Explaining Health Misinformation Belief through News, Social, and Alternative Health Media Use: The Moderating Roles of Need for Cognition and Faith in Intuition.

Explaining the spread and impact of health misinformation has garnered considerable attention with the uptake of social media and group messaging applications. This study contributes to that line of work by investigating how reliance on multiple digital media may help support or suppress misinformation belief, and how individual differences in misinformation susceptibility condition this process. Alternative health outlets (AH media), advocating home/homeopathic remedies over conventional medicine can be important sources of misinformation, yet are largely ignored previously. In this study, we first test how reliance on different platforms predicts health misinformation belief. Drawing from the elaboration likelihood model, we further investigate how need for cognition (NFC) and faith in intuition (FI) moderate the relationship between news reliance and susceptibility to misinformation. We conducted a survey in Singapore, Turkey, and the U.S (N = 3,664) to measure how these proposed relationships explain misinformed beliefs about vaccines, genetically modified foods and alternative medicine. We found reliance on online legacy news was negatively associated with the likelihood of believing health misinformation, while the reverse was true for social media and AH media. Additionally, those with both greater NFC and FI were more susceptible to health misinformation when they relied on social media and AH media more. In contrast, neither NFC nor FI moderated the relationship between reliance on online legacy news and health misinformation belief. These findings, mostly consistent across countries, also show that extensive reliance on social media and AH media for news mostly overwhelms the individual differences in predicting misinformation belief.

Severe Acute Respiratory Syndrome Coronavirus 2 Nosode: A Potential Alternative Vaccine Platform.

Besides conventional vaccinations, viable alternatives are needed to elicit an immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We propose and highlight the value of a homeopathic approach known as the "nosode" for the prevention of coronavirus disease-2019 (COVID-19). Nosode is an extract prepared from disease-affected tissues which is subsequently processed and administered as an antidote for the same medical condition. This concept might be a crucial therapeutic approach for viral infections since infected tissues contain a wide range of important viral antigens that could induce a functional host response via immunological sensitization. Thereby, nosode preparation produced from SARS-CoV-2-affected tissues may provide protection against COVID-19. "SARS-CoV-2 nosode" warrants more scientific investigation as a viable alternative vaccination platform. Keywords: COVID-19, Nosode, SARS-CoV-2, Variolation.

Social media, vaccine hesitancy and trust deficit in immunization programs: a qualitative enquiry in Malappuram District of Kerala, India.

BACKGROUND: With increased penetration of the internet and social media, there are concerns regarding its negative role in influencing parents' decisions regarding vaccination for their children. It is perceived that a mix of religious reasons and propaganda by anti-vaccination groups on social media are lowering the vaccination coverage in Malappuram district of Kerala. We undertook a qualitative study to understand the factors responsible for generating and perpetuating vaccine hesitancy, the pathways of trust deficit in immunization programs and the interaction between various social media actors. METHODS: In-depth interviews and focus group discussions were conducted among parents/caregivers, physicians, public sector health staff, alternative system medical practitioners, field healthcare workers and teachers in areas with highest and lowest vaccination coverage in the district, as well as with communication experts. RESULTS: The trust deficit between parents/caregivers and healthcare providers is created by multiple factors, such as providers' lack of technical knowledge, existing patriarchal societal norms and critical views of vaccine by naturopaths and homeopaths. Anti-vaccine groups use social media to influence caregivers' perceptions and beliefs. Religion does not appear to play a major role in creating vaccine resistance in this setting. CONCLUSIONS: A long-term, multipronged strategy should be adopted to address the trust deficit. In the short to medium term, the health sector can focus on appropriate and targeted vaccine-related communication strategies, including the use of infographics, soft skills training for healthcare workers, technical competency improvement through a mobile application-based repository of information and creation of a media cell to monitor vaccine-related conversations in social media and to intervene if needed.

"Imagine the Perfect Vaccine": Homeopathic Vaccine Alternatives and Vaccine Discourse in English Canada.

Advocates of homeopathic vaccines, also known as nosodes, reimagined the risks and benefits of vaccination from 1999 to 2015 by comparing "risky" vaccines to "risk-free" nosodes. I argue that nosodes allowed for a complementary argument to anti-vaccine discourse, fundamentally altering what had been framed as a choice between the risks of vaccination and the risks of vaccine-preventable disease. Despite evidence of their efficacy being flawed, advocates presented nosodes as an alternative to vaccines and a middle ground between anti-vaccination and vaccination. While a campaign from 2013 to 2015 tried to expose nosodes as ineffective, I argue that the campaign was unsuccessful. Instead, the mainstream media brought more attention to nosodes. The history of nosodes further complicates the history of vaccines and alternative medicine in Canada by adding vaccine alternatives to the growing literature on vaccine hesitancy.

