Misinformation and Its Correction: Continued Influence and Successful Debiasing

Perceived social presence reduces fact-checking

Today's media landscape affords people access to richer information than ever before, with many individuals opting to consume content through social channels rather than traditional news sources. Although people frequent social platforms for a variety of reasons, we understand little about the consequences of encountering new information in these contexts, particularly with respect to how content is scrutinized. This research tests how perceiving the presence of others (as on social media platforms) affects the way that individuals evaluate information-in particular, the extent to which they verify ambiguous claims. Eight experiments using incentivized real effort tasks found that people are less likely to fact-check statements when they feel that they are evaluating them in the presence of others compared with when they are evaluating them alone. Inducing vigilance immediately before evaluation increased fact-checking under social settings.

Perceived social presence reduces fact-checking

Today's media landscape affords people access to richer information than ever before, with many individuals opting to consume content through social channels rather than traditional news sources. Although people frequent social platforms for a variety of reasons, we understand little about the consequences of encountering new information in these contexts, particularly with respect to how content is scrutinized. This research tests how perceiving the presence of others (as on social media platforms) affects the way that individuals evaluate information-in particular, the extent to which they verify ambiguous claims. Eight experiments using incentivized real effort tasks found that people are less likely to fact-check statements when they feel that they are evaluating them in the presence of others compared with when they are evaluating them alone. Inducing vigilance immediately before evaluation increased fact-checking under social settings.

Myths about HIV and AIDS among serodiscordant couples in Malawi

Purpose

The purpose of this paper is to report on research that uncovered myths about HIV and AIDS held by serodiscordant couples in Malawi, and the sources of these myths. The paper reflects on how the myths affect serodiscordant couples’ engagement with HIV and AIDS information.

Design/methodology/approach

Van Manen’s (1997) approach to analysis of phenomenological data was used to analyse data from in-depth interviews conducted in Malawi with 21 serodiscordant couples and three individuals who had separated from their partners because of serodiscordance.

Findings

Serodiscordant couples in Malawi believe and hold on to some inaccurate HIV and AIDS information that can be seen as “myths”. Some of these myths are perpetuated by official HIV and AIDS information when it is translated into the local languages. Other myths derive from social norms of the societies where the couples live.

Practical implications

The findings of this paper have practical implications for how HIV and AIDS information providers should engage with target audiences to understand the origins of the myths they hold. The findings also imply that some myths have technical, religious, moral and cultural bases which need to be addressed before challenging the myth itself.

Originality/value

Using real-life descriptions of experiences of HIV and AIDS information provided by serodiscordant couples, the authors reveal how myths can affect engagement with the information. The authors make recommendations on how to address myths in ways that contribute to a positive experience of HIV and AIDS information by serodiscordant couples.

Neutralizing misinformation through inoculation: Exposing misleading argumentation techniques reduces their influence

Misinformation can undermine a well-functioning democracy. For example, public misconceptions about climate change can lead to lowered acceptance of the reality of climate change and lowered support for mitigation policies. This study experimentally explored the impact of misinformation about climate change and tested several pre-emptive interventions designed to reduce the influence of misinformation. We found that false-balance media coverage (giving contrarian views equal voice with climate scientists) lowered perceived consensus overall, although the effect was greater among free-market supporters. Likewise, misinformation that confuses people about the level of scientific agreement regarding anthropogenic global warming (AGW) had a polarizing effect, with free-market supporters reducing their acceptance of AGW and those with low free-market support increasing their acceptance of AGW. However, we found that inoculating messages that (1) explain the flawed argumentation technique used in the misinformation or that (2) highlight the scientific consensus on climate change were effective in neutralizing those adverse effects of misinformation. We recommend that climate communication messages should take into account ways in which scientific content can be distorted, and include pre-emptive inoculation messages.

E-Health literacy of medical and health sciences university students in Mashhad, Iran in 2016: a pilot study

BACKGROUND

In order to provide a better healthcare education to the society, health care students should have an acceptable electronic health (E-Health) literacy.

OBJECTIVE

The aim of this study was to assess the level of E-Health literacy of Medicine and Health Sciences university students in Mashhad, Iran.

