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. 2022 Oct 27;40(1):135–143. doi: 10.1111/phn.13143

Filipinos’ COVID‐19 vaccine hesitancy comments in TikTok videos: A manifest content analysis

Daniel Joseph E Berdida 1,2,✉, Franchesca Mae C Franco 2, Xyllyne Allyah G Santos 2, Camille B Dacol 2, Michaela Dimaano 2, Erika S Del Rosario 2, Charlotte Christianne Lantin 2
PMCID: PMC9874770  PMID: 36300833

Abstract

Objectives

Vaccine hesitancy is one of the top 10 threats to world health. The ongoing pandemic highlighted this health threat. The COVID‐19 vaccine hesitancy remains underreported in the Philippines. Thus, this study aimed to describe and analyze the comments of Filipinos in TikTok videos about COVID‐19 vaccine hesitancy.

Design

Manifest content analysis.

Sample

A total of 25 TikTok videos and their comments (n = 4564) were analyzed.

Methods

We collected data between July 2021 and October 2021. Bengtsson's approach to content analysis was utilized to analyze the data. Data were validated using member‐checking and intercoder reliability.

Results

This study afforded three themes of COVID‐19 vaccine hesitancy: (a) fear and mistrust (subthemes: influence of Dengvaxia vaccine, the influence of people who refuse to be vaccinated, lack of trust in the government, lack of trust in healthcare workers, doubts on vaccines’ effectiveness), (b) misinformation and disinformation (subthemes: misbeliefs, insufficient knowledge), and (c) adamant attitudes (subthemes: unwillingness to be vaccinated, picky on vaccine brand).

Conclusion

Our study established Filipinos’ diverse reasons for COVID‐19 vaccine hesitancy. TikTok, as a social media platform, is used for COVID‐19 vaccine discussions and the dissemination of misinformation. To prepare for the next pandemic or public health disaster, the government, HCWs, and the public must efficiently convey timely, accurate health information and dispel misinformation on social media platforms.

Keywords: content analysis, COVID‐19 vaccine, infodemic, social media, TikTok, vaccine hesitancy

1. INTRODUCTION

The COVID‐19 pandemic, a viral disease, continues to burden every country's economic and healthcare systems worldwide (World Health Organization [WHO], 2021). COVID‐19 vaccination is an effective management strategy for reducing morbidity and mortality caused by this virulent virus (Lanyi et al., 2022; Sharma et al., 2021). More than 12 billion COVID‐19 vaccine doses had been administered as of July 2022 (WHO, 2022b). However, numerous issues were reported during the vaccine roll‐out (Forman et al., 2021). Individual factors (e.g., knowledge, attitudes, beliefs, vaccine hesitancy), interpersonal factors (e.g., relationships and social networks), and structural factors (e.g., healthcare delivery system; mass and social media; national laws; global policies) are among these challenges (Amit et al., 2022; Berdida, Grande et al., 2022).

Despite substantial scientific evidence regarding the safety and efficiency of the COVID‐19 vaccine, vaccine hesitancy remains a significant obstacle to ending the pandemic (Karlsson et al., 2021). Vaccine hesitancy or unwillingness to vaccinate is one of the top ten threats to world health (WHO, 2019), despite evidence of vaccines' vital role in enhancing population health outcomes (Amit et al., 2022). It harms the vaccine demand and efforts to maintain decent vaccination coverage (Scannell et al., 2021). Vaccine hesitancy is complex and context‐dependent, varying by time, geography, and vaccine kind (MacDonald & SAGE Working Group on Vaccine Hesitancy, 2015). People can exhibit vaccination hesitancy for various reasons, including a lack of confidence in vaccine use, complacency, and the difficulty of vaccine availability (Dubé et al., 2021).