Vaccination Attitudes and Practices of Integrative Medicine Physicians.

Context • The growth of Internet-based information and social networking has increased the accessibility and importance of antivaccine information. That information has led to a questioning of vaccination schedules and policies by many individuals. Although the attitudes of complementary and alternative practitioners, such as homeopaths and chiropractic students, toward vaccination have been assessed, despite the growth of integrative medicine, no assessment of the attitudes and practices regarding vaccination of these physicians has been performed. Objective • The study intended to evaluate the attitudes and practices regarding vaccination of members of the American Board of Integrative and Holistic Medicine (ABIHM). Design • The research team conducted a survey of practitioners. Setting • The administration and evaluation of the survey took place at San Diego State University (San Diego, CA, USA). Participants • Prospective participants were 1419 diplomats of the ABIHM on June 19, 2013. Outcome Measures • The survey assessed members' (1) use of and confidence in the vaccination recommendations of the Centers for Disease Control and Prevention (CDC) and of medical-specialty associations, (2) confidence in the manufacturing safety of vaccines and in manufacturer's surveillance of adverse events, and (3) attitudes toward vaccination mandates. The questionnaire included 33 items, with 5 open-ended questions that provided a space for comments. Results • The survey was completed by 290 of 1419 diplomats (20%). The survey showed a diversity of opinions in many vaccination issues. Integrative medicine physicians were less likely to administer vaccinations than physicians in traditional allopathic medicine. Among the 44% who provide vaccinations, 35% used alternative schedules regularly. Integrative medicine physicians showed a greater support of vaccination choice, were less concerned about maintaining herd immunity, and were less supportive of school, day care, and employment mandates. Toxic chemical and viral contaminants were of greater concern to a higher percentage of integrative medicine physicians. Integrative medicine physicians were also more likely to accept a connection between vaccinations and both autism and other chronic diseases. Overall, there was dissatisfaction with the Vaccine Adverse Event Reporting System as well as the vaccination recommendations of the CDC and their primary specialty. Conclusions • This survey documents significant variations in the vaccination attitudes and practices of integrative medicine physicians. This survey provides benchmark data for future surveys of this growing specialty and other practitioners. It is important for public health leaders and the vaccination industry to be aware that integrative medicine physicians have vaccination attitudes and practices that differ from the guidelines of the CDC and the Advisory Council on Immunization Practices.

Vaccine hesitancy among physicians: a qualitative study with general practitioners and paediatricians in Austria and Germany.

OBJECTIVE: This study aims to understand reasons for vaccine hesitancy (VH) among general practioners (GPs) and paediatricians. We aim to analyse how and when the healthcare workers (HCWs) developed vaccine-hesitant views and how they transfer these to patients. DESIGN AND SETTING: Semistructured interviews with vaccine-hesitant GPs and paediatricians were conducted in Austria and Germany using an explorative qualitative research design. PARTICIPANTS: We contacted 41 physicians through letters and emails and 10 agreed to participate, five were male and five female. DATA COLLECTION AND ANALYSIS: Ten interviews were recorded, transcribed verbatim and anonymised. The material was analysed inductively following a grounded theory approach with open coding using the software atlas.ti. RESULTS: Key themes that were identified were education and career path, understanding of medicine and medical profession, experiences with vaccines, doctor-patient interactions and continuous education activities and the link to VH. GPs and paediatricians' vaccine-hesitant attitudes developed during their medical training and, in particular, during extracurricular training in homeopathy, which most of the participants completed. Most participants work in private practices rather than with contracts with social insurance because they are not satisfied with the health system. Furthermore, they are critical of biomedicine. Most of the interview partners do not consider themselves antivaccination, but are sceptical towards vaccines and especially point out the side effects. Most do not vaccinate in their practices and some do only occasionally. Their vaccine-hesitant views are often fostered through respective online communities of vaccine-hesitant HCWs. CONCLUSIONS: More studies on a connection between complementary medicine and vaccine-hesitant views of HCWs are needed. Education about vaccines and infectious diseases among healthworkers must increase especially tailored towards the use of internet and social media. Physicians should be made aware that through time and empathy towards their patients they could have a positive impact on undecided patients and parents regarding vaccine decisions.

Vaccines and Homeopathy.

The title refers to the conceptual quality of being similar, as a kind of resemblance between both procedures.

Vaccine hesitancy is strongly associated with distrust of conventional medicine, and only weakly associated with trust in alternative medicine.