METHODS

This cross-sectional study was performed on 192 students of Mashhad University of Medical Sciences using a validated Persian translate of the E-Health literacy scale (P-EHEALS) questionnaire in 2016. Demographic data including age, monthly income, level of education, preference of website for obtaining health related information and minutes of Internet use per day were obtained from the subjects. Independent-samples t-test and analysis of variance (ANOVA) were used for comparison between groups, and Pearson correlation coefficient and linear regression were used to assess the correlation between study parameters and EHEALS score using SPSS version 21.

RESULTS

A total of 192 (67.2% female and 32.8% male) subjects with mean age of 24.71±5.30 years participated in the study. Mean P-EHEALS score of the subjects was 28.21±6.95. There was a significant difference in P-EHEALS score between genders (p<0.001), department (p=0.001), education level (p<0.001) and health status (p=0.003) as well as monthly income (p=0.03), website preference categories (p=0.02). Male students were significantly more likely to gain higher P-EHEALS scores.

CONCLUSION

The level of E-Health literacy was low in Medical and Health Sciences university students in Mashhad. More studies are needed to assess the contributors to E-Health literacy.

Processing political misinformation: comprehending the Trump phenomenon

This study investigated the cognitive processing of true and false political information. Specifically, it examined the impact of source credibility on the assessment of veracity when information comes from a polarizing source (Experiment 1), and effectiveness of explanations when they come from one's own political party or an opposition party (Experiment 2). These experiments were conducted prior to the 2016 Presidential election. Participants rated their belief in factual and incorrect statements that President Trump made on the campaign trail; facts were subsequently affirmed and misinformation retracted. Participants then re-rated their belief immediately or after a delay. Experiment 1 found that (i) if information was attributed to Trump, Republican supporters of Trump believed it more than if it was presented without attribution, whereas the opposite was true for Democrats and (ii) although Trump supporters reduced their belief in misinformation items following a correction, they did not change their voting preferences. Experiment 2 revealed that the explanation's source had relatively little impact, and belief updating was more influenced by perceived credibility of the individual initially purporting the information. These findings suggest that people use political figures as a heuristic to guide evaluation of what is true or false, yet do not necessarily insist on veracity as a prerequisite for supporting political candidates.

Publicly Available Online Tool Facilitates Real-Time Monitoring Of Vaccine Conversations And Sentiments

Real-time monitoring of mainstream and social media can inform public health practitioners and policy makers about vaccine sentiment and hesitancy. We describe a publicly available platform for monitoring vaccination-related content, called the Vaccine Sentimeter. With automated data collection from 100,000 mainstream media sources and Twitter, natural-language processing for automated filtering, and manual curation to ensure accuracy, the Vaccine Sentimeter offers a global real-time view of vaccination conversations online. To assess the system's utility, we followed two events: polio vaccination in Pakistan after a news story about a Central Intelligence Agency vaccination ruse and subsequent attacks on health care workers, and a controversial episode in a television program about adverse events following human papillomavirus vaccination. For both events, increased online activity was detected and characterized. For the first event, Twitter response to the attacks on health care workers decreased drastically after the first attack, in contrast to mainstream media coverage. For the second event, the mainstream and social media response was largely positive about the HPV vaccine, but antivaccine conversations persisted longer than the provaccine reaction. Using the Vaccine Sentimeter could enable public health professionals to detect increased online activity or sudden shifts in sentiment that could affect vaccination uptake.

Is It Time for Vaccination to "Go Viral"?

To promote and sustain excellent vaccination coverage, while preserving the key core values of ethics, truth, transparency and trust, the vaccine community should adopt modern digital communication strategies. This article summarizes our views-as experts in multidisciplinary field of vaccinology (consisting of an anthropologist, a public health policy advisor, a vaccine industry expert, a health care journalist and a practicing physician)-which were presented at a satellite symposium held at the 33rd European Society of Paediatric Infectious Disease conference in Leipzig, Germany, in May 2015. This article aims to suggest and recommend strategies to promote vaccination awareness, and highlight proactive measures for building, maintaining and enhancing trust in vaccination through innovative communication and evidence-based interaction with the end user. We believe that converting the results of vaccine research into a successful vaccination program, and replacing misinformation with evidence-based communication, will require a multidisciplinary approach that embraces modern digital and tailored applications to reach out to all populations.

