The Importance of 'Likes': The Interplay of Message Framing, Source, and Social Endorsement on Credibility Perceptions of Health Information on Facebook

Virtual lab coats: The effects of verified source information on social media post credibility

Social media platform's lack of control over its content made way to the fundamental problem of misinformation. As users struggle with determining the truth, social media platforms should strive to empower users to make more accurate credibility judgements. A good starting point is a more accurate perception of the credibility of the message's source. Two pre-registered online experiments (N = 525;N = 590) were conducted to investigate how verified source information affects perceptions of Tweets (study 1) and generic social media posts (study 2). In both studies, participants reviewed posts by an unknown author and rated source and message credibility, as well as likelihood of sharing. Posts varied by the information provided about the account holder: (1) none, (2) the popular method of verified source identity, or (3) verified credential of the account holder (e.g., employer, role), a novel approach. The credential was either relevant to the content of the post or not. Study 1 presented the credential as a badge, whereas study 2 included the credential as both a badge and a signature. During an initial intuitive response, the effects of these cues were generally unpredictable. Yet, after explanation how to interpret the different source cues, two prevalent reasoning errors surfaced. First, participants conflated source authenticity and message credibility. Second, messages from sources with a verified credential were perceived as more credible, regardless of whether this credential was context relevant (i.e., virtual lab coat effect). These reasoning errors are particularly concerning in the context of misinformation. In sum, credential verification as tested in this paper seems ineffective in empowering users to make more accurate credibility judgements. Yet, future research could investigate alternative implementations of this promising technology.

What Influences Audience Susceptibility to Fake Health News: An Experimental Study Using a Dual Model of Information Processing in Credibility Assessment

This experimental study investigates the effects of several heuristic cues and systematic factors on users' misinformation susceptibility in the context of health news. Specifically, it examines whether author credentials, writing style, and verification check flagging influence participants' intent to follow article behavioral recommendations provided by the article, perceived article credibility, and sharing intent. Findings suggest that users rely only on verification checks (passing/failing) in assessing information credibility. Of the two antecedents to systematic processing, social media self-efficacy moderates the links between verification and participants' susceptibility. Theoretical and practical implications are discussed.

The (Mis)Information Game: A social media simulator

Given the potential negative impact reliance on misinformation can have, substantial effort has gone into understanding the factors that influence misinformation belief and propagation. However, despite the rise of social media often being cited as a fundamental driver of misinformation exposure and false beliefs, how people process misinformation on social media platforms has been under-investigated. This is partially due to a lack of adaptable and ecologically valid social media testing paradigms, resulting in an over-reliance on survey software and questionnaire-based measures. To provide researchers with a flexible tool to investigate the processing and sharing of misinformation on social media, this paper presents The Misinformation Game-an easily adaptable, open-source online testing platform that simulates key characteristics of social media. Researchers can customize posts (e.g., headlines, images), source information (e.g., handles, avatars, credibility), and engagement information (e.g., a post's number of likes and dislikes). The platform allows a range of response options for participants (like, share, dislike, flag) and supports comments. The simulator can also present posts on individual pages or in a scrollable feed, and can provide customized dynamic feedback to participants via changes to their follower count and credibility score, based on how they interact with each post. Notably, no specific programming skills are required to create studies using the simulator. Here, we outline the key features of the simulator and provide a non-technical guide for use by researchers. We also present results from two validation studies. All the source code and instructions are freely available online at https://misinfogame.com .

Testing Behavioral Messages to Increase Recruitment to Health Research When Embedded Within Social Media Campaigns on Twitter: Web-Based Experimental Study

BACKGROUND

Social media is rapidly becoming the primary source to disseminate invitations to the public to consider taking part in research studies. There is, however, little information on how the contents of the advertisement can be communicated to facilitate engagement and subsequently promote intentions to participate in research.

OBJECTIVE

This paper describes an experimental study that tested different behavioral messages for recruiting study participants for a real-life observational case-control study.

METHODS

We included 1060 women in a web-based experiment and randomized them to 1 of 3 experimental conditions: standard advertisement (n=360), patient endorsement advertisement (n=345), and social norms advertisement (n=355). After seeing 1 of the 3 advertisements, participants were asked to state (1) their intention to take part in the advertised case-control study, (2) the ease of understanding the message and study aims, and (3) their willingness to be redirected to the website of the case-control study after completing the survey. Individuals were further asked to suggest ways to improve the messages. Intentions were compared between groups using ordinal logistic regression, reported in percentages, adjusted odds ratio (aOR), and 95% CIs.

RESULTS

Those who were in the patient endorsement and social norms-based advertisement groups had significantly lower intentions to take part in the advertised study compared with those in the standard advertisement group (aOR 0.73, 95% CI 0.55-0.97; P=.03 and aOR 0.69, 95% CI 0.52-0.92; P=.009, respectively). The patient endorsement advertisement was perceived to be more difficult to understand (aOR 0.65, 95% CI 0.48-0.87; P=.004) and to communicate the study aims less clearly (aOR 0.72, 95% CI 0.55-0.95; P=.01). While the patient endorsement advertisement had no impact on intention to visit the main study website, the social norms advertisement decreased willingness compared with the standard advertisement group (157/355, 44.2% vs 191/360, 53.1%; aOR 0.74, 95% CI 0.54-0.99; P=.02). The majority of participants (395/609, 64.8%) stated that the messages did not require changes, but some preferred clearer (75/609, 12.3%) and shorter (59/609, 9.7%) messages.

CONCLUSIONS

The results of this study indicate that adding normative behavioral messages to simulated tweets decreased participant intention to take part in our web-based case-control study, as this made the tweet harder to understand. This suggests that simple messages should be used for participant recruitment through Twitter (subsequently rebranded X).

Exploring motivations for engagement with the Healthy Lunch Box campaign on social media

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations.

Are digital social media campaigns the key to raise stroke awareness in low-and middle-income countries? A study of feasibility and cost-effectiveness in Nepal

BACKGROUND

Stroke is a major global health problem and was the second leading cause of death worldwide in 2020. However, the lack of public stroke awareness especially in low- and middle-income countries (LMICs) such as Nepal severely hinders the effective provision of stroke care. Efficient and cost-effective strategies to raise stroke awareness in LMICs are still lacking. This study aims to (a) explore the feasibility of a social media-based stroke awareness campaign in Nepal using a cost-benefit analysis and (b) identify best practices for social media health education campaigns.

METHODS

We performed a stroke awareness campaign over a period of 6 months as part of a Stroke Project in Nepal on four social media platforms (Facebook, Instagram, Twitter, TikTok) with organic traffic and paid advertisements. Adapted material based on the World Stroke Day Campaign and specifically created videos for TikTok were used. Performance of the campaign was analyzed with established quantitative social media metrics (impressions, reach, engagement, costs).

