When Do People Verify and Share Health Rumors on Social Media? The Effects of Message Importance, Health Anxiety, and Health Literacy

Future anxiety mediates the relationship between organ donation and transplantation knowledge and health-related quality of life

BACKGROUND

Knowledge about organ donation and transplantation plays a crucial role in shaping individuals' health behaviors and perceptions, potentially impacting their health-related quality of life (HRQoL). Future anxiety, defined as the anticipatory worry individuals experience regarding potential negative events and outcomes in their future, may further influence these outcomes.

AIM

To investigate the effect of such knowledge on HRQoL and to examine whether future anxiety mediates this relationship.

METHODS

A cross-sectional study was conducted with 659 participants aged 18 to 65 years. Participants completed the Organ Tissue Donation and Transplantation Knowledge Scale, the Dark Future Scale, and the European Health Interview Survey-Quality of Life 8. Correlation analyses were performed, followed by Structural Equation Modeling to test the proposed mediation model.

RESULTS

The findings indicated that greater knowledge about organ donation and transplantation was positively associated with higher HRQoL and negatively associated with future anxiety. Future anxiety was negatively correlated with HRQoL. Structural Equation Modeling analysis indicated that knowledge directly enhanced HRQoL and reduced future anxiety. Additionally, future anxiety negatively affected HRQoL, mediating the relationship between knowledge and HRQoL. The mediation effect was significant, as confirmed by bootstrapping (bootstrap coefficient = 0.068, 95%CI: 0.046-0.093).

CONCLUSION

The study concludes that future anxiety partially mediates the positive impact of knowledge about organ donation and transplantation on HRQoL. These results suggest that increasing public knowledge in this area may reduce future anxieties and enhance quality of life.

Self-Correction or Other-Correction: The Effects of Source Consistency and Ways of Correction on Sharing Intention of Health Misinformation Correction

The spread of misinformation, especially health-related misinformation has raised concerns globally. As an immediate remedy, fact-checking has been identified as an important solution. Adopting a 2 (source credibility: high vs. low) × 2 (source consistency: consistent vs. inconsistent) × 3 (ways of correction: human fact-checking vs. AI fact-checking vs. simple rebuttal) factorial design experiment (N = 754), this study examined how ways of correction and source consistency may affect individuals' intentions to share health misinformation correction on social media on two health topics: sunscreen safety and vaccine safety. Results showed that human and AI fact-checking correction elicited higher sharing intention compared to simple rebuttal. Correction coming from a different source than the original misinformation source elicited higher sharing intention, compared to correction from the same source. Perceived correction source credibility mediated the effects of ways of correction and source consistency on correction sharing intention. Theoretical and practical implications were discussed.

Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis

BACKGROUND

Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals' cultural, social, and personal backgrounds, further complicating efforts to combat its spread.

OBJECTIVE

This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation.

METHODS

Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information.

RESULTS

Over 35.61% (1740/4959) of respondents reported encountering "a lot" of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing "some" amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access.

CONCLUSIONS

This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions.

Heuristic Information Processing as a Mediating Factor in the Process of Exposure to COVID-19 Vaccine Information and Misinformation Sharing on Social Media

Social media use for risk communication during the COVID-19 pandemic has caused considerable concerns about an overabundance of information, particularly misinformation. However, how exposure to COVID-19 information on social media can lead to subsequent misinformation sharing during the pandemic has received little research attention. This study adopted the social amplification of risk framework to delineate how exposure to COVID-19 vaccine information on social media can be associated with individuals' misinformation sharing through heuristic information processing. The role of social media trust was also examined. Results from an online survey (N = 1488) of Chinese Internet users revealed that exposure to COVID-19 vaccine information on social media was associated with misinformation sharing, mediated by both affect heuristics (i.e., negative affect toward the COVID-19 pandemic in general) and availability heuristics (i.e., perceived misinformation availability). Importantly, both high and low levels of trust in social media strengthened the mediating associations. While a low level of trust strengthened the association between exposure to COVID-19 vaccine information on social media and the affect heuristics, a high level of trust strengthened its association with the availability heuristics, both of which were associated with misinformation sharing. Our findings suggest that heuristic information processing is essential in amplifying the spread of misinformation after exposure to risk information on social media. It is also suggested that individuals should maintain a middle level of trust in social media, being open while critical of risk information on social media.

The Relationship between Cyberchondria and Health Anxiety and the Moderating Role of Health Literacy among the Pakistani Public

Following the COVID-19 pandemic, the current study examines the association between cyberchondria and health anxiety in the Pakistani population, with health literacy as a moderator. This study utilized a cross-sectional research approach, with data gathered through simple random sampling. The study enlisted 1295 participants from Pakistan aged between 18 and 70, 63% of whom were male and 36% of whom were female. The researchers found a statistically significant positive link between cyberchondria and health anxiety (β = 0.215; t = 1.052; p 0.000). The moderating influence of health literacy suggests that health anxiety has a significantly negative effect on the relationship between cyberchondria and health anxiety (β = -0.769; t = 2.097; p 0.037). Moreover, females had higher cyberchondria scores than males. Health-related anxiety did not differ between the sexes, and males had greater health literacy than females. These results emphasize the critical role of health literacy in the moderating effects of cyberchondria on health anxiety. Furthermore, they reveal significant gender differences in both cyberchondria and health literacy.

Qualified fitness trainers practice scientifically based judgement in prescribing exercise programs

Fitness trainers are widely in demand by both commercial fitness centres and individual people. They serve members in one-to-one personal training (PT) or group training (GX) in commercial fitness centres. However, the services provided by fitness trainers have not been consistent across the industry. This service inconsistency has led to an increased doubt about professionalism in conducting safe and correct exercise for the public. No studies have evaluated how fitness trainers make decisions when they curate exercise programs for members. This research utilized a qualitative semi-structured interview method to collect data from 16 fitness trainers in Greater Kuala Lumpur, Malaysia. Inverview data was verbatim transcribed and analyzed using a theory-driven analysis. The study investigated fitness training professional decision-making processes when they design and precribe fitness execise programming to clients. Using Cognitive Continuum Theory (CCT) as a lens to explore the decision-making processes revealed a dichotomy of decision-making processes for curating personal training and group training. Feedback mechanism in the implementation of personal training was proven to be more personalized than group training. There are four themes in decision-making processed discovered to be impreative characteristics for fitness trainers. The application of CCT allowed further understanding of the implementation of exercise programs for PT and GX training when fitness trainers modified exercise programs.