In February 2020, the WHO (2020) deemed the dissemination of misinformation regarding COVID‐19 an “infodemic.” The two types of infodemic, misinformation (unintentional misleading) and disinformation (intentional misleading) in social media, are contributors to vaccine hesitancy (van der Linden, 2022). The ongoing dissemination of misinformation has resulted in confusion, skepticism, and hostility toward the COVID‐19 vaccination (Scannell et al., 2021). Thus, an infodemic can undermine faith in science and public health authority and reduce vaccination rates (Yousefinaghani et al., 2021).

Notably, social media has a significant impact on COVID‐19 immunization. Videos uploaded on YouTube, TikTok, Instagram, and Twitter depict how individuals comprehend COVID‐19 immunization, their experiences during and after vaccinations, and how they support or oppose the vaccination (Southwick et al., 2021; Teng et al., 2022; Yousefinaghani et al., 2021). Since they were made public, these videos have attained millions of views and comments. The videos and the comments they contain could influence the viewers' decision to receive COVID‐19 immunization (Rotolo et al., 2022; Wilson & Wiysonge, 2020). In a systematic review of the literature on how social media influences vaccine hesitancy, Cascini et al. (2022) found that vaccine‐hesitant social media content creators predominately explain the correlation between dependence on social media and vaccine intentions. Additionally, most comments on YouTube about the COVID‐19 vaccine are antivaccine narratives, adverse effects, and vaccine hesitancy (Teng et al., 2022). Social media users may convey unfavorable opinions and inaccurate information, which may affect personal beliefs and cause vaccine hesitancy or refusal (Cascini et al., 2022; Piedrahita‐Valdés et al., 2021).

The Philippines was formerly one of the nations with usually high vaccine trust rates (Larson et al., 2019). However, confidence has drastically decreased since the dengue vaccine controversy in 2017 and has negatively influenced subsequent immunization campaigns, such as the COVID‐19 vaccination program (Mendoza et al., 2021; Vergara, 2021). This controversy was highly politicized and harmed public confidence in vaccines and the medical community (Mendoza et al., 2021). As a result, immunization rates decreased, and illnesses like measles and polio that had been under control due to vaccinations began to spread throughout the nation (Amit et al., 2022). As a result, Filipinos are still reluctant to immunize even after the COVID‐19 vaccine became available in the Philippines (Mendoza et al., 2021). Additionally, Filipinos posted videos on social media that they had filmed of their doubtful attitudes and critical remarks. Studies on the COVID‐19 vaccine in the Philippines concentrated on requesting information (Berdida, Grande et al., 2022), brand hesitation (Amit et al., 2022), public trust and the COVID‐19 vaccination campaign (Mendoza et al., 2021), and COVID −19 vaccination intent (Caple et al., 2022). Nevertheless, by April 2022, more than 63 million Filipinos had received their COVID‐19 vaccinations (WHO, 2022b).

The Philippines is often dubbed the world's social media capital, with over 92 million users (84.7% of the total population) (Statista.com, 2022). TikTok, one of the most common social media that Filipinos use, with over 40 million active users, served as their medium for sharing videos (Statista.com, 2022). TikTok, an international social media network for sharing and amplifying 60‐s micro‐videos, is one of the world's largest social media platforms (Oberlo, 2022). The network allows users to create and share short movies. It is accessible in over 150 nations, with over 800 million active users. Forty percent of TikTok users are between the ages of 16 and 24, and 63.5 percent are younger than 29 (Oberlo, 2022). During the COVID‐19 pandemic, when practically all contact is virtual, young people gravitate to TikTok. This population group is also essential for focused health assessment and risk communication to halt the ongoing pandemic (Southwick et al., 2021).