RESULTS

Campaign posts were displayed 7.5 million times to users in Nepal. 2.5 million individual social media users in Nepal were exposed to the campaign on average three times, which equals 8.6% of Nepal's total population. Of those, 250,000 users actively engaged with the posts. Paid advertisement on Facebook and Instagram proved to be more effective in terms of reach and cost than organic traffic. The total campaign cost was low with a "Cost to reach 1,000 users" of 0.24 EUR and a "Cost Per Click" of 0.01 EUR.

DISCUSSION

Social media-based campaigns using paid advertisement provide a feasible and, compared to classical mass medias, a very cost-effective approach to inform large parts of the population about stroke awareness in LMICs. Future research needs to further analyze the impact of social media campaigns on stroke knowledge.

Assessing the credibility of COVID-19 vaccine mis/disinformation in online discussion

This study examines how the credibility of the content of mis- or disinformation, as well as the believability of authors creating such information is assessed in online discussion. More specifically, the investigation was focused on the credibility of mis- or disinformation about COVID-19 vaccines. To this end, a sample of 1887 messages posted to a Reddit discussion group was scrutinised by means of qualitative content analysis. The findings indicate that in the assessment of the author's credibility, the most important criteria are his or her reputation, expertise and honesty in argumentation. In the judgement of the credibility of the content of mis/disinformation, objectivity of information and plausibility of arguments are highly important. The findings highlight that in the assessment of the credibility of mis/disinformation, the author's qualities such as poor reputation, incompetency and dishonesty are particularly significant because they trigger expectancies about how the information content created by the author is judged.

Public Officials' Engagement on Social Media During the Rollout of the COVID-19 Vaccine: A Content Analysis of Tweets

BACKGROUND

Social media is an important way for governments to communicate with the public. This is particularly true in times of crisis such as the COVID-19 pandemic, during which time government officials had a strong role in promoting public health measures such as vaccines.

OBJECTIVE

In Canada, provincial COVID-19 vaccine rollout was delivered in three phases aligned with federal government COVID-19 vaccine guidance for priority populations. In this study, we examined how Canadian public officials used Twitter to engage with the public about vaccine rollout and how this engagement has shaped public response to vaccines across jurisdictions.

METHODS

We conducted a content analysis of tweets posted between December 28, 2020, and August 31, 2021. Leveraging social media artificial intelligence (AI) tool Brandwatch Analytics©, we constructed a list of public officials in three jurisdictions (Ontario, Alberta and British Columbia) organized across six public official types, then conducted an English/French keyword search for tweets about vaccine rollout and delivery that mentioned, retweeted, or replied to the public officials. We identified the top 30 tweets with the highest impressions in each jurisdiction in each of the three phases (approximately a 26-day window) of the vaccine rollout. The metrics of engagement (impressions, retweets, likes, and replies) from the top 30 tweets per phase in each jurisdiction were then extracted for additional annotation. We specifically annotated sentiment towards public officials' vaccine response (I.e., positive, negative, neutral) in each tweet, and also annotated the type of social media engagement. A thematic analysis of tweets was then conducted to add nuance to extracted data characterizing sentiment and interaction type.

RESULTS

Of the six categories of public officials, 142 prominent accounts were included from Ontario, Alberta and British Columbia. 270 tweets were included in the content analysis. Public officials mostly used Twitter for information provision (65.6%), followed by horizontal engagement (17.5%), citizen engagement (11.3%), and public service announcements (5.7%). Information provision by government bodies (e.g., provincial government and public health authorities) or municipal leaders are more prominent than tweets by other public official groups. Neutral sentiment accounted for 51.1% of all tweets, while positive sentiment (43.2%) was the second most common sentiment. In Ontario, 60% of the tweets were positive. Negative sentiment (e.g., public officials criticizing vaccine rollout) accounted for 12.6% of all tweets.

CONCLUSIONS

As governments continue to promote the uptake of the COVID-19 "booster" doses, findings from this study are useful in informing how governments can best utilize social media to engage with the public to achieve democratic goals.

CLINICALTRIAL

Fostering mask-wearing with virality metrics and social media literacy: evidence from the U.S. and Korea

Although social media can pose threats to the public health by spreading misinformation and causing confusion, they can also provide wider access to health information and opportunities for health surveillance. The current study investigates the ways in which preventive health behaviors and norms can be promoted on social media by analyzing data from surveys and experiments conducted in the U.S. and South Korea. Survey results suggest that the pathway from social media use for COVID-19 information to mask-wearing behavior through mask-wearing norms emerges only among individuals with strong perceived social media literacy in the U.S. Experimental findings show that wear-a-mask campaign posts on social media foster mask-wearing norms and behavioral intention when they come with large (vs. small) virality metrics (e.g., Likes, shares) in both the U.S. and South Korea. Additionally, American users are more willing to engage with posts that come with supportive (vs. mixed) comments by Liking, sharing and commenting. The results highlight the need to cultivate social media literacy and opportunities for exploiting social media virality metrics for promoting public health norms and behaviors.

Who and what messages are more suitable for health ads: the combined influence of endorsers and message framing on visual attention and ad effectiveness

Purpose

The author examined effects of endorser type and message framing on visual attention and ad effectiveness in health ads, including the moderator of involvement. This paper aims to discuss this issue.

Design/methodology/approach

An experiment was conducted with a 2 (celebrity vs. expert) × 2 (positive vs. negative framing) between-subject factorial design. Eye-tracking measured visual attention and a questionnaire measured ad effectiveness and product involvement.

Findings

Experimental data from 78 responses showed no vampire effect in the health advertisements. Celebrity endorsement with negative message framing received more attention and had less ad recall than that with positive message framing. Negative and positive message framing attracted the same amount of attention and ad recall in the expert endorsement condition. High involvement participants paid more attention to the ad message with the expert than that with the celebrity, but ad recall was not significantly increased. Low involvement participants exhibited the same attention to the ad message with the expert and with the celebrity, but had greater recall of the ad message with the expert. Visual attention to the endorser was associated with ad attitude but not with ad recall. Ad attitude impacted behavioral intention.

Originality/value

Studies examining influences of celebrity and message framing on ad effectiveness have focused on the response to advertising stimuli, not the information process. The author provides empirical evidence of the viewers' information processing of endorsers and health messages, and its relationship with ad effectiveness. The study contributes to the literature by combining endorser and message framing in health ads to promote public health communication from the information processing perspective.

