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research-article2021
HPPXXX10.1177/15248399211013002Health Promotion PracticeBoatman et al. / HPV Vaccine Messaging on Tiktok

Research Brief

Human Papillomavirus Vaccine Messaging on

TikTok: Social Media Content Analysis
Dannell D. Boatman, EdD, MS1
Susan Eason, MA1
Mary Ellen Conn, MS1
Stephenie K. Kennedy-Rea, EdD, MA1

Background. The human papillomavirus (HPV) vaccine Keywords: cancer prevention and control; cervical
is viewed as a critical tool to protect against six HPV- cancer; cancer prevention and control;
related cancers. Vaccination is recommended from early child/adolescent health; immunization
adolescence through age 26 years. As young people have
become increasingly involved in personal health-related
decisions, there is a need to tailor HPV vaccine messag-
ing and reach this priority population on social media
>>
Background
and digital outlets. TikTok is a growing social media The human papillomavirus (HPV) vaccine protects
platform with approximately 70% of its users between against six HPV-related cancers and is viewed as a criti-
the ages of 13 and 24 years. Purpose. The aim of this cal tool for cancer prevention (Miller et al., 2014). The
study was to understand HPV vaccine messaging and Centers for Disease Control and Prevention (CDC) rec-
interactions on TikTok as a needed first step to identify- ommends vaccination for both boys and girls between
ing effective strategies to reach young people with the ages of 9 and 26 years and is often included with
important health messaging. Methods. Content analysis routine vaccines given between the ages of 11 and 12
was performed on 170 top TikToks focused on the HPV years (CDC, 2020). Guidelines were changed in October
vaccine. TikToks were assessed for content, classifica- 2018 to recommend a shared decision-making process
tion type, and number of interactions. Results. Most between doctors and patients from age 27 to 45 years
TikToks were provaccine, while antivaccine TikToks had when considering vaccination (CDC, 2020).
more user interactions. Cancer and prevention were the Uptake of the HPV vaccine in early adolescence is
main content areas of the analyzed provaccine TikToks, still relatively low in the United States, with 49.8% of
while the side effects were the primary focus of antivac- adolescent (age 13–17 years) boys and 62.8% of adoles-
cine messages. Approximately 30% of all top TikToks cent girls reporting having one or more HPV vaccine
analyzed were developed by health professionals. shot, well below the 80% national Healthy People 2020
TikToks without an explicit vaccine opinion primarily target (Reagan-Steiner et  al., 2016). Various barriers
described personal experiences and mentioned side to the vaccine, spanning from religion to trust issues,
effects most often. Implications. TikTok is a growing have been identified (Basch & MacLean, 2019). Factors
social media platform that can be used to reach young influencing HPV vaccination decisions include pain,
people and encourage HPV vaccine uptake. Health pro- fear, risk, parental influence, and the involvement of
fessionals need to consider the interest that users have others (Sisson & Wilkinson, 2019). While the influence
in personal experiences and address antivaccine narra- of parents on vaccination decisions is often essential,
tives related to side effects. especially as consent is usually needed, young people

1
West Virginia University Cancer Institute, Morgantown, WV,
USA
Health Promotion Practice
Month XXXX Vol. XX, No. (X) 1­–6
DOI: 10.1177/15248399211013002 https://doi.org/
Authors’ Note: Address correspondence to Dannell D. Boatman,
Article reuse guidelines: sagepub.com/journals-permissions West Virginia University Cancer Institute, PO Box 9350,
© 2021 Society for Public Health Education Morgantown, WV 26506, USA; e-mail: dboatman@hsc.wvu.edu.