Differential effects of digital media platforms on climate change risk information-sharing intention: A moderated mediation model

This study analyzes the mechanisms through which risk messages about climate change lead to people's risk information-sharing intention, and how digital media platform type serves as a context that moderates those mechanisms. Our analysis is informed by the influence of presumed influence (IPI) model, and we adapt and expand that model in three ways. First, we apply the concept of perceived media reach to the context of digital media platforms, specifically news aggregators and social networking sites. Second, we integrate the two mediators of risk perception and presumed influence. Third, we examine potential moderating roles of digital media platforms in the IPI model. An online survey was conducted among 1000 South Korean adults, and a moderated mediation model (PROCESS Macro Model 59) generated the following results. (1) Perceived media reach was positively related to both mediators-risk perception and presumed influence. (2) By way of those two mediators, perceived reach significantly led to information-sharing intention. (3) Presumed influence, but not risk perception, was significantly related to information-sharing intention. (4) Digital media platforms moderated the relation between perceived reach and risk perception: the role of content-related risk perception was more pronounced in news aggregators, while the role of context-related presumed influence was greater in social networking sites. Theoretical and practical implications for risk communication are discussed.

Effective use of online COVID-19 information and eHealth information literacy among US university students

Objective: This study aimed to understand students' ability to search the Internet for COVID-19 information and apply it to evaluate the veracity of specific statements. Participants: Undergraduate students (N = 239) at a US university completed a Web-based questionnaire in September-October 2020. Methods: The questionnaire included self-reported measures of online health information literacy, COVID-19 knowledge, and anxiety along with exercises on searching and evaluating COVID information online. Results: Students reported moderate levels of information literacy (76%, 3.8 out of 5), but did not perform as well while searching the Internet for COVID-19 information (average accuracy: 65%, 10.5 out of 16 points). Students with higher Internet exercise scores reported higher GPA, higher household income, and liberal political views, and were more likely to follow public health measures [ie, social distancing, mask wearing, and not self-medicating with (hydroxy)chloroquine]. Conclusions: University students may overestimate their information literacy while struggling with searching the Internet for accurate COVID-19 information.

Gaming with health misinformation: a social capital-based study of corrective information sharing factors in social media

Correction is an important tool to reduce the negative impact of health misinformation on social media. In the era of "I share, therefore I am" social media, users actively share corrective information to achieve the "anti-convincing" effect of health misinformation. Focusing on the local Chinese context, this study constructs a structural equation model using social capital as a mediating variable to explore whether usage of Chinese users' social media can promote corrective information sharing by influencing the structural, cognitive, and relational dimensions of social capital and the role of health literacy in corrective information sharing. It was found that social media use did not significantly affect corrective information share willingness but significantly influenced share willingness through social interaction connections, trust, and shared experiences, and share willingness significantly influenced sharing behavior. The moderating effect showed that health literacy played a significant moderating effect in the influence of corrective information share willingness on sharing behavior. This study introduces the three dimensions of social capital at the theoretical level and finds that users will share corrective information for the purpose of social capital accumulation. It also provides empirical evidence for specific practices, including improving users' health literacy and actively mobilizing them to participate in the blocking and management of health misinformation in social media.

Risk Perception and Preventive Behavior During the COVID-19 Pandemic : Testing the Effects of Government Trust and Information Behaviors

Given the absence of COVID-19 treatments, the best way to control the spread of the virus is to break the chain of infection by increasing public participation in preventive behaviors recommended by health authorities. This study proposes a moderated mediation model of information behaviors (e.g. information seeking and information verification) and trust in government that explores the relationship between risk perception and preventive behaviors regarding COVID-19. Using a survey study in South Korea, we conducted the moderated mediation analysis with latent moderated structural equation modeling (LMS). We found serial mediation effects for risk perception, information behaviors, and preventive behaviors, as people both seek out information and verify that information before adopting preventive behaviors. Additionally, trust in government moderated information behaviors in the relationship between risk perception and preventive behaviors, suggesting that trust in government encourages people to adopt more preventive actions via information seeking and information verification. Further implications are discussed to promote public understanding of the health crisis and public participation in preventive measures.

Educational Video Intervention to Improve Health Misinformation Identification on WhatsApp Among Saudi Arabian Population: Pre-Post Intervention Study

BACKGROUND

Health misinformation can adversely affect individuals' quality of life and increase the risk of mortality. People often fail to assess the content of messages before sharing them on the internet, increasing the spread of misinformation. The problem is exacerbated by the growing variety of digital information environments, especially social media, which presents as an effective platform for spreading misinformation due to its rapid information-sharing capabilities. Educational interventions have been developed to help consumers verify the validity of digital health information. However, tools designed to detect health misinformation on social media content have not been validated. Given the increased use of social media platforms, particularly WhatsApp, it is crucial to develop tools to help consumers assess the credibility of messages and detect misinformation.

OBJECTIVE

The main objective of this study is to develop and assess an educational tool aimed at educating consumers about detecting health misinformation on WhatsApp. The secondary objective is to assess the association between demographic factors and knowledge levels.

METHODS

The study used a single-arm, pre-post intervention design to evaluate the effectiveness of an educational video in improving participants' ability to detect health-related misinformation in WhatsApp messages. In the first phase, an educational video intervention was developed and validated. In the second phase, participants were invited to complete a web-based survey that consisted of pre-evaluation questions, followed by the educational video intervention. Subsequently, they were asked to answer the same questions as the postevaluation questions.

RESULTS

The web-based survey received 485 responses. The completion rate was 99.6% (n=483). Statistically significant associations existed between knowledge level and age, gender, employment, and region of residence (P<.05). The video intervention did elicit a statistically significant change in the participants' abilities to identify misinformation in WhatsApp messages (z=-6.887; P<.001). Viewing the video was associated with increased knowledge about the following concepts: checking the "forwarded" label (P<.001), looking for spelling and grammatical errors (P<.001), analyzing the facts (P=.03), checking links (P=.002, P=.001), and assessing the photos and videos (P<.001). There was a statistically significant difference in knowledge level before and after the intervention (P<.001).

