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. 2021 Apr 13;23(4):e26874.
doi: 10.2196/26874.

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

Janessa Griffith  1   2   3 , Husayn Marani  4 , Helen Monkman  5
Affiliations

COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework

Janessa Griffith et al. J Med Internet Res. .

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.

Keywords: COVID-19; Canada; Twitter; behavior; behavioral science; content analysis; framework; hesitancy; immunization; infodemiology; infoveillance; social media; vaccine; vaccine hesitancy.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
A graph depicting Google Trends data for the combined search terms “covid” and “vaccine” aligning with vaccine approval and administration dates in Canada. Tweets that were posted between December 10 and 23, 2020 were eligible for analysis. This date range aligned with the time when the highest peaks in related Google search activity occurred in Canada. This figure indicates that the number of searches on Google for the combined words “COVID” and “vaccine” was highest in December 9, 2020. All other searches were relative to this highest peak. For example, on December 14, 2020, roughly 70% of related searches occurred in December 9, 2020 [28]. It was not possible to obtain more detailed numbers.
Figure 2
Figure 2
A map of where Twitter users were located. Tweets from outside of Canada (ie, those from the United States) were excluded.
Figure 3
Figure 3
Modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram of the data extraction process.
Figure 4
Figure 4
Themes were categorized based on the TDF. The TDF domains are represented by the dark-gray circles. The themes from the content analysis (smaller colored circles) were mapped to relevant TDF domains. TDF: Theoretical Domains Framework.
See this image and copyright information in PMC

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References

    1. Detoc M, Bruel S, Frappe P, Tardy B, Botelho-Nevers E, Gagneux-Brunon A. Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic. Vaccine. 2020 Oct 21;38(45):7002–7006. doi: 10.1016/j.vaccine.2020.09.041. http://europepmc.org/abstract/MED/32988688 - DOI - PMC - PubMed
    1. Harrison EA, Wu JW. Vaccine confidence in the time of COVID-19. Eur J Epidemiol. 2020 Apr;35(4):325–330. doi: 10.1007/s10654-020-00634-3. http://europepmc.org/abstract/MED/32318915 - DOI - PMC - PubMed
    1. Ten threats to global health in 2019. World Health Organization. [2020-12-31]. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-....
    1. Angus RI. More Canadians willing to roll up their sleeves right away as national COVID-19 vaccine rollout begins. Angus Reid Institute. 2020. Dec 14, [2020-12-31]. https://angusreid.org/canada-COVID-vaccine-december/
    1. Dror AA, Eisenbach N, Taiber S, Morozov NG, Mizrachi M, Zigron A, Srouji S, Sela E. Vaccine hesitancy: the next challenge in the fight against COVID-19. Eur J Epidemiol. 2020 Aug;35(8):775–779. doi: 10.1007/s10654-020-00671-y. - DOI - PubMed

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