Recommending Breast Cancer Screening to My Mum: Examining the Interplay of Threat, Efficacy, and Virality on Recommendation Intention in the Chinese Context

The burgeoning eHealth campaigns and the emerging daughter-to-mother health communication necessitate a close examination of the intricate mechanism behind recommending preventive behaviors in online settings. The present study addresses existing gaps by investigating how message characteristics and platform-generated virality cues jointly influence younger females' intention to recommend breast cancer screening to their mothers. Drawing on the extended parallel process model (EPPM) as the theoretical basis, a 2 (threat: low vs. high) × 2 (efficacy: low vs. high) × 2 (virality: low vs. high) randomized between-subjects experiment (n = 269) was performed. Results revealed a three-way interaction effect between threat, efficacy, and virality on message involvement. Message involvement was positively associated with recommendation intention and mediated the three-way interaction effect on recommendation intention. This study demonstrates that a high threat can initiate message involvement but fail to trigger recommendation intention. In contrast, a low-threat, high-efficacy, high-virality combination would yield a salutary outcome. Besides, the indispensable role of message involvement in the underlying psychological mechanism behind recommending preventive behaviors was reaffirmed. Theoretical and practical implications are further discussed.

Factors Associated with Cancer Message Believability: a Mixed Methods Study on Simulated Facebook Posts

The ability to share and obtain health information on social media (SM) places higher burden on individuals to evaluate the believability of such health messages given the growing nature of misinformation circulating on SM. Message features (i.e., format, veracity), message source, and an individual's health literacy all play significant roles in how a person evaluates health messages on SM. This study assesses how message features and SM users' health literacy predict assessment of message believability and time spent looking at simulated Facebook messages. SM users (N = 53) participated in a mixed methods experimental study, using eye-tracking technology, to measure relative time and message believability. Measures included individual health literacy, message format (narrative/non-narrative), and information veracity (evidence-based/non-evidence-based). Results showed individuals with adequate health literacy rated evidence-based posts as more believable than non-evidence-based posts. Additionally, individuals with limited health literacy spent more relative time on the source compared to individuals with adequate health literacy. Public health and health communication efforts should focus on addressing myths and misinformation found on SM. Additionally, the source of message may be equally important when evaluating messages on SM, and strategies should identify reliable sources to prevent limited health literate individuals from falling prey to misinformation.

Health Promotion on Instagram: Descriptive-Correlational Study and Predictive Factors of Influencers' Content

The pandemic has accentuated the power that influencers have to influence their followers. Various scientific approaches highlight the lack of moral and ethical responsibility of these creators when disseminating content under highly sensitive tags such as health. This article presents a correlational statistical study of 443 Instagram accounts with more than one million followers belonging to health-related categories. This study aims to describe the content of these profiles and their authors and to determine whether they promote health as accounts that disseminate health-related content, identifying predictive factors of their content topics. In addition, it aims to portray their followers and establish correlations between the gender of the self-described health influencers, the characteristics of their audience and the messages that these prescribers share. Health promotion is not the predominant narrative among these influencers, who tend to promote beauty and normative bodies over health matters. A correlation is observed between posting health content, the gender of the influencers and the average age of their audiences. The study concludes with a discussion on the role of public media education and the improvement of ethical protocols on social networks to limit the impact of misleading and false content on sensitive topics, increasing the influence of real health prescribers.

“Masks do not work”: COVID-19 misperceptions and theory-driven corrective strategies on Facebook

Purpose

One of the most prolific areas of misinformation research is examining corrective strategies in messaging. The main purposes of the current study are to examine the effects of (1) partisan media (2) credibility perceptions and emotional reactions and (3) theory driven corrective messages on people's misperceptions about COVID-19 mask wearing behaviors.

Design/methodology/approach

The authors used a randomized experimental design to test the hypotheses. The data were collected via the survey firm Lucid. The number of participants was 485. The study was conducted using Qualtrics after the research project was exempt by the Institutional Research Board of a large University in the US. The authors conducted an online experiment with four conditions, narrative versus statistics and individual versus collective. The manipulation messages were constructed as screenshots from Facebook.

Findings

The findings of this study show that higher exposure to liberal media was associated with lower misperceptions, whereas higher credibility perceptions of and positive reactions toward the misinformation post and negative emotions toward the correction comment were associated with higher misperceptions. Moreover, the findings showed that participants in the narrative and collective-frame condition had the lowest misperceptions.

Originality/value

The authors tested theory driven misinformation corrective messages to understand the impact of these messages and multiple related variables on misperceptions about COVID-19 mask wearing. This study contributes to the existing misinformation correction literature by investigating the explanatory power of the two well-established media effects theories on misinformation correction messaging and by identifying essential individual characteristics that should be considered when evaluating how misperceptions about the COVID-19 crisis works and gets reduced.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-11-2021-0600

Effects of personalization and source expertise on users' health beliefs and usage intention toward health chatbots: Evidence from an online experiment

Objective

Based on the heuristic–systematic model (HSM) and health belief model (HBM), this study aims to investigate how personalization and source expertise in responses from a health chatbot influence users’ health belief-related factors (i.e. perceived benefits, self-efficacy and privacy concerns) as well as usage intention.

Methods

A 2 (personalization vs. non-personalization) × 2 (source expertise vs. non-source expertise) online between-subject experiment was designed. Participants were recruited in China between April and May 2021. Data from 260 valid observations were used for the data analysis.

Results

Source expertise moderated the effects of personalization on health belief factors. Perceived benefits and self-efficacy mediated the relationship between personalization and usage intention when the source expertise cue was presented. However, the privacy concerns were not influenced by personalization and source expertise and did not significantly affect usage intention toward the health chatbot.

Discussion

This study verified that in the health chatbot context, source expertise as a heuristic cue may be a necessary condition for effects of the systematic cue (i.e. personalization), which supports the HSM's arguments. By introducing the HBM in the chatbot experiment, this study is expected to provide new insights into the acceptance of healthcare AI consulting services.

Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages

Background

Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance.

Objective

In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media.

Methods

A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother–daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages.

Results

Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=–0.10, 95% CI –0.12 to –0.08, P<.001) and daughters (b=–0.10, 95% CI –0.18 to –0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=–0.04, 95% CI –0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers’ intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=–0.50, 95% CI –0.99 to –0.01, P=.05).

Conclusions

Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general.