CONCLUSIONS

This study developed and evaluated the effectiveness of an educational video intervention to improve health misinformation identification on WhatsApp among the Saudi Arabian population. The results indicate that educational videos can be valuable tools for improving participants' abilities to identify misinformation. The outcomes of this research can contribute to our understanding of what constitutes an effective tool for enhancing health misinformation awareness. Such interventions may be particularly useful in combating misinformation among Arabic-speaking populations on WhatsApp, which may ultimately improve eHealth literacy. Limiting the prevalence and impact of misinformation allows people to make better-informed health decisions.

Doing public health differently: How can public health departments engage with local communities through social media interventions?

Objectives

This paper evaluates a collaborative intervention between public health professionals and local social media administrators, in which the social media site Facebook was used with a view to strengthening engagement with and, dissemination of, core messages and building trust and resilience within local communities during the COVID-19 pandemic.

Study design

A qualitative design was used, exploring the research question: how does collaboration between public health professionals and local social network group administrators create community engagement during a global crisis?

Methods

Fourteen semi-structured interviews were conducted with public health staff and online group administrators. Data was analysed using framework analysis.

Results

Collaboration between public health professionals and local group administrators created both opportunities and challenges. Local group administrators had wide reach and trust within the local community, but message credibility was enhanced through local authority involvement. Such collaborations contain inherent tensions due to perceived risks to social capital and independence but can be successful if receiving strong risk-tolerant support from the local authority. Findings are discussed in the context of Bourdieu's theory of social capital to examine how public health information can be delivered by trusted social media actors in communication tailored to the local community.

Conclusions

Social media provides new channels of communication for delivery of public health messages, enabling new ways of working which create long-term engagement and community building. Although the intervention was developed quickly in response to the COVID-19 pandemic, participants felt it could be mobilised to address a wider range of issues.

Distractions, analytical thinking and falling for fake news: A survey of psychological factors

Analytical thinking safeguards us against believing or spreading fake news. In various forms, this common assumption has been reported, investigated, or implemented in fake news education programs. Some have associated this assumption with the inverse claim, that distractions from analytical thinking may render us vulnerable to believing or spreading fake news. This paper surveys the research done between 2016 and 2022 on psychological factors influencing one's susceptibility to believing or spreading fake news, considers which of the psychological factors are plausible distractors to one's exercise of analytical thinking, and discusses some implications of considering them as distractors to analytical thinking. From these, the paper draws five conclusions: (1) It is not analytical thinking per se, but analytical thinking directed to evaluating the truth that safeguards us from believing or spreading fake news. (2) While psychological factors can distract us from exercising analytical thinking and they can also distract us in exercising analytical thinking. (3) Whether a psychological factor functions as a distractor from analytical thinking or in analytical thinking may depend on contextual factors. (4) Measurements of analytical thinking may not indicate vulnerability to believing or spreading fake news. (5) The relevance of motivated reasoning to our tendency to believe fake news should not yet be dismissed. These findings may be useful to guide future research in the intersection of analytical thinking and susceptibility to believing or spreading fake news.

Behavior patterns and influencing factors: Health information acquisition behavior of Chinese senior adults on WeChat

Due to the gradual adoption of WeChat by older adults in China and their interest in health information, Chinese older people started to acquire health information through WeChat. We explored the specific patterns and influencing factors of the elderly's health information acquisition behavior senior adults. The cross-sectional study collected self-reported data with survey (N = 336) in the southeast of China, Zhejiang province. The findings of this study extend the previous research by suggesting that elderly adults' health information acquisition behavior has three patterns (actively seeking, passively browsing, and long-term collecting). These findings contribute to a better understanding of digital literacy, three dimensions of health literacy and their relationship with three specific patterns of health acquisition behavior. This study also provides practical insights related to narrow the technological gap of the older adults, improve their e-Health literacy of the elderly, and purify the health information environment in the network.

Understanding the role of social media usage and health self-efficacy in the processing of COVID-19 rumors: A SOR perspective

Apart from the direct health and behavioral influence of the COVID-19 pandemic itself, COVID-19 rumors as an infodemic enormously amplified public anxiety and cause serious outcomes. Although factors influencing such rumors propagation have been widely studied by previous studies, the role of spatial factors (e.g., proximity to the pandemic) on individuals' response regarding COVID-19 rumors remain largely unexplored. Accordingly, this study, drawing on the stimulus-organism-response (SOR) framework, examined how proximity to the pandemic (stimulus) influences anxiety (organism), which in turn determines rumor beliefs and rumor outcomes (response). Further, the contingent role of social media usage and health self-efficacy were tested. The research model was tested using 1246 samples via an online survey during the COVID-19 pandemic in China. The results indicate that: (1)The proximity closer the public is to the pandemic, the higher their perceived anxiety; (2) Anxiety increases rumor beliefs, which is further positively associated rumor outcomes; (3) When the level of social media usage is high, the relationship between proximity to the pandemic and anxiety is strengthened; (4) When the level of health self-efficacy is high, the effect of anxiety on rumor beliefs is strengthened and the effect of rumor beliefs on rumor outcomes is also strengthened. This study provides a better understanding of the underlying mechanism of the propagation of COVID-19 rumors from a SOR perspective. Additionally, this paper is one of the first that proposes and empirically verifies the contingent role of social media usage and health self-efficacy on the SOR framework. The findings of study can assist the pandemic prevention department in to efficiently manage rumors with the aim of alleviating public anxiety and avoiding negative outcomes cause by rumors.

Understanding Rumor Sharing Behavior During COVID-19: The Dominant Motivation and the Potential Consequences for Life Satisfaction

During the COVID-19 pandemic, rumors were shared widely and quickly, leading to unfortunate consequences. To explore the dominant motivation underlying such rumor sharing behavior and the potential consequences for sharers' life satisfaction, two studies were conducted. Study 1 was based on representative popular rumors that circulated throughout Chinese society during the pandemic to examine the dominant motivation underlying rumor sharing behavior. Study 2 employed a longitudinal design to further test the dominant motivation underlying rumor sharing behavior and its effects on life satisfaction. The results of these two studies generally supported our hypotheses that people chose to share rumors during the pandemic mainly for the purpose of fact-finding. Regarding the effects of rumor sharing behavior on life satisfaction, although sharing wish rumors (i.e., rumors expressing hopes) had no effect on sharers' life satisfaction, sharing dread rumors (i.e., rumors reflecting fears) and aggression rumors (i.e., rumors implying aggression and hatred) reduced sharers' life satisfaction. This research lends support to the integrative model of rumor and provides practical implications for mitigating the spread of rumors.

