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01.12.2015 | Research article | Ausgabe 1/2016 Open Access

BMC Public Health 1/2016

Comparing the quality of pro- and anti-vaccination online information: a content analysis of vaccination-related webpages

BMC Public Health > Ausgabe 1/2016
Gabriele Sak, Nicola Diviani, Ahmed Allam, Peter J. Schulz
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12889-016-2722-9) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

GS (first author), ND, AA, and PJS conceived the study design. GS carried out data collection, statistical analysis and draft manuscript. ND participated in the statistical analysis and coordinated and assisted draft the manuscript. AA provided the initial sample of data collection. All co-authors reviewed manuscript drafts and approved the final version of the manuscript before submission for publication.



The exponential increase in health-related online platforms has made the Internet one of the main sources of health information globally. The quality of health contents disseminated on the Internet has been a central focus for many researchers. To date, however, few comparative content analyses of pro- and anti-vaccination websites have been conducted, and none of them compared the quality of information. The main objective of this study was therefore to bring new evidence on this aspect by comparing the quality of pro- and anti-vaccination online sources.


Based on past literature and health information quality evaluation initiatives, a 40-categories assessment tool (Online Vaccination Information Quality Codebook) was developed and used to code a sample of 1093 webpages retrieved via Google and two filtered versions of the same search engine. The categories investigated were grouped into four main quality dimensions: web-related design quality criteria (10 categories), health-specific design quality criteria (3 categories), health related content attributes (12 categories) and vaccination-specific content attributes (15 categories). Data analysis comprised frequency counts, cross tabulations, Pearson’s chi-square, and other inferential indicators.


The final sample included 514 webpages in favor of vaccination, 471 against, and 108 neutral. Generally, webpages holding a favorable view toward vaccination presented more quality indicators compared to both neutral and anti-vaccination pages. However, some notable exceptions to this rule were observed. In particular, no differences were found between pro- and anti-vaccination webpages as regards vaccination-specific content attributes.


Our analyses showed that the overall quality of pro-vaccination webpages is superior to anti-vaccination online sources. The developed coding scheme was proven to be a helpful and reliable tool to judge the quality of vaccination-related webpages. Based on the results, we advance recommendations for online health information providers as well as directions for future research in this field.
Additional file 1: Table S1. Comparing the Quality of Pro- and Anti-Vaccination Online Information: A Content Analysis of Vaccination-Related Webpages.pdf. (DOCX 83 kb)
Additional file 2: Table S3. Comparing the Quality of Pro- and Anti-Vaccination Online Information: A Content Analysis of Vaccination-Related Webpages.pdf. (DOCX 29 kb)
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