Trial Registration

ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807

Better safe than sorry: a study on older adults' credibility judgments and spreading of health misinformation

The online world is flooded with misinformation that puts older adults at risk, especially the misinformation about health and wellness. To understand older adults' vulnerability to online misinformation, this study examines how eye-catching headlines and emotional images impact their credibility judgments and spreading of health misinformation. Fifty-nine older adults aged between 58 and 83 years participated in this experiment. Firstly, participants intuitively chose an article for further reading among a bunch of headlines. Then they viewed the emotional images. Finally, they judged the credibility of health articles and decided whether to share these articles. On average, participants only successfully judged 41.38% of health articles. Attractive headlines not only attracted participants' clicks at first glance but also increased their credibility judgments on the content of health misinformation. Although participants were more willing to share an article they believed than not, 62.5% of the articles they want to share were falsehoods. Older adults in this study were notified of possible falsehoods in advance and were given enough time to discern misinformation before sharing. However, these efforts neither lead to a high judgment accuracy nor a high quality of information that they wanted to share. That may be on account of eye-catching headlines which misled participants into believing health misinformation. Besides, the most older adults in this study may follow the "better safe than sorry" principle when confronted with health misinformation, that is to say they would rather trust the misinformation to avoid health risks than doubt it.

Exploring the Linkages of Digital Food Communication and Analog Food Behavior: A Scoping Review

The linkages of digital food communication on social media platforms and analog food behavior of social media users are widely discussed in media and research, but less differentiated. Due to the interdisciplinary nature of the research field, the scientific studies are characterized by great heterogeneity in approaching the role of communication and modelling of food behavior, and thus also the conclusions on how digital food communication might be linked to analog food behavior. There is still much uncertainty regarding the relationship and underlying assumptions between digital communication and analog action. The rationale of this scoping review is to systematically summarize the findings of this heterogeneous body of knowledge. The importance and originality of this review are that it focuses explicitly on studies that provide insights into the nexus of digital food communication and analog food behavior, be it in the theoretical foundation, the results, or their interpretation. It draws on a socio-ecological model of food behavior that depicts food behavior variables in different domains and uses a differentiated categorization of food behavior (food choice, dietary intake, and eating behavior) to synthesize the results. Using the Web of Science and PubMed databases, 267 abstracts were identified and screened, of which 20 articles met the inclusion criteria and were selected for full-text analysis. The review offers some important insights on how different variables of the socio-ecological model of food behavior are related to digital food communication and different areas of analog food behavior. This review provides a more discerning understanding of which aspects of analog food behavior may be linked to social media food communication and in which ways. Implications are derived to reflect the role of communication in previous models of food behavior by adding a more nuanced and cross-cutting understanding of food communication.

Reducing the Use of Disposable Plastics through Public Engagement Campaigns: An Experimental Study of the Effectiveness of Message Appeals, Modalities, and Sources

This study examines how different ways of presenting information about the ecological threats stemming from the use of disposable plastics may affect people’s willingness to reduce their use. To test our hypotheses, we used a 2 × 3 × 2 between-subjects experimental design, utilizing a sample of 1001 Hong Kong residents. The independent variables tested included: (a) message frame (gain vs. loss), (b) modality (text vs. image vs. infographic), and (c) information source (government vs. non-governmental organization). The findings demonstrate that the loss frame was more effective than the gain frame in persuading participants to reduce the use of disposable plastics. Furthermore, compared to image-based messages, text-based and infographic-based messages were more effective in promoting the reduction in the use of disposable plastics. For information sources, however, we found no main effect on behavioral intentions. However, this study still suggests an interaction effect of the loss frame and NGO source, as well as the interaction between text-based modality and government source, both leading to more positive outcomes. Furthermore, the study reveals that negative emotional responses mediate the effect of media frames on behavioral intentions. The findings offer useful insights for designing more effective communication campaigns aimed at curbing the use of disposable plastics.

Web-Based Perspectives of Deemed Consent Organ Donation Legislation in Nova Scotia: Thematic Analysis of Commentary in Facebook Groups

Background

The Canadian province of Nova Scotia recently became the first jurisdiction in North America to implement deemed consent organ donation legislation. Changing the consent models constituted one aspect of a larger provincial program to increase organ and tissue donation and transplantation rates. Deemed consent legislation can be controversial among the public, and public participation is integral to the successful implementation of the program.

Objective

Social media constitutes key spaces where people express opinions and discuss topics, and social media discourse can influence public perceptions. This project aimed to examine how the public in Nova Scotia responded to legislative changes in Facebook groups.

Methods

Using Facebook's search engine, we searched for posts in public Facebook groups using the terms "deemed consent," "presumed consent," "opt out," or "organ donation" and "Nova Scotia," appearing from January 1, 2020, to May 1, 2021. The finalized data set included 2337 comments on 26 relevant posts in 12 different public Nova Scotia-based Facebook groups. We conducted thematic and content analyses of the comments to determine how the public responded to the legislative changes and how the participants interacted with one another in the discussions.

Results

Our thematic analysis revealed principal themes that supported and critiqued the legislation, raised specific issues, and reflected on the topic from a neutral perspective. Subthemes showed individuals presenting perspectives through a variety of themes, including compassion, anger, frustration, mistrust, and a range of argumentative tactics. The comments included personal narratives, beliefs about the government, altruism, autonomy, misinformation, and reflections on religion and death. Content analysis revealed that Facebook users reacted to popular comments with "likes" more than other reactions. Comments with the most reactions included both negative and positive perspectives about the legislation. Personal donation and transplantation success stories, as well as attempts to correct misinformation, were some of the most "liked" positive comments.

Conclusions

The findings provide key insights into perspectives of individuals from Nova Scotia on deemed consent legislation, as well as organ donation and transplantation broadly. The insights derived from this analysis can contribute to public understanding, policy creation, and public outreach efforts that might occur in other jurisdictions considering the enactment of similar legislation.

The science of YouTube: What factors influence user engagement with online science videos?

As the reach of science content in traditional media declines, many institutions and scientists are turning to YouTube as a powerful tool for communicating directly with non-expert publics. They do so with little empirical social science research guiding their efforts. This study explores how video characteristics and social endorsement cues provided by audience members might influence user engagement with online science videos. Shorter videos are more likely to be viewed. Social endorsement cues significantly relate to variations in user engagement, with likes having a consistent positive association with all types of engagement. Implications for science communication through YouTube are discussed.

Modeling and Comparing Brain Processes in Message and Earned Source Credibility Evaluation

Understanding how humans evaluate credibility is an important scientific question in the era of fake news. Source credibility is among the most important aspects of credibility evaluations. One of the most direct ways to understand source credibility is to use measurements of brain activity of humans who make credibility evaluations. This article reports the results of an experiment during which we have measured brain activity during credibility evaluation using EEG. In the experiment, participants had to learn source credibility of fictitious students based on a preparatory stage, during which they evaluated message credibility with perfect knowledge. The experiment allowed for identification of brain areas that were active when a participant made positive or negative source credibility evaluations. Based on experimental data, we modeled and predicted human source credibility evaluations using EEG brain activity measurements with F1 score exceeding 0.7 (using 10-fold cross-validation). We are also able to model and predict message credibility evaluations with perfect knowledge, and to compare both models obtained from a single experiment.