Disinformation about COVID-19 Preventions and Treatments: Analysis of USFDA Warning Letters

COVID-19 poses a challenge beyond the virus itself, in that lockdown has been associated increased use of the internet and social media. Disinformation about prevention and treatment strategies for COVID-19 can have lethal consequences. The United States Food and Drug Administration (USFDA) is currently monitoring the compliance of manufacturing firms as well as medicinal product advertisers to the Federal Food, Drug, and Cosmetic Act, 21 USC § 321(h) regulations. In the event of noncompliance in the form of advertising products without prior USFDA approval for specific indications, doses, or route of administration, warning letters (WLs) are issued. WLs are intended to address the concerns identified by USFDA and encourage the recipient to take corrective steps to avoid similar instances in the future. We analyzed 182 WLs that were issued for noncompliance with drugs/devices related to either treatment, prevention, or testing of COVID-19 infections. The medicinal product website was identified as the major source of disinformation, followed by disseminated information on Facebook, Twitter, and Instagram. Nearly four-fifths were related to drugs, followed by devices and biologicals. Several biologicals, as well as allopathic, herbal, and non-herbal drugs were identified in the WLs. We observed that noncompliance with the USFDA regulations in terms of advertising a variety of products for prevention and treatment of COVID-19 infection was widely prevalent. More efforts are required by the respective national drug regulatory authorities to initiate or continue their monitoring of disinformation that may have lethal consequences.

Intention of health experts to counter health misinformation in social media: Effects of perceived threat to online users, correction efficacy, and self-affirmation

Our study analyzes the intention of Chinese health experts (health professionals and medical students) to correct health misinformation in social media. In an experimental 2 × 2 × 2 between-subjects factorial design (n = 415), we manipulated the experts' perception of the threat that health misinformation poses for online users, their self-efficacy with respect to correcting misinformation, and their self-affirmation. To select the potential influence factors, we draw on self-affirmation theory and the extended parallel process model. Results of our experiment revealed that correction intention increases if experts perceive the threat for online users as severe, believe that they are capable of countering the impact of misinformation, and have a high motivation to maintain a positive self-image of caring for others. We discuss the consequences of our findings for motivating experts to help reduce the adverse effects of health misinformation in social media.

Social Media Data Mining of Antitobacco Campaign Messages: Machine Learning Analysis of Facebook Posts

BACKGROUND

Social media platforms provide a valuable source of public health information, as one-third of US adults seek specific health information online. Many antitobacco campaigns have recognized such trends among youth and have shifted their advertising time and effort toward digital platforms. Timely evidence is needed to inform the adaptation of antitobacco campaigns to changing social media platforms.

OBJECTIVE

In this study, we conducted a content analysis of major antitobacco campaigns on Facebook using machine learning and natural language processing (NLP) methods, as well as a traditional approach, to investigate the factors that may influence effective antismoking information dissemination and user engagement.

METHODS

We collected 3515 posts and 28,125 associated comments from 7 large national and local antitobacco campaigns on Facebook between 2018 and 2021, including the Real Cost, Truth, CDC Tobacco Free (formally known as Tips from Former Smokers, where "CDC" refers to the Centers for Disease Control and Prevention), the Tobacco Prevention Toolkit, Behind the Haze VA, the Campaign for Tobacco-Free Kids, and Smoke Free US campaigns. NLP methods were used for content analysis, including parsimonious rule-based models for sentiment analysis and topic modeling. Logistic regression models were fitted to examine the relationship of antismoking message-framing strategies and viewer responses and engagement.

RESULTS

We found that large campaigns from government and nonprofit organizations had more user engagements compared to local and smaller campaigns. Facebook users were more likely to engage in negatively framed campaign posts. Negative posts tended to receive more negative comments (odds ratio [OR] 1.40, 95% CI 1.20-1.65). Positively framed posts generated more negative comments (OR 1.41, 95% CI 1.19-1.66) as well as positive comments (OR 1.29, 95% CI 1.13-1.48). Our content analysis and topic modeling uncovered that the most popular campaign posts tended to be informational (ie, providing new information), where the key phrases included talking about harmful chemicals (n=43, 43%) as well as the risk to pets (n=17, 17%).

CONCLUSIONS

Facebook users tend to engage more in antitobacco educational campaigns that are framed negatively. The most popular campaign posts are those providing new information, with key phrases and topics discussing harmful chemicals and risks of secondhand smoke for pets. Educational campaign designers can use such insights to increase the reach of antismoking campaigns and promote behavioral changes.

Health-related social media use and COVID-19 anxiety in adolescence: health anxiety as covariate and moderator

Background

Adolescents can benefit from engagement with health-related content on social media (e.g., viewing, commenting, or sharing content related to diseases, prevention, or healthy lifestyle). Nevertheless, such content may be distressing or exaggerated and present a challenge to mental well-being, especially during the COVID-19 pandemic. Rumination about such content may lead to COVID-19 anxiety. Yet, the individual factors that would explain the association between health-related social media use (SMU) and COVID-19 anxiety are understudied.

Objective

In the current study, we aimed to fill the gap by investigating the association between health-related social media use (SMU) and COVID-19 anxiety in light of several individual factors: health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection. We (1) studied the relationship between individual factors and health-related SMU, (2) tested health anxiety as a moderator in the association between health-related SMU and COVID-19 anxiety, and (3) explored a direct effect of experience with COVID-19 on COVID-19 anxiety.

Methods

Using structural equation modeling, we analyzed cross-sectional data from a representative sample of 2,500 Czech adolescents aged 11-16, 50% girls. Sociodemographic measures, health-related SMU, COVIDCOVID-19 anxiety, health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection were assessed with an anonymous online survey. The data were collected in June 2021.