Why Do People Believe What They Do? A Functionalist Perspective

Why do people believe what they do? Scholars and laypeople alike tend to answer this question by focusing on the representational functions of beliefs (i.e., representing the world accurately). However, a growing body of theory and research indicates that beliefs also can serve important hedonic functions (i.e., decreasing/increasing negative or positive emotional states). In this manuscript, we describe: (1) the features of belief, (2) the functions served by beliefs, with a focus on the hedonic function, (3) an integrative framework highlighting the hedonic function and contrasting it with the representational function, (4) the implications of our framework, and related future research directions for individual differences in belief, belief change, and the ways in which beliefs contribute to adaptive versus maladaptive psychological functioning.

Single- and Dual-Process Models of Biased Contingency Detection

Decades of research in causal and contingency learning show that people's estimations of the degree of contingency between two events are easily biased by the relative probabilities of those two events. If two events co-occur frequently, then people tend to overestimate the strength of the contingency between them. Traditionally, these biases have been explained in terms of relatively simple single-process models of learning and reasoning. However, more recently some authors have found that these biases do not appear in all dependent variables and have proposed dual-process models to explain these dissociations between variables. In the present paper we review the evidence for dissociations supporting dual-process models and we point out important shortcomings of this literature. Some dissociations seem to be difficult to replicate or poorly generalizable and others can be attributed to methodological artifacts. Overall, we conclude that support for dual-process models of biased contingency detection is scarce and inconclusive.

A comparison of language use in pro- and anti-vaccination comments in response to a high profile Facebook post

BACKGROUND

Vaccinations are important for controlling the spread of disease, yet an increasing number of people are distrustful of vaccines, and choose not to (fully) vaccinate themselves and their children. One proposed contributor to this distrust is anti-vaccination misinformation available on the internet, where people search for and discuss health information. The language people use in these discussions can provide insights into views about vaccination.

METHODS

Following a prominent Facebook post about childhood vaccination, language used by participants in a comment thread was analysed using LIWC (Linguistic Inquiry and Word Count). Percentage of words used across a number of categories was compared between pro-vaccination, anti-vaccination, and unrelated (control) comments.

RESULTS

Both pro- and anti-vaccination comments used more risk-related and causation words, as well as fewer positive emotion words compared to control comments. Anti-vaccine comments were typified by greater analytical thinking, lower authenticity, more body and health references, and a higher percentage of work-related word use in comparison to pro-vaccine comments, plus more money references than control comments. In contrast, pro-vaccination comments were more authentic, somewhat more tentative, and evidenced higher anxiety words, as well as more references to family and social processes when compared to anti-vaccination comments.

CONCLUSION

Although the anti-vaccination stance is not scientifically-based, comments showed evidence of greater analytical thinking, and more references to health and the body. In contrast, pro-vaccination comments demonstrated greater comparative anxiety, with a particular focus on family and social processes. These results may be indicative of the relative salience of these issues and emotions in differing understandings of the benefits and risks of vaccination. Text-based analysis is a potentially useful and ecologically valid tool for assessing perceptions of health issues, and may provide unique information about particular concerns or arguments expressed on social media that could inform future interventions.

Going with the Grain of Cognition: Applying Insights from Psychology to Build Support for Childhood Vaccination

Childhood vaccination is widely considered to be one of the most successful public health interventions. Yet, the effective delivery of vaccination depends upon public willingness to vaccinate. Recently, many countries have faced problems with vaccine hesitancy, where a growing number of parents perceive vaccination to be unsafe or unnecessary, leading some to delay or refuse vaccines for their children. Effective intervention strategies for countering this problem are currently sorely lacking, however. Here, we propose that this may be because existing strategies are grounded more in intuition than insights from psychology. Consequently, such strategies are sometimes at variance with basic psychological principles and assumptions. By going against the grain of cognition, such strategies potentially run the risk of undermining persuasive efforts to reduce vaccine hesitancy. We demonstrate this by drawing on key insights from cognitive and social psychology to show how various known features of human psychology can lead many intuitively appealing intervention strategies to backfire, yielding unintended and undesirable repercussions. We conclude with a summary of potential avenues of investigation that may be more effective in addressing vaccine hesitancy. Our key message is that intervention strategies must be crafted that go with the grain of cognition by incorporating key insights from the psychological sciences.