1
are increasingly becoming more involved in personal
health-related decision making (Sisson & Wilkinson,
2019). This suggests the importance of tailoring HPV
vaccination information to both parents and young
people (Sisson & Wilkinson, 2019). The internet is an
important source of health-related information for young
people (Freeman et  al., 2018). Furthermore, they use
social media at the highest rate of all age-groups, revo-
lutionizing how they share and receive ideas and infor-
mation, including health-related content (Hausmann
et al., 2017).
The 2014 President’s Cancer Panel Report identified
the reduced uptake of HPV vaccination in the United
States as a critical public health challenge and recom-
mended communication strategies to promote awareness
and emphasize safety and benefits (Chido-Amajuoyi
et al., 2020). Social media platforms represent a novel
way to reach an important audience with recommended
HPV vaccination messaging. TikTok is a rapidly expand-
ing social media outlet that features short video clips
developed by its users (Basch et al., 2020). While content
on various social media platforms has been examined,
there are a relatively small number of studies that have
assessed public health messaging by TikTok creators
(Basch et al., 2020). Over half of all TikTok users (~ 69%)
are between the ages of 13 and 24 years of age, making
it an ideal outlet to reach a priority population for HPV
vaccination (Sehl, 2020).
>>
Purpose
The goal of this study was to describe the content of
top HPV vaccine TikToks. There were two aims for this
study. First, we sought to investigate the content areas
of HPV vaccine TikToks to understand associations with
user interactions and vaccine opinion. Content areas for
this study are defined as the HPV topics that TikToks
addressed. Second, we sought to investigate TikTok clas-
sification types by assessing associations with vaccine
opinion and creator identification as a health profes-
sional. Classification types for this study are how crea-
tors approached the development of TikToks.
>>
Method
A cross-sectional, retrospective, observational review
of TikToks was undertaken, aligning with previous
studies of public health messaging on social media
(El-Awaisi et al., 2020). Qualitative content analysis is a
well-known and respected approach to communication-
based research on social media (Krippendorff, 2019).
This study used summative content analysis to quan-
tify themes, which allowed for analysis to interpret the
2  HEALTH PROMOTION PRACTICE / Month XXXX
underlying context (Hsieh & Shannon, 2005). While no
studies assessing HPV-related messaging on TikTok have
been identified to date, a previous study, which exam-
ined the topic on Instagram, used content categories
derived from CDC messaging as an approach to content
analysis (Basch & MacLean, 2019). A similar technique
was adopted for this study. Furthermore, analysis of
classification types for health-related posts have been
shown to be an effective social media research approach
(Rivas et al., 2020). Again, this technique was adopted
for this study.
Content categories were established using the CDC
HPV Vaccine Information Statement (CDC, 2019).
Classification types were based on the findings from
Rivas et  al. (2020). A coding spreadsheet was cre-
ated, which included content and classification types
among other categories for TikTok characterization.
The top TikToks related to HPV vaccination were col-
lected on four separate dates across a 30-day period
(September–October 2020). TikToks were identified
using six HPV-related hashtags with the most views
(#hpvvaccine—81.9K views, #hpvshots—10.7K views,
#gardasil—63.3K views, #gardasilshot—12.7K views,
#hpv—12.5M views, and #hpvawareness—37.2K). Only
TikToks written and recorded in the English language
were analyzed. A TikTok had to mention the HPV vac-
cine in either the video or the written post to be included
in the analysis.
Once a TikTok was identified for inclusion in the
study, it was categorized by content, classification type,
HPV vaccine opinion, gender of creator, and whether it
was created by someone identifying as a health profes-
sional. In addition, the number of interactions were tal-
lied and tracked. Interactions included the total number
of times users chose to click the “like” button, shared
the post with their networks, and responded with a com-
ment. Through this process, 170 TikToks were coded
by a single researcher for inclusion. Another research
team member coded a random selection of 16 TikToks,
and a high level of inter-rater reliability was established.
Following this coding process, SPSS (v27) was used to
conduct Fischer’s exact tests. Statistically significant
results were determined if p < .05. Research category
