Infodemics and health misinformation: a systematic review of reviews

SARS-CoV-2 epidemiology, kinetics, and evolution: A narrative review

Since winter 2019, SARS-CoV-2 has emerged, spread, and evolved all around the globe. We explore 4 y of evolutionary epidemiology of this virus, ranging from the applied public health challenges to the more conceptual evolutionary biology perspectives. Through this review, we first present the spread and lethality of the infections it causes, starting from its emergence in Wuhan (China) from the initial epidemics all around the world, compare the virus to other betacoronaviruses, focus on its airborne transmission, compare containment strategies ("zero-COVID" vs. "herd immunity"), explain its phylogeographical tracking, underline the importance of natural selection on the epidemics, mention its within-host population dynamics. Finally, we discuss how the pandemic has transformed (or should transform) the surveillance and prevention of viral respiratory infections and identify perspectives for the research on epidemiology of COVID-19.

Family Members' Perspectives on Mental Illness Stigma: A Community Study

BackgroundThe literature on mental illnesses demonstrates the complex vulnerabilities that individuals with mental disorders face in their daily interactions with the public, given the frequent stigma associated with mental health problems. We focused on family members' perspectives on mental illness stigma and ways to reduce it.MethodsWe employed a narrative inquiry to understand participants' views on mental illness stigma and ways to ameliorate it from the perspective of 15 immediate family members of persons with mental illness. Data analysis was guided by Braun and Clarke's technique for thematic analysis.ResultsThe narrative accounts of participants were categorized using two broad themes: mental illness stigma in action and addressing stigma as a society. Participants' reflections on mental illness stigma were based on their professional experiences, conversations within their families, and their awareness of the stigma associated with mental illness within the broader social realm, as well as recent campaigns toward reducing the stigma of mental illness. They described stigma as a 'mark of shame' that translates into discriminatory behaviors and actions toward persons with mental illness, and called for structural reforms to curb this stigma. The promotion of positive mental health and mental illness awareness is necessary for reducing all forms of mental illness-related stigma.ConclusionParticipants advocated the need for equal attention to both preventive and therapeutic healthcare delivery, particularly within the mental health system. Moving forward, policies, interventions, and well-coordinated programs towards reducing social mental illness stigma are key to ensuring inclusiveness at both the family and societal levels.

Quality and Misinformation About Health Conditions in Online Peer Support Groups: Scoping Review

BACKGROUND

The use of health-related online peer support groups to support self-management of health issues has become increasingly popular. The quality of information and advice may have important implications for public health and for the utility of such groups. There is some evidence of variable quality of web-based health information, but the extent to which misinformation is a problem in online peer support groups is unclear.

OBJECTIVE

We aimed to gain insight into the quality of information and advice about health conditions in online peer support groups and to review the tools available for assessing the quality of such information.

METHODS

A scoping review was undertaken following the Joanna Briggs Institute scoping review methodology. We searched electronic databases (MEDLINE [Ovid], CINAHL, Web of Science, ASSIA, ProQuest Dissertation and Theses, and Google Scholar) for literature published before November 2023, as well as citations of included articles. Primary research studies, reviews, and gray literature that explored the quality of information and advice in online peer support groups were included. Title and abstracts were independently screened by 2 reviewers. Data were extracted and tabulated, and key findings were summarized narratively.

RESULTS

A total of 14 (0.45%) relevant articles, from 3136 articles identified, were included. Of these, 10 (71%) were primary research articles comprising diverse quality appraisal methodologies, and 4 (29%) were review articles. All articles had been published between 2014 and 2023. Across the literature, there was more evidence of poor quality information and misinformation than of good quality information and advice, particularly around long-term and life-threatening conditions. There were varying degrees of misinformation about non-life-threatening conditions and about mental health conditions. Misinformation about noncommunicable diseases was reported as particularly prevalent on Facebook. Fellow online peer support group users often played an active role in correcting misinformation by replying to false claims or providing correct information in subsequent posts. Quality appraisal tools were reported as being used by researchers and health care professionals in appraising the quality of information and advice, including established tools for the appraisal of health-related information (eg, DISCERN, HONcode criteria, and Journal of the American Medical Association benchmark criteria). No tools reported were specifically designed to appraise online peer support group content.

CONCLUSIONS

While there is good quality information and advice exchanged between users in online peer support groups, our findings show that misinformation is a problem, which is a matter of public health concern. Confidence in the quality of information shared may determine the utility of online peer support groups for patients and health care professionals. Our review suggests that clinical and academic experts in health conditions could play a valuable role in ensuring the quality of content. Several quality appraisal tools are available to support such an initiative.

Opportunities and challenges of social media for oral health literacy improvement: a qualitative investigation based on Iranian dentists' perspectives

BACKGROUND

Despite the possible impacts of social media on oral health literacy, the specific challenges and opportunities in this particular setting remain underexplored. The current research objective was identify the opportunities and challenges of social media for oral health literacy based on Iranian dentists' perspectives.

METHODS

In the current qualitative investigation, a semi-structured interview was conducted with 24 dentists utilizing a purposive snowball sampling method. The analysis of the data was performed using thematic analysis in the MAXQDA 10 software.

RESULTS

The analysis of the interview data led to recognition of six main themes and a total of 16 sub-themes. The three main themes identified as opportunities for using social media for oral health literacy include facilitating accessibility, popularizing, and supporting usability. Three identified challenges for oral health literacy include quality issues, incomplete understandability, and create bias in usability for oral health information. Social media platforms present unique opportunities for enhancing information accessibility through increasing information encountering, interactive question-answering, and communication empowerment. Providing opportunities for simplifying information, promoting the prevention of oral health diseases, and clarifying information claims are social media facilitate roles that can effectively make information more understandable. Moreover, social media platforms facilitate the use of oral health information by supporting decision-making, dental counseling presentations, and experience sharing. Misinformation, the complexity of information quality evaluation and privacy, and ethical and security concerns are significant social media challenges for oral information accessibility. Insufficent published information and creating fear by reading health information (cyberchondria) are social media challenges that affect the understandability of information. Ignoring content disclaimers and misleading advertising are two challenges within social media that hinder the usability of oral health information.

CONCLUSION

Social media acts as a dual-faceted method for oral health literacy, providing both opportunities and challenges. Confronting the obstacles associated with social media demands the creation of solutions that strengthen their positive attributes.

Social networking sites use and life satisfaction: a moderated mediation model of e-health literacy, fatigue, uncertainty, and stress

Excessive social media use during health crises can lead to information overload and psychological distress, yet the mechanisms underlying this relationship remain unclear. This study investigated how social networking sites (SNS) affected life satisfaction during the COVID-19 pandemic in Iran and whether this relationship was explained by SNS fatigue, uncertainty about disease, and stress. The research also examined whether e-health literacy was a protective factor in this process. Results confirmed that SNS use negatively affected life satisfaction through a sequential pathway of increased fatigue, uncertainty, and stress. E-health literacy moderated the initial link between SNS use and fatigue, with higher literacy weakening this relationship. The results demonstrate the complex relationship between SNS use and wellbeing during health crises and highlight the potential protective role of e-health literacy.

Biases and debiasing in policy decision-making

Policy decision-making should use the best evidence obtained with the most rigorous and reproducible science and should be applied with minimal bias to maximize positive outcomes. This is particularly important in public health and other major decisions. Reality, however, is usually far from this ideal. The quality and use of scientific evidence to address wicked problems and sticky crises have been the focus of intense debate. Policymakers often succumb to fallacies, leading to suboptimal decision-making and maladaptive practices. We map the key biases involved at three different, but communicating, domains: the scientific evidence itself, the policymakers and the citizens. Biases may be classified along two axes pertaining to the perception of the risk and the perception of the effectiveness of the intervention: minimizing risk (e.g. crisis denial), maximizing risk (e.g. moral panic), minimizing intervention effectiveness (e.g. anti-medicine, anti-government) and maximizing effectiveness (e.g. drug lobbyism). We discuss common cognitive biases, including normalcy bias, ostrich effect, negativity bias, Just World Fallacy, false consensus effect, action bias and death spiral effect. Furthermore, we present an overview of potential debiasing processes and tools. Debiasing may help enhance the quality of implementations and trust in institutions, to the benefit of both science and society at large.

Nurse misinformation and the digital era: Abrogating professional responsibility

In the current digital era, reliance on technology for communication and the gathering and dissemination of information is growing. However, the information disseminated can be misleading or false. Nurses tend to be trusted by the public, but not all information brought to the public forum is well-informed. Ill-informed discussions have resulted in harm to individuals who take such information as fact and act on it. As technology continues to evolve and fact versus fiction becomes more challenging to discern, it is critical that nurses recognize their ethical responsibility to the public in providing information for which sound evidence exists. This analysis will explore medical misinformation through concepts such as confirmation bias and the politicization of science. Also, the impact of nurses not recognizing the power and responsibility associated with using their credentials in public fora, even when the central motivator is that they believe they are helping other individuals. Using nursing goals and perspectives, we will discuss the ethical responsibility of nurses to be aware of the soundness of what they think they know. Utilizing ideas of professional responsibilities, as outlined by professional codes of ethics as well as the ethical principles of non-maleficence and veracity, we explore the problem of nurses propagating misinformation and suggest strategies to enhance nurse awareness of their ethical responsibilities for veracity and transparency regarding what is known and what is not.