Communication Skills for Patient Engagement: Argumentation Competencies As Means to Prevent or Limit Reactance Arousal, with an Example from the Italian Healthcare System

The paper discusses the role of argumentative competencies for the achievement of patient engagement through communication in doctor-patient consultations. The achievement of patient engagement is being proposed by recent studies as a condition that can facilitate in particular patient adherence, which involves behavior change. One obstacle to behavior change that has been observed is reactance, i.e., resistance to persuasive messages when a threat to freedom is perceived. In the medical field, reactance theory has been mostly applied in the field of mental health, less frequently to understand non-adherence in general. However, a few studies have revealed that reactance can actually explain in part the motives behind non-adherence. These studies propose that the arousal of reactance could be limited or prevented by adopting relational measures aimed at giving patients the feeling that they still hold some control over the process of care and that the "impositions" on their freedoms are acceptable because they have had the opportunity to decide about them. However, they do not discuss how these strategies should be operationalized at the dialogical level. A debated issue in the study of reactance is the role played by knowledge. It seems that pure information regarding an issue is likely to represent a threat in itself. Complementary to this is the finding that quality of argument does not impact on the degree of reactance. These findings pose a problem in view of the goal of patient education, itself considered as a necessary premise for any process of patient engagement and adherence. It seems necessary to move away from a conception of education as mere transmission of information and look for more effective ways of transferring knowledge to patients. With regard to this issue, the paper argues that useful insights can be found in studies on science education, in which it is shown experimentally that argumentative processes favor learning and understanding. Drawing on previous studies and taking an interdisciplinary perspective on the issue, the paper brings into the discussion on engagement concepts developed in the field of argumentation theory, showing how the suggestions for avoiding reactance could be realized dialogically.

The Consequences of Reading Inaccurate Information

We are regularly confronted with statements that are inaccurate, sometimes obviously so. Unfortunately, people can be influenced by and rely upon inaccurate information, engaging in less critical evaluation than might be hoped. Empirical studies have consistently demonstrated that even when people should know better, reading inaccurate information can affect their performance on subsequent tasks. What encourages people’s encoding and use of false statements? The current article outlines how reliance on inaccurate information is a predictable consequence of the routine cognitive processes associated with memory, problem solving, and comprehension. This view helps identify conditions under which inaccurate information is more or less likely to influence subsequent decisions. These conditions are informative in the consideration of information-design approaches and instructional methods intended to support critical thinking.

Motivated Rejection of Science

Some scientifically well-established results—such as the fact that emission of greenhouse gases produces global warming—are rejected by sizable proportions of the population in the United States and other countries. Rejection of scientific findings is mostly driven by motivated cognition: People tend to reject findings that threaten their core beliefs or worldview. At present, rejection of scientific findings by the U.S. public is more prevalent on the political right than the left. Yet the cognitive mechanisms driving rejection of science, such as the superficial processing of evidence toward the desired interpretation, are found regardless of political orientation. General education and scientific literacy do not mitigate rejection of science but, rather, increase the polarization of opinions along partisan lines. In contrast, specific knowledge about the mechanisms underlying a scientific result—such as human-made climate change—can increase the acceptance of that result.

Adding Natural Areas to Social Indicators of Intra-Urban Health Inequalities among Children: A Case Study from Berlin, Germany

Research suggests that there is a relationship between the health of urban populations and the availability of green and water spaces in their daily environment. In this paper, we analyze the potential intra-urban relationships between children's health determinants and outcomes and natural areas in Berlin, Germany. In particular, health indicators such as deficits in viso-motoric development in children are related to environmental indicators such as the natural area cover, natural area per capita and distance to natural areas; however, these indicators are also correlated with social determinants of health. The methodological approach used in this study included bivariate and multivariate analyses to explore the relations between health inequalities and social, socio-economic, and land use parameters. The results on a sub-district level indicated that there was a correlation between natural areas and social health determinants, both of which displayed a certain intra-urban spatial pattern. In particular, a lower percentage of natural area cover was correlated with deficits in viso-motoric development. However, results with percentage of natural area cover and per capita natural area with childhood overweight were not conclusive. No significant correlation was found for percentage of natural area cover and overweight, while significant negative correlation values were found between overweight and per capita natural area. This was identified particularly in the districts that had lower social conditions. On the other hand, the districts with the highest social conditions had the comparatively lowest levels of complete measles immunization. This study may facilitate public health work by identifying the urban areas in which the strengthening of health resources and actions should be prioritized and also calls for the inclusion of natural areas among the social health indicators included in intra-urban health inequality tools.

