title: Examining Perceptions about Mandatory Influenza Vaccination of Healthcare Workers through Online Comments on News Stories.
abstract: BACKGROUND
  The aim of this study was to understand online public perceptions of the debate surrounding the choice of annual influenza vaccinations or wearing masks as a condition of employment for healthcare workers, such as the one enacted in British Columbia in August 2012.
  
  
  METHODS
  Four national and 82 local (British Columbia) Canadian online news sites were searched for articles posted between August 2012 and May 2013 containing the words "healthcare workers" and "mandatory influenza vaccinations/immunizations" or "mandatory flu shots and healthcare workers." We included articles from sources that predominantly concerned our topic of interest and that generated reader comments. Two researchers coded the unedited comments using thematic analysis, categorizing codes to allow themes to emerge. In addition to themes, the comments were categorized by: 1) sentiment towards influenza vaccines; 2) support for mandatory vaccination policies; 3) citing of reference materials or statistics; 4) self-identified health-care worker status; and 5) sharing of a personal story.
  
  
  RESULTS
  1163 comments made by 648 commenters responding to 36 articles were analyzed. Popular themes included concerns about freedom of choice, vaccine effectiveness, patient safety, and distrust in government, public health, and the pharmaceutical industry. Almost half (48%) of commenters expressed a negative sentiment toward the influenza vaccine, 28% were positive, 20% were neutral, and 4% expressed mixed sentiment. Of those who commented on the policy, 75% did not support the condition to work policy, while 25% were in favour. Of the commenters, 11% self-identified as healthcare workers, 13% shared personal stories, and 18% cited a reference or statistic.
  
  
  CONCLUSIONS
  The perception of the influenza vaccine in the comment sections of online news sites is fairly poor. Public health agencies should consider including online forums, comment sections, and social media sites as part of their communication channels to correct misinformation regarding the benefits of HCW influenza immunization and the effectiveness of the vaccine.
authors.affiliation: Public Health Ontario, Toronto, ON, Canada; University of Toronto Faculty of Medicine, Toronto, ON, Canada.
authors.forename: Yang
authors.initials: Y
authors.lastname: Lei
authors.affiliation: Public Health Ontario, Toronto, ON, Canada.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Pereira
authors.affiliation: Public Health Ontario, Toronto, ON, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Quach
authors.affiliation: Vaccine Evaluation Center, Vancouver, BC, Canada; BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bettinger
authors.affiliation: Public Health Ontario, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Kwong
authors.affiliation: The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Corace
authors.affiliation: Public Health Ontario, Toronto, ON, Canada; University of Toronto Faculty of Medicine, Toronto, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Ottawa, ON, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Garber
authors.affiliation: Public Health Ontario, Toronto, ON, Canada; University of Toronto Faculty of Medicine, Toronto, ON, Canada.
authors.forename: Yael
authors.initials: Y
authors.lastname: Feinberg
authors.affiliation: Département des sciences de la santé communautaire, Université de Sherbrooke, Longueuil, QC, Canada; Institut national de santé publique du Québec, Longueuil, QC, Canada; Centre de recherche de l'Hôpital Charles LeMoyne, Longueuil, QC, Canada; Agence de la santé et des services sociaux de la Montérégie, Longueuil, QC, Canada.
authors.forename: Maryse
authors.initials: M
authors.lastname: Guay
mesh_terms: D001955:British Columbia; D006282:Health Personnel; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D037141:Mandatory Programs; D011634:Public Health; D061108:Social Media; D014611:Vaccination
chemical_list: D007252:Influenza Vaccines