Determinants of Infodemics During Disease Outbreaks: A Systematic Review

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.

Innovating health prevention models in detecting infectious disease outbreaks through social media data: an umbrella review of the evidence

Introduction and objective

The number of literature reviews examining the use of social media in detecting emerging infectious diseases has recently experienced an unprecedented growth. Yet, a higher-level integration of the evidence is still lacking. This study aimed to synthesize existing systematic literature reviews published on this topic, offering an overview that can help policymakers and public health authorities to select appropriate policies and guidelines.

Methods

We conducted an umbrella review: a review of systematic reviews published between 2011 and 2023 following the PRISMA statement guidelines. The review protocol was registered in the PROSPERO database (CRD42021254568). As part of the search strategy, three database searches were conducted, specifically in PubMed, Web of Science, and Google Scholar. The quality of the included reviews was determined using A Measurement Tool to Assess Systematic Reviews 2.

Results

Synthesis included 32 systematic reviews and 3,704 primary studies that investigated how the social media listening could improve the healthcare system's efficiency in terms of a timely response to treat epidemic situations. Most of the included systematic reviews concluded showing positive outcomes when using social media data for infectious disease surveillance.

Conclusion

Systematic reviews showed the important role of social media in predicting and detecting disease outbreaks, potentially reducing morbidity and mortality through swift public health action. The policy interventions strongly benefit from the continued use of online data in public health surveillance systems because they can help in recognizing important patterns for disease surveillance and significantly improve the disease prediction abilities of the traditional surveillance systems.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42021254568].

Mental Health and (Online) Behaviors during the COVID-19 Pandemic in Spain: A Network-Based Approach

The COVID-19 pandemic has contributed to the increase in mortality and morbidity rates globally, but it has also led to a generalized worsening of mental health and risk behaviors in different population groups regardless of the measures adopted by different governments. In this paper, using data from a Spanish survey of emotional well-being, we aim to explore through mixed graphical models the complex structure of relationships between the mental health of populations, their lifestyles, and forms of cultural and leisure consumption during the pandemic. The results bring to light some interesting findings, such as the association between teleworking and greater rest or greater stress with the use of social media, a variable that enables the connection with other mental health problems of greater severity. Increased physical activity and the consumption of streaming content at home, as well as increased care for family, friends, and neighbors, are some of the variables that show relevant associations. These findings highlight the usefulness and versatility of this network approach for the study of health behaviors and health outcomes, which offer the researcher a holistic and organic view of the relational structure of complex data characterized by high dimensionality and variables with different levels of measurement.

Why fall for misinformation? Role of information processing strategies, health consciousness, and overconfidence in health literacy

Health misinformation, defined as false or misleading claims lacking scientific evidence, poses a significant threat to public health. This paper investigates factors associated with the failure to discern misinformation, including health consciousness, information processing strategies, and inaccurate self-assessments of health literacy. Through an online experiment involving 707 English-speaking U.S. participants (mean age = 43 years, 56.2% female), we found that misinformation beliefs about nutrition, vaccination, vaping, and cancer were significantly correlated, implying susceptibility across health topics. Greater susceptibility was associated with higher health consciousness, lower objective health literacy, more elaboration, and more selective scanning. Results provided evidence for the Dunning-Kruger effect and metacognitive monitoring errors, whereby confident individuals were unaware of inadequate health literacy and showed poor misinformation identification. Findings suggest that promoting both health literacy education and cognitive reflection skills among the general adult population could empower them to more critically evaluate online health information.

Fake news research trends, linkages to generative artificial intelligence and sustainable development goals

In the digital age, where information is a cornerstone for decision-making, social media's not-so-regulated environment has intensified the prevalence of fake news, with significant implications for both individuals and societies. This study employs a bibliometric analysis of a large corpus of 9678 publications spanning 2013-2022 to scrutinize the evolution of fake news research, identifying leading authors, institutions, and nations. Three thematic clusters emerge: Disinformation in social media, COVID-19-induced infodemics, and techno-scientific advancements in auto-detection. This work introduces three novel contributions: 1) a pioneering mapping of fake news research to Sustainable Development Goals (SDGs), indicating its influence on areas like health (SDG 3), peace (SDG 16), and industry (SDG 9); 2) the utilization of Prominence percentile metrics to discern critical and economically prioritized research areas, such as misinformation and object detection in deep learning; and 3) an evaluation of generative AI's role in the propagation and realism of fake news, raising pressing ethical concerns. These contributions collectively provide a comprehensive overview of the current state and future trajectories of fake news research, offering valuable insights for academia, policymakers, and industry.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