Most COVID‐19 vaccine hesitancy studies explored data from YouTube (Teng et al., 2022) and Twitter (Lanyi et al., 2022; Scannell et al., 2021; Wilson & Wiysonge, 2020; Yousefinaghani et al., 2021). A few studies used a content analysis method to analyze TikTok comments (Basch et al., 2021; Southwick et al., 2021). TikTok comments may reveal how Filipinos perceived COVID‐19 hesitancy. It should be noted, however, that empirical attempts to investigate TikTok comments about COVID‐19 vaccine hesitancy using content analysis remained underreported. Thus, this manifest content analysis aimed to investigate Filipinos' TikTok comments concerning their COVID‐19 vaccine hesitancy. Our findings may provide insights into future research avenues and directions for improving COVID‐19 vaccine acceptance and alleviating the vaccination infodemic.

1.1. Theoretical background

The health belief model (HBM) gives a theoretical foundation for people's hesitation to receive vaccines (Limbu et al., 2022). Specific beliefs held by individuals, such as the perceived seriousness and susceptibility of the illness and the advantages and hazards of the vaccine, are related to health behaviors (Carpenter, 2010). The central claim of HBM is that an individual's propensity to engage in specific health behavior, such as receiving the COVID‐19 vaccine, is influenced by their perception of the risk of and severity of an illness or condition, such as COVID‐19, as well as their faith in the efficacy of the suggested health behavior (Wong et al., 2021). Perceived barriers and perceived advantages were the most frequent HBM constructs significantly associated with vaccine reluctance, according to a comprehensive evaluation of HBM utilized in the COVID‐19 vaccine trial. While perceived benefits and vaccine reluctance were negatively correlated, perceived barriers and hesitancy were positively correlated (Limbu et al., 2022).

2. METHODS

2.1. Study design

The study employed manifest content analysis (MCA) to analyze comments on TikTok videos about COVID‐19 vaccine hesitancy. Content analysis is an approach that investigates the phenomenon of interest in an unobtrusive and nonreactive way (Hsieh & Shannon, 2005). MCA describes what the participants say literally, using their language and describing the obvious in the text (Bengtsson, 2016). MCA was appropriate for the study's purpose because it entails counting and comparing keywords or content and interpreting the underlying context and meanings (Bengtsson, 2016; Hsieh & Shannon, 2005).

2.2. Data source

The data source of our study was the comments on COVID‐19 vaccine hesitancy on TikTok videos. TikTok publishes short, entertaining videos on social media. Since its 2016 launch, it has had 1.1 billion users (Teoh et al., 2021). It is an information‐rich social media platform. With TikTok's popularity, more people seek information online (Tan et al., 2021). TikTok videos reach a broader and more diverse audience than their follower‐based counterparts, allowing for the widespread dissemination of factually incorrect information among users of all ages and backgrounds. Additionally, the platform has spread false information about COVID‐19 vaccines (Basch et al., 2021).

2.3. Data collection

Initially, data was collected from uploaded videos on TikTok between July 2021 and October 2021 (Figure 1). We manually extracted the data from TikTok's search engine for content or videos. This search feature is called the “search bar.” We searched for content or videos using key terms (e.g., covid‐19 vaccine, covid‐19 vaccine hesitancy, covid‐19 vaccine Philippines, covid‐19 vaccine ph, coronavirus vaccine Philippines, and vaccine hesitancy). From there, relevant videos appeared first in the top feed. These are the most popular videos for that specific search term/keyword. Then, we look for similar phrases or hashtags to broaden our video search. These keyword searches (e.g., phrases, hashtags) in TikTok generated billions of results (approximately 118 billion hits). Researchers filtered the search results according to their content using the inclusion criteria. The inclusion criteria included: uploaded in the Philippines, data belonging to public accounts, clear audio‐video quality, and content creator presenting COVID‐19 vaccine hesitancy.

FIGURE 1.

FIGURE 1

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Flowchart of TikTok videos collection process [Colour figure can be viewed at wileyonlinelibrary.com]

After using the inclusion criteria, we obtained 62 TikTok videos depicting Filipinos' vaccine hesitancy comments. In the first screening, 18 videos were excluded because the videos were not uploaded in the Philippines, focused on vaccine side effects, duplicated video links, presented other vaccine hesitancy, and educated the public about the vaccine. In the second screening, 19 videos were removed due to irrelevant comments, repeated video links, private accounts, and videos no longer accessible (Figure 1)—a total of 25 videos qualified for final analysis (Supplementary Files 1 and 2). The length of these videos ranges between 1 and 3 min.