Exploring Resource-Sharing Behaviors for Finding Relevant Health Resources: Analysis of an Online Ovarian Cancer Community

BACKGROUND

Online health communities (OHCs) provide patients and survivors of ovarian cancer (OvCa) and their caregivers with help beyond traditional support channels, such as health care providers and clinicians. OvCa OHCs promote connections and exchanges of information among users with similar experiences. Users often exchange information, which leads to the sharing of resources in the form of web links. Although OHCs are important platforms for health management, concerns exist regarding the quality and relevance of shared resources. Previous studies have examined different aspects of resource-sharing behaviors, such as the purpose of sharing, the type of shared resources, and peer user reactions to shared resources in OHCs to evaluate resource exchange scenarios. However, there is a paucity of research examining whether resource-sharing behaviors can ultimately determine the relevance of shared resources.

OBJECTIVE

This study aimed to examine the association between OHC resource-sharing behaviors and the relevance of shared resources. We analyzed three aspects of resource-sharing behaviors: types of shared resources, purposes of sharing resources, and OHC users' reactions to shared resources.

METHODS

Using a retrospective design, data were extracted from the National Ovarian Cancer Coalition discussion forum. The relevance of a resource was classified into three levels: relevant, partially relevant, and not relevant. Resource-sharing behaviors were identified through manual content analysis. A significance test was performed to determine the association between resource relevance and resource-sharing behaviors.

RESULTS

Approximately 48.3% (85/176) of the shared resources were identified as relevant, 29.5% (52/176) as partially relevant, and 22.2% (39/176) as irrelevant. The study established a significant association between the types of shared resources (χ²₁₈=33.2; P<.001) and resource relevance (through chi-square tests of independence). Among the types of shared resources, health consumer materials such as health news (P<.001) and health organizations (P=.02) exhibited significantly more relevant resources. Patient educational materials (P<.001) and patient-generated resources (P=.01) were more significantly associated with partially relevant and irrelevant resources, respectively. Expert health materials, including academic literature, were only shared a few times but had significantly (P<.001) more relevant resources. A significant association (χ²₁₀=22.9; P<.001) was also established between the purpose of resource sharing and overall resource relevance. Resources shared with the purpose of providing additional readings (P=.01) and pointing to resources (P=.03) had significantly more relevant resources, whereas subjects for discussion and staying connected did not include any relevant shared resources.

CONCLUSIONS

The associations found between resource-sharing behaviors and the relevance of these resources can help in collecting relevant resources, along with the corresponding information needs from OvCa OHCs, on a large scale through automation. The results from this study can be leveraged to prioritize the resources required by survivors of OvCa and their caregivers, as well as to automate the search for relevant shared resources in OvCa OHCs.

Evaluating the effectiveness of Internet-based communication for public health: a systematic review (Preprint)

Background

Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication.

Objective

The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies.

Methods

Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist.

Results

A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly.

Conclusions

Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

Looking at young millennials' risk perception and purchase intention toward GM foods: Exploring the role of source credibility and risk attitude

This study investigated young millennials' risk perception, benefit perception, and purchase intention toward GM foods by testing the effects of source credibility and risk attitude. By comparing two samples collected in the U.S. (N = 207) and China (N = 242), we found that source credibility positively influenced benefit perceptions of GM foods among Chinese millennial consumers. Results also revealed risk attitude significantly influenced both American and Chinese millennial consumers' intention to purchase GM foods. Furthermore, a significant interaction effect between source credibility and risk attitude was found on Chinese millennial consumers' risk perception of GM foods.

Consumers’ Evaluation of Online Health Information Quality: Meta-analysis (Preprint)

Background

The internet has become a major source of health information for general consumers. Web-based health information quality varies widely across websites and applications. It is critical to understand the factors that shape consumers’ evaluation of web-based health information quality and the role that it plays in their appraisal and use of health information and information systems.

Objective

This paper aimed to identify the antecedents and consequences of consumers’ evaluation of web-based health information quality as a means to consolidate the related research stream and to inform future studies on web-based health information quality.

Methods

We systematically searched 10 databases, examined reference lists, and conducted manual searches. Empirical studies that investigated consumers’ evaluation of web-based health information quality, credibility, or trust and their respective relationships with antecedents or consequences were included.

Results

We included 147 studies reported in 136 papers in the analysis. Among the antecedents of web-based health information quality, system navigability (ρ=0.56), aesthetics (ρ=0.49), and ease of understanding (ρ=0.49) had the strongest relationships with web-based health information quality. The strongest consequences of web-based health information quality were consumers’ intentions to use health information systems (ρ=0.58) and satisfaction with health information (ρ=0.46). Web-based health information quality relationships were moderated by numerous cultural dimensions, research designs, and publication moderators.

Conclusions

Consumers largely rely on peripheral cues and less on cues that require more information processing (eg, content comprehensiveness) to determine web-based health information quality. Surprisingly, the relationships between individual differences and web-based health information quality are trivial. Web-based health information quality has stronger effects on cognitive appraisals and behavioral intentions than on behavior. Despite efforts to include various moderators, a substantial amount of variance is still unexplained, indicating a need to study additional moderators. This meta-analysis provides broad and consistent evidence for web-based health information quality relationships that have been fractured and incongruent in empirical studies.

Wired to seek, comment and share? Examining the relationship between personality, news consumption and misinformation engagement

Purpose

News consumption is critical in creating informed citizenry; however, in the current context of media convergence, news consumption becomes more complex as social media becomes a primary news source rather than news media. The current study seeks to answer three questions: why the shifted pattern of news seeking only happens to some but not all of the news consumers; whether the differentiated patterns of news seeking (news media vs social media) would result in different misinformation engagement behaviors; and whether misperceptions would moderate the relationship between news consumption and misinformation engagement.

Design/methodology/approach

A survey consisted of questions related to personality traits, news seeking, misperceptions and misinformation engagement was distributed to 551 individuals. Multiple standard regression and PROCESS Macro model 1 were used to examine the intricate relationships between personality, news use and misinformation engagement.

Findings

Results indicate that extroversion was positively associated with social media news consumption while openness was inversely related to it. Social media news consumption in turn positively predicted greater misinformation sharing and commenting. No association was found between Big Five personality traits and news media news seeking. News media news seeking predicted higher intention to reply to misinformation. Both relationships were further moderated by misperceptions that individuals with greater misperceptions were more likely to engage with misinformation.