2 exemption was granted for this study by the West
Virginia University Institutional Review Board (proto-
col # 2010147316).
>>
Results
Of the 170 TikToks analyzed, most (71.1%) were
created by women versus men (14.7%; see Table 1).
While women are the primary users of TikTok (58.8%),
this does represent a higher level of content creation
 Provaccine TikToks primarily provided science-based
Table 1 information and were classified as educational (57.1%),
Characteristics of TikToks Analyzed (n = 170) while antivaccine TikToks were mainly classified as
opinion (64.3%; see Table 3). Of the 51 TikToks that did
Characteristics n % not present an opinion on the HPV vaccine, all (100.0%)
were classified as personal experience. There were sta-
Gender Women 121 71.1
tistically significant associations between identification
displayed Men 25 14.7
as a health professional and the classification of TikToks.
Other 24 14.1
Health professionals were more likely to create educa-
Health Yes 52 30.5 tional TikToks (90.0%), while those who did not iden-
professional No/unsure 118 69.4 tify as a health professional focused more on personal
TikTok Education 52 30.5 experience (63.3%).
classifications Personal experience 80 47.0
Opinion 38 22.3
Number of 500 or fewer 134 78.8 >>
Discussion
interactions 501–2,500 22 12.9 These findings suggest that HPV vaccine–related
2,501+ 14 8.2 content on TikTok is varied; however, there seem to
HPV vaccine Pro 91 53.5 be patterns of use. Most HPV messaging was related to
opinion Anti 28 16.4 cancer, prevention, and side effects. Provaccine TikToks
None given 51 30.0 adhered to cancer and prevention messaging. In con-
TikTok content Cancer 53 31.1 trast, antivaccine TikToks focused on side effects. For
mentionsa Prevention 51 30.0 those who did not indicate a pro- or antivaccine stance,
Gender/sex 17 10.0 there was a focus on side effects. This echoes the find-
Age range 19 11.1 ings of a study on HPV messaging on Instagram, which
Doses 9 5.2
found provaccine posts focused on cancer and preven-
tion while antivaccine posts did not (Basch & MacLean,
Talk to doctor 6 3.5
2019). This study expands on these findings, suggesting
Side effects 56 32.9
that the content of creators who did not indicate a pro- or
Genital warts 20 11.7
antivaccine stance were also found to have focused on
Note. HPV = human papillomavirus. messaging outside of cancer and prevention. Like previ-
a
Categories not mutually exclusive. ous studies, most of the top TikToks were provaccine,
while antivaccine TikToks had more interactions (Basch
& MacLean, 2019; Massey et al., 2020). That said, under-
compared with men (Clement, 2020). Total interac- standing the full extent of these interactions cannot be
tions per TikTok ranged from 7 to approximately 400K. ascertained without a thematic analysis of comments.
Identified health professionals created 30.5% of all Learning more about how users react to specific TikTok
TikToks analyzed. Most TikToks were classified as either content would be an important next step to providing a
personal experience (47.0%) or educational (30.5%). complete understanding of interactions.
Content was most frequently related to cancer (31.1%) Health professionals are engaged on this social media
or prevention (30.0%). The majority (53.5%) of TikToks outlet, suggesting that they view it as an important plat-
expressed a provaccination opinion versus an antivac- form to reach a younger population with health-related
cination opinion (16.4%), or none expressed (30.0%). messaging. That said, misinformation is widely avail-
Cancer (p = .037) and prevention (p = .021) were able, evident by the large number of interactions with
content categories with the highest number of total inter- antivaccine posts, like other social media platforms
actions (see Table 2). Antivaccine posts had a higher num- (Basch & MacLean, 2019). This could be confusing
ber of total interactions (M = 18040.5, SD = 74587.7), for young people who may not have the sophistica-
compared with provaccine (M = 1162.4, SD = 2948.4) tion needed to appraise health information accurately
and no opinion given (M = 317.82, SD = 982.3, p = (Freeman et al., 2018).
.024). Provaccine TikToks primarily focused content on It is noteworthy that TikTok users have expressed
cancer (58.2%) and prevention (56.0%), while antivac- an interest in personal experiences with the HPV vac-
cine content primarily focused on side effects (75.0%). cine, including potential side effects. This is particu-
Of the 51 TikToks that did not give an explicit vaccine larly important on TikTok as many users are within the
opinion, nearly half (45.0%) focused on side effects. ideal age range to receive the HPV vaccine. While health