Seven researchers (six graduating nursing students and one lecturer) were involved in the analysis of videos included in the study. The nursing research lecturer is experienced in qualitative content analysis. Six researchers (FMCF, XAGS, CBD, MD, ESDR, and CCL) independently collected and evaluated the TikTok videos using the inclusion criteria. Afterward, the authors gathered to discuss their findings. When all authors agreed to the inclusion of a video, authors included the video in the final data analysis. However, when there was disagreement over a particular video, all authors watched the video again and sought consensus once more. The seventh author (DJEB) served as a referee when there was disagreement.

2.4. Mode of analysis

After identifying the final list of TikTok videos qualified for data analysis, we began extracting all the video comments and transferred them to a Microsoft excel file. The authors convened to screen these comments and decided whether the comments constituted vaccine hesitancy. All authors must agree to include a comment in the final data analysis. When there was disagreement, the nursing research lecturer (DJEB) acted as the arbitrator. Only 4564 significant comments were subjected to MCA from the 25 analyzed TikTok videos, and 79,679 extracted comments on vaccine hesitancy (Figure 1; Table 1). Three Filipino and English language experts translated the Filipino TikTok comments into English. A forward‐backward translation of the comments was followed. This type of translation ensured that the actual meaning of the comments was captured.

TABLE 1.

Distribution of TikTok comments per theme and subthemes (n = 4564)

Theme and subthemes Frequency (f) Percentage (%)
Fear and mistrust 2725 59.71%
Dengvaxia vaccine's influence 762 27.96%
Influence of people who refuse to be vaccinated 572 21.00%
Lack of trust in the government 556 20.40%
Lack of trust in healthcare workers 447 16.40%
Doubts on vaccine's effectiveness 388 14.24%
Misinformation and disinformation 1236 27.08%
Insufficient knowledge 829 67.07%
Misbeliefs 407 32.93%
Adamant attitude 603 13.21%
Unwillingness to be vaccinated 398 66.00%
Picky on vaccine brand 205 34.00%
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This study's data analytic procedure included four steps: decontextualization, recontextualization, categorization, and compilation (Bengtsson, 2016). The decontextualization process involved identifying meaning units from the significant comments. The recontextualization phase involved including the essential meaning units while excluding the dross meaning units. In the categorization stage, condensed meaning units were formed, eventually leading to the development of themes or the underlying meaning of the comments gathered in the compilation stage.

To increase the rigor of qualitative content analysis, the researchers regularly identify crucial areas before the data collection process using the checklist developed by Elo et al. (2014). Throughout the study and until the conclusion of the findings report, we continuously reviewed and analyzed the data to verify its reliability (Berdida, Elero et al., 2022). Finally, a member‐checking procedure was carried out to ensure the credibility of the findings in this qualitative study.

Furthermore, we implemented intercoder reliability (ICR) during the decontextualization and recontextualization phases. ICR is a practical way of determining reliability when qualitative data, such as nominal data, are analyzed (O'Connor & Joffe, 2020). Six researchers analyzed and coded the transcripts independently from each other. After that, they all met to explore the transcript, meaning units, and codes. The aim is to obtain the consensus of the research team. The research supervisor acts as the arbitrator when there is a non‐consensus over a specific meaning unit or code.

2.5. Ethical considerations

This study was exempt from full ethics board review because it used an unobtrusive research design and did not involve human participants. After submitting the requirements, the researchers obtained ethical approval from the Universidad de Manila Ethics Research Committee (Reference number: UdM‐ERC‐2021‐0050; approved: August 21, 2021). The content creators’ personal information (e.g., name, gender, age, geographic location) was not included to maintain anonymity. The usernames they used on social media were not revealed. This study only looked at Filipino COVID‐19 vaccine hesitancy comments on TikTok. As a result, it lacks any identifying information that could be linked to the comments made by the content creators in their videos or posts (e.g., name, location, username). Consent was not sought because the TikTok videos were publicly available data, and no specific participants were involved.