Discovery and characterisation of socially polarised communities on social media

Social polarisation processes have become a central phenomenon for the explanation of population behavioural dynamics in today's societies. Although recent works offer solutions for the detection of polarised political communities in social media, there is still a lack of works that allow an adequate characterization of the specific topics on which these divides between social groups are articulated. Our study aims to discover and characterise antagonistic communities on Twitter based on a method that combines the identification of authorities and textual classifiers around three public debates that have recently produced major controversies: (1) vaccination; (2) climate change; and (3) abortion. The proposed method allows the capture of polarised communities with little effort, requiring only the selection of some terms that characterise the topic and some initial authorities. Our findings show that the processes of social polarisation can vary considerably depending on the subject on which the debates are articulated. Specifically, polarisation manifests more prominently in the realms of vaccination and abortion, whereas this divide is less apparent in the context of climate change.

Spreading of misinformation on mass media and digital platforms regarding vaccines. A systematic scoping review on stakeholders, policymakers, and sentiments/behavior of Italian consumers

Studies on traditional and social media have found that misinformation about vaccines has been widely spread over the last decade, negatively impacting public opinion and people's willingness to get vaccinated. We reviewed the sentiments of Italian users to define the characteristic of anti-vax and pro-vax contents and defined the strategies to deal with the misinformation. Scopus, MEDLINE/PubMed, Google Scholar (up to page 10), and ISI Web of Knowledge databases were systematically searched. Research articles, brief reports, commentaries, and letters published between January 1, 2010 and March 30, 2022 were included in the search. No-vax or ambiguous contents in Italian mass media are not prevalent compared to neutral and pro-vax content; the communication of no-vax groups is significantly simplified, favoring the understanding of the topics by users. Events related to vaccinations are associated with news coverage by media, search engine consultations, and user reactions on social networks. In this context, the activity of no-vax groups is triggered, and misinformation and fake news spread even further. A multifactorial approach is necessary to manage online user sentiment and use mass and social media as health promotion tools.

The invisible burden of managing COVID-19 for Australian women: Cognitive labor and public health information

Providing accurate and timely public health information is an ongoing challenge for public health officials. The COVID-19 pandemic has exacerbated such challenges and presented unique difficulties in providing public health information, through the parallel rise of an "infodemic" of mis/dis-information. Understanding why individuals select, use and change their public health information seeking behaviors around COVID-19, and the relationship of these decisions relative to participant characteristics, is therefore an important step in understanding and responding to infodemics. This study used a qualitative survey (n = 255) and free-text qualitative questions to ask (1) Why participants use an information source, (2) How participants used an information source, and (3) How information seeking behavior has changed since the COVID-19 pandemic. Participants were primarily women, born in Australia, with de-facto/married relationships, without children at home, with university/college qualifications, and employed full-time or unemployed/retired. Most participants identified "easiness" and "immediacy" as reasons why they chose and used information, with sources primarily used for planning, communication, and decision making. A minority of participants changed their information seeking behavior since the COVID-19 pandemic. Those who did change, desired more immediate and accurate information. Emergent themes of care and anxiety were also noted, raising questions around the impact of mental load and cognitive labor in some female populations. Women may be suffering from increased cognitive labor and a gendering of public health information seeking behavior in the context of COVID-19. The impact of these attributes on women requires greater empirical research and consideration amongst front line practitioners and public health professionals.

