Ingraining Polio Vaccine Acceptance through Public Service Advertisements in the Digital Era: The Moderating Role of Misinformation, Disinformation, Fake News and Religious Fatalism

"...findings provide empirical evidence to deal with public reluctance and skepticism through strategic media messages to cultivate the literacy necessary to counter the phenomena that breed polio vaccine reluctance, such as misinformation, disinformation, fake news, and religious fatalism."

Polio cases reported in Pakistan - one of the two polio-endemic countries - are rising, compared to the rates in the rest of the world. There are a myriad of challenges associated with eradicating the disease, including disinformation emanating from religious beliefs and the social-media-driven overabundance of misinformation and fake news based on myths about the polio vaccine in Pakistan. This research provides empirical evidence on the efficacy of risk communication strategies to address polio vaccine reluctance in the digital age.

This study is informed by the protective action decision model (PADM), which presents tenets to understand people's risk adaption behaviour. PADM postulates that individuals exposed to hazards or adversities can obtain cautionary information from external sources, such as the media. Information featuring warnings and hazard-related cues underwrites the development and realisation of individuals' risk perception, which leads to protective behavioural responses. Public perceptions about evolving phenomena are influenced mainly by perceived risk. On the model being tested in the study (see below), public aversion to vaccination increases as people become aware of and weigh their hazards owing to misinformation, disinformation, and fake news. Stakeholders' perceptions of authority (local governments and provincial or national television stations, in this study) and experts' credibility may also be crucial in determining people's propensity to take preventative action (e.g., vaccination).

This study used a cross-sectional design vis-à-vis a survey method to investigate the influence of televised public service advertisements in facilitating polio vaccine acceptance. In addition, the moderating role of digital platforms in disseminating polio-related misinformation, disinformation, fake news, and religious fatalism among the general public in Pakistan was evaluated. The research involved 2,160 married parents with children below five years from all provinces (e.g., administrative units) of Pakistan. Data were collected from May 2022 to August 2022.

The results, based on structural equation modeling (SEM), revealed that the study's 8 hypotheses (H) were supported:

• The findings of H1 indicate that risk perception positively influenced polio vaccine acceptance. This finding implies that a person with a higher perceived risk of falling prey to polio is more willing to take the polio vaccine.
• H2 posited that the perceived credibility and trustworthiness of the stakeholders recommending the polio vaccine encourages polio vaccine acceptance among the public. The higher the level of expertise, reliability, and credibility of the local and foreign authorities, the higher the acceptance level of the polio vaccine among the audience. H2 was supported by the evidence.
• Findings supporting H3 show that perceived protective action mitigates the risks and increases polio vaccine intake, which is in line with previous literature suggesting that confidence in the polio vaccine boosts public trust.
• H4-6 suggest that media campaigns in the form of public service advertisements positively influence risk perception (H4), stakeholder perception (H5), and protective action perception (H6). The cues used in messages in public service advertisements can activate one's deliberation and comprehension about the benefits of the polio vaccine. Consequently, public service advertisements trigger one's cognitive and affective mechanisms.
• The findings of this study support the belief that misinformation, disinformation, and fake news inversely moderate the relationship between stakeholder perception (H7a) and protective action perception (H7b) - with impacts polio vaccine acceptance (protective action motivation). Digital media platforms have generated myths, lies, and falsehoods about vaccines, which could hinder protective actions and negatively influence one's motivation to engage in protective behaviour.
• The findings of this study also prove H8: that religious fatalism (viewing a person's health as decided by external factors such as God) inversely moderates the relationship between risk perception and polio vaccine acceptance. Therefore, more fatalistic individuals are less likely to participate in preventive care. Religious beliefs and practices can clash with medical experts' recommendations and lead adherents to be less willing to participate in health-related programmes, including vaccination.

In short, this study finds that public service advertisements (in this case, on TV) are an effective tool to counter the inverse impacts of misinformation, disinformation, fake news, and religious fatalism. Furthermore, the inverse moderating role of misinformation, disinformation, fake news, and religious fatalism risk potentially diminishing polio vaccine acceptance. Thus, the study implies that policymakers may use public service messages strategically to counter polio vaccine acceptance barriers, including misinformation, disinformation, fake news, and religious fatalism, in both traditional and new media.

In conclusion: "These results suggest that healthcare providers must identify and address all forms of digitally disseminated information that encumbers public health behaviors. Accordingly, this research recognized the utilization of evidence-based strategic communication campaigns to cultivate and encourage the literacy necessary to counter health hazard information, including misinformation. This study's findings will benefit health and other concerned authorities in utilizing strategic communication on different media platforms to reduce or eradicate the polio endemic."