks of vaccinations. Numerous anti-vaccination Web sites disseminate erroneous information, discredit the medical community, and create fear about vaccinations. Often these sites are not moderated by experts, and the sources of health information are anonymous. New and expecting parents are typically active users of social media, which puts them at risk of finding these sites and believing the erroneous information.

This project built and evaluated an interactive social media Web site devoted to vaccines. The site has a forum in which parents can access truthful, unbiased information, and discuss vaccine-related issues with other parents and pediatricians. The participants in this study were active Kaiser Permanente Colorado members.

The specific aims of this project were to:

• Design and develop an interactive social media Web site devoted to immunization. 
• Conduct a qualitative formative evaluation of the social media Web site using focus groups. 
• Qualitatively and quantitatively evaluate Web site usability through one-on-one testing sessions with end users. 
• Pilot test the social media Web site with a representative cohort of end users over a 6-month followup period. 

In the first phase of the project, the Web site was designed and an initial prototype built. The objective was to create a resource that was both easy to use and interactive, with a blog, discussion forum, chat room, and an anonymous portal through which parents were able to ask questions. In the second phase of the project, focus groups and interviews were conducted with parents and providers to generate qualitative data to further develop and refine the Web site. Usability testing sessions with eight parents and two providers were conducted in Phase 3. In Phase 4, the Web site was modified based on the results of the focus groups, interviews, and usability testing to improve its functionality. In the final phase of the project, a survey with 443 parents and pregnant women was conducted to assess the vaccine decisionmaking process and preferences for vaccine information. The pilot test was completed with 86 participants.

The project team found that vaccine-hesitant parents were more likely to begin thinking about vaccines early, indicating that pregnancy is an important decisionmaking time for parents who are considering delaying or refusing vaccines. In addition, vaccine-hesitant parents indicated that they constantly re-evaluate their vaccine decisions. Participants used the prototype between zero and three times over a 6-month period. The project team concluded that an interactive social media Web site has the potential to help parents address vaccination concerns. Such an intervention, however, poses numerous challenges, including establishing trust, making it cost-effective, and recruiting new and expecting parents whose time is limited. The team is conducting a follow-on AHRQ-funded randomized intervention trial to further evaluate this tool and address these challenges.