Susceptibility to COVID-19 Nutrition Misinformation and Eating Behavior Change during Lockdowns: An International Web-Based Survey

To understand the susceptibility to nutrition-health misinformation related to preventing, treating, or mitigating the risk of COVID-19 during the initial lockdowns around the world, the present international web-based survey study (15 April-15 May 2020) gauged participants' (n = 3707) level of nutrition-health misinformation discernment by presenting them with 25 statements (including unfounded or unproven claims circulated at the time), alongside the influence of information sources of varying quality on the frequency of changes in their eating behavior and the extent of misinformation held, depending on the source used for such changes. Results revealed widespread misinformation about food, eating, and health practices related to COVID-19, with the 25 statements put to participants receiving up to 43% misinformed answers (e.g., 'It is safe to eat fruits and vegetables that have been washed with soap or diluted bleach'). Whereas higher quality information sources (nutrition scientists, nutrition professionals) had the biggest influence on eating behavior change, we found greater misinformation susceptibility when relying on poor quality sources for changing diet. Appropriate discernment of misinformation was weakest amongst participants who more frequently changed their eating behavior because of information from poor quality sources, suggesting disparities in the health risks/safety of the changes performed.

A conceptual model on caregivers' hesitancy of topical fluoride for their children

BACKGROUND

Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care.

PURPOSE

To explore the determinants of topical fluoride hesitancy for caregivers with dependent children.

METHODS

In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant.

RESULTS

The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice.

CONCLUSIONS

Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.

Disinformation: A Bibliometric Review

OBJECTIVES

This paper aimed to provide a systematic review of relevant articles from the perspectives of literature distribution, research hotspots, and existing results to obtain the frontier directions in the field of disinformation.

METHODS

We analyzed disinformation publications published between 2002 and 2021 using bibliometric methods based on the Web of Science. There were 5666 papers analyzed using Derwent Data Analyzer (DDA).

RESULTS

The result shows that the USA was the most influential country in this area, while Ecker and Lewandowsky from the University of Western Australia published the largest volumes of papers. Keywords such as "social media", "COVID-19", and "vaccination" have gained immense popularity recently.

CONCLUSIONS

We summarized four themes that are of the biggest concern to scholars: group heterogeneity of misinformation in memory, disinformation mechanism in social media, public health related to COVID-19, and application of big data technology in the infodemic. The future agenda of disinformation is summarized from three aspects: the mechanism of disinformation, social media users, and the application of algorithms. This work can be a meaningful resource for researchers' study in the area of disinformation.

Infodemics and health misinformation: a systematic review of reviews

Objective

To compare and summarize the literature regarding infodemics and health misinformation, and to identify challenges and opportunities for addressing the issues of infodemics.

Methods

We searched MEDLINE®, Embase®, Cochrane Library of Systematic Reviews, Scopus and Epistemonikos on 6 May 2022 for systematic reviews analysing infodemics, misinformation, disinformation and fake news related to health. We grouped studies based on similarity and retrieved evidence on challenges and opportunities. We used the AMSTAR 2 approach to assess the reviews' methodological quality. To evaluate the quality of the evidence, we used the Grading of Recommendations Assessment, Development and Evaluation guidelines.

Findings

Our search identified 31 systematic reviews, of which 17 were published. The proportion of health-related misinformation on social media ranged from 0.2% to 28.8%. Twitter, Facebook, YouTube and Instagram are critical in disseminating the rapid and far-reaching information. The most negative consequences of health misinformation are the increase of misleading or incorrect interpretations of available evidence, impact on mental health, misallocation of health resources and an increase in vaccination hesitancy. The increase of unreliable health information delays care provision and increases the occurrence of hateful and divisive rhetoric. Social media could also be a useful tool to combat misinformation during crises. Included reviews highlight the poor quality of published studies during health crises.

Conclusion

Available evidence suggests that infodemics during health emergencies have an adverse effect on society. Multisectoral actions to counteract infodemics and health misinformation are needed, including developing legal policies, creating and promoting awareness campaigns, improving health-related content in mass media and increasing people's digital and health literacy.

Assessing the Role of Social Bots During the COVID-19 Pandemic: Infodemic, Disagreement, and Criticism

BACKGROUND

Social media has changed the way we live and communicate, as well as offering unprecedented opportunities to improve many aspects of our lives, including health promotion and disease prevention. However, there is also a darker side to social media that is not always as evident as its possible benefits. In fact, social media has also opened the door to new social and health risks that are linked to health misinformation.

OBJECTIVE

This study aimed to study the role of social media bots during the COVID-19 outbreak.

