Viruses, Vaccines, and COVID-19: Explaining and Improving Risky Decision-making

"It's Not Literally True, But You Get the Gist:" How nuanced understandings of truth encourage people to condone and spread misinformation

People have a more-nuanced view of misinformation than the binary distinction between "fake news" and "real news" implies. We distinguish between the truth of a statement's verbatim details (i.e., the specific, literal information) and its gist (i.e., the general, overarching meaning), and suggest that people tolerate and intentionally spread misinformation in part because they believe its gist. That is, even when they recognize a claim as literally false, they may judge it as morally acceptable to spread because they believe it is true "in spirit." Prior knowledge, partisanship, and imagination increase belief in the gist. We argue that partisan conflict about the morality of spreading misinformation hinges on disagreements not only about facts but also about gists.

Gist Knowledge and Misinformation Acceptance: An Application of Fuzzy Trace Theory

Applying fuzzy trace theory to misinformation related to COVID-19, the present study (a) examines the roles of gist knowledge in predicting misinformation acceptance, and (b) further examines whether a gist cue in fact checking scales affects the level of gist knowledge. Study 1 (a survey) showed that categorical gist knowledge was negatively related to misinformation acceptance, whereas ordinal gist knowledge was not, when both types of knowledge were included in the model. In addition, Study 2 (an experiment) showed that fact checking scales containing a categorical gist cue resulted in greater categorical gist knowledge.

Scenario-Based Messages on Social Media Motivate COVID-19 Information Seeking

Communicating information about health risks empowers individuals to make informed decisions. To identify effective communication strategies, we manipulated the specificity, self-relevance, and emotional framing of messages designed to motivate information seeking about COVID-19 exposure risk. In Study 1 (N=221,829), we conducted a large-scale social media field study. Using Facebook advertisements, we targeted users by age and political attitudes. Episodic specificity drove engagement: Advertisements that contextualized risk in specific scenarios produced the highest click-through rates, across all demographic groups. In Study 2, we replicated and extended our findings in an online experiment (N=4,233). Message specificity (but not self-relevance or emotional valence) drove interest in learning about COVID-19 risks. Across both studies, we found that older adults and liberals were more interested in learning about COVID-19 risks. However, message specificity increased engagement across demographic groups. Overall, evoking specific scenarios motivated information seeking about COVID-19, facilitating risk communication to a broad audience.

Empathic Engagement With the COVID-19 Vaccine Hesitant in Private Facebook Groups: A Randomized Trial

BACKGROUND

Vaccine misinformation has been widely spread on social media, but attempts to combat it have not taken advantage of the attributes of social media platforms for health education.

METHODS

The objective was to test the efficacy of moderated social media discussions about COVID-19 vaccines in private Facebook groups. Unvaccinated U.S. adults were recruited using Amazon's Mechanical Turk and randomized. In the intervention group, moderators posted two informational posts per day for 4 weeks and engaged in relationship-building interactions with group members. In the control group, participants received a referral to Facebook's COVID-19 Information Center. Follow-up surveys with participants (N = 478) were conducted 6 weeks post-enrollment.

RESULTS

At 6 weeks follow-up, no differences were found in vaccination rates. Intervention participants were more likely to show improvements in their COVID-19 vaccination intentions (vs. stay same or decline) compared with control (p = .03). They also improved more in their intentions to encourage others to vaccinate for COVID-19. There were no differences in COVID-19 vaccine confidence or intentions between groups. General vaccine and responsibility to vaccinate were higher in the intervention compared with control. Most participants in the intervention group reported high levels of satisfaction. Participants engaged with content (e.g., commented, reacted) 11.8 times on average over the course of 4 weeks.

CONCLUSIONS

Engaging with vaccine-hesitant individuals in private Facebook groups improved some COVID-19 vaccine-related beliefs and represents a promising strategy.

Trust in public health institutions moderates the effectiveness of COVID-19 vaccine discussion groups on Facebook

BACKGROUND

Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake.

METHOD

We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook's COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants' partisan identity, political views, and information trust views.

RESULTS

We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P = .04), intentions to encourage others to vaccinate (P = .03), and vaccine confidence beliefs (P = .01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P = .008) and intentions to encourage others to vaccinate (P = .002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P = .048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P = .03), conservatives (P = .02), and participants who distrusted government (P = .02).

CONCLUSIONS

Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.