Originality/value

The current study integrates personality traits, news consumption and misperceptions in understanding misinformation engagement behaviors. Findings suggest that news consumption via news media in the digital era merits in-depth examinations as it may associate with more complex background factors and also incur misinformation engagement. Social media news consumption deserves continuous scholarly attention. Specifically, extra attention should be devoted to extrovert and pragmatic individuals in future research and interventions. People with these characteristics are more prone to consume news on social media and at greater risk of falling prey to misinformation and becoming a driving force for misinformation distribution.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-10-2021-0520

Do We Trust the Crowd? Effects of Crowdsourcing on Perceived Credibility of Online Health Information

Crowdsourcing websites such as Wikipedia have become go-to places for health information. To what extent do we trust such health content that is generated by other Internet users? Will it make a difference if such entries are curated by medical professionals? Does the affordance of crowdsourcing make users feel like they themselves could be contributors, and does that influence their credibility judgments? We explored these questions with a 2 (Crowdsourcing: absence vs. presence) × 2 (Professional source: absence vs. presence) × 2 (Message: sunscreen vs. milk) between-subjects experiment (N = 189). Two indirect paths for crowdsourcing effects were found. The crowd-as-source path suggests that crowdsourcing negatively affects content credibility through decreased source trustworthiness and information completeness. In contrast, the self-as-source path indicates that crowdsourcing elevates source trustworthiness via heightened interactivity and sense of control. Although the additional professional source raises perceived gatekeeping on the site, it does not have substantial influence on credibility judgments. Theoretical and practical implications of the findings are discussed.

The Relationship among COVID-19 Information Seeking, News Media Use, and Emotional Distress at the Onset of the Pandemic

Although several theories posit that information seeking is related to better psychological health, this logic may not apply to a pandemic like COVID-19. Given uncertainty inherent to the novel virus, we expect that information seeking about COVID-19 will be positively associated with emotional distress. Additionally, we consider the type of news media from which individuals receive information—television, newspapers, and social media—when examining relationships with emotional distress. Using a U.S. national survey, we examine: (1) the link between information seeking about COVID-19 and emotional distress, (2) the relationship between reliance on television, newspapers, and social media as sources for news and emotional distress, and (3) the interaction between information seeking and use of these news media sources on emotional distress. Our findings show that seeking information about COVID-19 was significantly related to emotional distress. Moreover, even after accounting for COVID-19 information seeking, consuming news via television and social media was tied to increased distress, whereas consuming newspapers was not significantly related to greater distress. Emotional distress was most pronounced among individuals high in information seeking and television news use, whereas the association between information seeking and emotional distress was not moderated by newspapers or social media news use.

Determining the credibility, accuracy and comprehensiveness of websites educating consumers on complex regional pain syndrome accessible in Australia: a systematic review

Complex regional pain syndrome (CRPS) is a distressing and disabling pain condition. Many people with CRPS and the health professionals who treat them seek information about the condition via the Internet. The credibility, accuracy and comprehensiveness of online CRPS information remains unknown. The aim of this study was to determine the credibility, accuracy and comprehensiveness of information presented on freely accessible websites that aim to educate people about CRPS. Keyword searches were conducted on the Australian Google site, with 'trustworthy' websites included and critically appraised. Primary outcomes were recognised metrics of credibility (JAMA benchmark credibility criteria) and website accuracy (according to European CRPS guidelines). Comprehensiveness was assessed using the proportion of European CRPS guidelines covered by the websites. In all, 30 websites with 819 recommendations were critically appraised. Five (17%) websites met all credibility criteria; of the recommendations, 349 (43%) were accurate, 252 (31%) were inaccurate and 218 (26%) were unclear. For comprehensiveness, an average of 17% of general guidelines, 15% of therapeutic guidelines and 6% of medication/supplement guidelines were covered. Online information about CRPS available to Australians has low credibility, accuracy and comprehensiveness. Many website recommendations are inaccurate or unclear, and many websites endorse inappropriate treatments. There is an urgent need for accurate and comprehensive sources of CRPS information online.

Credibility of scientific information on social media: Variation by platform, genre and presence of formal credibility cues

Responding to calls to take a more active role in communicating their research findings, scientists are increasingly using open online platforms, such as Twitter, to engage in science communication or to publicize their work. Given the ease with which misinformation spreads on these platforms, it is important for scientists to present their findings in a manner that appears credible. To examine the extent to which the online presentation of science information relates to its perceived credibility, we designed and conducted two surveys on Amazon’s Mechanical Turk. In the first survey, participants rated the credibility of science information on Twitter compared with the same information in other media, and in the second, participants rated the credibility of tweets with modified characteristics: presence of an image, text sentiment, and the number of likes/retweets. We find that similar information about scientific findings is perceived as less credible when presented on Twitter compared to other platforms, and that perceived credibility increases when presented with recognizable features of a scientific article. On a platform as widely distrusted as Twitter, use of these features may allow researchers who regularly use Twitter for research-related networking and communication to present their findings in the most credible formats.

Promoting HPV vaccination on social media: interactive effects of threat, efficacy and social cues

BACKGROUND

Women are currently facing a tremendous threat of cervical cancer globally. Social media health campaigns have the potential to shape public health behaviors. This study explores the effects of cervical-cancer-related fear appeal messages with social cues on social media using the extended parallel processing model (EPPM).

METHOD

We use a 2 (threat: present vs. absent) × 2 (efficacy: present vs. absent) × 2 (social cues: high vs. low) factorial experimental design to examine the effects of fear appeal messages with social cues on behavioral intention to receive the human papillomavirus (HPV) vaccination.

RESULTS

There was a significant main effect of threat on the intention to receive HPV vaccination. Additionally, a significant three-way interactive effect among threat, efficacy, and social cues was detected.

CONCLUSION

Women exposed to threat messages had a higher intention of HPV vaccination compared to those who were exposed to non-threat messages. Furthermore, with the low number of likes, women who were exposed to messages containing both threat and efficacy tended to have the highest intention of HPV vaccination.

PRACTICE IMPLICATIONS

When conducting fear appeal campaigns on social media, the side effects of number of likes should be recognized. For vaccination promotion campaigns, the efficacy information should be more specific and audience-centered.

What to Believe? Impact of Knowledge and Message Length on Neural Activity in Message Credibility Evaluation

Understanding how humans evaluate credibility is an important scientific question in the era of fake news. Message credibility is among crucial aspects of credibility evaluations. One of the most direct ways to understand message credibility is to use measurements of brain activity of humans performing credibility evaluations. Nevertheless, message credibility has never been investigated using such a method before. This article reports the results of an experiment during which we have measured brain activity during message credibility evaluation, using EEG. The experiment allowed for identification of brain areas that were active when participant made positive or negative message credibility evaluations. Based on experimental data, we modeled and predicted human message credibility evaluations using EEG brain activity measurements with F1 score exceeding 0.7.

