Community-Oriented Motivational Interviewing to Address Anti-COVID-19 Vaccine Sentiment in Virtual Communities: Manifestations of Change Talk and Sustain Talk and Practitioner Approaches

Objective: Circulating antivaccine tropes in online platforms are linked to low vaccination uptake, including for COVID-19 vaccines. Motivational interviewing (MI) is an effective intervention to increase vaccination rates. Community-oriented Motivational Interviewing (COMI) expands MI to online groups. We examine COMI processes-manifestations of change and sustain talk unique to group intervention in online spaces-as well as practitioner strategies to elicit and amplify cohesion and collective motivation. Method: Case examples are presented from comments on public, antivaccine Facebook and Twitter posts targeted toward Black and Latinx communities between April and October, 2021. Transcripts were coded deductively according to well-described antivaccine tropes. Emergent codes were also inductively identified. Results: 295 intervention transcripts were analyzed. 157 (53%) received engagement (reply/emoji). Speech indicative of increased relatedness and community orientation facilitated change talk. Manifestations of sustain (i.e., antivaccine) talk included "science denial" themes. Expressions of individualism were a novel form of sustain talk. Responses to sustain talk included contextualizing behavior amid shared values, providing context for true information, emphasizing common ground, and collective affirmations. Conclusions: Consistent with MI with groups, findings suggest change talk manifests in part through fostering group cohesion. Infodemiologists' posts could potentially activate and motivate the group at large, influencing the occurrence and content of engagement among group members. Additionally, our findings revealed ways change talk and sustain talk manifest in online community settings. Strategies employed by trained, in-group peer practitioners explicitly seeking to foster group cohesion showed potential to mitigate sustain talk in this setting.