Parental Mediation, Digital Media Usage, and Health Literacy: An Exploration Among Chinese Elementary School Students

This study examines the relationship between parental interactions, digital media usage, and health literacy among 19,386 elementary students (ages 6-11) in Guangdong Province, China, using the framework of parental mediation theory. Path analysis revealed that increased digital media usage is associated with decreased health literacy, particularly for short video platforms, which exhibit a significant negative correlation (β = -.335). Parental interaction was found to significantly reduce the use of instant messaging apps (β = -.007) and short video platforms (β = -.008), with the influence being moderated by the student's residence status (boarding or non-boarding). The findings highlight the importance of frequent parental interaction in limiting digital media usage and enhancing health literacy among children. This study suggests that parental mediation theory should pay closer attention to environmental or living status factors, as they can significantly influence its mechanisms of action. Overall, this research contributes to the discourse on digital behavior in childhood and offers evidence-based insights for improving educational and health literacy strategies.

Use of Retrieval-Augmented Large Language Model for COVID-19 Fact-Checking: Development and Usability Study

BACKGROUND

The COVID-19 pandemic has been accompanied by an "infodemic," where the rapid spread of misinformation has exacerbated public health challenges. Traditional fact-checking methods, though effective, are time-consuming and resource-intensive, limiting their ability to combat misinformation at scale. Large language models (LLMs) such as GPT-4 offer a more scalable solution, but their susceptibility to generating hallucinations-plausible yet incorrect information-compromises their reliability.

OBJECTIVE

This study aims to enhance the accuracy and reliability of COVID-19 fact-checking by integrating a retrieval-augmented generation (RAG) system with LLMs, specifically addressing the limitations of hallucination and context inaccuracy inherent in stand-alone LLMs.

METHODS

We constructed a context dataset comprising approximately 130,000 peer-reviewed papers related to COVID-19 from PubMed and Scopus. This dataset was integrated with GPT-4 to develop multiple RAG-enhanced models: the naïve RAG, Lord of the Retrievers (LOTR)-RAG, corrective RAG (CRAG), and self-RAG (SRAG). The RAG systems were designed to retrieve relevant external information, which was then embedded and indexed in a vector store for similarity searches. One real-world dataset and one synthesized dataset, each containing 500 claims, were used to evaluate the performance of these models. Each model's accuracy, F1-score, precision, and sensitivity were compared to assess their effectiveness in reducing hallucination and improving fact-checking accuracy.

RESULTS

The baseline GPT-4 model achieved an accuracy of 0.856 on the real-world dataset. The naïve RAG model improved this to 0.946, while the LOTR-RAG model further increased accuracy to 0.951. The CRAG and SRAG models outperformed all others, achieving accuracies of 0.972 and 0.973, respectively. The baseline GPT-4 model reached an accuracy of 0.960 on the synthesized dataset. The naïve RAG model increased this to 0.972, and the LOTR-RAG, CRAG, and SRAG models achieved an accuracy of 0.978. These findings demonstrate that the RAG-enhanced models consistently maintained high accuracy levels, closely mirroring ground-truth labels and significantly reducing hallucinations. The CRAG and SRAG models also provided more detailed and contextually accurate explanations, further establishing the superiority of agentic RAG frameworks in delivering reliable and precise fact-checking outputs across diverse datasets.

CONCLUSIONS

The integration of RAG systems with LLMs substantially improves the accuracy and contextual relevance of automated fact-checking. By reducing hallucinations and enhancing transparency by citing retrieved sources, this method holds significant promise for rapid, reliable information verification to combat misinformation during public health crises.

A review of Canadian online resources providing information on COVID-19 vaccination for caregivers of children aged 5-11 years

BACKGROUND AND OBJECTIVES

Vaccination is one of the most searched health topics online, yet the quality of resources varies considerably. This study evaluated the quality of Canadian COVID-19 vaccines online resources for caregivers of 5-11-year-old children.

METHODS

We reviewed Canadian public-facing websites from academic pediatric hospitals, governments, professional organizations, and public health authorities until April 22, 2022. Inclusion criteria included English/French resources targeting caregivers of 5-11-year-olds, presented as webpages, FAQs, posters/infographics, and/or videos. Reliability, readability, and understandability/actionability were appraised using the JAMA Benchmark, Flesch-Kincaid Grade Level, and Patient Education Material Assessment Tool for Printable/Audiovisual materials, respectively. We used a content checklist to assess key vaccine topics (e.g., effectiveness and safety). Descriptive statistics included Fisher's exact and ANOVA tests.

RESULTS

Of 1046 websites screened, 43 primary webpage clusters and 141 secondary webpages were analyzed. Twenty (46.5 %), 9 (20.9 %), 7 (16.3 %), and 7 (16.3 %) primary webpage clusters belonged to government, academic pediatric hospitals, professional organizations, and public health authorities, respectively. The mean JAMA Benchmark score was 3.47 ± 0.55 (out of 43). Of 43 clusters, only five (11.6 %) scored at or below a US 6th-grade education level. While 42/43 (97.7 %) primary clusters including printable materials were understandable (PEMAT-P > 70 %), only 7/43 (16.3 %) were considered actionable. The mean content score was 12.65 ± 3.60 (out of 20) among the 43 primary clusters. No differences in quality were seen across organization types, except for actionability (p = 0.016).

CONCLUSIONS

Although most Canadian webpages on COVID-19 vaccines received high scores in understandability, areas requiring improvement in actionability, readability, and content were identified.

Patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions: a scoping review

Background

Access to oxygen therapy is essential for ensuring a functioning health care system. Despite its widespread application across multiple patient groups and all ages, there is a lack of understanding about community perceptions and experiences while receiving oxygen therapy for acute conditions. We aimed to understand patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions.

Methods

We conducted a scoping review. We searched Medline, Embase, and Web of Science (26 February 2024) for original studies published since 2000 relating to patient or caregiver perceptions and experiences of oxygen for an acute medical need in health facility settings. We used an adapted theoretical framework of acceptability to extract and structure the findings.

Results

Searches returned 10 425 unique records, and 25 articles were included. 20 were from high-income countries, and 18 were qualitative studies. The results showed that patient and caregiver attitudes and feelings about oxygen therapy are strongly influenced by perceived effectiveness, which was almost universally positive. Patients and their caregivers suffer different types of burdens, and these are greater for more advanced respiratory therapies than for simple oxygen therapy. Patient and caregiver understanding of oxygen therapy was low, presenting an opportunity for improved communication. Opportunity costs were highest in caregivers of neonates, who were often separated from their infants for long periods, and out-of-pocket costs were a major consideration in low- and middle-income countries.

Conclusions

In this scoping review, we found distinctions in caregiver and patient burden, and their perspectives of oxygen varied between country income. Intervention coherence - the extent to which the patient and their caregivers understand the treatment - was singled out as the key policy area for improvement. Educational campaigns, like those implemented for previous public health emergencies, could lead to increased public knowledge, and thus acceptability, of oxygen therapy.

Ameloblastoma on YouTube: content analysis and strategies to address misinformation

PURPOSE

Internet platforms, such as YouTube, play a significant role in disseminating health information. This study assessed the quality and reliability of YouTube videos related to ameloblastoma.

METHODS

This cross-sectional study examined videos using the Global Quality Scale (GQS) to assess content quality and the DISCERN tool to determine reliability. The creators' profiles and target audiences were also evaluated. Data were analyzed descriptively and analytically.

RESULTS

A total of 65 videos were analyzed. Most videos (84.6%) were educational, while 15.4% were case reports. Specialists produced 40% of the videos, general dentists 21.5%, and students 6.2%. Regarding content quality, 23.2% of the videos received the highest GQS score, while 27.6% were rated as low quality (scores 1-2). According to DISCERN, 1.5% of videos were classified as maximum quality, 21.6% as high quality, and 17% as low quality. A significant difference in GQS scores was observed between oral and maxillofacial surgeons and general dentists (p = 0.025). A strong positive correlation was found between GQS and DISCERN scores (r = 0.79).

CONCLUSION

While most videos exhibited good production quality, their overall reliability was moderate, with notable deficiencies. Additional validation strategies are needed to enhance the accuracy and educational value of online health information.

CLINICAL TRIAL

Not applicable.

