Did the COVID-19 experience change U.S. parents' attitudes towards HPV vaccination? Results from a national survey.

BACKGROUND: In the U.S., uptake of the HPV vaccine remains below coverage goals. There is concern that negative reactions to emergency initiatives during the COVID-19 pandemic, including vaccination, may have increased some parents' hesitancy towards all vaccines, including HPV. Understanding how different parent populations view routine vaccination post-pandemic is key to strategic efforts to maintaining and increasing uptake of HPV vaccine. METHODS: In early 2022, we recruited an online panel of English-speaking U.S. parents and caregivers, who used the social media platform Twitter and had HPV vaccine-eligible but unvaccinated children age 9-14 years. Respondents completed a 20-minute survey measuring knowledge, attitudes and intentions regarding HPV vaccination for their child, as well as background socio-demographics and health information-seeking practices. Questions regarding experiences during the COVID-19 pandemic included changes in access to preventive care, and perceptions of whether pandemic experiences had positively or negatively affected their attitudes about routine vaccination, with open text capturing reasons for this change. RESULTS: Among 557 respondents, 81 % were definitely or likely to vaccinate their child against HPV, with 12 % being uncertain, and 7 % unlikely to vaccinate. Regarding routine vaccination, most (70 %) felt their attitudes had not changed, while 26 % felt more positively, and only 4 % felt more negatively. Reasons for positive attitude change included increased appreciation for vaccines overall, and motivation to proactively seek preventive care for their child. Negative attitude changes stemmed from distrust of COVID-19 public health efforts including vaccine development, and disillusionment with vaccines' ability to prevent disease. In multivariable models, intention to vaccinate was greater among parents reporting greater education, Democratic affiliation, greater religiosity, and urban residence. Negative attitude change due to the pandemic independently predicted reduced HPV vaccination intention, while positive attitude change predicted positive intention. CONCLUSIONS: Post-pandemic, most U.S. parents remain committed to vaccinating their children against HPV. However, addressing residual COVID-19 concerns could improve uptake among vaccine-hesitant parents.

A Conditional Process Analysis of Emerging Adults' Motivated Information Management with Parents, Family Conversation Orientation, and Intentions to Vaccinate for COVID-19.

Using the theory of motivated information management (TMIM), this study tested the effect of emerging adults' uncertainty discrepancy about COVID-19 vaccines on their intentions to vaccinate. In March and April of 2021, 424 emerging adult children reported on the likelihood of seeking or avoiding information from a parent about COVID-19 vaccines in response to their uncertainty discrepancy and negative emotions related to the vaccines. Results supported the direct and indirect effects specified by the TMIM. Moreover, the indirect effects of uncertainty discrepancy on intentions to vaccinate via the TMIM's explanatory mechanisms were conditioned by family conversation orientation. Consequently, the family communication environment may alter motivated information management in parent-child relationships.

COVID-19 Message Fatigue: How Does It Predict Preventive Behavioral Intentions and What Types of Information are People Tired of Hearing About?

This study examines the impact of message fatigue and what makes people fatigued in the context of the COVID-19 pandemic. Data collected with a Qualtrics panel (N = 744) showed that both active (i.e., reactance) and passive (i.e., inattention) resistance in message processing mediated the relationships between message fatigue and intentions to follow three types of preventive behaviors against COVID-19 (i.e., wearing masks, social distancing, and washing hands). The indirect effect of message fatigue on intention to seek COVID-19 information was explained by inattention but not reactance. Analyses of open-ended responses identified 18 types of COVID-related information that individuals were tired of hearing about. About 73.38% of participants (n = 546) reported that they were tired of hearing about at least one type of information about COVID-19, with mask-wearing being the most frequently mentioned (21.91%). The results extend existing research on message fatigue-evoked resistance to persuasion and provide practical implications for public health message design.

Beyond Depth and Breadth: Taking "Types" of Health Information Sought into Consideration with Cluster Analysis.

