Online media use and COVID-19 vaccination in real-world personal networks

Background Most studies assessing the impact of online and social media usage on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fails to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research employing social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person’s social circle, which combines online and offline interactions, affects vaccine acceptance. Objective We examined how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European Union (EU) member state. Methods We conducted 83 face-to-face interviews with participants from a living lab in Leresti, a small rural community in Romania, employing a Personal Network Analysis (PNA) framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as social alters ). After excluding cases with missing data, our analysis proceeded with 61 complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we utilized a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the ego’s preferred source of health and prevention information. This variable was categorized into three types: traditional media, online media (including social media), and a combination of both, with traditional media serving as the reference category. Results In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P =.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination odds (OR 0.75, 95% CI 0.32-1.78; P =.52). Additionally, our analysis reveals that alters in personal networks with vaccinated egos are more likely to be vaccinated themselves (OR 3.75, 95% CI 1.79-7.85; P <.001). Conclusion Real-world networks combine offline and online human interactions with consequences on health opinions and behaviors. As individuals’ vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by HORIZON-MISS-2022-CANCER-01, project ID 101104432, programme HORIZON; the Research Institute of the University of Bucharest (ICUB) (grant 8405 / 22.07.2023); Deutsche Forschungsgemeinschaft (DFG 321869138); the Slovenian Research and Innovation Agency (Javna agencija za znanstvenoraziskovalno in inovacijsko dejavnost Republike Slovenije) (grant P1-0403). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of the Center for Innovation in Medicine (InoMed) gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The code and the dataset analyzed in the current study are made openly available in the Zenodo data repository as Oană, I., Hâncean, M.-G., Perc, M., Lerner, J., Pintoiu-Mihăilă, B.- E., Geantă, M., Molina, J.L., Tincă, I., Espina, C. (2024). Replication data for: Online media use and COVID-19 vaccination in real-world personal networks. Zenodo. .