Critical tests of fuzzy trace theory in brain and behavior: uncertainty across time, probability, and development

Uncertainty permeates decisions from the trivial to the profound. Integrating brain and behavioral evidence, we discuss how probabilistic (varied outcomes) and temporal (delayed outcomes) uncertainty differ across age and individuals; how critical tests adjudicate between theories of uncertainty (prospect theory and fuzzy-trace theory); and how these mechanisms might be represented in the brain. The same categorical gist representations of gains and losses account for choices and eye-tracking data in both value-allocation (add money to gambles) and risky-choice tasks, disconfirming prospect theory and confirming predictions of fuzzy-trace theory. The analysis is extended to delay discounting and disambiguated choices, explaining hidden-zero effects that similarly turn on categorical distinctions between some gain and no gain, certain gain and uncertain gain, gain and loss, and now and later. Bold activation implicates dorsolateral prefrontal and posterior parietal cortices in gist strategies that are not just one tool in a grab-bag of cognitive options but rather are general strategies that systematically predict behaviors across many different tasks involving probabilistic and temporal uncertainty. High valuation (e.g., ventral striatum; ventromedial prefrontal cortex) and low executive control (e.g., lateral prefrontal cortex) contribute to risky and impatient choices, especially in youth. However, valuation in ventral striatum supports reward-maximizing and gist strategies in adulthood. Indeed, processing becomes less "rational" in the sense of maximizing gains and more noncompensatory (eye movements indicate fewer tradeoffs) as development progresses from adolescence to adulthood, as predicted. Implications for theoretically predicted "public-health paradoxes" are discussed, including gist versus verbatim thinking in drug experimentation and addiction.

Numeracy, gist, literal thinking and the value of nothing in decision making

The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.

Poorer decision making among college students during the COVID-19 pandemic: Evidence for "pandemic-brain"

OBJECTIVE

Did living through the COVID-19 pandemic cause healthy college students to experience "pandemic-brain," a phenomenon characterized by difficulties with various cognitive abilities? Did students shift from deliberative to more impulsive decision making?

PARTICIPANTS

We compared a pre-pandemic sample of 722 undergraduate students to 161 undergraduate students recruited in Fall 2020, during the COVID-19 pandemic.

METHOD

We compared scores on the Adult Decision Making Competence scale among participants who completed the task pre-pandemic or across two time points in Fall 2020, during the pandemic.

RESULTS

Decision making was less consistent and more reliant on gain/loss framing during the pandemic compared to pre-pandemic, but college students were no less confident in their decisions. No significant changes in decision making occurred during the pandemic.

CONCLUSIONS

These decision making changes could increase the risk of making an impulsive choice with negative health consequences affecting demands on student health centers and imperiling learning environments.

Social media: Why sharing interferes with telling true from false

Sharing on social media decreases true-false discrimination but focusing on accuracy helps people recognize what they already know. Process-oriented research offers hope in combatting misinformation.

How Does COVID-19 Risk Perception Affect Sense of Control? The Roles of Death Anxiety and Confucian Coping

This research examined the impact of COVID-19 risk perception on sense of control, testing the hypotheses that COVID-19 risk perception would reduce sense of control and that this effect would be mediated by death anxiety and moderated by Confucian coping. A series of six studies were conducted with Chinese participants (N = 2202) and employed different research designs in lab and real-life settings. Across the studies, we found that the perceived risk of COVID-19 impaired sense of control. Studies 3a to 5 further revealed that death anxiety mediated the adverse effect of COVID-19 risk perception on sense of control, and Studies 4 to 5 revealed that Confucian coping strategies alleviated the adverse effect of COVID-19 risk perception on sense of control. These findings shed new light on the psychological impact of risk perception in times of crisis and identify mitigating factors and boundary conditions.

Understanding the landscape of web-based medical misinformation about vaccination

Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.

Risk heatmaps as visual displays: Opening movie studios after the COVID-19 shutdown

Upon shutting down operations in early 2020 due to the COVID-19 pandemic, the movie industry assembled teams of experts to help develop guidelines for returning to operation. It resulted in a joint report, The Safe Way Forward, which was created in consultation with union members and provided the basis for negotiations with the studios. A centerpiece of the report was a set of heatmaps displaying SARS-CoV-2 risks for a shoot, as a function of testing rate, community infection prevalence, community transmission rate (R0), and risk measure (either expected number of cases or probability of at least one case). We develop and demonstrate a methodology for evaluating such complex displays, in terms of how well they inform potential users, in this case, workers deciding whether the risks of a shoot are acceptable. We ask whether individuals making hypothetical return-to-work decisions can (a) read display entries, (b) compare display entries, and (c) make inferences based on display entries. Generally speaking, respondents recruited through the Amazon MTurk platform could interpret the display information accurately and make coherent decisions, suggesting that heatmaps can communicate complex risks to lay audiences. Although these heatmaps were created for practical, rather than theoretical, purposes, these results provide partial support for theoretical accounts of visual information processing and identify challenges in applying them to complex settings.

Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory

HIGHLIGHTS

Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.

Incorporating Fuzzy Cognitive Inference for Vaccine Hesitancy Measuring

Vaccine hesitancy plays a key role in vaccine delay and refusal, but its measurement is still a challenge due to multiple intricacies and uncertainties in factors. This paper attempts to tackle this problem through fuzzy cognitive inference techniques. Firstly, we formulate a vaccine hesitancy determinants matrix containing multi-level factors. Relations between factors are formulated through group decision-making of domain experts, which results in a fuzzy cognitive map. The subjective uncertainty of linguistic variables is expressed by fuzzy numbers. A double-weighted method is designed to integrate the distinguished decisions, in which the subjective hesitancy is considered for each decision. Next, three typical scenarios are constructed to identify key and sensitive factors under different experimental conditions. The experimental results are further discussed, which enrich the approaches of vaccine hesitancy estimation for the post-pandemic global recovery.

Gist Representations and Decision-Making Processes Affecting Antibiotic Prescribing for Children with Acute Otitis Media

Objective. To test the predictions of fuzzy-trace theory regarding pediatric clinicians’ decision-making processes and risk perceptions about antibiotics for children with acute otitis media (AOM). Methods. We conducted an online survey experiment administered to a sample of 260 pediatric clinicians. We measured their risk perceptions and prescribing decisions across 3 hypothetical AOM treatment scenarios. Participants were asked to choose among the following options: prescribe antibiotics immediately, watchful waiting (“hedging”), or not prescribing antibiotics. Results. We identified 4 gists based on prior literature: 1) “why not take a risk?” 2) “antibiotics might not help but can hurt,” 3) “antibiotics do not have harmful side effects,” and 4) “antibiotics might have harmful side effects.” All 4 gists predicted risky choice (P < 0.001), and gist endorsements varied significantly between scenarios when antibiotics were indicated, F(2, 255) = 8.53, P < 0.001; F(2, 255) = 5.14, P < .01; and F(2, 255) = 3.56, P < 0.05 for the first 3 factors, respectively. In a logistic regression, more experienced clinicians were less likely to hedge (B = −0.05; P < 0.01). Conclusion. As predicted by fuzzy-trace theory, pediatric clinicians’ prescription decisions are associated with gist representations, which are distinct from verbatim risk estimates. Implications. Antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients.

When do persuasive messages on vaccine safety steer COVID-19 vaccine acceptance and recommendations? Behavioural insights from a randomised controlled experiment in Malaysia

Introduction

Vaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions.

Methods

A randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes.

Results

We found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms.

Conclusion

Message frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions.

Trial registration number

NCT05244356.

Internal and External Motivations and Risk Perception toward COVID-19 Vaccination in Adolescents in the U.S

The COVID-19 vaccine is widely available to adolescents in the U.S.; however, vaccine hesitancy poses a threat to full coverage. The literature shows that perceived risks and the presence or lack of motivators are determinants for vaccination decisions, yet research evidence from minors is scant. This study adopted the Protection Motivation framework to identify differences in these facilitators and compare the influence of internal and external motivators among American adolescents in COVID-19 vaccine uptake. A nationwide online survey analyzed 13−17-year-old teenagers’ COVID-19 beliefs as well as present or potential reasons for accepting the vaccine. Of the 439 participants, 21.18% were not and did not plan to get vaccinated. Another 52.39% had at least one dosage, of which over three-quarters were internally motivated (whereas those unvaccinated were more likely to be externally motivated, X2 = 4.117, p = 0.042). In unvaccinated individuals, older adolescents reported slightly more internal motivators than younger adolescents (t = −2.023, p = 0.046). Internal motivation was associated with higher risk perception (r2 = 0.06651, p = 0.001), but risk perception had a stronger relationship with vaccination status (r2 = 0.1816, p < 0.001), with vaccinated individuals showing higher risk perception than those unvaccinated (mean difference = 0.42 on a scale of 1−4; t = −3.603, p < 0.001); the risk perception difference was even greater between hesitant and non-hesitant participants (mean difference = 0.63; t = −0.892, p < 0.001). The relationship was moderated by perceived knowledge, where the difference in risk perception between vaccination status was only significant for those with low perceived knowledge (f = 10.59, p = 0.001). Increasing awareness of disease risks and stressing internal motivators may be key to improving uptake in young people. Future research could delve deeper into risk perception formation of adolescents and why and how it differs across populations.