Boatman et al. / HPV VACCINE MESSAGING ON TIKTOK  3

 Table 2
Associations of Interactions and Vaccine Opinions With HPV Vaccine TikTok Content Areas

Number of interactions Vaccine opinion

(n = 170) (n = 119)

  1,000 or fewer 1,001+ Provaccine Antivaccine

Content areas   n % n % p n % n % p

Cancer Yes 40 27.8 13 50 .037 53 58.2 0 0.0 <.001

No 104 75.5 13 50 38 41.8 28 100.0
Prevention Yes 38 26.4 13 50 .021 51 56.0 0 0.0 <.001
No 106 73.6 13 50 40 44.0 28 100.0
Gender Yes 14 9.7 3 11.5 .727 16 17.6 0 0.0 .012
No 130 90.3 23 88.5 75 82.4 28 100.0
HPV Yes 11 7.6 2 7.7 1.000 13 14.3 0 0.0 .037
transmission No 133 92.4 24 92.3 78 85.7 28 100.0
Age range Yes 15 10.4 4 15.4 .498 19 20.9 0 0.0 .006
No 129 89.6 22 84.6 72 79.1 28 100.0
Doses Yes 5 3.5 4 15.4 .032 9 9.9 0 0.0 .113
No 139 96.5 22 84.6 82 90.1 28 100.0
Talk to doctor Yes 3 2.1 3 11.5 .047 6 6.6 0 0.0 .334
No 141 97.9 23 88.5 85 93.4 28 100.0
Side effects Yes 49 34.0 7 26.9 .651 12 13.2 21 75.0 <.001
No 95 66.0 19 73.1 79 86.8 7 25.0
Genital warts Yes 15 10.4 5 19.2 .197 20 22.0 0 0.0 .003
No 129 89.6 21 80.8 71 78.0 28 100.0

Note. HPV = human papillomavirus. Boldfaced values indicate p < .05.

Table 3
Associations of Interactions and Health Professional Status With HPV Vaccine TikTok Classification

Vaccine opinion (n = 119) Health professionals (n = 170)

  Provaccine Antivaccine Yes No

Classification   n % n % p n % n % p

Personal Yes 20 22.0 10 35.7 .212 4 8.0 76 63.3 <.001

experience No 71 78.0 18 64.3 46 92.0 44 36.7
Education Yes 52 57.1 0 0.0 <.001 45 90.0 7 5.8 <.001
No 39 42.9 28 100.0 5 10.0 113 94.2
Opinion Yes 19 20.9 18 64.3 <.001 1 2.0 37 30.8 <.001
No 72 79.1 10 35.7 49 98.0 83 69.2

Note. HPV = human papillomavirus. Boldfaced values indicate p < .05.

professionals focus primarily on cancer and prevention younger population and address specific concerns and
content, there are fewer provaccine TikToks that take on questions.
antivaccine narratives related to side effects. This may Additional research is needed to assess the reactions
be an opportunity for health professionals to reach a of young people to HPV vaccine TikToks and social media

4  HEALTH PROMOTION PRACTICE / Month XXXX

posts to develop effective content. Furthermore, the lack
of men creating HPV vaccine TikToks may be an area
that needs to be explored to see if additional messaging
strategies are required for this population. In addition,
as the age guidelines have expanded to include a shared
decision-making process for adults aged between 27 and
45 years, research is needed to see if social media may
also be an effective platform to reach this older popula-
tion with information about the HPV vaccine and if the
messaging approach should be different.
The primary limitations of this study are its cross-
sectional design and relatively small sample size. Future
studies should review TikTok content over a longer
period and expand the sample size. In addition, to
expanding generalizability, other social media platforms
should be analyzed similarly.
>>
Implications
This research approach could be used to study
posts on various social media platforms and for other
health-related topics. Misinformation about the HPV
vaccine is pervasive on social media platforms and is
often hidden beyond traditional hashtags such as #HPV
or #HPVVaccine (Massey et  al., 2020). This indicates
the need to characterize interactions in the comment
sections of social media posts where misinformation
could spread without the use of hashtags. The research
approach used for this study could provide the founda-
tion from which to analyze these comments.
Health professionals may feel hesitant to engage on
social media, but their interactions are critical to dispel-
ling misinformation (Keller et al., 2014). Initial steps to
engaging on social media include creating a professional
account that clearly identifies who you are and where
you work, sharing only credible information from reli-
able sources, and identifying the most popular hashtags
in the field to increase visibility (Ventola, 2014). This
study has shown that provaccine TikToks do garner a
high number of interactions, making them an important
tool to counter misinformation.
As TikTok rapidly expands its users, composed of
primarily young people, HPV vaccine messaging on this
platform could provide critical information and support.
While provaccine TikToks provide science-based infor-
mation, it is not clear whether the current messaging res-
onates with young people. Future research should seek
to understand which social media messages encourage
behavioral change in young people and encourage them
to receive their HPV vaccinations.
ORCID iD
Dannell D. Boatman https://orcid.org/0000-0003-0219-0322
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