Exploring the ethics of using fictional stories for health education on social media to share information and emotions about the HPV vaccine: A cross-sectional study with interdisciplinary health experts

Social media is used to promote the HPV vaccine through various strategies, including the use of stories and narratives. Understanding the ethical concerns related to the use of social media in this capacity are important. The purpose of this study is to identify ethical concerns of using fictional stories to share information and emotions about the HPV vaccine on social media, ultimately to influence parents on their decision to vaccinate their child. METHODS: We conducted a cross-sectional survey with researchers in the fields of health communication, cancer prevention, social media, and public health ethics from October to December 2021. Respondents were presented with a fictional story that consisted of seven connected vignettes about the HPV vaccine. For each vignette, respondents were asked to rate the potential benefits and risk, as well as the potential for ethical concerns of using the fictional narrative style to share information about the HPV vaccine. Descriptive statistics summarized responses, and qualitative data were analyzed thematically. RESULTS: On average, respondents (n = 41) perceived more benefits than risks when it comes to 1) using social media for health education generally and 2) using a story with connected vignettes for vaccine communication. The vignettes prioritizing vaccine hesitancy, positive emotion, and health equity were seen as having the most potential benefit, while the vignettes highlighting vaccine confidence and skepticism were seen as having the most potential risk. Overall, respondents felt there were several ethical concerns of note - persuasion was the most common (15 % of respondents) followed by deception (9 %) and manipulation (8 %). Qualitative data highlighted the importance of transparency and trust to avoid ethical violations and negative outcomes. CONCLUSIONS: Ethical concerns exist when using fictional stories to share health information on social media, particularly as new online technologies make it harder to tell fact from fiction. Practical and actionable recommendations for researchers must be developed, defining a range of ethical responsibilities.