Mental health stigma in Ukraine over time: A cross-sectional study

This study examined changes in public knowledge, behaviours and attitudes towards individuals with mental health disorders in Ukraine. A nationwide survey was used to gather data from Ukrainian adults; this data was then compared with data gathered by Quirke et al. (2021, Cambridge Prisms Global Mental Health, 8) to form a comparison study. In congruence with the original study, the Mental Health Knowledge Schedule, the Community Attitudes towards Mental Illness Scale and the Reported Intended Behaviour scales were used. Measures of knowledge and attitudes towards individuals with mental disorders reflected a small reduction of knowledge (r = 0.13, p < .001) and a large reduction in benevolent attitudes (r = 0.96, p < .001). Conversely, there was a large decrease in authoritarian attitudes (r = -0.50, p < .001). Measures of behaviour reflected a medium positive increase in past and present behaviour (r = 0.33, p < .001) and a small positive increase in intended future behaviour towards individuals with mental illness (r = 0.24, p < .001). These findings provide a snapshot of changes in stigma towards those with mental health disorders in Ukraine and highlighted the growing need for evidence-based anti-stigma interventions and the monitoring of their impact.

Strategies for Effective Public Health Communication in a Complex Information Environment

Development and amplification of effective, culturally resonant, trustworthy, and evidence-based public health communication are urgently needed. Research evidence, theory, and practical experience from within and beyond the interdisciplinary field of health communication are well-positioned to help public health authorities, researchers, and advocates navigate the complex societal challenges that influence health and well-being in global contexts. This review offers a broad overview of the field, considers what constitutes "effectiveness" versus "effects" in public health communication, and describes core concepts of public health communication as a process rather than a product. We review domains and dominant foci of public health communication research, articulate challenges for health communication to advance health and social equity and address mis-/disinformation, and offer practical guidance on message development, audience segmentation, multilevel intervention, and evaluation of communication programs. We conclude by identifying important questions for future public health communication research, interventions, and funding.

An argumentation theory-based assessment tool for evaluating disinformation in health-related claims

OBJECTIVE

This study leverages argumentation theory to combat the growing threat of health disinformation by enhancing public competency in evaluating health-related information.

METHODS

We systematically analyzed common persuasive tactics used in health disinformation, categorizing them into thematic groups linked to specific argument types. Based on these analyses, we developed critical questions to test the validity and strength of these arguments, resulting in an assessment tool.

RESULTS

The assessment tool, formatted as a flowchart, guides users through targeted critical questions to assess the credibility of health information. It addresses tactics like data misuse, logical fallacies, and emotional manipulation, effectively improving users' ability to identify and resist misleading health claims.

CONCLUSION

Utilizing argumentation theory offers a structured framework to dissect and counteract persuasive disinformation techniques, thereby boosting public health literacy and empowering informed health decisions. The assessment tool serves as both an immediate practical tool and a long-term educational resource for building cognitive resilience.

PRACTICE IMPLICATIONS

Our findings suggest that health institutions should regularly conduct workshops to strengthen public argumentation skills. Accessible online resources and the integration of argumentation theory into educational curricula are recommended to foster critical thinking and discernment of health information, promoting a more informed and engaged public.

COVID-19 open data: An ecological study and international collaboration examining pandemic trends in Northern Periphery arctic countries

Objectives: In the early stages of the COVID-19 pandemic, evidence generation lagged behind public health responses. This study describes an international collaboration of frontline clinicians who used open data describing COVID-19 trends to generate "practice-based evidence". Methods: Open data resources from nine Northern Periphery and Arctic (NPA) countries were harnessed using the open-source programming language 'R' and our collaborations analyses and insights were published on a public-facing website. The website's visualisations guided teleconference discussions from September 2020 to March 2021, focusing on contextualizing national responses, especially in rural regions. Results: This project facilitated shared learning from COVID-19 trends and highlighted key aspects of national responses. Notably, rural NPA regions experienced less COVID-19 cases and mortality in the first year of the pandemic. Conclusion: This international collaborative effort, driven by open data analysis, provided a platform to share real-world insights. The study offers a potential template for future pandemics and emphasises the importance of sustaining open data resources, including granular data like excess mortality, for effective pandemic learning.

Exploring Implications of Risk Communication Strategies in Diminishing Adversities of Misinformation and Disinformation Against Hepatitis Vaccination in Global South

Background and Purpose

Concern over the low hepatitis immunization rates is growing. It is generally believed that misinformation and disinformation are the main barriers to the success of mass immunization campaigns. This study intends to investigate the matter of online misinformation and disinformation about hepatitis vaccination and its implications.

Material and Methods

The researchers employed a cross-sectional research design vis-à-vis a web-based survey method to collect data. Data were collected from a nationally representative sample of 1931 internet users across Pakistan. Participation in the study was voluntary. Data collection continued for four months, from Mar 1, 2024, to Jun 30, 2024.

Results

The "results" of structural equation modeling show that misinformation and disinformation substantially structure risk perception regarding hepatitis, which, in turn, impacts problem recognition, involvement recognition, and constraint recognition. Besides, the outcomes uncovered that the chain of problem identification impacts situational motivation, which drives risk communication behaviors. Also, these risk communication behaviors are closely linked to individuals' motivation to receive the hepatitis vaccine.

Conclusion

This research concludes that managing misinformation and disinformation via strategically designed, valid, and reliable digital interventions improves the public's active response regarding willingness to get vaccinated against hepatitis. This study contributes to increasing public acceptance of the hepatitis vaccine by utilizing reliable and valid digital interventions to achieve a more active public health response.

The People's Review protocol: planning an innovative study powered by the public

BACKGROUND

Systematic reviews provide the best quality evidence about the effectiveness of health treatments. However, systematic reviews and the important role they play in healthcare are not well understood beyond the walls of academia and healthcare. Systematic reviews can help the public make more informed health choices, based on the best available evidence. The People's Review aims to provide an opportunity to members of the public to plan and complete a full systematic review online in a supportive and engaging manner. It will be a learning-by-doing experience to support the public's understanding of what reviews are, how they are done, why they matter, and how they can be used to support everyday health decisions.

METHODS

In The People's Review the public will conduct a full systematic review, deciding the review question, planning the review, working on the parts of the review, and deciding how to share the review findings, in a 'learning by doing' process. The review will be conducted online in eight stages using Cochrane Crowd, an existing citizen science platform. The team working behind-the-scenes of The People's Review will design, produce, and share learning material to support the public's understanding at each stage of the review.

DISCUSSION

Involving the public in a systematic review online will enable members of the public to understand and use systematic reviews in everyday health choices. It provides the public with a unique 'learning by doing' opportunity to get to grips with what systematic reviews are and how they are produced. This article describes how we plan to involve the public in The People's Review. It is not a protocol for the systematic review itself - this will be published separately once the project has commenced, and the public have decided the review question.

Understanding knowledge and media influence on people with hepatitis B in Senegal: a mixed-methods study

OBJECTIVES

Public awareness and the dissemination of tailored information to lay populations are essential for highly endemic countries like Senegal to achieve hepatitis B elimination targets by 2030. In Senegal, despite its high prevalence, hepatitis B has not received sufficient attention in health communication campaigns compared with other health issues like HIV. We aimed to explore knowledge and perceptions surrounding hepatitis B virus (HBV), as well as the influence of digital media on the information accessed by individuals living with HBV in Senegal.

DESIGN

We employed a mixed-methods approach combining qualitative semistructured interviews conducted with people living with HBV enrolled in the Senegalese hepatitis B cohort (SEN-B), with a quantitative content analysis of online news coverage focused on HBV within the online media of Senegal.

SETTING

A referral University hospital in Dakar, Senegal.

PARTICIPANTS

29 individuals aged >18 years presenting with a positive hepatitis B surface antigen (HBsAg) with a median age of 40 years (IQR 27-54), of whom 51.7% were female.

OUTCOMES AND ANALYSIS

Qualitative interviews were conducted between December 2019 and October 2021, and we employed purposive sampling to select participants enrolled in SEN-B. Thematic analysis facilitated a systematic synthesis of respondents' narratives. All data analyses were performed using Atlas.ti (V.22). For content analysis of online media news collected from September 2019 to May 2022, a structured data extraction form was developed to collect relevant information from the selected online news articles. Data on readers' comments spaces were extracted using an inductive approach and were processed using thematic analyses. The quantitative data issued from content analysis were exported to Stata SE V.17.0 (StataCorp) for statistical analysis.