Results

We conducted a path analysis to test the main relationships and an additional simple-slopes analysis to explore the moderating effect of health anxiety. Higher health anxiety and eHealth literacy were associated with increased health-related SMU. The effect of experience with COVID-19 infection on both COVID-19 anxiety and health-related SMU was negligible. Health-related SMU and COVID-19 anxiety were positively associated, however, only for adolescents high in health anxiety. For other adolescents, the two variables were unrelated.

Conclusion

Our findings show that adolescents with higher health anxiety and eHealth literacy engage in health-related SMU more intensively. Furthermore, for adolescents high in health anxiety, the frequency of health-related SMU is associated with the risk of COVID-19 anxiety. This is likely due to differences in media use. Adolescents with high health anxiety may use social media for content that is more likely to lead to COVID-19 anxiety compared to other adolescents. We recommend focusing on the identification of such content, which may lead to more precise recommendations regarding health-related SMU compared to cut-back on the frequency of overall SMU.

Establishing the typology and the underlying structure of rumor-combating behaviors: a multidimensional scaling approach

Purpose

Social media rumor combating is a global concern in academia and industry. Existing studies lack a clear definition and overall conceptual framework of users' rumor-combating behaviors. Therefore, this study attempts to empirically derive a typology of rumor-combating behaviors of social media users.

Design/methodology/approach

A three-phase typology development approach is adopted, including content analysis, multidimensional scaling (MDS), interpreting and labeling. Qualitative and quantitative data collection and analysis methods are employed.

Findings

The elicited 40 rumor-combating behaviors vary along two dimensions: high versus low difficulty of realization, and low versus high cognitive load. Based on the two dimensions, the 40 behaviors are further divided into four categories: rumor-questioning behavior, rumor-debunking behavior, proactive-appealing behavior, and literacy enhancement behavior.

Practical implications

This typology will serve as reference for social media platforms and governments to further explore the interventions to encourage social media users to counter rumor spreading based on various situations and different characteristics of rumor-combating behaviors.

Originality/value

This study provides a typology of rumor-combating behaviors from a novel perspective of user participation. The typology delves into the conceptual connotations and basic forms of rumor combating, allowing for a comprehensive understanding of the complete spectrum of users' rumor-combating behaviors. Furthermore, the typology identifies the similarities and the differences between various rumor-combating behaviors, thus providing implications and directions for future research on rumor-combating behaviors.

When do people believe, check, and share health rumors on social media? Effects of evidence type, health literacy, and health knowledge

Vaccine rumors on social media endanger public health. This study examined how evidence types influenced perceived persuasiveness and relevance and engagement intentions of vaccine rumors. We conducted a 2 (evidence type: anecdotes vs. anecdotal statistics) × 2 (stance: pro-vaccine rumor vs. anti-vaccine rumor) online experiment (N = 551) and surveyed participants' health literacy and vaccine knowledge. Anecdotal statistics were perceived as more relevant than anecdotes and indirectly influenced perceived persuasiveness and behavior intentions. This finding was confirmed when vaccine rumors were pro-attitudinal. Health literacy positively predicted perceived persuasiveness; health knowledge negatively predicted relevance and behavior intentions. Practical implications and future research directions are discussed.

Association of family wellbeing with forwarding and verifying COVID-19-related information, and mediation of family communication quality

OBJECTIVE

We assessed the associations of family wellbeing with verifying and subsequently forwarding COVID-19-related information to family members and the mediating effect of the quality of family communication on these associations among Chinese adults in Hong Kong.

METHODS

Under the Jockey Club SMART Family-Link Project, we conducted an online population-based survey, using Family wellbeing Scale and questions related to the family communication quality and forwarding and verifying COVID-19 information. Data were collected from 4,891 adults in May 2020. Prevalence estimates of forwarding and verifying COVID-19 information were weighted by sex, age, and education of the general population, and their associations with family wellbeing (ranged 0-10) were analyzed using generalized linear models with mutual adjustment. Their interactive effects on family wellbeing and the mediating effects of family communication quality were examined.

RESULTS

In total, 53.9% of respondents usually/always forwarded COVID-19 information related to their family, 68.7% usually/always verified it before forwarding, and 40.9% did both. Greater family wellbeing was associated with usually/always forwarding [adjusted β (95% CI): 0.82 (0.72-0.92)] and usually/always verifying [0.43 (0.32-0.55)] (both P < 0.001) the information. Forwarding and verifying such information showed an additive effect on family wellbeing [1.25 (1.11-1.40)]. Family communication quality mediated the associations of family wellbeing with forwarding (83.7%) and verifying (86.6%) COVID-19-related information.

CONCLUSION

Forwarding COVID-19 information to family, verifying such information, and especially doing both, were associated with greater family wellbeing, being strongly mediated by the quality of family communication. Individuals should be encouraged to verify COVID-19-related information before forwarding it to family members amidst the COVID-19 pandemic.

Health-Related Rumor Control through Social Collaboration Models: Lessons from Cases in China during the COVID-19 Pandemic

Widely spread health-related rumors may mislead the public, escalate social panic, compromise government credibility, and threaten public health. Social collaboration models that maximize the functions and advantages of various agents of socialization can be a promising way to control health-related rumors. Existing research on health-related rumors, however, is limited in studying how various agents collaborate with each other to debunk rumors. This study utilizes content analysis to code the text data of health-related rumor cases in China during the COVID-19 pandemic. The study found that socialized rumor-debunking models could be divided into the following five categories: the government-led model, the media-led model, the scientific community-led model, the rumor-debunking platform-led model, and the multi-agent collaborative model. In addition, since rumors in public health crises often involve different objects, rumor refutation requires various information sources; therefore, different rumor-debunking models apply. This study verifies the value of socialized collaborative rumor debunking, advocates and encourages the participation of multiple agents of socialization and provides guidance for establishing a collaborative rumor-debunking model, thereby promoting efficient rumor-debunking methods and improving the healthcare of society.

Do Chinese netizens cross-verify the accuracy of unofficial social media information before changing health behaviors during COVID-19? A Web-based study in China

Background

As social media platforms have become significant sources of information during the pandemic, a significant volume of both factual and inaccurate information related to the prevention of COVID-19 has been disseminated through social media. Thus, disparities in COVID-19 information verification across populations have the potential to promote the dissemination of misinformation among clustered groups of people with similar characteristics.