METHODS

The Twitter streaming API was used to collect tweets regarding COVID-19 during the early stages of the outbreak. The Botometer tool was then used to obtain the likelihood of whether each account is a bot or not. Bot classification and topic-modeling techniques were used to interpret the Twitter conversation. Finally, the sentiment associated with the tweets was compared depending on the source of the tweet.

RESULTS

Regarding the conversation topics, there were notable differences between the different accounts. The content of nonbot accounts was associated with the evolution of the pandemic, support, and advice. On the other hand, in the case of self-declared bots, the content consisted mainly of news, such as the existence of diagnostic tests, the evolution of the pandemic, and scientific findings. Finally, in the case of bots, the content was mostly political. Above all, there was a general overriding tone of criticism and disagreement. In relation to the sentiment analysis, the main differences were associated with the tone of the conversation. In the case of self-declared bots, this tended to be neutral, whereas the conversation of normal users scored positively. In contrast, bots tended to score negatively.

CONCLUSIONS

By classifying the accounts according to their likelihood of being bots and performing topic modeling, we were able to segment the Twitter conversation regarding COVID-19. Bot accounts tended to criticize the measures imposed to curb the pandemic, express disagreement with politicians, or question the veracity of the information shared on social media.

Risk Communication in the Alert Phase of the COVID-19 Pandemic: Analysis of News Flow at National and Global Levels

This study examined the global media citation network of COVID-19-related news at two stages of the pandemic alert phase, i.e., the national level alert stage and the global level alert stage. The findings reveal that the small-world pattern and scale-free property of media citation networks contributed to the rapid spread of COVID-19-related news around the world. Within the networks, a small number of media outlets from a few countries formed the backbone of the network to control the risk communication; meanwhile, many media of geographical and cultural similarities formed cross-border collaborative cliques in the periphery of the network. When the alert phase escalated from the national level to the global level, the network demonstrated a number of changes. The findings contribute to the understanding of risk communication for international public health emergencies by taking into account the network perspective and evolutionary nature of public health emergencies in analysis.

Misinformation and Disinformation: The Potential Disadvantages of Social Media in Infectious Disease and How to Combat Them

Although the use of social media to spread misinformation and disinformation is not a new concept, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has further highlighted the dangers that misinformation can pose to public health. More than two-thirds of Americans receive their news from at least 1 social media outlet, most of which do not undergo the same review process as academic journals and some professional news organizations. Unfortunately, this can lead to inaccurate health information being conveyed as truth. The purpose of this article is to inform the infectious diseases community of the history and dangers of health misinformation and disinformation in social media, present tools for identifying and responding to misinformation, and propose other ethical considerations for social media.

Evaluating Rumor Debunking Effectiveness During the COVID-19 Pandemic Crisis: Utilizing User Stance in Comments on Sina Weibo

Background: The spread of rumors related to COVID-19 on social media has posed substantial challenges to public health governance, and thus exposing rumors and curbing their spread quickly and effectively has become an urgent task. This study aimed to assist in formulating effective strategies to debunk rumors and curb their spread on social media.

Methods: A total of 2,053 original postings and 100,348 comments that replied to the postings of five false rumors related to COVID-19 (dated from January 20, 2020, to June 28, 2020) belonging to three categories, authoritative, social, and political, on Sina Weibo in China were randomly selected. To study the effectiveness of different debunking methods, a new annotation scheme was proposed that divides debunking methods into six categories: denial, further fact-checking, refutation, person response, organization response, and combination methods. Text classifiers using deep learning methods were built to automatically identify four user stances in comments that replied to debunking postings: supporting, denying, querying, and commenting stances. Then, based on stance responses, a debunking effectiveness index (DEI) was developed to measure the effectiveness of different debunking methods.

Results: The refutation method with cited evidence has the best debunking effect, whether used alone or in combination with other debunking methods. For the social category of Car rumor and political category of Russia rumor, using the refutation method alone can achieve the optimal debunking effect. For authoritative rumors, a combination method has the optimal debunking effect, but the most effective combination method requires avoiding the use of a combination of a debunking method where the person or organization defamed by the authoritative rumor responds personally and the refutation method.

Conclusion: The findings provide relevant insights into ways to debunk rumors effectively, support crisis management of false information, and take necessary actions in response to rumors amid public health emergencies.