RESULTS

We observed a generalised lack of knowledge about HBV among participants, some of whom had never heard of the virus prior to their screening. Incomprehension regarding the disease contributed to feelings of fear and anxiety, leading participants to express various concerns about their personal health status, transmission, cure and treatment(s). The presence of rumours surrounding the disease further underscored the limited awareness of HBV revealing the marginal recognition of HBV as a significant societal concern. In many cases, the absence of effective health communication strategies at the national level resulted in individuals turning to traditional and online media for information, which often intensified their fears and concerns about HBV. An analysis of Senegalese media coverage about HBV included 157 articles published between 2009 and 2022. 55.4% (87/157) of these publications appeared in July, coinciding with World Hepatitis Day, while 65.0% (102/157) focused on general HBV epidemiology and activities led by the National Hepatitis Programme. Online media also served as informal spaces where unaccredited actors within the health sector promoted treatments lacking official verification. Additionally, the reactions' spaces provided a venue for the exchange of information, though without any guarantee of its accuracy.

CONCLUSIONS

Facilitating collaboration and engagement between health communication stakeholders and communities is crucial for effectively disseminating structured information and culturally appropriate messages, ultimately contributing to raising awareness of HBV.

Debunking COVID-19 vaccine misinformation with an audio drama in Ghana, a randomized control trial

Misinformation about COVID-19 vaccines has hampered their uptake worldwide. In Ghana, a belief that COVID-19 vaccines affect fertility is prevalent and difficult to counter. UNICEF Ghana co-produced a context-driven, behavioral science-based audio drama ('A shot of love') that aimed to debunk this misinformation narrative. In a randomized controlled trial, 13,000 young adults who had previously interacted with UNICEF's Agoo platform were randomized to either control (audio about nutrition) or intervention (audio drama debunking the COVID-19 misinformation). We found that the intervention had a strong protective effect against belief in misinformation, both directly after listening to the audio drama (adjusted Odds Ratio (aOR) 0.45, 95% Confidence Interval (CI) 0.34-0.59) as well as at the one-month follow-up (aOR 0.66, 95% CI 0.49-0.91). Similarly, the intervention had a strong effect on perceived safety of the COVID-19 vaccines directly after listening to the audio drama (aOR 1.56, 95% CI 1.22-2.00) and at one-month follow-up (aOR 1.53, 95% CI 1.13-2.07). Overall, our behavioral science-based, context-driven audio drama was effective in reducing the strength of belief in COVID-19 vaccine misinformation and increasing the perceived safety of the vaccines in Ghana.

Beliefs in Misinformation About COVID-19 and the Russian Invasion of Ukraine Are Linked: Evidence From a Nationally Representative Survey Study

BACKGROUND

Detrimental effects of misinformation were observed during the COVID-19 pandemic. Presently, amid Russia's military aggression in Ukraine, another wave of misinformation is spreading on the web and impacting our daily lives, with many citizens and politicians embracing Russian propaganda narratives. Despite the lack of an objective connection between these 2 societal issues, anecdotal observations suggest that supporters of misinformation regarding COVID-19 (BM-C) have also adopted misinformation about the war in Ukraine (BM-U) while sharing similar media use patterns and political attitudes.

OBJECTIVE

The aim of this study was to determine whether there is a link between respondents' endorsement of the 2 sets of misinformation narratives, and whether some of the selected factors (media use, political trust, vaccine hesitancy, and belief rigidity) are associated with both BM-C and BM-U.

METHODS

We conducted a survey on a nationally representative sample of 1623 individuals in the Czech Republic. Spearman correlation analysis was performed to identify the relationship between BM-C and BM-U. In addition, multiple linear regression was used to determine associations between the examined factors and both sets of misinformation.

RESULTS

We discovered that BM-C and BM-U were moderately correlated (Spearman ρ=0.57; P<.001). Furthermore, increased trust in Russia and decreased trust in the local government, public media, and Western allies of the Czech Republic predicted both BM-C and BM-U. Media use indicating frustration with and avoidance of public or mainstream media, consumption of alternative information sources, and participation in web-based discussions indicative of epistemic bubbles predicted beliefs in misinformation narratives. COVID-19 vaccine refusal predicted only BM-C but not BM-U. However, vaccine refusers were overrepresented in the BM-U supporters (64/161, 39.8%) and undecided (128/505, 25.3%) individuals. Both beliefs were associated with belief rigidity.

CONCLUSIONS

Our study provides empirical evidence that supporters of COVID-19 misinformation were susceptible to ideological misinformation aligning with Russian propaganda. Supporters of both sets of misinformation narratives were primarily linked by their shared trust or distrust in the same geopolitical actors and their distrust in the local government.

"Your Life, Your Health: Tips and Information for Health and Well-Being": Development of a World Health Organization Digital Resource to Support Universal Access to Trustworthy Health Information

Background

Access to trustworthy, understandable, and actionable health information is a key determinant of health and is an essential component of universal health coverage and primary health care. The World Health Organization has developed a new digital resource for the general public to improve health and well-being across different life phases and to support people in caring for themselves, their families, and their communities. The goal was to make trustworthy health information accessible, understandable, and actionable for the general public in a digital format and at the global scale.

Objective

The aim of this paper was to describe the multistage approach and methodology used to develop the resource Your life, your health: Tips and information for health and well-being (hereafter, Your life, your health).

Methods

A 5-step process was used to develop Your life, your health, including (1) reviewing and synthesizing existing World Health Organization technical guidance, member state health and health literacy plans, and international human rights frameworks to identify priority messages; (2) developing messages and graphics that are accessible, understandable, and actionable for the public using health literacy principles; (3) engaging with experts and stakeholders to refine messages and message delivery; (4) presenting priority content in an accessible digital format; and (5) adapting the resource based on feedback and new evidences.

Results

The Your life, your health online resource adopts a life-course approach to organize health information based on priority actions and rights that support peoples' health and well-being across different life stages and specific health topics. The resource promotes health literacy by offering advice on asking questions to health workers, making informed decisions about personal and family health, and effectively using digital media to obtain reliable health information. Additionally, it reflects the ambitions of the Sustainable Development Goals by providing essential information on the social determinants of health and clarifies the distinct roles of individuals, frontline workers, governments, and the media in promoting and protecting health.

Conclusions

Making health information available-including to the public-is an essential step in strengthening the global health information system. The development process for the Your life, your health online resource outlined in this article offers a structured approach to translate technical health guidelines into accessible, understandable, and actionable health information for the general public.

Health literacy in adults with a spinal cord injury or disorder: An updated and expanded systematic review

BACKGROUND

The importance of health literacy in personal health management is widely recognised in the general population, yet remains poorly understood in some patient groups, including people with spinal cord injury or disorder (SCI/D).

OBJECTIVES

The systematic review had two objectives: (1) to determine the health literacy levels of individuals with SCI/D, and (2) to identify facilitators and barriers to developing health literacy in this group.

METHODS

Seven databases (CINAHL, Embase, Emcare, ProQuest, PsycINFO, PubMed, and Web of Science) were searched from inception, with an updated search completed on January 21, 2025. Study quality was evaluated (QualSyst Checklist) and both quantitative and qualitative research narratively summarised by our research aims.

RESULTS

Seven quantitative studies and one qualitative study (N = 2471 participants) published from 2005 to 2022 were included. All demonstrated good methodological rigour. Most participants reported having sufficient health literacy. Those with higher health literacy were more likely to have higher education and socio-economic advantage, and to experience better physical and mental health outcomes. Evidence regarding the role of SCI/D variables in developing health literacy capacity was limited.

CONCLUSIONS

Health literacy remains an under-researched topic in the SCI/D literature. Further studies are needed to examine how health literacy can impact health behaviours and overall health for this group. This research would also benefit from focusing on personal experiences of health literacy development.

Modeling diffusion in networks with communities: A multitype branching process approach

The dynamics of diffusion in complex networks are widely studied to understand how entities, such as information, diseases, or behaviors, spread in an interconnected environment. Complex networks often present community structure, and tools to analyze diffusion processes on networks with communities are needed. In this paper, we develop theoretical tools using multitype branching processes to model and analyze diffusion processes, following a simple contagion mechanism, across a broad class of networks with community structure. We show how, by using limited information about the network-the degree distribution within and between communities-we can calculate standard statistical characteristics of propagation dynamics, such as the extinction probability, hazard function, and cascade size distribution. These properties can be estimated not only for the entire network but also for each community separately. Furthermore, we estimate the probability of spread crossing from one community to another where it is not currently spreading. We demonstrate the accuracy of our framework by applying it to two specific examples: the stochastic block model and a log-normal network with community structure. We show how the initial seeding location affects the observed cascade size distribution on a heavy-tailed network and that our framework accurately captures this effect.

Evaluation of the measurement properties of online health information quality assessment tools: A systematic review

Objectives

This study aimed to evaluate the measurement properties and methodological quality of instruments developed to evaluate the quality of online health information.

Methods

In this study, a systematic search was conducted across a range of databases, including the China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal (VIP), SinoMed, PubMed, Web of Science, CINAHL, Embase, the Cochrane Library, PsycINFO, and Scopus. The search period spanned from the inception of the databases to October 2023. Two researchers independently conducted the literature screening and data extraction. The methodological quality of the included studies was assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias checklist. The measurement properties were evaluated using the COSMIN criteria. The modified Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to determine the quality grade.