Objective

This study aimed to identify the characteristics of social media users who obtained COVID-19 information through unofficial social media accounts and were (1) most likely to change their health behaviors according to web-based information and (2) least likely to actively verify the accuracy of COVID-19 information, as these individuals may be susceptible to inaccurate prevention measures and may exacerbate transmission.

Methods

An online questionnaire consisting of 17 questions was disseminated by West China Hospital via its official online platforms, between May 18, 2020, and May 31, 2020. The questionnaire collected the sociodemographic information of 14,509 adults, and included questions surveying Chinese netizens’ knowledge about COVID-19, personal social media use, health behavioral change tendencies, and cross-verification behaviors for web-based information during the pandemic. Multiple stepwise regression models were used to examine the relationships between social media use, behavior changes, and information cross-verification.

Results

Respondents who were most likely to change their health behaviors after obtaining web-based COVID-19 information from celebrity sources had the following characteristics: female sex (P=.004), age ≥50 years (P=.009), higher COVID-19 knowledge and health literacy (P=.045 and P=.03, respectively), non–health care professional (P=.02), higher frequency of searching on social media (P<.001), better health conditions (P<.001), and a trust rating score of more than 3 for information released by celebrities on social media (P=.005). Furthermore, among participants who were most likely to change their health behaviors according to social media information released by celebrities, female sex (P<.001), living in a rural residence rather than first-tier city (P<.001), self-reported medium health status and lower health care literacy (P=.007 and P<.001, respectively), less frequent search for COVID-19 information on social media (P<.001), and greater level of trust toward celebrities’ social media accounts with a trust rating score greater than 1 (P≤.04) were associated with a lack of cross-verification of information.

Conclusions

The findings suggest that governments, health care agencies, celebrities, and technicians should combine their efforts to decrease the risk in vulnerable groups that are inclined to change health behaviors according to web-based information but do not perform any fact-check verification of the accuracy of the unofficial information. Specifically, it is necessary to correct the false information related to COVID-19 on social media, appropriately apply celebrities’ star power, and increase Chinese netizens’ awareness of information cross-verification and eHealth literacy for evaluating the veracity of web-based information.

Definitions and measurement of health literacy in health and medicine research: a systematic review

OBJECTIVES

The way health literacy is understood (conceptualised) should be closely linked to how it is measured (operationalised). This study aimed to gain insights into how health literacy is defined and measured in current health literacy research and to examine the relationship between health literacy definitions and instruments.

DESIGN

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

DATA SOURCES

The MEDLINE, PsycINFO, ERIC and CINAHL databases were searched for articles published during two randomly selected months (March and October) in 2019.

ELIGIBILITY CRITERIA

We included articles with a quantitative design that measured health literacy, were peer-reviewed and original, were published in the English language and included a study population older than 16 years.

DATA EXTRACTION AND SYNTHESIS

Six researchers screened the articles for eligibility and extracted the data independently. All health literacy definitions and instruments were considered in relation to category 1 (describing basic reading and writing skills, disease-specific knowledge and practical skills) and category 2 (social health literacy competence and the ability to interpret and critically assess health information). The categories were inspired by Nutbeam's descriptions of the different health literacy levels.

RESULTS

120 articles were included in the review: 60 within public health and 60 within clinical health. The majority of the articles (n=77) used instruments from category 1. In total, 79 of the studies provided a health literacy definition; of these, 71 were in category 2 and 8 were in category 1. In almost half of the studies (n=38), health literacy was defined in a broad perspective (category 2) but measured with a more narrow focus (category 1).

CONCLUSION

Due to the high degree of inconsistency between health literacy definitions and instruments in current health literacy research, there is a risk of missing important information about health literacy considered be important to the initial understanding of the concept recognised in the studies.

PROSPERO REGISTRATION NUMBER

CRD42020179699.

Smokers' Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial

Background

Information and misinformation on the internet about e-cigarette harms may increase smokers’ misperceptions of e-cigarettes. There is limited research on smokers’ engagement with information and misinformation about e-cigarettes on social media.

Objective

This study assessed smokers’ likelihood to engage with—defined as replying, retweeting, liking, and sharing—tweets that contain information and misinformation and uncertainty about the harms of e-cigarettes.

Methods

We conducted a web-based randomized controlled trial among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: (1) e-cigarettes are as harmful or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) uncertainty about e-cigarette harms, or (4) control (physical activity). The outcome measure was participants’ likelihood of engaging with tweets, which comprised the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants.

Results

Among Twitter users, participants were more likely to engage with tweets in condition 1 (e-cigarettes are as harmful or more harmful than smoking) than in condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in condition 1 than in conditions 2 and 3 (e-cigarettes are completely harmless and uncertainty about e-cigarette harms).

Conclusions

Tweets stating information and misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420

Collective Value Promotes the Willingness to Share Pro-Vaccination Messages on Social Media in China: A Randomized Controlled Trial (Preprint)

Background

The proliferation of vaccine misinformation on social media has seriously corrupted the public’s confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed.

Objective

This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value.

Methods

We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6%) and experiment 2 (n=200, 44.4%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform’s randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2.

Results

The valid sample included 213 adults in experiment 1 (females: n=151, 70.9%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8%; single: n=131, 61.5%) and 171 adults in experiment 2 (females: n=106, 62.0%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3%; single: n=95, 55.6%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F_3,166=4.96, P=.03, η²=0.03). The reverse result was found for the willingness to share provaccination messages (F_3,165=6.87, P=.01, η²=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F_3,165=6.87, P=.01, η²=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95% lower limit confidence interval [LLCI] 0.41, 95% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F_3,166=5.96, P=.02, η²=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing.

Conclusions

Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role.

