Health-Related Disaster Communication and Social Media: Mixed-Method Systematic Review

Experiences of Governments and Public Health Agencies Regarding Crisis Communication During the COVID-19 Pandemic in the Digital Age: Protocol for a Systematic Review of Qualitative Studies

BACKGROUND

Governments and public health agencies worldwide experienced difficulties with social media-mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies.

OBJECTIVE

This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises.

METHODS

We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data-based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review.

RESULTS

The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024.

CONCLUSIONS

To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public.

TRIAL REGISTRATION

PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/58040.

Mapping automatic social media information disorder. The role of bots and AI in spreading misleading information in society

This paper presents an analysis on information disorder in social media platforms. The study employed methods such as Natural Language Processing, Topic Modeling, and Knowledge Graph building to gain new insights into the phenomenon of fake news and its impact on critical thinking and knowledge management. The analysis focused on four research questions: 1) the distribution of misinformation, disinformation, and malinformation across different platforms; 2) recurring themes in fake news and their visibility; 3) the role of artificial intelligence as an authoritative and/or spreader agent; and 4) strategies for combating information disorder. The role of AI was highlighted, both as a tool for fact-checking and building truthiness identification bots, and as a potential amplifier of false narratives. Strategies proposed for combating information disorder include improving digital literacy skills and promoting critical thinking among social media users.

Social Representations and Symbolic Coping: A Cross-Cultural Discourse Analysis of the COVID-19 Pandemic in Newspapers

This study used a framework grounded in social representations theory to investigate cross-cultural variation and consistency in the discursive construction of the COVID-19 pandemic by the mass media, in the week following WHO's declaration of a global pandemic in March 2020. News reports from media outlets in the United Kingdom and China were sourced, with articles from the most popular media sources selected for analysis. Four discourses were identified to be the most prominent representations present throughout these accounts: war; other illnesses; a general emergency; an unknown situation. The findings demonstrated consistency with past research, highlighting how the sociogenesis of social representations in the case of the COVID-19 pandemic followed a similar pattern to other novel infectious disease outbreaks. Consistency between UK and Chinese media accounts was identifiable throughout the construction of these discourses; however, variation was detectable regarding use of culturally relevant anchors for existing illness representations, along with Chinese media accounts constructing images of a comparatively optimistic local situation, whilst depicting the rest of the world as in the midst of a global emergency. Future research has the potential to build on these findings by going beyond media representations to explore actual lay population beliefs, attitudes, and opinions, considering how they compare to the representations portrayed in mass-mediated news reports.

"I am Young, Why Should I Vaccinate?" How empathetic and aggressive communication on social media impact young adults' attitudes toward COVID-19 vaccination

Introduction

To combat the current COVID-19 pandemic, high vaccination rates are of crucial value. However, young people in particular tend to be hesitant toward vaccination. On social media, young adults are often called to vaccinate in an aggressive tone, arguing that there is no choice than to vaccinate and that all else is wrong.

Methods

In an experimental study (N = 410), we investigated the effects of (a) empathetic vs. aggressive communication styles in social media postings and (b) the origin of the communicator on young adults' supportive attitudes toward COVID-19 vaccinations. We treated the gender of the communicator as a moderator, and expectancy violation, psychological distance as well as the perceived credibility of the communicator as mediators.

Results

Findings showed that an aggressive communication style generally had a negative impact on young adults' COVID-19 vaccination attitudes, fully mediated by expectancy violation and perceived credibility of the communicator. Gender and the origin of the communicator did not moderate this mediation processes.

Discussion

Further implications for online health communication strategies are discussed.

A data-based participatory approach for health equity and digital inclusion: prioritizing stakeholders

This article starts from the premise that projects informed by data science can address social concerns, beyond prioritizing the design of efficient products or services. How can we bring the stakeholders and their situated realities back into the picture? It is argued that data-based, participatory interventions can improve health equity and digital inclusion while avoiding the pitfalls of top-down, technocratic methods. A participatory framework puts users, patients and citizens as stakeholders at the centre of the process, and can offer complex, sustainable benefits, which go beyond simply the experience of participation or the development of an innovative design solution. A significant benefit for example is the development of skills, which should not be seen as a by-product of the participatory processes, but a central element of empowering marginalized or excluded communities to participate in public life. By drawing from different examples in various domains, the article discusses what can be learnt from implementations of schemes using data science for social good, human-centric design, arts and wellbeing, to argue for a data-centric, creative and participatory approach to address health equity and digital inclusion in tandem.

Institutional crisis communication during the COVID-19 pandemic in Switzerland. A qualitative study of the experiences of representatives of public health organizations

OBJECTIVES

To identify the main challenges in public communication encountered by representatives in Swiss health institutions during the first two waves of the COVID-19 pandemic.

METHODS

In-depth qualitative interviews were conducted with representatives of key public health institutions (N = 25) across Switzerland. Participants were asked to identify barriers, facilitators, problems, and solutions in their public communication. The interviews were analyzed thematically.

RESULTS

Swiss institutional communication faced internal challenges (e.g., lack of human resources and training, rigid organizational structure), external challenges related to the public (e.g., low health and scientific literacy, low levels of trust), and environmental challenges related to the broader context (e.g., infodemics). At the same time, institutions developed best practices to foster collaboration, promote transparency, and address misinformation.