Online health information-seeking behavior (OHIS) has been typically operationalized in an aggregate form representing either depth (e.g., how long) or breadth (e.g., how much) of seeking, which is irrespective of what types of information are sought. Recognizing limitations of such practice, this research employs cluster analysis to reflect the content and types of health information sought in studying OHIS. Three online studies providing participants with opportunities to actually seek information about meningitis (Study 1; N = 408), Alzheimer's disease (Study 2; N = 190), and cancer (Study 3; N = 208) recorded the participants' information-seeking activities unobtrusively. Across the three studies, cluster analysis identified three common clusters representing distinctive information-seeking patterns (i.e., combinations of different types of information sought): One cluster sought information on "overview," the second one focused on "protection" information, and the third cluster sought "all" types of information provided. The relative preference for these types of information was predicted by several antecedents of information-seeking behavior proposed in Comprehensive Model of Information Seeking (CMIS) including age, fear, self- and response-efficacy. The findings demonstrate the utility of taking the actual content or types of health information sought into consideration and suggest several fruitful avenues it paves for future research on OHIS.

Modeling the Mediating and Moderating Roles of Risk Perceptions, Efficacy, Desired Uncertainty, and Worry in Information Seeking-Cancer Screening Relationship Using HINTS 2017 Data.

Despite mixed findings in the literature, health information seeking is considered as a promising antecedent of health behavior and outcome. However, little research has been conducted to identify factors that explain the health information seeking-health behavior relationship. In the contexts of breast, cervical, and prostate cancer screening, this research utilized recently collected Health Information National Trends Survey data (HINTS 5 Cycle 1) to examine whether, among the population at risk of cancer, previous cancer information seeking influenced cancer screening via perceptions of risk and efficacy, desired uncertainty, and worry. The results indicated that previous cancer information seeking had a direct effect on cancer screening. Across the three cancer screening behaviors, desired uncertainty mediated the relationship between previous cancer information seeking and screening behavior. Worry about getting cancer moderated and mediated the relationship between cancer information seeking and cervical cancer screening. Moreover, desired uncertainty and perceived susceptibility respectively interacted with previous cancer information seeking to influence breast cancer screening. Perceptions of risk and efficacy had limited effects on cancer screening. Theoretical and practical implications are discussed.

Communicating COVID-19 information on TikTok: a content analysis of TikTok videos from official accounts featured in the COVID-19 information hub.

Amid the COVID-19 pandemic, TikTok, an emerging social media platform, has created an information hub to provide users with engaging and authoritative COVID-19 information. This study investigates the video format, type and content of the COVID-19 TikTok videos, and how those video attributes are related to quantitative indicators of user engagement, including numbers of views, likes, comments and shares. A content analysis examined 331 videos from official accounts featured in the COVID-19 information hub. As of 5 May 2020, the videos received 907 930 000 views, 29 640 000 likes, 168 880 comments and 781 862 shares. About one in three videos had subtitles, which were positively related to the number of shares. Almost every video included a hashtag, and a higher number of hashtags was related to more likes. Video types included acting, animated infographic, documentary, news, oral speech, pictorial slideshow and TikTok dance. Dance videos had the most shares. Video themes included anti-stigma/anti-rumor, disease knowledge, encouragement, personal precautions, recognition, societal crisis management and work report. Videos conveying alarm/concern emotions, COVID-19 susceptibility and severity, precaution response efficacy had higher user engagement. Public health agencies should be aware of the opportunity of TikTok in health communication and create audience-centered risk communication to engage and inform community members.

Associations Between Mother-Child Communication Apprehension, and Young Adult Resilience, Depressive Symptoms, and Self-Esteem.

This study tested associations between mother-child communication apprehension, adult child communication apprehension, and adult child resilience, self-esteem, and depressive symptoms. Data were collected from 154 mother-child dyads (N = 308) who completed measures of communication apprehension, depressive symptoms, resilience, and self-esteem. Results showed that mother communication apprehension positively predicted adult child communication apprehension. Moreover, adult child communication apprehension predicted lower levels of resilience and self-esteem, and higher levels of depressive symptoms. Mother communication apprehension indirectly predicted all three psychological outcomes for adult children through adult children's communication apprehension. We discuss the potential implications for communication apprehension and social skill training that could help families improve psychological problems.