3. FINDINGS

The primary aim of this study is to analyze Filipinos' Covid‐19 vaccine hesitancy via comments on select TikTok videos. Based on the analyzed videos, most vaccine hesitancy comments pertain to fear and mistrust of the vaccine (59.71%). The influence of the Dengavaxia vaccine was the primary source of COVID‐19 vaccine fear and mistrust. Moreover, Filipinos’ adamant behavior received the least cause of vaccine hesitancy (13.21%), particularly their unwillingness to be vaccinated (66.00%) (Table 1).

Utilizing the MCA, we surface there major themes of COVID‐19 vaccine hesitancy: (a) fear and mistrust with the following subthemes, the influence of the Dengvaxia vaccine, the influence of people who refuse to be vaccinated, lack of trust in the government, lack of trust in healthcare workers (HCWs), doubts on vaccines’ effectiveness; (b) misinformation and disinformation with the following subthemes, misbeliefs, and insufficient knowledge; and (c) adamant attitudes with the following subthemes, unwillingness to be vaccinated and picky on vaccine brand (Table 2).

TABLE 2.

Themes, subthemes, and exemplar comments of Filipinos’ COVID‐19 vaccine hesitancy (n = 25)

Theme Subthemes Exemplar comments
Fear and mistrust Dengvaxia vaccine's influence The covid vaccine was quickly made. Isn't that dangerous? Maybe it will be like Dengvaxia for other people? (TV17)
It's normal to fear that way, we can't blame people because of what happened with Dengvaxia. (TV4)
Influence of people who refuse to be vaccinated When you feel sick, don't get vaccinated because you will die like my relatives. (TV2)
Because of that video, my mom doesn't want to get a vaccine. It's crazy! I hope fake news will stop. (TV23)
Lack of trust in the government Don't get vaccinated, we are fooled by our government and World Health Organization. (TV8)
That's the worst thing Doc, you don't have a choice to choose the best vaccine because you're a frontliner. The government really failed this pandemic. (TV12)
Lack of trust in healthcare workers Doctors are not telling the truth nowadays. cannot trust them. (TV12)
Oh, don't believe in doctors, nurses, and midwives, of course, money is being discussed there, for me, I am not in favor of what the health workers are saying. (TV21)
Doubts on vaccine's effectiveness It should be!! COVID vaccine are not Safe… May I ask what happened to AstraZeneca, why many people died?? Because COVID vaccine is NOT safe. (TV9)
Doc, why are there so many rumors that the vaccine is dangerous? What is true? It's scary and confusing, doc. (TV20)
Misinformation and disinformation Misbeliefs Vaccine is useless. (TV3)
We will not die of COVID. We will die of Covid‐19 vaccine. (TV5)
Vaccine is just a business. The rich get richer while the poor get poorer. It's very sad even though there is really no covid. (TV6)
Insufficient knowledge Why should we get vaccinated when we are not sick? Maybe we will get sicker with that vaccine. (TV22)
Is it true that the aztra vaccination has been stopped? because of bad side effects? They say it caused blood clots in the brain. (TV22)
Can you explain the benefits of getting vaccinated because there is a lot of negative information about it. This makes people hesitant for vaccination, thank you. (TV23)
Adamant attitude Unwillingness to be vaccinated I had 6 vaccine opportunities. And I still said "no." (TV1)
Whatever happens, I will never get vaccinated. (TV5)
“For me I don't like vaccine” (TV25)
Picky on vaccine brand Do I have a choice of vaccine brand? I don't like Sinovac! (TV14)
If it's Sinovac, I'm still hesitant. Because it's still an inactivated coronavirus. I just based on what I read about it (TV15)
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*TV = TikTok video (e.g., TV11 = TikTok video number 11).