Results

A total of 18 studies were included, and the measurement properties of 17 scales were assessed. Fifteen scales had content validity, three had structural validity, six had internal consistency, two had test-retest reliability, nine had interrater reliability, one had measurement error, six instruments had criterion validity, and three scales had hypotheses testing for construct validity; however, the evaluation of their methodological quality and measurement properties revealed deficiencies. Of these 17 scales, 15 were assigned a Level B recommendation, and two received a Level C recommendation.

Conclusions

The Health Information Website Evaluation Tool (HIWET) can be temporarily used to evaluate the quality of health information on websites. The Patient Education Materials Assessment Tool (PEMAT) can temporarily assess the quality of video-based health information. However, the effectiveness of both tools needs to be further verified.

Stop the spread: Empowering students to address misinformation through community-engaged, interdisciplinary science communication training

Teaching science in an age of disinformation and misinformation requires empowering students to address inaccurate information in evidence-based ways. Science communication scholarship highlights the growing importance of inclusive and relational approaches for addressing misinformation. Thus, we developed, implemented, and evaluated an interdisciplinary, graduate-level course for students in STEM, journalism/communication, and public health to learn to address misinformation using community-engaged, evidence-based approaches. We used the Theory of Planned Behavior as a theoretical framework for our mixed-methods analysis of the efficacy of this course, assessing both the behaviors that students planned to utilize in community-engaged science communication to address misinformation, as well as the attitudes, norms, and perceived behavioral control that influenced these planned behaviors. Quantitative self-report metrics indicated that this curriculum increased students' subjective norms for misinformation correction as well as perceived behavioral control of science communication and science civic engagement. Thematic analysis of qualitative student interview data showed that the course helped students increase their plans for inclusive approaches to addressing misinformation. This study indicates the importance of community-engaged curriculum to develop the mindset and self-efficacy necessary for scientists-in-training to address misinformation in their communities.

Describing acute coronary syndrome symptom information on social media platforms

BACKGROUND

Social media is a common source of health-related information. However, more clarity regarding ACS symptom information posted on social media is needed.

OBJECTIVES

The objective was to describe ACS symptom information on social media platforms, including Twitter (now named X), Instagram, and TikTok.

METHODS

A cross-sectional, qualitative descriptive design was used. The three social media platforms were searched in 2022 for posts containing ACS symptom information. A random sample of posts meeting inclusion was drawn. Posts were analyzed using a qualitative coding process, and network analysis was used to triangulate data.

RESULTS

Posts (N = 342) included in the final analysis were most often published by healthcare organizations (46.2 %), lay persons (20.8 %), or healthcare professionals (13.7 %). Five key themes were identified: 1) a focus on gendered symptom experiences, 2) diverse types of symptom messages (educational, emphasis on getting help, personal testimony, advertising, diagnostic help, research findings), 3) variety of specific symptoms mentioned, 4) different dimensions of symptoms included, and 5) varying levels of information quality and accuracy. Chest pain was the most common ACS symptom highlighted in posts, and symptom differences between men and women were often emphasized.

CONCLUSIONS

Of particular concern was incorrect or misleading ACS symptom information on social media that could create misconceptions and contribute to delays in seeking care for ACS. The findings from this study provide more insight into the ACS symptom information shared on social media platforms and provide preliminary information that can influence practice and future research.

I eat, therefore I am? Revealing differences and incongruences in dietary identities among omnivores and flexitarians in Europe

Sustainable diets have been forwarded as initiatives to mitigate the impact of current food consumption towards health and the environment. For instance, adopting a flexitarian diet and reducing the consumption of animal-sourced food (ASF) are said to help limit the rate of food system greenhouse gas emissions. However, much remains to be explored on how individuals associate themselves with alternative diets. In filling this gap, self-declared omnivores and flexitarians from ten European countries (N = 5870) were surveyed to determine how they identify with a particular diet, considering their food preferences and consumption frequency of ASF and ASF substitutes. The analysis of the data revealed that flexitarians seemed to consume more plant-based alternatives than omnivores, yet their consumption of ASF remained comparable. A series of segmentation analyses likewise revealed that some individuals (N = 563, 34.2%) reporting as flexitarians seemed to behave similarly to conventional omnivores and conversely, some omnivores (N = 1202, 28.5%) behaved similarly to conventional flexitarians in terms of food consumption frequencies. Moreover, significant associations with consuming plant-based food were found when considering the current readiness level of the respondent to transform diets. Taken together, the findings of this study show that identifying with a particular dietary lifestyle is contingent on how individuals set personal thresholds to qualify for a particular diet, thereby providing implications to the way nutritional guidelines frame and define recommendations for dietary intake.

[Professional health literacy. Professional and gender-specific aspects]

BACKGROUND

The importance of health professionals (HPs) in promoting health literacy (HL) is being increasingly emphasized. This article aims to analyze the professional HL of selected HPs, examine professional and gender-specific differences, and identify the challenges in promoting HL as well as its relationship to organizational and qualification-related conditions.

METHOD

In May and June 2022, 624 nursing professionals and 297 physicians were surveyed online using a newly developed questionnaire, which measures professional health literacy through 34 items across four key domains (HLS-PROF‑Q). Participants were recruited via two online panels. Scores for professional health literacy (ranging from 0-100) and the perceived difficulties in managing tasks were examined. The analysis of perceived difficulties in promoting HL and associations with organizational and qualification-related conditions was conducted using descriptive and bivariate statistics.

RESULTS

Depending on the domain, HPs achieved an average of 54.0 to 73.8 out of 100 possible points. The tasks in the domains "professional digital HL" and "conveying information and knowledge" were considered the most challenging. Overall differences between the two HP groups were minimal, though some gender-specific differences were observed. Managing tasks involved in promoting HL was positively associated with the organizational and qualification-related conditions examined.

DISCUSSION

The results show that professional HL is moderate. However, they also highlight areas for improvement and provide insights into where professional HL can be strengthened as well as which adjustments to organizational and qualification-related conditions are needed.

Comparison of bacterial vaginosis symptoms reported in social media vs. those reported by patients

Introduction

There is an increasing tendency to seek health information online rather than through medical professionals. However, the easy accessibility of information online allows for an increased risk of encountering medical misinformation.

Methods

We compared descriptions of symptomatology of bacterial vaginosis (BV) on four social media platforms: Instagram, Facebook, YouTube and X (Twitter). We then compared the frequency of discussion of symptoms with patients' report of symptoms in clinically diagnosed BV, vulvovaginal candidiasis and vulvodynia.

Results

Social media was more likely to report burning (45% of posts), itching (45%) or pain (23%) as symptoms of BV than patients (moderate-severe itching 30%, burning 21% or pain 21%). Although pain was reported more often by people with vulvodynia, other symptoms were not different across diagnoses.

Discussion

Social media overemphasizes the ability of symptoms to allow self-diagnosis of vaginitis, which can lead to delayed treatment, highlighting the need to promote accurate health information online.

An examination of the quality of kidney stone information on YouTube and TikTok

Social media is increasingly consulted by patients for health-related information. The quality of this information is unknown and unregulated. This study aimed to investigate the quality of kidney stones information on two popular video platforms, YouTube and TikTok, and examine factors related to its quality. A search using keywords of "kidney stones" alongside "information, prevention, treatment" was used across YouTube and TikTok. The top 50 videos on each platform were rated by 4 independent reviewers on: general information, epidemiology, symptoms/presentation, treatment, and prevention. The American Urological Association's kidney stone curriculum was utilised as the benchmark for quality. The total number of views across the 100 videos was over 46 million. Overall, 91% of videos were educational in terms of genre. Misinformation was present in 34% of TikTok and 2% of YouTube videos. YouTube received significantly higher quality ratings across all parameters bar prevention (z's>-4.79 p's < 0.001); however, less than 50% of YouTube videos were rated as good quality. There was no association between quality and the number of likes or views across platforms (p's > 0.3). The quality of information presented across platforms was very variable with over half of videos considered poor quality. Given the high usage of social media as a source of health information it is important that healthcare providers and the general public are aware of the limits of information available on both platforms and continued efforts are made to develop high quality videos suitable for patient consumption.

Effects of the Modern Digital Information Environment on Maternal Health Care Professionals, the Role of Midwives, and the People in Their Care: Scoping Review

BACKGROUND

The digital information environment poses challenges for pregnant women and other people seeking care, as well as for their midwives and other health care professionals (HCPs). They can encounter questions, concerns, information gaps, and misinformation, which can influence health care decisions.

OBJECTIVE

This scoping review examines how HCPs are affected by the modern digital information environment including health misinformation, its effects on the women and people they care for, and its implications for care provision.