Beliefs about Childhood Vaccination in the United States: Political Ideology, False Consensus, and the Illusion of Uniqueness

Several contagious diseases were nearly eradicated through childhood vaccination, but some parents have decided in recent years not to fully vaccinate their children, raising new public health concerns. The question of whether and how beliefs about vaccination are linked to political ideology has been hotly debated. This study investigates the effects of ideology on perceptions of harms and benefits related to vaccination as well as judgments of others' attitudes. A total of 367 U.S. adults (131 men, 236 women; Mage = 34.92 years, range = 18-72) completed an online survey through Mechanical Turk. Results revealed that liberals were significantly more likely to endorse pro-vaccination statements and to regard them as "facts" (rather than "beliefs"), in comparison with moderates and conservatives. Whereas conservatives overestimated the proportion of like-minded others who agreed with them, liberals underestimated the proportion of others who agreed with them. That is, conservatives exhibited the "truly false consensus effect," whereas liberals exhibited an "illusion of uniqueness" with respect to beliefs about vaccination. Conservative and moderate parents in this sample were less likely than liberals to report having fully vaccinated their children prior to the age of two. A clear limitation of this study is that the sample is not representative of the U.S.

POPULATION

Nevertheless, a recognition of ideological sources of potential variability in health-related beliefs and perceptions is a prerequisite for the design of effective forms of public communication.

Qualitative inquiry into reasons why vaccination messages fail

A growing tendency to refuse child vaccination is commonly regarded as a reason for concern. Attempts to promote vaccination by authorities often prove to be unsuccessful or even counter-productive. The aim of this study was to explore how parents perceived four messages used to promote vaccination. In eight focus groups ( N = 73), we presented participants with messages and asked them to assess them. Using thematic analysis, we identified themes that our participants considered the most important. Messages that promote vaccination should be unambiguous, more balanced, not focus on repeating the negative effects of vaccine-preventable diseases and provide links to the evidence.

Epilepsy misconceptions and stigma reduction: Current status in Western countries

OBJECTIVE

This systematized literature review identified reports describing epilepsy misconceptions in the developed Western countries and research interventions focused on reducing these misconceptions.

MATERIALS AND METHODS

English language publications from January 2004 to January 2015 that described original research conducted in Europe, North/Central/South America, or Australia on misconceptions about epilepsy among the general public were used for this review.

RESULTS

Eighty-one publications were selected. Most studies were conducted in the Americas (N=30) and Europe (N=31). Misconceptions and attitudes about epilepsy were assessed among clinical providers (N=9), family members of people with epilepsy (PWE) (N=5), teachers (N=11), students (N=22), and the general public (N=25). Most studies used structured questionnaires, sometimes adding open-ended questions. Misconceptions reflected socially exclusionary attitudes directed at PWE, ignorance about treatment, and overgeneralizations that are stigmatizing when applied to all PWE. Misconceptions were more prevalent in those with less education, lower socioeconomic status, and no exposure to PWE. There were only 12 intervention studies. While intervention studies were generally effective in improving attitudes, many were targeted to healthcare and education settings, were time-intensive, and impractical for broad general population implementation. None incorporated newer technology-based strategies regarding effective health communication approaches.

CONCLUSIONS

Types of epilepsy misconceptions were similar in reports published over the last decade, although most referred to misconceptions that have already been previously described. Existing questionnaires may fail to identify more subtle forms of current misconceptions and negative attitudes. Few interventional studies specifically target epilepsy stigma. Practical and broad scalable approaches to destigmatize epilepsy may help reduce misconceptions.

Concern About Hunger May Increase Receptivity to GMOs

Due to a phenomenon known as the 'backfire effect', intuition-based opinions can be inadvertently strengthened by evidence-based counterarguments. Students' views on genetically modified organisms (GMOs) may be subject to this effect. We explored the impact of an empathetically accessible topic, world hunger, on receptivity to GMO technology as an alternative to direct evidence-based approaches.