4. DISCUSSION

Our study utilized MCA to explore COVID‐19 vaccine hesitancy using Filipinos’ TikTok videos. We found that fear and mistrust were common reasons for COVID‐19 vaccine hesitancy. Fear of infection and ineffectiveness are common causes of hesitancy (Karlsson et al., 2021). Conspiracy theories, vaccine credibility, and the government's immunization campaign engendered public mistrust (Habila et al., 2022). Conversely, fear of COVID‐19 infection increases vaccination acceptability in Canadian (Rotolo et al., 2022), German (Bendau et al., 2021), and Finnish (Karlsson et al., 2021) populations.

According to this study, the Dengvaxia vaccination affected Filipinos' COVID‐19 vaccine hesitancy. Sanofi's (2017) Dengvaxia prevents Dengue fever. In 2017, 800,000 Filipino youngsters received this immunization. Accordingly, Sanofi (2017) reported that the vaccine raises the risk for dengue‐negative people. New political leadership emerged at the outset of these events, and the previous government's immunization program was accused of corruption. Denvangxia was blamed for the deaths of vaccinated children, and parents complained online. In December 2017, Dengvaxia was suspended (Mendoza et al., 2021). Dengvaxia damaged Filipinos' belief in government‐recommended vaccines (Vergara, 2021). Thus, the Dengvaxia dispute was the most significant in Philippine vaccination history, altering vaccine acceptability (Mendoza et al., 2021).

Individuals' TikTok video comments refusing the COVID‐19 vaccine influenced a person's vaccination decisions. Before the COVID‐19 pandemic, social media caused vaccine hesitancy (Piedrahita‐Valdés et al., 2021). This hesitancy continued during the pandemic due to unfavorable social media content (Cascini et al., 2022). Contrastingly, Qatari university students and personnel were unaffected by social media comments (Al‐Mulla et al., 2021). Thus, health‐related decisions, such as vaccination, are complicated phenomena influenced by health status and beliefs (Limbu et al., 2022; Wong et al., 2021).

Lack of government trust affected Filipinos' vaccination acceptance decisions. Filipinos' vaccine hesitancy stems from the government's inefficiency in managing healthcare initiatives (Mendoza et al., 2021). Joshi et al. (2021) found that government trust affects vaccine acceptability and predicts vaccination uptake (Fisher et al., 2020). Therefore, building vaccine skeptics' faith is vital. Social and government cooperation will improve COVID‐19 vaccine confidence and hasten herd immunity (Al‐Qerem & Jarab, 2021). To recover public trust in vaccination, the Philippine government advocated accountability, transparency, and proper communication (Mendoza et al., 2021).

The public's lack of trust in HCWs (e.g., nurses, midwives, doctors) is another reason for vaccine hesitancy. This finding is rooted in the Dengvaxia controversy (Mendoza et al., 2021). Since nurses and midwives were the vaccinators and significant information sources in that vaccine controversy, Filipinos fear the present COVID‐19 vaccination effort. HCWs are trusted sources of COVID‐19 information (Mendoza et al., 2021). Hence, when HCWs publicly express vaccine hesitation, public trust in immunization suffers (Leigh et al., 2022). To enhance vaccine acceptance, WHO (2022a) suggested that HCWs understand hesitation factors, develop a work culture that promotes COVID‐19 vaccine uptake, and employ evidence‐based COVID‐19 vaccination resources.

Our study found that doubts about vaccine effectiveness contributed to vaccine hesitancy. This finding echoes Filipinos' belief that COVID‐19 vaccinations are harmful, causing illness and death (Amit et al., 2022). Public trust in vaccination is always tied to vaccines' disease‐prevention effectiveness. Government campaigns should provide reliable information, and HCWs should be confident in vaccination's safety and efficacy (Dubé et al., 2021).