The causes, impacts and countermeasures of COVID-19 "Infodemic": A systematic review using narrative synthesis

An unprecedented infodemic has been witnessed to create massive damage to human society. However, it was not thoroughly investigated. This systematic review aims to (1) synthesize the existing literature on the causes and impacts of COVID-19 infodemic; (2) summarize the proposed strategies to fight with COVID-19 infodemic; and (3) identify the directions for future research. A systematic literature search following the PRISMA guideline covering 12 scholarly databases was conducted to retrieve various types of peer-reviewed articles that reported causes, impacts, or countermeasures of the infodemic. Empirical studies were assessed for risk of bias using the Mixed-Methods Appraisal Tool. A coding theme was iteratively developed to categorize the causes, impacts, and countermeasures found from the included studies. Social media usage, low level of health/eHealth literacy, and fast publication process and preprint service are identified as the major causes of the infodemic. Besides, the vicious circle of human rumor-spreading behavior and the psychological issues from the public (e.g., anxiety, distress, fear) emerges as the characteristic of the infodemic. Comprehensive lists of countermeasures are summarized from different perspectives, among which risk communication and consumer health information need/seeking are of particular importance. Theoretical and practical implications are discussed and future research directions are suggested.

Why Do Citizens Share COVID-19 Fact-Checks Posted by Chinese Government Social Media Accounts? The Elaboration Likelihood Model

Widespread misinformation about COVID-19 poses a significant threat to citizens long-term health and the combating of the disease. To fight the spread of misinformation, Chinese governments have used official social media accounts to participate in fact-checking activities. This study aims to investigate why citizens share fact-checks about COVID-19 and how to promote this activity. Based on the elaboration likelihood model, we explore the effects of peripheral cues (social media capital, social media strategy, media richness, and source credibility) and central cues (content theme and content importance) on the number of shares of fact-checks posted by official Chinese Government social media accounts. In total, 820 COVID-19 fact-checks from 413 Chinese Government Sina Weibo accounts were obtained and evaluated. Results show that both peripheral and central cues play important roles in the sharing of fact-checks. For peripheral cues, social media capital and media richness significantly promote the number of shares. Compared with the push strategy, both the pull strategy and networking strategy facilitate greater fact-check sharing. Fact-checks posted by Central Government social media accounts receive more shares than local government accounts. For central cues, content importance positively predicts the number of shares. In comparison to fact-checks about the latest COVID-19 news, government actions received fewer shares, while social conditions received more shares.

Identifying features of health misinformation on social media sites: an exploratory analysis

Purpose

The purpose of this paper is to explore the features of health misinformation on social media sites (SMSs). The primary goal of the study is to investigate the salient features of health misinformation and to develop a tool of features to help users and social media companies identify health misinformation.

Design/methodology/approach

Empirical data include 1,168 pieces of health information that were collected from WeChat, a dominant SMS in China, and the obtained data were analyzed through a process of open coding, axial coding and selective coding. Then chi-square test and analysis of variance (ANOVA) were adopted to identify salient features of health misinformation.

Findings

The findings show that the features of health misinformation on SMSs involve surface features, semantic features and source features, and there are significant differences in the features of health misinformation between different topics. In addition, the list of features was developed to identify health misinformation on SMSs.

Practical implications

This study raises awareness of the key features of health misinformation on SMSs. It develops a list of features to help users distinguish health misinformation as well as help social media companies filter health misinformation.

Originality/value

Theoretically, this study contributes to the academic discourse on health misinformation on SMSs by exploring the features of health misinformation. Methodologically, the paper serves to enrich the literature around health misinformation and SMSs that have hitherto mostly drawn data from health websites.

Characterizing the dissemination of misinformation on social media in health emergencies: An empirical study based on COVID-19

The dissemination of misinformation in health emergencies poses serious threats to public health and increases health anxiety. To understand the underlying mechanism of the dissemination of misinformation regarding health emergencies, this study creatively draws on social support theory and text mining. It also explores the roles of different types of misinformation, including health advice and caution misinformation and health help-seeking misinformation, and emotional support in affecting individuals' misinformation dissemination behavior on social media and whether such relationships are contingent on misinformation ambiguity and richness. The theoretical model is tested using 12,101 textual data about COVID-19 collected from Sina Weibo, a leading social media platform in China. The empirical results show that health caution and advice, help seeking misinformation, and emotional support significantly increase the dissemination of misinformation. Furthermore, when the level of ambiguity and richness regarding misinformation is high, the effect of health caution and advice misinformation is strengthened, whereas the effect of health help-seeking misinformation and emotional support is weakened, indicating both dark and bright misinformation ambiguity and richness. This study contributes to the literature on misinformation dissemination behavior on social media during health emergencies and social support theory and provides implications for practice.

Message sharing and verification behaviour on social media during the COVID-19 pandemic: a study in the context of India and the USA

Purpose

Technology has eased access to information. During the ongoing COVID-19 pandemic, ease of access and transmission of information via social media has led to ambiguity, misinformation and uncertainty. This research studies the aforementioned behaviours of information sharing and verification related to COVID-19, in the context of social media.

Design/methodology/approach

Two studies have been carried out. Study 1, with Indian social media users, is a two-factor between-subjects experimental design that investigated the effect of message polarity (positive versus negative) and message type (news versus rumour) on the dissemination and verification behaviour of COVID-19-related messages. The study also investigated the mediation of perceived message importance and health anxiety. Study 2 is a replica study conducted with US users.

Findings

The study finding revealed significantly higher message sharing for news than rumour. Further, for the Indian users, message with positive polarity led to higher message sharing and message with negative polarity led to higher verification behaviour. On the contrary, for the US users, message with negative polarity led to higher message sharing and message with positive polarity led to higher verification behaviour. Finally, the study revealed message importance mediates the relationship of message type and message sharing behaviour for Indian and US users; however, health anxiety mediation was significant only for Indian users.

Practical implications

The findings offer important implications related to information regulation during a health crisis. Unverified information sharing is harmful during a pandemic. The study sheds light on this behaviour such that stakeholders get insights and better manage the information being disseminated.

Originality/value

The study investigates the behaviour of sharing and verification of social media messages between users containing health information (news and rumour) related to the ongoing COVID-19 pandemic.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-07-2020-0282

Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study

BACKGROUND

The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic.

OBJECTIVE

This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic.

METHODS

From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants' levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety.

RESULTS

This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety.

CONCLUSIONS

This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety.