Manipulating Google's Knowledge Graph Box to Counter Biased Information Processing During an Online Search on Vaccination: Application of a Technological Debiasing Strategy

Background

One of people’s major motives for going online is the search for health-related information. Most consumers start their search with a general search engine but are unaware of the fact that its sorting and ranking criteria do not mirror information quality. This misconception can lead to distorted search outcomes, especially when the information processing is characterized by heuristic principles and resulting cognitive biases instead of a systematic elaboration. As vaccination opponents are vocal on the Web, the chance of encountering their non‒evidence-based views on immunization is high. Therefore, biased information processing in this context can cause subsequent impaired judgment and decision making. A technological debiasing strategy could counter this by changing people’s search environment.

Objective

This study aims at testing a technological debiasing strategy to reduce the negative effects of biased information processing when using a general search engine on people’s vaccination-related knowledge and attitudes. This strategy is to manipulate the content of Google’s knowledge graph box, which is integrated in the search interface and provides basic information about the search topic.

Methods

A full 3x2 factorial, posttest-only design was employed with availability of basic factual information (comprehensible vs hardly comprehensible vs not present) as the first factor and a warning message as the second factor of experimental manipulation. Outcome variables were the evaluation of the knowledge graph box, vaccination-related knowledge, as well as beliefs and attitudes toward vaccination, as represented by three latent variables emerged from an exploratory factor analysis.

Results

Two-way analysis of variance revealed a significant main effect of availability of basic information in the knowledge graph box on participants’ vaccination knowledge scores (F_2,273=4.86, P=.01), skepticism/fear of vaccination side effects (F_2,273=3.5, P=.03), and perceived information quality (F_2,273=3.73, P=.02). More specifically, respondents receiving comprehensible information appeared to be more knowledgeable, less skeptical of vaccination, and more critical of information quality compared to participants exposed to hardly comprehensible information. Although, there was no significant interaction effect between the availability of information and the presence of the warning, there was a dominant pattern in which the presence of the warning appeared to have a positive influence on the group receiving comprehensible information while the opposite was true for the groups exposed to hardly comprehensible information and no information at all. Participants evaluated the knowledge graph box as moderately to highly useful, with no significant differences among the experimental groups.

Conclusion

Overall, the results suggest that comprehensible information in the knowledge graph box positively affects participants’ vaccination-related knowledge and attitudes. A small change in the content retrieval procedure currently used by Google could already make a valuable difference in the pursuit of an unbiased online information search. Further research is needed to gain insights into the knowledge graph box’s entire potential.

Misinformation in Online Social Networks

Online social networks have become an effective and important social platform for communication, opinions exchange, and information sharing. However, they also make it possible for rapid and wide misinformation diffusion, which may lead to pernicious influences on individuals or society. Hence, it is extremely important and necessary to detect the misinformation propagation by placing monitors.

In this article, we first define a general misinformation-detection problem for the case where the knowledge about misinformation sources is lacking, and show its equivalence to the influence-maximization problem in the reverse graph. Furthermore, considering node vulnerability, we aim to detect the misinformation reaching to a specific user. Therefore, we study a τ-Monitor Placement problem for cases where partial knowledge of misinformation sources is available and prove its # P complexity. We formulate a corresponding integer program, tackle exponential constraints, and propose a Minimum Monitor Set Construction (MMSC) algorithm, in which the cut-set 2 has been exploited in the estimation of reachability of node pairs. Moreover, we generalize the problem from a single target to multiple central nodes and propose another algorithm based on a Monte Carlo sampling technique. Extensive experiments on real-world networks show the effectiveness of proposed algorithms with respect to minimizing the number of monitors.

Interactive effects of the probability of the cue and the probability of the outcome on the overestimation of null contingency

Overestimations of null contingencies between a cue, C, and an outcome, O, are widely reported effects that can arise for multiple reasons. For instance, a high probability of the cue, P(C), and a high probability of the outcome, P(O), are conditions that promote such overestimations. In two experiments, participants were asked to judge the contingency between a cue and an outcome. Both P(C) and P(O) were given extreme values (high and low) in a factorial design, while maintaining the contingency between the two events at zero. While we were able to observe main effects of the probability of each event, our experiments showed that the cue- and outcome-density biases interacted such that a high probability of the two stimuli enhanced the overestimation beyond the effects observed when only one of the two events was frequent. This evidence can be used to better understand certain societal issues, such as belief in pseudoscience, that can be the result of overestimations of null contingencies in high-P(C) or high-P(O) situations.

Patient engagement and shared decision-making: What do they look like in neurology practice?