METHODS

English-language peer-reviewed literature, published from January 1, 2020, to May 31, 2024, with keywords related to midwifery, misinformation, and health equity collected and analyzed by a team of midwives and maternal care professionals and mapped onto a patient-centered conceptual model.

RESULTS

A total of 105 studies were ultimately included. Further, 95 papers identified specific digital information environment issues that affected clients; 58 specifically highlighted digital information environment issues impacting HCPs; 91 papers identified specific topics of common questions, concerns, misinformation, information voids, or narratives; 57 papers identified patient or population vulnerability; and 75 included mentions of solutions or recommendations for addressing a digital information environment issue around clients seeking care from midwives and other HCPs. When mapped onto the Journey to Health model, the most prominent barrier was access to care and information. Individual-level issues dominate the step related to knowledge, awareness, and belief, with more social norms and wider engagement appearing at steps related to intent. Client-specific themes dominate the left-hand side of the model and provider-specific issues dominate the right-hand side of the model.

CONCLUSIONS

Misinformation, information voids, unaddressed questions and concerns, and lack of access to high-quality health information are worldwide prevalent barriers that affect both patients and HCPs. We identified individual, provider-level, health systems, and societal-level strategies that can be used to promote healthier digital information environments.

Engagement With and Use of Health Information on Social Media Among US Latino Individuals: National Cross-Sectional Survey Study

BACKGROUND

During the COVID-19 pandemic, US Latino individuals were more likely to report accessing coronavirus information on social media than other groups, despite copious amounts of health misinformation documented on these platforms. Among the existing literature on factors associated with engagement and use of health information, racial minority status has been associated with greater susceptibility to health misinformation. However, literature to date has not reported national trends on how Latino individuals engage with or use health information on social media compared to non-Latino White (NLW) individuals, nor whether perceptions of the amount of health misinformation on social media influence health information engagement and usage.

OBJECTIVE

This study aimed to examine differences in engagement with and use of health information on social media among Latino and NLW individuals in the United States.

METHODS

We examined a nationally representative cross-sectional sample of Latino (n=827) and NLW (n=2563) respondents of the 2022 Health Information National Trends Survey who used social media in 2022 to assess differences in engagement with and use of health information. Items related to the perceived quantity of health misinformation on social media, social media use frequency, health information engagement (sharing content; watching videos), and health information usage (health decision-making; discussions with health care providers) were selected to conduct weighted bivariate analyses and logistic regressions.

RESULTS

Latino individuals perceive lower amounts of health misinformation on social media (28.9% perceived little to no misinformation vs 13.6% NLW individuals, P<.001). Latino audiences also reported higher health information engagement compared to NLW individuals (20% vs 10.2% shared information several times a month or more, P<.001; 42.4% vs 27.2% watched videos several times a month or more, P<.001), as well as higher information usage for health decision-making (22.8% vs 13.7%, P=.003). When controlling for ethnicity and other sociodemographic variables, perceiving lower amounts of health misinformation on social media was associated with higher odds of watching videos more frequently, making health decisions, and discussing health-related content with a health care provider (P<.001). Furthermore, Latino audiences were 1.85 times more likely to watch videos (P<.001), when controlling for the perceived amount of health misinformation and other sociodemographic variables. Finally, when compared to NLW individuals perceiving little to no health misinformation, Latino audiences perceiving little to no health misinformation were 2.91 times more likely to watch videos (P<.001).

CONCLUSIONS

The findings suggest that Latino individuals engage with visual health (mis)information at higher rates. Digital health literacy interventions should consider video formats and preferred social media platforms among Latino individuals. Further research is warranted to understand sociocultural factors important to Latino social media users when consuming health information, as these may impact the success of digital media literacy interventions that teach users how to navigate misinformation online.

Evaluation of Douyin Short Videos on Mammography in China: Quality and Reliability Analysis

Background

Breast cancer is the most common malignant tumor and the fifth leading cause of cancer death worldwide, imposing a significant disease burden in China. Mammography is a key method for breast cancer screening, particularly for early diagnosis. Douyin, a popular social media platform, is increasingly used for sharing health information, but the quality and reliability of mammography-related videos remain unexamined.

Objective

This study aimed to evaluate the information quality and reliability of mammography videos on Douyin.

Methods

In October 2023, a search using the Chinese keywords for "mammography" and "mammography screening" was conducted on Douyin. From 200 retrieved videos, 136 mammography-related videos were selected for analysis. Basic video information, content, and sources were extracted. Video content was assessed for comprehensiveness across 7 categories: conception, examination process, applicable objects, precautions, combined examinations, advantages, and report. Completeness was evaluated using a researcher-developed checklist, while reliability and quality were measured using 2 modified DISCERN (mDISCERN) tool and the Global Quality Score (GQS). Correlations between video quality and characteristics were also examined.

Results

Among the video sources, 82.4% (112/136) were attributed to health professionals, and 17.6% (24/136) were attributed to nonprofessionals. Among health professionals, only 1 was a radiologist. Overall, 77.2% (105/136) of the videos had useful information about mammography. Among the useful videos, the advantages of mammography were the most frequently covered topic (53/105, 50.5%). Median values for the mDISCERN and GQS evaluations across all videos stood at 2.5 (IQR 1.63-3) and 2 (IQR 1-2), respectively. Within the subgroup assessment, the median mDISCERN score among the useful and professional groups stood at 2 (IQR 2-3) and 3 (IQR 2-3), respectively, surpassing the corresponding score for the unhelpful and nonprofessional groups at 0 (IQR 0-0) and 0 (IQR 0-0.75; P<.001). Likewise, the median GQS among the useful and professional groups was evaluated at 2 (IQR 1.5-2) and 2 (IQR 1-2), respectively, eclipsing that of the unhelpful and nonprofessional groups at 1 (IQR 1-1) and 1 (IQR 1-1.37; P<.001). The GQS was weak and negatively correlated with the number of likes (r=-0.24; P=.004), comments (r=-0.29; P<.001), and saves (r=-0.20; P=.02). The mDISCERN score was weak and negatively correlated with the number of likes (r=-0.26; P=.002), comments (r=-0.36; P<.001), saves (r=-0.22; P=.009), and shares (r=-0.18; P=.03).

Conclusions

The overall quality of mammography videos on Douyin is suboptimal, with most content uploaded by clinicians rather than radiologists. Radiologists should be encouraged to create accurate and informative videos to better educate patients. As Douyin grows as a health information platform, stricter publishing standards are needed to enhance the quality of medical content.

Assessing the Quality of YouTube Content on Laryngoplasty: A Resource for Patient Education

OBJECTIVES

With increasing reliance on online platforms for health information, ensuring the accuracy, accessibility, and reliability of content is essential. To date, no studies have evaluated the quality of laryngoplasty content on YouTube. Assessing quality will (1) Reveal deficits in existing content to help providers facilitate patient education prior to laryngoplasty and (2) Provide a framework for institutions to produce better laryngoplasty content in the future.

METHODS

A search of YouTube videos was performed using the keyword "laryngoplasty." The first three pages of results were filtered for videos from hospitals and universities under 20 minutes long. Transcripts were created based on YouTube's autogenerated transcripts that were edited by one author (N Weiss). Content was assessed with the DISCERN instrument, Flesch Readability Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL). Videos were grouped by DISCERN scores: good (DISCERN > 3), moderate (DISCERN = 3), and poor (DISCERN < 3). Engagement metrics were collected. Variables were summarized using mean and standard deviation.

RESULTS

Eleven videos met inclusion criteria. Good videos (36.3%) scored 4.25 (0.5) on DISCERN, 10.97 (1.54) on FKGL, and 51.94 (7.37) on FRES. Engagement averaged 114.25 likes and 16 325 views. Duration averaged 3:05 minutes. Moderate videos (36.3%) scored 3 (0) on DISCERN, 7.61 (1.79) on FKGL, and 66.36 (5.29) on FRES. Engagement averaged 389 likes and 269 107 views. Duration averaged 1:44 minutes. Poor videos (27.2%) scored 1.33 (0.58) on DISCERN, 7.54 (0.64) on FKGL, and 69.11 (3.78) on FRES. Engagement averaged 294.3 likes and 59 621 views. Duration averaged 13:52 minutes.

CONCLUSION

Good videos exhibited high FKGL (10.97) and low FRES (51.94), indicating that they are difficult for patients to understand. Moderate/poor videos had higher engagement (269 107 and 59 621 views, respectively) than good videos (16 325 views), indicating that patients are more often watching lower-quality content. Disparities seen in these data underscore the importance of providing thorough patient education in preparation for laryngoplasty and reveal a need to develop higher-quality, accessible laryngoplasty education on YouTube.

EDUCATIONAL OBJECTIVES

1-Provide information for institutions to create accessible and reliable laryngoplasty videos 2-Evaluate the accuracy and quality of information available on YouTube 3-Facilitate patient cooperation and education for laryngoplasty procedure.