Misinformation and disinformation influenced Filipinos' vaccine hesitancy.  Misbeliefs and insufficient knowledge of COVID‐19 vaccines caused people to misunderstand the vaccine's efficacy, leaving them confused, hesitant, and declining vaccination (Cascini et al., 2022). Basch et al. (2021) observed that anti‐vaccination messages on TikTok caused COVID‐19 vaccine hesitancy among young individuals who watched TikTok. WHO (2020) declared that social media is the most significant source of COVID‐19 vaccination misinformation. This information dissemination led to public misbeliefs, reluctance, and vaccination rejection (Scannell et al., 2021), undermining health authorities and reducing vaccine adoption (Yousefinaghani et al., 2021). Government health agencies, HCWs, and academic institutions must employ multifaceted measures to combat the infodemic. Hernandez et al. (2021) proposed the following to counter infodemic: develop and implement methods to identify common health infodemic; expand conversations with social media executives to determine safeguards against health‐related infodemic; and assign socioculturally diverse frontline HCWs roles specific to pro‐vaccination in countering vaccination infodemic.

Our investigation showed that Filipinos' adamant attitude about the COVID‐19 vaccine led to their unwillingness and brand preference. Filipinos' TikTok comments showed no interest in vaccines due to personal reasons, ineffectiveness, and severe side effects. Fisher et al. (2020) discovered that anti‐vaccine attitudes, beliefs, feelings, antagonism to, desire for, or faith in vaccines were causes for not receiving the vaccine. In addition, additional vaccine concerns led people to assume the COVID‐19 vaccine was ineffective.

Filipinos' vaccination hesitancy stems from vaccine brand hesitancy. Because of social media misinformation, most TikTok comments exemplify hesitation to receive the vaccine brand (e.g., Sinovac, Sputnik, Astra Seneca). Amit et al. (2022) found that Filipinos' vaccine brand hesitancy delayed vaccination. Filipinos are wary of Chinese‐made and mRNA‐based vaccines (Mendoza et al., 2021). Vaccine hesitancy is caused by a lack of transparency and social media misinformation. Some try to correct misconceptions by alienating others, worsening the problem. Therefore, HCWs need sufficient training to encourage vaccination among doubters.

4.1. Limitations

Admittedly, we identified several limitations in our study. First, this study included 25 Filipino‐made TikTok videos. This is considered a small sample compared to most published studies that included social media as the data source. Also, there could be videos excluded from other countries that are information‐rich on vaccine hesitancy. Second, the analyzed data were limited to a specific period (July–October 2021). Videos uploaded after data collection may change the public's knowledge, attitude, and behavior toward COVID‐19 vaccines. Third, we utilized content analysis of TikTok comments. Although big data analysis is a promising way of conducting research, this does not permit researchers to examine deeper than a face‐to‐face interview. Fourth, we used search terms in TikTok that might exclude videos pertinent to our study objectives. As TikTok's ranking algorithm is volatile, the videos collected are influenced by the type of content rather than the content creators. Fifth, we cannot determine the content creators’ or commenters’ demographic details, such as age, gender, or race‐ethnicity. We can only speculate about the user's intent, such as humor/parody and trustworthiness. Finally, in analyzing comments on social media platforms, the researchers might be biased based on their educational background and healthcare professional experiences. Thus, our findings cannot generalize the studied phenomenon and must be interpreted cautiously.

4.2. Recommendations

To enhance generalizability, we recommend using a larger sample of videos and a more extended data collection period from various social media platforms (e.g., YouTube, Twitter, and Facebook). A longitudinal study will be beneficial in uncovering changes in individuals’ vaccine hesitancy over time. Future research may utilize other content analysis designs (e.g., summative, sentiment) and conduct in‐depth face‐to‐face interviews to substantiate the current finding of our study. Finally, a diverse group of researchers from various socioeconomic and educational backgrounds should be included in future research to lessen bias.

