Types of HPV Vaccine Misinformation Circulating on Twitter (X) That Parents Find Most Concerning: Insights From a Cross-Sectional Survey and Content Analysis

Background Parents frequently use social media as a source of information about the human papillomavirus (HPV) vaccine. Our previous work identified that, on Twitter (now X), almost 25% of tweets about the HPV vaccine contain misinformation, and these tweets receive higher audience engagement than accurate tweets. Exposure to misinformation can increase vaccine hesitancy, but the types of misinformation found on social media vary widely, and not all misinformation exposure influences vaccine attitudes and vaccine uptake. Despite the prevalence of misinformation and antivaccine information on social media, little work has assessed parents’ assessments of these posts. Objective This study examines which types of misinformation on Twitter parents find the most concerning. Methods In April 2022, we surveyed 263 US parents of children ages 7-10 years using a Qualtrics survey panel. They viewed a first round of 9 randomly selected tweets from a pool of 126 tweets circulating on Twitter that contained misinformation about the HPV vaccine. Then parents selected up to 3 that they found most concerning. The process was repeated once more with 9 selected from the pool of 117 messages not shown in the first round. Using this information, a concern score for each tweet was calculated based on the number of parents who viewed the tweet and selected it as concerning. In total, 2 researchers independently coded the misinformation tweets to identify rhetorical strategies used and health concerns mentioned. Multiple linear regression tested whether tweet content significantly predicted the concern score of the tweet. Results Parental concern about the different misinformation tweets varied widely, with some misinformation being selected as most concerning just 2.8% of the time it was viewed and other misinformation being selected 79.5% of the time it was viewed. Multiple beta regression analyses found that misinformation tweets using negative emotional appeals (b=.79, P<.001), expressing pharmaceutical company skepticism (b=.36, P=.036), invoking governmental authority (b=.44, P=.02), and mentioning hospitalization (b=1.00, P=.003), paralysis (b=.54, P=.02), and infertility (b=.52, P=.04) significantly increased the percent of parents rating the misinformation tweets as most concerning. Conclusions Misinformation about HPV vaccination is ubiquitous on social media, and it would be impossible to target and correct all of it. Counter-messaging campaigns and interventions to combat misinformation need to focus on the types of misinformation that concern parents and ultimately may impact vaccine uptake. Results from this study identify the misinformation content that parents find most concerning and provide a useful list of targets for researchers developing interventions to combat misinformation with the goal of increasing HPV vaccine uptake.