Can people with epilepsy trust AI chatbots for information on physical exercise?

PURPOSE

This study aims to evaluate the similarity, readability, and alignment with current scientific knowledge of responses from AI-based chatbots to common questions about epilepsy and physical exercise.

METHODS

Four AI chatbots (ChatGPT-3.5,ChatGPT 4, Google Gemini, and Microsoft Copilot) were evaluated. Fourteen questions on epilepsy and physical exercise were designed to compare the platforms. Lexical similarity, response patterns, and thematic content were analyzed. Readability was measured using the Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Seven experts rated the quality of responses on a Likert scale from "very poor" to "very good."

RESULTS

The responses showed lexical similarity, with approaches to physical exercise ranging from conservative to holistic. Microsoft Copilot scored the highest on the Flesch Reading Ease scale (48.42 ± 13.71), while ChatGPT-3.5 scored the lowest (23.84 ± 8.19). All responses were generally rated as difficult to read. Quality ratings ranged from "Good" to "Acceptable," with ChatGPT 4 being the preferred platform, chosen by 48.98 % of reviewers.

CONCLUSION

The findings highlight the potential of AI chatbots as useful sources of information on epilepsy and physical exercise. However, simplifying language and tailoring content to user's needs is essential to enhance their effectiveness.

Does exposure necessarily lead to misbelief? A meta-analysis of susceptibility to health misinformation

A meta-analysis was conducted to quantify the overall effect of health misinformation exposure on shaping misbelief. Aggregation of results from 28 individual randomized controlled trial studies (n = 8752) reveals a positive but small average effect, d = 0.28. Moderation analyses suggest that adults who are younger and female tend to develop higher misbelief if exposed to health misinformation. Furthermore, media platform, message falsity, and misbelief measurements also contribute to the exposure effect. These findings offer nuanced but crucial insights into existing misinformation literature, and development of more effective strategies to mitigate the adverse impacts of health misinformation.

Clusters of Patient Empowerment and Mental Health Literacy Differentiate Professional Help-Seeking Attitudes in Online Mental Health Communities Users

OBJECTIVES

Grounded in the Health Empowerment Model, which posits that health literacy and patient empowerment are intertwined yet distinct constructs, this study investigates how the interplay of these factors influences attitudes toward seeking professional psychological help in members of online communities for mental health (OCMHs). This while acknowledging the multidimensionality of patient empowerment, encompassing meaningfulness, competence, self-determination, and impact.

DESIGN AND METHODS

A cluster analysis of data gathered from 269 members of Italian-speaking OCMHs on Facebook has been performed.

RESULTS

Four profiles have been identified: dangerous self-managers (11.2%), effective self-managers (21.2%), disempowered (40.5%) and ambivalent empowered (27.1%). Clusters provided meaningful variations in help-seeking attitudes, also when controlling for depression and anxiety severity, F3, 265 = 11.910, p < 0.001.

CONCLUSIONS

The findings provided further evidence of the multidimensionality of patient empowerment. Considering the results, we discussed potential interventions aimed at enhancing the quality of OCMHs, tailoring to the unique characteristics of each cluster.

PATIENT OR PUBLIC CONTRIBUTION

Administrators and moderators of mental health Facebook communities-whether expert-led by mental health professionals or peers-played a key role in this study. They provided valuable insights during the questionnaire design process to ensure the questions were both relevant and appropriate for community members. These administrators and moderators also actively facilitated participant recruitment by creating and sharing posts, either video- or text-based, on community homepages. Furthermore, after completing the questionnaire, participants were encouraged to comment on the Facebook posts where the survey link was shared, mentioning that they participated and inviting other members to take part. This approach aimed to foster a sense of involvement and further promoted the survey within the community.

Generating credible referenced medical research: A comparative study of openAI's GPT-4 and Google's gemini

BACKGROUND

Amidst the increasing use of AI in medical research, this study specifically aims to assess and compare the accuracy and credibility of openAI's GPT-4 and Google's Gemini in their ability to generate medical research introductions, focusing on the precision and reliability of their citations across five medical fields.

METHODS

We compared the two models, OpenAI's GPT-4 and Google's Gemini Ultra, across five medical fields, focusing on the credibility and accuracy of citations, alongside the analysis of introduction length and unreferenced data.

RESULTS

Gemini outperformed GPT-4 in reference precision. Gemini's references showed 77.2 % correctness and 68.0 % accuracy, compared to GPT-4's 54.0 % correctness and 49.2 % accuracy (p < 0.001 for both). This 23.2 percentage point difference in correctness and 18.8 in accuracy represents an improvement in citation reliability. GPT-4 generated longer introductions (332.4 ± 52.1 words vs. Gemini's 256.4 ± 39.1 words, p < 0.001) but included more unreferenced facts and assumptions (1.6 ± 1.2 vs. 1.2 ± 1.06 instances, p = 0.001).

CONCLUSION

While Gemini demonstrates significantly superior performance in generating credible and accurate references for medical research introductions, both models produced fabricated evidence, limiting their reliability for reference searching. This snapshot comparison of two prominent AI models highlights the potential and limitations of AI in academic content creation. The findings underscore the critical need for verification of AI-generated academic content and call for ongoing research into evolving AI models and their applications in scientific writing.

Developing and Validating a User-Friendly Quality Benchmark: Enhancing the Integrity of Online Health Information for Patients and Clinicians

The quality of online health information remains one of the leading causes in combating misinformation for patients and the public. However, assessing online health content is challenging for those without medical expertise. This article briefly outlines the development and validation of an evidence-based online health information evaluation tool. A systematic approach with five phases was adopted: (1) synthesizing the current state of the reliability of online health information, (2) conducting content analysis of existing quality assessment tools, (3) drafting a comprehensive list of quality criteria, (4) developing and validating a quality benchmark, and (5) disseminating the results. Collaborative input from healthcare providers, patients, caregivers, and the public developed and validated a quality benchmark. The quality benchmark consists of 5 quality criteria and 8 accompanying descriptions that define each quality criterion. A printable version of the benchmark is provided in the article to facilitate easy implementation by both patients and healthcare providers. The benchmark is recommended for use and intended to empower patients with a skill set to navigate through online misinformation, facilitating access to credible health information and promoting improved health outcomes.

Navigating Disagreements on Health Information: How Patients With Cancer Perceive Health Care Providers' Approaches to Discussing Patient-Identified Information

PURPOSE

Although publicly available cancer-related information online and offline could help patients make informed decisions, it also poses challenges due to prevalent misinformation. Patients need proper provider guidance to ensure they use valid and relevant information in decisions. We identify effective communication approaches for providers when (1) discussing patient-identified information and (2) disagreeing with it.

METHODS

From June to August 2023, people living with cancer were reached via online communities and asked first about their actual experiences discussing patient-identified information with their providers. Respondents were then randomly assigned into an experiment with three hypothetical scenarios where providers disagreed with patient-identified information. Provider responses included (1) dismissal, (2) explanation, and (3) explanation with relationship-building elements. Pearson correlation and multivariable analysis of variance were used to evaluate differences in patient perceptions.

RESULTS

One hundred seventy-five respondents completed the survey. Mean age: 53 years; 45% female; and 88% White, 10% Black, and 2% others. Forty-six percent held Bachelor's degrees or higher, 11% lived rurally, 36% reported financial difficulties, and 46% rated their health as good/excellent. Between 31% and 37% of respondents reported their provider used communication approaches that negatively correlated with discussion outcomes. The approaches included avoidance of such conversations due to limited time, discouragement of future information searches, or judgmental comments. In the experiment, respondents randomly assigned to receive relationship-building elements were significantly more comfortable sharing information, felt more satisfied, respected, and trusted their provider's opinion more than those receiving the dismissal scenario. The explanation scenario was not perceived differently compared with the dismissal scenario.

CONCLUSION

More than a third of respondents reported negative communication when sharing patient-identified information with their provider. Provider prioritization of relationship-building alongside explanations could foster trust and facilitate open information exchange, supporting informed decisions.

Communicating the interdependence of human, animal, and environmental health on X (formerly Twitter): Insights from the one health approach

The COVID-19 pandemic has underscored societies' need for education and preparedness in addressing global environmental and health crises. Raising public awareness of the interdependence of human, animal, and environmental health is essential to engaging the public in environmental conservation and disease prevention. The One Health approach offers a holistic and multidisciplinary view for tackling challenges related to environmental and health issues by emphasizing the interplay of these three interconnected health dimensions. We analyzed how the interconnectedness of health dimensions was disseminated through the OH approach on X (formerly Twitter) from April 2006 to December 2022 using machine learning methods. Results show an underrepresentation of environmental health, limited dissemination beyond academia, and a retweet network dominated by researchers and non-profits in veterinary and human health. We advocate for more inclusive communication strategies to bridge the gap between academia and the public and raise awareness of the interconnected nature of our world.