RATIONALE AND OBJECTIVE: It is well established that people who use complementary and alternative medicines (CAM) are, on the whole, more vaccine hesitant. One possible conclusion that can be drawn from this is that trusting CAM results in people becoming more vaccine hesitant. An alternative possibility is that vaccine hesitancy and use of CAM are both downstream consequences of a third factor: distrust in conventional treatments. We conducted analyses designed to disentangle these two possibilities. METHOD: We measured vaccine hesitancy and CAM use in a representative sample of Spanish residents (N = 5200). We also measured their trust in three CAM interventions (acupuncture, reiki, homeopathy) and two conventional medical interventions (chemotherapy and antidepressants). RESULTS: Vaccine hesitancy was strongly associated with (dis)trust in conventional medicine, and this relationship was particularly strong among CAM users. In contrast, trust in CAM was a relatively weak predictor of vaccine hesitancy, and the relationship was equally weak regardless of whether or not participants themselves had a history of using CAM. CONCLUSIONS: The implication for practitioners and policy makers is that CAM is not necessarily a major obstacle to people's willingness to vaccinate, and that the more proximal obstacle is people's mistrust of conventional treatments.

Vaccine confidence among parents: Large scale study in eighteen European countries.

BACKGROUND: Despite the fact that vaccines save 2-3 million lives worldwide every year, a percentage of children are not getting appropriately vaccinated, thus leading to disease outbreaks. One of the major reasons of low vaccine uptake in Europe is vaccine hesitancy, contributing to the recent measles outbreaks. Monitoring of vaccine hesitancy is valuable in early identification of vaccine concerns. METHODS: We performed an eighteen country European survey on parents' attitudes and behaviors regarding their children's immunization. Parents having at least one child 1-4 years old were mostly recruited by primary care paediatricians to reply to a web-based questionnaire. The questionnaire was developed by the European Academy of Paediatrics Research in Ambulatory Setting Network steering committee, based on similar surveys. An individual level hesitancy score was constructed using the answers to 21 questions, and correlations of the score with socio-demographic characteristics and types of providers were explored. To assess inter country differences, a country level self -reported confidence was defined. RESULTS: Fifty six percent and 24% of 5736 respondents defined themselves as "not at all hesitant", and "somewhat hesitant", respectively. Parents who consulted general practitioners were more hesitant than parents who consulted pediatricians (p < 0.05). Consultation with homeopathists was associated with the highest reported hesitancy (p < 0.05). Vaccine confidence was highest in Portugal and Cyprus, and lowest in Bulgaria and Poland. CONCLUSION: The majority of parents in Europe believe in the importance of childhood vaccination. However, significant lack of confidence was found in certain European countries, highlighting the need for continuous monitoring, awareness and response plans. The possible influence of different types of healthcare providers on parental decisions demonstrated for the first time in our survey, calls for further research. Monitoring and continuous medical education efforts aimed mostly at those professionals who might not be likely to recommend vaccination are suggested.

Vaccination discourses among chiropractors, naturopaths and homeopaths: A qualitative content analysis of academic literature and Canadian organizational webpages.

Vaccine hesitancy-the reluctance to receive recommended vaccination because of concerns and doubts about vaccines-is recognized as a significant threat to the success of vaccination programs and has been associated with recent major outbreaks of vaccine-preventable diseases. Moreover, the association between complementary and alternative medicine (CAM) use and vaccine hesitancy and/or refusal has been frequently reported in the literature. To date, significant gaps persist in our understanding of contemporary Canadian CAM providers' beliefs regarding vaccination and how socio-professional influences may shape their vaccine-related attitudes and behaviours. To address the latter gap, the current study aims to explore the content of professional guidelines, recommendations and other discourses among CAM providers as they concern vaccination by analyzing both academic, peer-reviewed literature and Canadian organizational webpages prepared by and/or for practicing chiropractors, naturopaths and homeopaths. In the academic literature, we identified a number of complex and diverging views on vaccination that spanned topics of effectiveness; safety; theoretical, empirical, and ethical soundness; political justifiability; and compatibility with CAM philosophy and professional boundaries. However, in its current state the CAM literature cannot be described in broad strokes as being either pro- or anti-vaccination without considering finer areas of disagreement. Compared to the academic literature, which focuses more on the conceptual and evidentiary basis of vaccination, a greater proportion of vaccine-related content on Canadian CAM organizations' webpages seems to be dedicated to offering specific directives and prescriptions to providers. Guidelines and standards of practice address a number of issues, including vaccine administration, counsel, education and marketing. As CAM organizations further evolve in Canada and elsewhere as part of a broader "professionalization" initiative, greater attention will need to be directed at their role in shaping providers' beliefs and practices that both support and undermine vaccine promotion efforts.