Exploring the Role of Social Support in Promoting Patient Participation in Health Care among Women with Breast Cancer.

Scholars have adopted Street's (2003) ecological model of communication in medical encounters to investigate the factors promoting patient participation in health care. However, factors demonstrated in the ecological model were bounded in the context of medical care primarily focusing on health care providers and patients. Social factors, such as patients' relationships and supportive communication with others outside the context of health care remain relatively unexplored. To expand the purview of our understanding of factors that influence patient participation, this research integrated social support literature into the research on physician-patient communication and proposed a model which described a process through which social support can enhance patient participation in health care. The data analyzed in this study were a part of two larger clinical trials in which 661 women with breast cancer were recruited from three cancer institutions in the United States. The results from structural equation modeling analysis from cross-sectional and longitudinal data provided strong evidence for the hypotheses predicting that perceived social support was positively associated with health information competence, which in turn fully mediated the association between social support and patient participation in health care. Theoretical and practical implications are discussed.

Tailoring Temporal Message Frames to Individuals' Time Orientation Strengthens the Relationship between Risk Perception and Behavioral Intention.

While health behavior theories conceptualize risk perception as a major factor motivating protective action against risk, empirical support for this widely-assumed proposition has been inconclusive. Given the inherent issue concerning the delay of desired outcomes in most health behaviors, this research proposes the congruence between temporal frame and individuals' trait time orientation (i.e., consideration of future consequences; CFC) as an important moderator in the risk perception-behavioral intention relationship. Findings from two experiments concerning messages promoting adequate sleep (N = 227; Study 1) and plastic bottle recycling (N = 223; Study 2) showed that the relationship between risk perception and behavioral intention was significantly stronger when temporal frames and CFC were more congruent (i.e., tailored). Nuanced differences in the moderating effects of frame-CFC congruence were observed depending on how risk perception was operationalized (i.e., susceptibility only, severity only, or combination of the two). Implications for health communication message design are discussed.

Rise of Health Consumerism in China and Its Effects on Physicians' Professional Identity and the Physician-Patient Relationship and Communication.

The physician-patient relationship in China is highly strained. This study examined the professional identity of physicians and their perceptions of the physician-patient relationship against the backdrop of the rise of health consumerism in China. Structured interviews with 29 physicians found that the marketization of medical care and the rise of health consumerism caused physicians to have a conflicted professional identity. The traditional bureaucratic relationship between physicians and patients based on implicit trust was gradually replaced by an arm's length relationship characterized by self-interest, opportunism, and mistrust. In addition, the transition from physician-centered communication to patient-centered communication in China was tenacious. Theoretical and practical implications of the current study are discussed.

Incorporating Communication into the Theory of Planned Behavior to Predict Condom Use Among African American Women.

The present research extends the theory of planned behavior (TPB) to investigate how communication-related variables influence condom use intention and behavior among African American women. According to the TPB, attitudes, subjective norms, and self-efficacy are associated with behavioral intent, which predicts behavior. For women, it was argued that condom negotiation self-efficacy was more important than condom use self-efficacy in predicting consistent condom use. Moreover, an important environmental factor that affects condom use for African American women is fear or worry when negotiating condom use because the sex partners might leave, threaten, or abuse them. Fears associated with negotiating condom use were predicted to be negatively associated with attitudes, subjective norms, and self-efficacy. African American women (N = 560; M age = 20.58) completed assessments of TPB variables at baseline and condom use 3 months later. Condom negotiation self-efficacy was a significant indicator of behavioral intent, while condom use self-efficacy was not. Fear of condom negotiation was negatively associated with all TPB components, which was in turn significantly associated with behavioral intent and condom use. Implications for the TPB, safer sex literature, and sexually transmitted infection prevention intervention design are discussed.