JMIR Publications

ABSTRACT

Background:

Human papillomavirus (HPV) is a leading cause of preventable cancers, yet HPV vaccination rates remain well below national targets, particularly in rural and highly religious communities. Social media plays a dual role as both a platform for health education and a conduit for vaccine misinformation. In Utah, where internet use is high across geographic and religious lines, online discourse from news outlets may shape public perceptions of HPV vaccination. However, little is known about how the linguistic framing of HPV vaccine information varies across rural and urban, or more and less religious, online news ecosystems.

Objective:

This study aimed to evaluate how HPV vaccine information is framed in online news outlet posts on social media in Utah, comparing linguistic patterns across rural versus urban areas and communities with higher versus lower religiosity.

Methods:

We collected 851 Facebook posts related to HPV and HPV vaccination from 23 Utah-based news outlets published between March 2012 and March 2022. After removing duplicates (n=531 unique posts) and screening for relevance, 36 posts specifically addressing HPV or HPV vaccination were retained for analysis. Posts were coded by rurality (Rural-Urban Commuting Area codes) and religiosity (county-level religious affiliation prevalence) of the originating news outlet. Natural language processing was applied using Linguistic Inquiry and Word Count (LIWC-22) software to estimate emotional valence, including positive emotion, negative emotion, and overall emotionality. Narrative arc analysis was conducted to characterize the structural and psychological patterns of online discourse. Summary statistics and independent t tests compared linguistic features across geographic and religious contexts.

Results:

Only 5 of Utah’s 29 counties had news outlets that posted about HPV vaccination over the study period. Urban outlets produced more posts than rural ones (69.7% vs 30.3%), and nearly 70% of posts came from less religious areas. Posts from urban and less religious areas used significantly more positive language (mean 2.04 vs 1.28 words; P=.003), while posts from rural and more religious areas used more emotional language (mean 1.17 vs 0.63 words; P<.001) and more negative emotional language (mean 0.73 vs 0.42 words; P=.02). Threat-based language was significantly more prevalent in rural posts (P=.03), and rural posts contained significantly more references to death (P<.01) and religion (P<.01). Narrative arc analysis revealed that online HPV vaccine discourse followed a consistent structural pattern with descriptive, information-rich comment sections, fluctuating cognitive tension, and a conclusive, nonprogressive ending.

Conclusions:

In Utah, rural and religious communities are exposed to HPV vaccine information that is less positive and more emotionally charged than that in urban and less religious communities. These linguistic patterns may reinforce vaccine hesitancy and contribute to persistently low HPV vaccination rates in underserved areas. Tailored public health messaging that accounts for the emotional and cultural dimensions of vaccine discourse in rural and religious communities is needed to improve HPV vaccine equity.