Neurology is inherently patient-centered given that clinical uncertainty is common, forcing physicians, patients, and families to partner on treatment approach. An increasing emphasis on patient-centered care, patient engagement, and shared decision-making (SDM) in health care provides neurologists with an opportunity to reassess current clinical approaches to decision-making. Such assessment is not simply theoretical but has clear practice implications, with patients indicating a desire for SDM and calls for reimbursement to be tied to demonstration of SDM in practice. We present a framework for how neurologists enhance patient-centered practice by (1) eliciting patients' values and goals, (2) targeting discussion of clinical options to those values and goals, and (3) partnering with patients to make individualized decisions. We also highlight resources that facilitate SDM and examples of SDM in neurology clinical practice.

Rational Irrationality: Modeling Climate Change Belief Polarization Using Bayesian Networks

Belief polarization is said to occur when two people respond to the same evidence by updating their beliefs in opposite directions. This response is considered to be "irrational" because it involves contrary updating, a form of belief updating that appears to violate normatively optimal responding, as for example dictated by Bayes' theorem. In light of much evidence that people are capable of normatively optimal behavior, belief polarization presents a puzzling exception. We show that Bayesian networks, or Bayes nets, can simulate rational belief updating. When fit to experimental data, Bayes nets can help identify the factors that contribute to polarization. We present a study into belief updating concerning the reality of climate change in response to information about the scientific consensus on anthropogenic global warming (AGW). The study used representative samples of Australian and U.S.

PARTICIPANTS

Among Australians, consensus information partially neutralized the influence of worldview, with free-market supporters showing a greater increase in acceptance of human-caused global warming relative to free-market opponents. In contrast, while consensus information overall had a positive effect on perceived consensus among U.S. participants, there was a reduction in perceived consensus and acceptance of human-caused global warming for strong supporters of unregulated free markets. Fitting a Bayes net model to the data indicated that under a Bayesian framework, free-market support is a significant driver of beliefs about climate change and trust in climate scientists. Further, active distrust of climate scientists among a small number of U.S. conservatives drives contrary updating in response to consensus information among this particular group.

Highlighting consensus among medical scientists increases public support for vaccines: evidence from a randomized experiment

Background

A substantial minority of American adults continue to hold influential misperceptions about childhood vaccine safety. Growing public concern and refusal to vaccinate poses a serious public health risk. Evaluations of recent pro-vaccine health communication interventions have revealed mixed results (at best). This study investigated whether highlighting consensus among medical scientists about childhood vaccine safety can lower public concern, reduce key misperceptions about the discredited autism-vaccine link and promote overall support for vaccines.

Methods

American adults (N = 206) were invited participate in an online survey experiment. Participants were randomly assigned to either a control group or to one of three treatment interventions. The treatment messages were based on expert-consensus estimates and either normatively described or prescribed the extant medical consensus: “90 % of medical scientists agree that vaccines are safe and that all parents should be required to vaccinate their children”.

Results

Compared to the control group, the consensus-messages significantly reduced vaccine concern (M = 3.51 vs. M = 2.93, p < 0.01) and belief in the vaccine-autism-link (M = 3.07 vs M = 2.15, p < 0.01) while increasing perceived consensus about vaccine safety (M = 83.93 vs M = 89.80, p < 0.01) and public support for vaccines (M = 5.66 vs M = 6.22, p < 0.01). Mediation analysis further revealed that the public’s understanding of the level of scientific agreement acts as an important “gateway” belief by promoting public attitudes and policy support for vaccines directly as well as indirectly by reducing endorsement of the discredited autism-vaccine link.

Conclusion

These findings suggest that emphasizing the medical consensus about (childhood) vaccine safety is likely to be an effective pro-vaccine message that could help prevent current immunization rates from declining. We recommend that clinicians and public health officials highlight and communicate the high degree of medical consensus on (childhood) vaccine safety when possible.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2541-4) contains supplementary material, which is available to authorized users.