How social media fosters the elders' COVID-19 preventive behaviors: perspectives of information value and perceived threat

Purpose

Although crisis communication via social media has engaged academia's attention during the disease outbreak, information value for preventive behaviors is inadequately studied. The purpose of this paper is to cast light on how to strengthen the uptake of older people's coronavirus disease 2019 (COVID-19) behavioral outcomes due to information value and perceived threat through social media.

Design/methodology/approach

This study designs a survey and applies structural equation modeling to examine a research framework. A sample comprises 334 Vietnamese older participants who have utilized social media.

Findings

The results illustrate that preventive behaviors are determined by perceived threat (i.e. severity and susceptibility). Furthermore, older people heighten risk perceptions based on information characteristics, including information relevance, informative support and source credibility. Lastly, information relevance is a strong predictor of source credibility.

Practical implications

The findings assist practitioners to enhance crisis communication effectiveness via social media by imparting valuable information to the public. Moreover, this paper offers overarching guidelines on the improvement in credibility with creators, risk consciousness and preventive behaviors.

Originality/value

Although earlier studies focused attentiveness on the power of social media for raising threat perceptions, this work seems the first to unveil informative motives for perceived COVID-19 threat across older individuals, which subsequently presents plausible reasons for behavioral disclosure, including facemask-wearing, hand-washing and social distancing.

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.

An Examination of Factors Contributing to the Acceptance of Online Health Misinformation

This study examined factors including health-related anxiety, preexisting misinformation beliefs, and repeated exposure contributing to individuals’ acceptance of health misinformation. Through a large-scale online survey, this study found that health-related anxiety was positively associated with health misinformation acceptance. Preexisting misinformation beliefs, as well as repeated exposure to health misinformation, were both positively associated with health misinformation acceptance. The results also showed that demographic variables were significantly associated with health misinformation acceptance. In general, females accepted more health misinformation compared to males. Participants’ age was negatively associated with health misinformation acceptance. Participants’ education level and income were both negatively associated with their acceptance of health misinformation.

Does Science Literacy Guarantee Resistance to Health Rumors? The Moderating Effect of Self-Efficacy of Science Literacy in the Relationship between Science Literacy and Rumor Belief

Health rumors not only incite unnecessary fears and skepticism, but may also cause individuals to refuse effective remedy and thus delay their treatment. Studies have found that health literacy may help the public identify the falsity of health rumors and avoid their negative impact. However, whether other types of literacy work in helping people disbelieve health rumors is still unknown. With a national survey in China (N = 1646), our study examined the effect of science literacy on rumor belief and further analyzed the moderating role of self-efficacy of science literacy in their relationship. Hierarchical regression analysis showed that science literacy significantly decreased the likelihood of people believing in health rumors, and moderator analysis showed that self-efficacy of science literacy plays a moderating role in this relationship; such that the relationship between science literacy and health rumor belief would be weakened if one′s self-efficacy of science literacy was low. This finding reveals that during campaigns to combat health rumors, improving and enhancing the self-efficacy of people′s science literacy is an effective way to prevent them from believing in health rumors. Our study highlights the benefits of science education in public health and the improvement of public science literacy.

Prediction of Number of Cases of 2019 Novel Coronavirus (COVID-19) Using Social Media Search Index

Predicting the number of new suspected or confirmed cases of novel coronavirus disease 2019 (COVID-19) is crucial in the prevention and control of the COVID-19 outbreak. Social media search indexes (SMSI) for dry cough, fever, chest distress, coronavirus, and pneumonia were collected from 31 December 2019 to 9 February 2020. The new suspected cases of COVID-19 data were collected from 20 January 2020 to 9 February 2020. We used the lagged series of SMSI to predict new suspected COVID-19 case numbers during this period. To avoid overfitting, five methods, namely subset selection, forward selection, lasso regression, ridge regression, and elastic net, were used to estimate coefficients. We selected the optimal method to predict new suspected COVID-19 case numbers from 20 January 2020 to 9 February 2020. We further validated the optimal method for new confirmed cases of COVID-19 from 31 December 2019 to 17 February 2020. The new suspected COVID-19 case numbers correlated significantly with the lagged series of SMSI. SMSI could be detected 6–9 days earlier than new suspected cases of COVID-19. The optimal method was the subset selection method, which had the lowest estimation error and a moderate number of predictors. The subset selection method also significantly correlated with the new confirmed COVID-19 cases after validation. SMSI findings on lag day 10 were significantly correlated with new confirmed COVID-19 cases. SMSI could be a significant predictor of the number of COVID-19 infections. SMSI could be an effective early predictor, which would enable governments’ health departments to locate potential and high-risk outbreak areas.

The Role of Resilience and Gender in Relation to Infectious-Disease-Specific Health Literacy and Anxiety During the COVID-19 Pandemic

BACKGROUND

Anxiety is one of the psychological problems being experienced by the general population during the current coronavirus disease 2019 (COVID-19) pandemic. Health literacy, such as infectious-disease-specific health literacy, is associated with anxiety, but the mechanism of such association is not clear. This study explored the relationship between infectious-disease-specific health literacy and anxiety.

METHODS

We conducted an online survey in Hubei province, the early epicenter of the COVID-19 pandemic. A total of 1038 COVID-19-negative participants accomplished a battery of online survey tools determining their sociodemographic characteristics, perceived risk of acquiring COVID-19, infectious-disease-specific health literacy, resilience, and anxiety symptoms. We examined the moderated mediation models, in which the mediator was resilience and the moderator was gender.

RESULTS

Most (63%) of the study participants experienced at least mild anxiety. The indirect effect of infectious-disease-specific health literacy on anxiety through resilience was -0.282 (95% confidence interval [CI] = [-0.511, -0.083]), contributing to 32.7% of the total effect of health literacy on anxiety. Resilience fully mediated the association. The mediation effect of resilience tended to be stronger for the male participants than for the female participants as the moderation effect of gender remained until we included perceived risk of acquiring COVID-19 in the model.

CONCLUSION

Resilience was found to mediate the association between infectious-disease-specific health literacy and anxiety. Individuals with good infectious-disease-specific health literacy are more likely to acquire higher resilience, which may in turn decrease their anxiety level. Males may benefit more from the mediation effect of resilience during the current pandemic. Infectious-disease-specific health literacy programs may help reduce the anxiety of the program participants by enhancing their resilience during a pandemic.