COVID-19 Vaccination Attitudes and Intention: Message Framing and the Moderating Role of Perceived Vaccine Benefits

The United States is one of the hardest-hit countries by the COVID-19 pandemic and yet there is widespread hesitancy to take the vaccine. In order to address vaccine hesitancy and foster public understanding of the COVID-19 vaccine, it is necessary to strategize public health messages based on evidence. To this end, we use experimental data to examine the effects of four message frames on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. The primary purposes of this paper are to examine the 1) impact of loss vs. gain frames and individual vs. collective frames and 2) role of perceived benefits on participants' attitudes toward the COVID-19 vaccine and their vaccine intention. Our findings show that participants with higher perceived benefits and exposed to the loss frame showed higher positive attitudes toward the COVID-19 vaccine and greater intention to vaccinate. Similar patterns were revealed in case of the individual frame message. Implications are discussed.

Influenced by Anonymous Others: Effects of Online Comments on Risk Perception and Intention to Communicate

Guided by the health risk communication literature and the social identity model of deindividualization effects, this study examines whether and how concurrent exposure to health news articles and congruent/incongruent comments posted by anonymous others may affect news viewers' personal risk perception, societal risk perception, and intention to communicate about health risk issues. Two controlled experiments were conducted in Vietnam concerning two controversial health risk issues, including ear picking and child corporal punishment. Results showed a significant interaction effect between comments and perceived similarity on personal risk perception and societal risk perception, such that comments influenced both types of risk perception when viewers perceived that anonymous commenters were ingroup members. Results also indicated the joint effect of comments and perceived similarity on participants' intention to communicate, mediated by their personal risk perception and societal risk perception. Theoretical and practical implications were discussed.

The Impact of Social Endorsement Cues and Manipulability Concerns on Perceptions of News Credibility

Social endorsement cues (SEC) offer information about how online users have engaged and evaluated online content. Some view that SEC thus can serve as useful heuristics when users evaluate the credibility of news content on social media. At the same time, SEC can be manipulated by a variety of commercial and political actors on social media. This study examines whether SEC influence individuals' credibility judgments of political news on social media, and how the salience of concerns that SEC can be manipulated by others can undermine the perceived credibility. Using an experiment, we found that SEC had a negative influence on news credibility, regardless of whether or not SEC manipulability concerns were primed. An independent effect of SEC manipulability concerns was also found, such that priming thoughts about the manipulability of SEC led participants to rate the news post as less credible, regardless of whether that post included SEC. These results suggest a spillover effect whereby concerns over the manipulation of SEC can create doubt about the authenticity of other cues from the news (e.g., source and message), and lead to perceptions that news shared on social media can be manipulated more generally.

Framing clinical and translational science: Examining the strategic social media communications of NCATS-funded CTSAs

INTRODUCTION

Many Clinical and Translational Science Awards (CTSAs) focus their energy on operational aspects of running their hub, but may not devote enough energy and resources toward branding and effective communication. However, CTSAs have an important mission when it comes to communicating effectively with their stakeholders through social media. Using framing theory as the underpinning, the purpose of this content analysis is to investigate the ways in which CTSAs use Twitter to communicate with their various stakeholders, the type of content they post, and the type of engagement their tweets garner.

METHODS

We examined 349 tweets posted from January 2019 to January 2020 from 19 CTSA Twitter accounts (sampled from a total of 35 CTSA accounts). A thematic codebook was generated using tweets randomly chosen from the sample. Content analysis was performed on the entire tweet sample by four coders using the codebook (alpha = 0.89).

RESULTS

CTSAs tweeted the most about events (29.8%), and the least about study recruitment (2.01%). Most tweets included images (59.31%) and hashtags (51.29%), but received little user engagement on the average post (average: 4.38 likes and 1.94 retweets). CTSAs tweeted most from 10 a.m. to 12 p.m. PST and received the most engagement. Most CTSAs had a dedicated person (e.g., manager, coordinator) handling their communications.

DISCUSSION

Our analysis shows multiple opportunities for CTSAs to engage with stakeholders and the public, as well as standardize and improve their Twitter communications to effectively reach a broader audience.

Use of bot and content flags to limit the spread of misinformation among social networks: a behavior and attitude survey

The COVID-19 infodemic is driven partially by Twitter bots. Flagging bot accounts and the misinformation they share could provide one strategy for preventing the spread of false information online. This article reports on an experiment (N = 299) conducted with participants in the USA to see whether flagging tweets as coming from bot accounts and as containing misinformation can lower participants’ self-reported engagement and attitudes about the tweets. This experiment also showed participants tweets that aligned with their previously held beliefs to determine how flags affect their overall opinions. Results showed that flagging tweets lowered participants’ attitudes about them, though this effect was less pronounced in participants who frequently used social media or consumed more news, especially from Facebook or Fox News. Some participants also changed their opinions after seeing the flagged tweets. The results suggest that social media companies can flag suspicious or inaccurate content as a way to fight misinformation. Flagging could be built into future automated fact-checking systems and other misinformation abatement strategies of the social network analysis and mining community.

The effects of message framing on online health headline selection of female users: A moderation of approach/avoidance motivation

BACKGROUND

More and more females are diagnosed with and die of cancers. Acquiring cancer-related information and enriching one's knowledge of cancers are important to cancer prevention and treatment. Effective online health headlines are indispensable to encouraging the reading of the hyperlinked health articles, especially those on daunting topics such as cancers.

OBJECTIVE

This study aims to reveal how message framing, i.e., gain- or loss-framing, influences female users' selection of cancer-related health headlines at two levels, i.e., attention and behavior.

METHODS

An eye-tracking experiment was conducted to capture female participants' attention and clicking behavior in response to cancer-related headlines manipulated in terms of message framing. The Stimulus-Organism-Response (S- O-R) framework was introduced to develop the research model that also took approach/avoidance motivation into account as moderator.

RESULTS

Compared with loss-framed headlines, gain-framed ones attracted more and longer fixations (β = .09, p < .01; β = .12, p < .01) as well as more clicks (exp(B) = 1.76, p < .001), and they additionally evoked a higher level of pleasure (β = .50, p = .00) yet a lower level of arousal (β=-.16, p = .00). Arousal partially mediated the relationship between message framing and headline selection (β = .16, p = .00; β = .16, p = .00; exp(B) = 1.8, p = .00). The participants high in approach motivation devoted more attention to gain-framed headlines than to loss-framed ones (F(1,1333) = 15.74, p < .001; F(1,1333) = 31.94, p < .001).