4.3. Implications to public health nursing

Globally, most countries could vaccinate their population with COVID‐19 vaccines, achieving herd immunity. However, there is still an urgent need to continue and sustain COVID‐19 programs. The government, HCWs, and the public must continue to implement and adhere to the following: work closely in maintaining the safety health protocols (e.g., proper handwashing, social distancing), strengthen vaccination safety campaigns (e.g., clear and consistent information dissemination in all media platforms), and engage in equitable distribution of vaccines.

More than ever, the misinformation and disinformation of COVID‐19 vaccines on social media (e.g., TikTok, YouTube, and Facebook) amplify the public's vaccine hesitancy and refusal. Using public health nursing principles of health promotion and disease prevention, it is critical for public health nurses (PHNs) and other HCWs to provide proactive guidance and health education about the safety and importance of vaccines to individuals, families, and communities. Furthermore, PHNs must uphold their professional values and social responsibility to protect, promote, and optimize health (Grande et al., 2022) by lobbying their legislators to enact legislation requiring immunization for all individuals up to their booster doses. In such cases, guidelines should be in place to monitor alternative plans and schedules to demonstrate progress toward eradicating vaccine‐preventable diseases.

Currently, the COVID‐19 pandemic is still ongoing. Therefore, the government, PHNs, and allied HCWs should continue intensifying the administration of COVID‐19 booster doses and encourage individuals who have booster dose hesitancy. In this manner, HCWs will improve vaccination coverage.

5. CONCLUSION

Our study established Filipinos’ myriad reasons for COVID‐19 vaccine hesitancy. Utilizing MCA, TikTok comments were inductively analyzed. Thus, surfacing three themes of vaccine hesitancy: (a) fear and mistrust, (b) misinformation and disinformation, and (c) adamant attitudes. Our research shows that TikTok is extensively utilized for COVID‐19 discussion and reflection and that deceptive or misleading videos are circulated. The government, HCWs, and the general public must be prepared to effectively disseminate timely, accurate health information and dispel misinformation on social media platforms as we prepare for the next pandemic or public health emergency. Our study provided a call to action to engage and advocate factual health information and counteract misinformation by identifying the types of videos released with information about the COVID‐19 vaccine. Hence, promoting vaccine acceptance, controlling the spread of COVID‐19, and preventing the wastage of health‐related resources.

AUTHOR CONTRIBUTIONS

Daniel Joseph E. Berdida: Conceptualization, Methodology, Investigation, Data Collection, Data Analysis, Writing – Original Draft, Writing – Review & Editing, Supervision, Project administration. Franchesca Mae C. Franco, Xyllyne Allyah G. Santos, Camille B. Dacol, Michaela Dimaano, Erika S. Del Rosario, and Charlotte Christianne Lantin: Conceptualization, Data Collection, Data Analysis, Writing – Original Draft.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest.

ETHICS STATEMENT

The Ethics Review Committee (ERC) Universidad de Manila (UdM‐ERC‐2021‐0050; approved: 08/21/2021) granted permission to conduct the study.

Supporting information

Supplementary information

Click here for additional data file. (17.1KB, docx)

Supplementary information

Click here for additional data file. (18.7KB, docx)

ACKNOWLEDGMENTS

We would like to express our gratitude to the administrators of the Department of Nursing College of Health Sciences, Universidad de Manila, for their encouragement in publishing our study. Many thanks go to our parents for their unwavering support. This research did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors.

Berdida, D. J. E. , Franco, F. M. C. , Santos, X. A. G. , Dacol, C. B. , Dimaano, M. , Rosario, E. S. D. , & Lantin, C. C. (2023). Filipinos’ COVID‐19 vaccine hesitancy comments in TikTok videos: A manifest content analysis. Public Health Nursing, 40, 135–143. 10.1111/phn.13143

Twitter handle

Daniel Joseph E. Berdida: @DJBerdidaPhD

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

REFERENCES

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Data Availability Statement

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