Survey of willingness to participate in clinical trials and influencing factors among cancer and non-cancer patients

Despite the expanding landscape of clinical trials, there is a lack of study concerning Malaysian patients' participation and perspectives. This study addresses these gaps by assessing patients' willingness, knowledge, perceptions, confidence, and religious barriers related to clinical trial participations at Sarawak General Hospital. We conducted a cross-sectional survey from March to September 2022 on 763 cancer and non-cancer patients. We collected patients' responses and calculated scores for willingness to participate (40.5/100), knowledge (29.9/100), perceived benefits (66.5/100) and risks (72.4/100) of participations, confidence in clinical trial conducts (66.3/100), and religious barriers (49.8/100). The higher scores indicated greater willingness, better knowledge, stronger perceptions of benefits and risk, increased confidence, and stronger religious barriers. Cancer patient demonstrated significantly greater willingness for trials involving new drugs (31.9/100 vs. 27.4/100, p = 0.021) but slightly higher religious barriers compared to non-cancer cohort (51.4/100 vs. 48.3/100, p = 0.006). Multivariable logistic regression identified female gender, unemployment, poor knowledge, low perceived benefits, high perceived risks, and low confidence as significant factors associated with reduced willingness to participate (p < 0.05). This study underscores the challenges in engaging Malaysian patients in clinical trials, particularly in Sarawak, emphasising the need for targeted strategies to raise awareness, effective communication, and enhancing public confidence in clinical trials.

Appropriate trust in online health information is associated with information platform, commercial status, and misinformation in patients with high cardiovascular risk

Background

The quality of online health information (OHI) on cardiovascular health is highly variable. Trusting poor quality OHI can lead to poorer health decisions. This study examined information characteristics associated with appropriate trust in OHI among patients with high cardiovascular risk.

Methods

This is a secondary analysis from a cohort study of 270 participants with high cardiovascular risk from a primary care clinic in Malaysia. Participants recorded OHI entries and their trust levels over 2 months using a digital diary. Overall, 1194 OHI entries were included and categorised by platform, commercial status, content focus, and presence of misinformation, and assessed for quality using the DISCERN tool. Appropriate trust was determined by trust-quality matching (trusting high quality or distrusting low quality OHI). The association between information characteristics and appropriate trust was analysed using multiple logistic regression.

Results

Most entries were from websites (62%) and non-commercial sources (88.2%). Misinformation was found in 23.3% (278 of 1194) of entries; 30.8% (367 of 1194) were of good or excellent quality; 51.5% (615 of 1194) were appropriately trusted. Information from websites (vs social media) (AOR 4.31, 95% CI 3.14-5.91, P < .001), non-commercial source (vs commercial) (AOR 1.59, 95% CI 1.01-2.50, P = .047), and absence of misinformation (vs presence of misinformation) (AOR 2.11, 95% CI 1.40-3.20, P < .001) were associated with higher appropriate trust.

Conclusions

OHI from websites, non-commercial sources, and information without misinformation has higher appropriate trust among patients with high cardiovascular risk. This study highlighted the need for good-quality OHI and dissemination through reliable sources.

Allergen immunotherapy in Italy: How, when, and why-A real-world study conducted through a patient association

Background

Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is only used in some eligible patients, is frequently underused, and only a few studies investigated this aspects. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing valuable insights on how to broaden the positive impact it can have on the population.

Methods

A questionnaire aiming to assess the trends of the use of AIT in Italy, patient health literacy on AIT, and the impact of respiratory allergies and AIT on patients' lives was submitted to patients affiliated with Respiriamo Insieme APS patient's association during the period between May and October 2023.

Results

Nine hundred forty-four patients completed the questionnaire. Most patients reported to be affected by allergic rhinitis (81.1%), allergic asthma (45.4%), and/or allergic conjunctivitis (41.2%), and many of them presenting a combination of these diseases. Only 53.8% knew about AIT's existence, and AIT was proposed to only 33.1% of the 858 patients affected by allergic rhinitis and/or allergic asthma, of which 29.2% decided not to initiate the therapy. Common reasons for AIT refusal were related to indecisiveness (26.5%), costs (22.9%), and skepticism (19.3%). Among the remaining 70.8% who accepted to start AIT, 21.4% discontinued the treatment beforehand, on average 18.26 months from initiation. There was a high heterogeneity in the suggested duration of AIT, with 20.4% of patients receiving indications to continue AIT for less than 3 years. AIT positively impacted patients' lives as most patients who completed AIT found it effective and safe, and experienced a significant reduction in the workdays/schooldays lost due to disease exacerbations.

Conclusions

The outcomes of this research pointed out a lot of misinformation surrounding AIT, calling for improvements in awareness and information on its efficacy and safety. Also, we noted a significant reduction in work/school days lost in patients who completed AIT and a good patient-reported safety and efficacy profile. We advocate for better economic accessibility through national-level standardization in treatment refundability. Notably, the collaboration with the patient association was crucial, and it would have been challenging to conduct this research otherwise.

Assessing the quality of ChatGPT's responses to questions related to radiofrequency ablation for varicose veins

OBJECTIVE

This study aimed to evaluate the accuracy and reproducibility of information provided by ChatGPT, in response to frequently asked questions about radiofrequency ablation (RFA) for varicose veins.

METHODS

This cross-sectional study was conducted at The Aga Khan University Hospital, Karachi, Pakistan. A set of 18 frequently asked questions regarding RFA for varicose veins were compiled from credible online sources and presented to ChatGPT twice, separately, using the new chat option. Twelve experienced vascular surgeons (with >2 years of experience and ≥20 RFA procedures performed annually) independently evaluated the accuracy of the responses using a 4-point Likert scale and assessed their reproducibility.

RESULTS

Most evaluators were males (n = 10/12 [83.3%]) with an average of 12.3 ± 6.2 years of experience as a vascular surgeon. Six evaluators (50%) were from the UK followed by three from Saudi Arabia (25.0%), two from Pakistan (16.7%), and one from the United States (8.3%). Among the 216 accuracy grades, most of the evaluators graded the responses as comprehensive (n = 87/216 [40.3%]) or accurate but insufficient (n = 70/216 [32.4%]), whereas only 17.1% (n = 37/216) were graded as a mixture of both accurate and inaccurate information and 10.8% (n = 22/216) as entirely inaccurate. Overall, 89.8% of the responses (n = 194/216) were deemed reproducible. Of the total responses, 70.4% (n = 152/216) were classified as good quality and reproducible. The remaining responses were poor quality with 19.4% reproducible (n = 42/216) and 10.2% nonreproducible (n = 22/216). There was nonsignificant inter-rater disagreement among the vascular surgeons for overall responses (Fleiss' kappa, -0.028; P = .131).

CONCLUSIONS

ChatGPT provided generally accurate and reproducible information on RFA for varicose veins; however, variability in response quality and limited inter-rater reliability highlight the need for further improvements. Although it has the potential to enhance patient education and support healthcare decision-making, improvements in its training, validation, transparency, and mechanisms to address inaccurate or incomplete information are essential.

Coping behaviors to reduce anxiety and depressive symptoms: A prospective repeated assessment study

INTRODUCTION

Health institutions provide general recommendations to cope with global crises such as pandemics or geopolitical tensions. However, these recommendations are mainly based on cross-sectional evidence. The preregistered Repeated Assessment of Behaviors and Symptoms in the Population (RABSYPO) study sought to establish prospective longitudinal evidence from a cohort with a demographic distribution similar to that of the Spanish population to provide evidence for developing solid universal recommendations to reduce anxiety and depressive symptoms during times of uncertainty.

MATERIAL AND METHODS

We first recruited via social networks a pool of Spanish individuals willing to participate and then randomly selected some within each stratum of age×gender×region×urbanicity to conduct a one-year-long bi-weekly online follow-up about the frequency of ten simple potential coping behaviors as well as anxiety (GAD-7) and depressive symptoms (PHQ-9). Mixed-effects autoregressive moving average models were used to analyze the relationship between past behaviors' frequency and subsequent symptom changes across the twenty-seven time points.

RESULTS

Among the 1049 who started the follow-up, 942 completed it and were included in the analyses. Avoiding excessive exposure to distressing news and maintaining a healthy/balanced diet, followed by spending time outdoors and physical exercise, were the coping behaviors most strongly associated with short and long-term reductions of anxiety and depressive symptoms. Engaging in relaxing activities and drinking water to hydrate were only associated with short-term symptom reductions. Socializing was associated with symptom reductions in the long term.

CONCLUSIONS

This study provides compelling prospective evidence that adopting a set of simple coping behaviors is associated with small but significant reductions in anxiety and depressive symptoms during times of uncertainty. It also includes a layman's summary of this evidence to help develop general recommendations that serve as universal tools for enhancing mental health and well-being.