CONCLUSION

Gain-framing is a preferred technique over loss-framing for online health information providers to create effective headlines of cancer-related information. Using gain-framed headlines helps alleviate cancer information avoidance and enrich people's knowledge of fatal diseases.

Engaging Māori with qualitative healthcare research using an animated comic

This article reports an effective strategy for recruiting patients with asthma to a qualitative study using an animated comic advertised on social media. An ad spend of NZ$432 on Facebook resulted in 101 study enquiries, and 27 participants taking part in the focus groups, of which 16 (56%) were Māori, the Indigenous Peoples of New Zealand. Representation of Māori amongst participants was over five times higher than their proportion in the local population (9.7%), resulting in data fulfilling the principle of equal explanatory power, an approach to research which can help advance Māori health development and address inequity. The success of this campaign is of particular interest for health researchers in New Zealand where Māori continue to be disproportionately affected by poorer health outcomes compared with non-Māori, particularly those with asthma. Approaches that better engage and support participation of under-represented communities in clinical research are of wider global interest. We reflect on the recruitment strategy and outcomes within a Kaupapa Māori framework, explore how this can be applied more widely in healthcare, and suggest direction for future study and implementation. Lay summary We designed an animated comic to advertise a study for patients with asthma. This was shared locally with a Facebook ad. The approach was highly engaging with the public, and resulted in rapid recruitment. Interestingly, participation of Māori (the Indigenous People of New Zealand) was over five times higher than their proportion in the local population. Māori have poorer health outcomes and increased barriers to healthcare access compared with non-Māori, particularly those with asthma. Approaches which can engage and support under-represented communities to participate in clinical research are of wider global interest. In this article, we reflect on the recruitment strategy and outcomes, and suggest direction for future study and implementation.

e-Health Campaigns for Promoting Influenza Vaccination: Examining Effectiveness of Fear Appeal Messages from Different Sources

Background: In recent years, influenza has become a severe disease and pandemic threat. There are more than 290,000 to 650,000 influenza-related deaths globally each year. Influenza vaccination is the best way to prevent influenza and potentially serious influenza-related complications. The current study aims to examine the effectiveness of fear-induced health campaigns on social media in promoting influenza vaccination with the focus on different sources. Methods: A 2 × 3 × 2 (visible source × receiver source × technological source) factorial online experiment was designed to investigate the effectiveness of fear appeal messages offered by different sources on social media. A total of 534 college students were recruited to participate in the experiment. Results: Individuals who receive messages from a verified visible source have greater intention to perform flu vaccination and seek flu-related information than those who acquire messages from an unverified one. Besides, visible source, receiver source, and technological source interact to affect flu-related information seeking. Conclusions: In addition to the message itself, different levels of message sources on social media should be considered for e-health campaign design, especially visible sources.

Perception of peer advice in online health communities: Access to lay expertise

When seeking advice online about health concerns, forums dedicated to medical themes are increasingly becoming an appreciated source of information for many individuals. In online health communities, patients can ask questions or otherwise seek advice that is particularly relevant to them. While they may find some of the advice useful, other advice may be perceived as less valuable. By studying the advice-seeking, advice-giving, and advice-evaluation behaviours in one of the largest online health communities in Europe, this paper looks at what determines which advice is perceived as helpful, and why. Drawing on network theory, we analysed the interaction data of 108,569 users over twelve consecutive years based on all publicly available information of an established Q&A online health community. Utilising zero-inflated negative binominal modelling, our results show that advice received from others, who have similar predominant interests, is valued more when reaching out for lay expertise. If this advice is given by peers, who can also draw on expertise from other health areas, allowing for a combination of diverse "lay" expertise, the advice is valued even more. Advice provided by those who are quick to obtain the latest knowledge available in the larger community further reinforces these effects. Our findings offer an original view to understand the influence of lay expertise exchanged via online health communities and hold implications for both policy-makers and medical practitioners regarding their approach to patient-initiated use of social media for health-related reasons.

Online Information of Vaccines: Information Quality, Not Only Privacy, Is an Ethical Responsibility of Search Engines

The fact that Internet companies may record our personal data and track our online behavior for commercial or political purpose has emphasized aspects related to online privacy. This has also led to the development of search engines that promise no tracking and privacy. Search engines also have a major role in spreading low-quality health information such as that of anti-vaccine websites. This study investigates the relationship between search engines' approach to privacy and the scientific quality of the information they return. We analyzed the first 30 webpages returned searching "vaccines autism" in English, Spanish, Italian, and French. The results show that not only "alternative" search engines (Duckduckgo, Ecosia, Qwant, Swisscows, and Mojeek) but also other commercial engines (Bing, Yahoo) often return more anti-vaccine pages (10-53%) than Google.com (0%). Some localized versions of Google, however, returned more anti-vaccine webpages (up to 10%) than Google.com. Health information returned by search engines has an impact on public health and, specifically, in the acceptance of vaccines. The issue of information quality when seeking information for making health-related decisions also impact the ethical aspect represented by the right to an informed consent. Our study suggests that designing a search engine that is privacy savvy and avoids issues with filter bubbles that can result from user-tracking is necessary but insufficient; instead, mechanisms should be developed to test search engines from the perspective of information quality (particularly for health-related webpages) before they can be deemed trustworthy providers of public health information.

Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health

Since 2016, social media companies and news providers have come under pressure to tackle the spread of political mis- and disinformation (MDI) online. However, despite evidence that online health MDI (on the web, on social media, and within mobile apps) also has negative real-world effects, there has been a lack of comparable action by either online service providers or state-sponsored public health bodies. We argue that this is problematic and seek to answer three questions: why has so little been done to control the flow of, and exposure to, health MDI online; how might more robust action be justified; and what specific, newly justified actions are needed to curb the flow of, and exposure to, online health MDI? In answering these questions, we show that four ethical concerns—related to paternalism, autonomy, freedom of speech, and pluralism—are partly responsible for the lack of intervention. We then suggest that these concerns can be overcome by relying on four arguments: (1) education is necessary but insufficient to curb the circulation of health MDI, (2) there is precedent for state control of internet content in other domains, (3) network dynamics adversely affect the spread of accurate health information, and (4) justice is best served by protecting those susceptible to inaccurate health information. These arguments provide a strong case for classifying the quality of the infosphere as a social determinant of health, thus making its protection a public health responsibility. In addition, they offer a strong justification for working to overcome the ethical concerns associated with state-led intervention in the infosphere to protect public health.