Like everyone, Dannell Boatman, EdD, assistant professor in the Department of Cancer Prevention and Control, was on COVID-19 lockdown through much of 2020. Like many of us, she spent some of that time on social media.

“I started scrolling through TikTok [social media platform that enables users to post and share short-form video clips] one day and noticed so much content on the HPV vaccine. As someone who works in cancer prevention and control, I was horrified by some of the misinformation that I saw,” she said. “So I reached out to my department chair, Stephenie Kennedy-Rea, and said ‘I really think this is something interesting. I want to do a content analysis of HPV vaccine messaging on TikTok,’ and she said, ‘Go for it.’”

HPV Vaccine

HPV, or the human papillomavirus, is an extremely common infection that can cause six types of cancer. Vaccination has been shown to be effective: Since it was approved for use in girls aged 9-26 in 2006, infections with variants that cause most HPV cancers have dropped 88 percent among teen girls and 81 percent among young adult women. In 2009, the vaccine was cleared for use in boys and young men, and in 2018, the FDA expanded the vaccine’s approval to include females and males 27-45 years old.

The Study Ramps Up

“It was fast and furious,” said Dr. Boatman. “In a couple of months, we had analyzed close to 200 TikToks and felt we had a really good sense of what was happening on that platform at that time.”

Dr. Boatman published her work. It received widespread attention, including from pharmaceutical company Merck &Co. Merck is now funding Dr. Boatman’s broader study – monitoring and analyzing conversations around the HPV vaccine not only on TikTok, but across the Internet.

This HPV project is a product of Dr. Boatman’s lab, Communicating for Health in Appalachia by Translating Science (CHATS). The goal of the CHATS Lab is to leverage the power of communication to improve health outcomes in Appalachia and beyond through original research and by fostering the adoption of evidence-based science. “Ultimately, our work boils down to how we can best communicate science with others,” said Dr. Boatman.

The HPV project has two prongs: social listening and analysis of existing narratives on social media. The components share a goal: to look for patterns and insights that may be used to craft health communication interventions, allowing the team to shift conversations, push back on misinformation and educate about the vaccine.

Social Listening

CHATS Lab manager Abby Starkey uses a software program called Brandwatch to monitor online conversations around the HPV vaccine on social media platforms, news, stories, and blogs. Brandwatch is used by companies, such as Toyota and Nestlé, to keep an eye on their products’ reputations, but its use in public health is relatively novel. Brandwatch archives social media data, and Starkey writes queries, analyzes the results, and adjusts based on these results. It categorizes mentions of the HPV vaccine by sentiment and emotion. It’s not always correct, though – for example, it started by assuming that every mention of “cancer” in a social media post or comment was negative. In those cases, Starkey has to “train” the AI by manually recategorizing the post or comment. Over time, Brandwatch AI features “learn” and achieve greater accuracy.

Dr. Boatman sees significant opportunities to leverage social listening in the field of public health. “If we can follow the flow of misinformation in real-time, we have the opportunity to intervene strategically and perhaps shift the narrative,” she said.

Analyzing Existing Narratives on Social Media

Zachary Jarrett, program manager at the WVU Cancer Institute, manually scours platforms like X (formerly Twitter), Facebook, and TikTok for mentions of the HPV vaccine, as an everyday social media user would. He copies text from posts and comments into a spreadsheet and then categorizes it based on coding categories, such as opinion of HPV vaccine – positive, negative, or undeterminable. He also notes whether the comment or post contains misinformation.

Dr. Boatman, Jarrett, and Starkey meet regularly for inter-rater reliability meetings – spot-checking posts and comments ensure consensus on how they’ve been coded – and to talk through instances that are ambiguous. The CHATS Lab team uses this data to understand the HPV vaccine narratives on each platform and more broadly across social media.

“A lot of people seek health information online, particularly in underserved populations, so understanding the narrative surrounding important issues like the HPV vaccine is critical to public health,” said Dr. Boatman. “While there’s so much misinformation online, particularly on social media, there are wonderful points of conversation, of contact, of questions. If we can engage individuals, we can provide them with the information they need to make positive health decisions.”