Narrative and Linguistic Strategies in HPV Vaccine Communication: A Content Analysis of Government, Medical Institutions, and Practitioners’ Accounts on Sina Weibo

Human papillomavirus (HPV) vaccination is a central public health concern in China, and public engagement with HPV-related content on social media varies widely. Identifying which narrative and linguistic strategies elicit stronger responses is therefore essential for improving the effectiveness of vaccine communication. Using fuzzy-set qualitative comparative analysis, an approach that identifies which combinations of message features are associated with an outcome, this study examines how narrative presence, narrative perspective, grammatical mood, linguistic modality, and account type combine to correspond to engagement with 638 HPV vaccine posts on Sina Weibo. The analysis identifies several distinct configurations associated with high audience engagement, as well as multiple patterns linked to low engagement. Posts from medical institutions were associated with stronger engagement when they adopted second-person, third-person, or impersonal narrative forms with high-modality language (i.e., language with high certainty), while medical practitioners were associated with high engagement when they relied on question-only posts that encouraged a conversational orientation. Low engagement was most often observed in non-narrative declarative posts using medium-modality language (i.e., moderately assertive wording) from medical practitioners, while tentative, low-modality language characterized three of the five low-engagement configurations and none of the high-engagement configurations. These findings specify boundary conditions under which narrative and linguistic strategies are associated with audience engagement, and illustrate how grammatical mood and linguistic modality function in relation to message content and source type. Moreover, the results offer practical insights for designing more engaging HPV vaccine communication on social media.