Identifying Parents Who Are Amenable to Pro-Vaccination Conversations

While health care providers are often cited as parents’ most trusted source for information and advice about vaccination, parents differ in their level of receptiveness to pro-vaccination conversations. The purpose of this research was to identify points in individual parents’ decision-making processes when parents are particularly open to receiving information and advice from their children’s health care providers. Interview data were collected from 20 mothers and 5 couples. Analysis of these data suggested 3 primary circumstances when parents were particularly open to receiving information and advice: during parents’ initial decision-making, as parents continued to assess vaccination options, and during particular circumstances that prompted parents to reconsider previously made vaccination choices. These results provide a mechanism for providers to identify parents who may be particularly receptive to pro-vaccination conversations. By prioritizing conversations with parents at one of these points, health care providers’ efforts at promoting vaccination may be more effective.

Recent changes in attitudes of US adults toward people with epilepsy - Results from the 2005 SummerStyles and 2013 FallStyles surveys

OBJECTIVES

This study aimed to evaluate the validity and the reliability of two components of the Attitudes and Beliefs about Living with Epilepsy (ABLE) scale and to measure the magnitude of the public's attitudes and behaviors toward persons with epilepsy using U.S. nationally representative samples in 2005 and 2013.

METHODS

We used data from the cross-sectional 2005 SummerStyles and 2013 FallStyles surveys to test the underlying structure of 16 items of the work and role expectations and personal fear and social avoidance subscales of ABLE by performing exploratory factor analysis (EFA). We estimated the percentages and 95% confidence intervals of adults who agreed or disagreed with each item. We also calculated the mean score of each subscale and used linear regression to obtain means adjusted for selected sociodemographic characteristics.

RESULTS

Exploratory factor analysis confirmed a two-factor structure, but with the exception of omitting one item regarding work activities persons with epilepsy cannot do work activities safely, from one subscale. Both subscales also showed a high level of reliability (Cronbach's α=0.8 and Cronbach's α=0.9, respectively). Among the items in the work and role expectations subscale, a significantly higher percentage of adults in 2013 than in 2005 reported strongly or moderately agreeing that persons with epilepsy can do anything as well as anyone else (56.4%, 95% CI=54.1-58.7 vs. 47.6%, 95% CI=45.8-49.3) and can cope with everyday life (69.8%, 95% CI=67.5-72.0 vs. 55.0%, 95% CI=53.2-56.7). Among the items in the personal fear and social avoidance subscale, a significantly higher percentage of adults reported in 2013 than in 2005 strongly or moderately agreeing that they would be nervous around persons with epilepsy (25.4%, 95% CI=23.4-27.5 vs. 16.8%, 95% CI=15.4-18.2) and would avoid those with frequent seizures (12.4%, 95% CI=11.0-13.9 vs. 7.6%, 95% CI=6.7-8.7). The adjusted mean score for work and role expectations differed by sex, age, race/ethnicity, education, and income in both years. The adjusted mean score for personal fear and social avoidance differed by sex, age, race/ethnicity, education, and marital status. Negative attitudes were slightly but significantly higher in 2013 than in 2005.

CONCLUSIONS

Centers for Disease Control and Prevention's ABLE scale is a valid and reliable scale that can be used to study and to track the public's attitudes and behaviors toward persons with epilepsy. Compared with 2005, US adults' reported level of expectations for persons with epilepsy improved only in certain aspects by 2013. Adults' level of personal fear and intention for social avoidance worsened from 2005 to 2013. Because the levels of expectations and of fear and social avoidance differed by sociodemographic characteristics, continued efforts tailored to specific groups are needed. To supplement educational programs focused on improving knowledge, new communication approaches grounded in decision theory that quell risk perceptions and allay negative emotional responses are recommended.

Using Behavioral Insights to Increase Vaccination Policy Effectiveness

Even though there are policies in place, and safe and effective vaccines available, almost every country struggles with vaccine hesitancy, that is, a delay in acceptance or refusal of vaccination. Consequently, it is important to understand the determinants of individual vaccination decisions to establish effective strategies to support the success of country-specific public health policies. Vaccine refusal can result from complacency, inconvenience, a lack of confidence, and a rational calculation of pros and cons. Interventions should, therefore, be carefully targeted to focus on the reason for non-vaccination. We suggest that there are several interventions that may be effective for complacent, convenient, and calculating individuals whereas interventions that might be effective for those who lack confidence are scarce. Thus, efforts should be concentrated on motivating the complacent, removing barriers for those for whom vaccination is inconvenient, and adding incentives and additional utility for the calculating. These strategies might be more promising, economic, and effective than convincing those who lack confidence in vaccination.