Vaccine hesitancy, psychological fatigue, and information distortion on social media in Chinese parents during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has highlighted the importance of high vaccination coverage in returning to normalcy. However, vaccine hesitancy (VH) among parents remains substantial, fuelled partially by misinformation or information distortion on social media. Alongside a decline in public confidence to follow recommended public health measures, an emerging issue of psychological fatigue may also influence parental VH over time. Moreover, the existence of hesitant-but-vaccinated parents places more focus on parental VH. Influencing factors of parental VH in the context of the COVID-19 pandemic were inconsistently reported and not well understood in cross-sectional studies, especially among Chinese parents who are more likely to be affected by government policies, situational factors, and social influences. It remains unclear how these recent-emerging factors may influence Chinese parental VH over time.

This thesis aims to (1) describe Chinese parental VH and investigate its potential factors during a local outbreak period; (2) identify the consistency of and differences in factors associated with parental VH between hesitant and non-hesitant parents; (3) examine the mediating effect of information distortion and psychological fatigue on the relationship between information exposure and parental VH; and (4) measure the association between VH and future intention to vaccinate children.

A prospective, longitudinal study was conducted among general Chinese parents of children aged under 18 years. The baseline data were collected from March to April 2022, when a local pandemic outbreak resurged. The one-month follow-up data were collected from May to June 2022 after the local outbreak was extinguished. In total, 588 respondents were recruited at baseline, with 268 (45.6%) further collected at the follow-up.

Parents with longer duration of information seeking (adjust  [a]=-0.47, 95% CI -0.90, -0.04) and more frequent information sharing on social media (a=-1.39, 95% CI -1.94, -0.84) reported lower levels of parental VH. Parent’s and child’s demographics were not associated with their VH. Of 533 vaccinated parents, 24% (134) were identified as hesitant-but-vaccinated. Hesitant parents tended to be younger and have a younger child. Group differences of parental VH were observed regarding information exposure (a=-0.33, 95% CI -0.63, -0.04), information distortion (=-0.22, 95% CI -0.36, -0.09), and psychological fatigue (=0.13, 95% CI 0.03, 0.24) between hesitant and accepted parents. Furthermore, longitudinal results showed that information distortion and psychological fatigue significantly mediated the relationship between information exposure and parental VH (total indirect effect: =-0.25, 95% CI=-0.41, -0.13). Additionally, parental VH mediated the association between parental vaccination status and their intention to vaccinate children (total indirect effect: β -0.12, 95% CI -0.22, -0.05), and the child’s age significantly moderated this mediation pathway.

This thesis presented first data on Chinese parental VH over time and assessed the mediating effects of information distortion and psychological fatigue on the relationship between information exposure on social media and parental VH. This thesis highlighted the significant influences of intensive responses to information on social media and psychological fatigue, resulting in the uncertainty of vaccination implementation. Future studies are needed to provide more transparent, accurate, and accessible information targeting paediatric vaccination interventions.