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

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.

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“…The vaccine opposing content on Twitter was steadily increasing during the first half of 2020; thus, requiring thematic analysis of such content [66]. The discourse analysis of Griffith et al (2021) for COVID-19 VH tweets found that concerns over safety, mistrust of governments and drug manufacturers, and insufficient knowledge about vaccines were the critical drivers of VH [67].…”

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“…Reliable and accurate information on social media is often mixed with inaccurate, conspiratorial, incomplete, or biased messages [22]. A recent study evaluating vaccine hesitancy through content analysis of tweets in Canada identified major themes including safety, suspicion of economic or political motivation, knowledge deficit, opinions of authority figures, and lack of liability from pharmaceutical companies [25]. This study demonstrates the significant utility of using Twitter to better understand vaccine hesitancy at a population level [25].…”

“…A recent study evaluating vaccine hesitancy through content analysis of tweets in Canada identified major themes including safety, suspicion of economic or political motivation, knowledge deficit, opinions of authority figures, and lack of liability from pharmaceutical companies [25]. This study demonstrates the significant utility of using Twitter to better understand vaccine hesitancy at a population level [25]. However, a broader reaching and deeper understanding of current patterns of communication that characterize the immunization debate on social media platforms is needed to inform public health interventions aimed toward influencing attitudes on immunization [15,17,22,23].…”

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“…Additionally, they noticed that rural individuals who did not have permitted residency (Hukou) in Shanghai showed more concerns about the side effects, safety, and effectiveness of vaccines compared to local residents of Shanghai. Janessa et al [36] sought to uncover the reasons for COVID-19 vaccine hesitancy in Canada. Using the Theoretical Domains Framework, they analyzed the contents of 3915 tweets based on knowledge, beliefs on consequences, environmental context and resources, social influence, and emotion.…”