Assessment of the Cultural Nuances in COVID-19 Vaccine Uptake Through a Comparative Analysis of English and Spanish Facebook Posts in Tarrant County, Texas: Longitudinal Study

Background: Prior studies have identified key factors contributing to COVID-19 vaccine hesitancy, including concerns over vaccine safety, potential side effects, and mistrust in the health care system. According to the World Health Organization, vaccine hesitancy is among the top 10 threats to global public health. Previous research has suggested that vaccine hesitancy is a significant barrier within the Hispanic population, particularly in Texas. Objective: This longitudinal study examined the relationships of daily stance, misinformation, and topics in vaccine-related English and Spanish Facebook posts with daily vaccination rates in Tarrant County, Texas, during 2021 and 2022. The goal was to identify the predictors associated with vaccination uptake and inform targeted social media interventions, with particular attention to the Hispanic population. Methods: COVID-19 vaccine-related English and Spanish Facebook posts from Tarrant County were collected for 2021 and 2022. The study analyzed 12,395 English posts and 1123 Spanish posts. Posts were annotated using GPT-4 for stance, misinformation, and relevant topics, including vaccine availability, safety, and side effects. Category prevalence was compared across English and Spanish posts and across years. Linear regression models were used to examine associations between post characteristics and daily vaccination rates in the total and Hispanic populations. Results: Regression analysis identified distinct predictors of Hispanic vaccination uptake, including encouraging posts (P=.02) and religion-related posts (P=.007), which were not significant predictors for vaccination uptake in the general population. A substantial proportion of Spanish discouraging posts focused on vaccine side effects (13/70, 19%) and health system distrust (24/70, 34%), suggesting concerns that may be especially relevant within the Hispanic community. Predictors associated with higher uptake in both the Hispanic and total populations included posts related to vaccine availability (P=.01), vaccine safety (P=.006), and misinformation debunking (P