CONCLUSION

Health organizations need a cultural shift to account for the increasing complexity of crisis communication. Their awareness of the importance of communication should match the implementation of enhanced dedicated infrastructures and processes.

PRACTICE IMPLICATIONS

Institutions need mechanisms allowing innovation and adaptation to prepare for future pandemics. Emphasis should be placed on training communication professionals who can design, develop, deliver, and evaluate texts that meet the information needs of the public, enhance health and scientific literacy, and counter mis/disinformation.

How health organizations communicate about COVID-19 on social media: a comparative content analysis

BACKGROUND

This study examined how different health organizations (i.e., the Chinese CDC, the Korean CDC, the United States CDC, and WHO) communicated about the COVID-19 pandemic on social media, thus providing implications for organizations touse social media effectively in global health crises in the future.

METHODS

Three bilingual researchers conducted a content analysis ofsocial media posts (N = 1,343) of these health organizations on Twitter and Sina Weibo to explore the frames of the COVID-19 pandemic, the purposes, and the strategies to communicate about it.

RESULTS

Prevention was the dominant frame of the social media content of these four health organizations. Information update was the major communication purpose for WHO, the United States CDC, and the Korean CDC; however, guidance was the primary communication purpose for the Chinese CDC. The United States CDC, the Chinese CDC, and the Korean CDC heavily relied on multiple social media strategies (i.e., visual, hyperlink, and authority quotation) in their communication to the public about the COVID-19 pandemic, whereas WHO primarily employed quoting authorities. Significantdifferences were revealed across these health organizations in frames, communication purposes, and strategies. Theoretical and practical implications and limitations were discussed.

CONCLUSIONS

This study examined how different global health organizations communicate about the COVID-19 pandemic on social media. We discussed how and why these global health organizations communicate the COVID-19 pandemic, which would help health-related organizations design messages strategically on global public health issues in the future.

Social media may hinder learning about science; social media's role in learning about COVID-19

Despite widespread concerns that misinformation is rampant on social media, little systematic and empirical research has been conducted on whether and how news consumption via social media affects people's accurate knowledge about COVID-19. Against this background, this study examines the causal effects of social media use on COVID-19 knowledge (i.e., both in the form of factual knowledge and misinformation detection) as well as the underlying mechanisms through which such effects occur. Based on original panel survey data across six weeks (W1 N = 1,363, W2 N = 752) in the U.S., we found that consuming news from social media fostered the perception that one need not actively seek news anymore because it would reach them anyway through their social connections (i.e., "news-finds-me" perception). This, in turn, can make one both uninformed and misinformed about COVID-19 issues. Furthermore, this mediated relationship is stronger among those who experience higher levels of information overload while on social media.

Social presence for strategic health messages: An examination of state governments' use of Twitter to tackle the Covid-19 pandemic

Scholars investigated the role of social presence theory in numerous communication contexts. However, we have limited knowledge about the impact of social presence strategies on public attention during a pandemic. This study fills this gap by investigating the connections between social presence strategies, Covid-19 strategies, and public attention. Twitter data of state governments from January 21, 2020 to July 21, 2020 were downloaded for this study. Content analysis of 1500 randomly selected posts revealed that social presence strategies were effective in generating public attention on Twitter. Furthermore, expressing appreciation, providing guidance, and informing the publics about governments' actions generated public attention. Theoretical and practical implications are discussed.

Impact of information timeliness and richness on public engagement on social media during COVID-19 pandemic: An empirical investigation based on NLP and machine learning

This paper investigates how information timeliness and richness affect public engagement using text data from China's largest social media platform during times of the COVID-19 pandemic. We utilize a similarity calculation method based on natural language processing (NLP) and text mining to evaluate three dimensions of information timeliness: retrospectiveness, immediateness, and prospectiveness. Public engagement is divided into breadth and depth. The empirical results show that information retrospectiveness is negatively associated with public engagement breadth but positively with depth. Both information immediateness and prospectiveness improved the breadth and depth of public engagement. Interestingly, information richness has a positive moderating effect on the relationships between information retrospectiveness, prospectiveness, and public engagement breadth but no significant effects on immediateness; meanwhile, it has a negative moderating effect on the relationship between retrospectiveness and depth but a positive effect on immediateness, prospectiveness. In the extension analysis, we constructed a supervised NLP model to identify and classify health emergency-related information (epidemic prevention and help-seeking) automatically. We find that public engagement differs in the two emergency-related information categories. The findings can promote a more responsive public health strategy that magnifies the transfer speed for critical information and mitigates the negative impacts of information uncertainty or false information.

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.

Social Support and Aggressive Communication on Social Network Sites during the COVID-19 Pandemic

During the COVID-19 pandemic, use of social networking sites (SNSs) surged in many countries, including the United States. This content analysis of a convenience sample of English language conversations examined how users sought and provided social support on three Western-dominated SNSs, Reddit (N = 100), YouTube (N = 100), and Facebook (N = 100), during the week following the declaration of COVID-19 as a pandemic. In addition to analyzing social support, this study examined aggressive communication, which often leads to undesirable mental health outcomes, on Reddit, YouTube, and Facebook during this period. According to the Social Identity Model of Individuation Effects (SIDE), anonymous environments which codify civil communication norms are more likely to yield prosocial behavior. Results indicate that Reddit, YouTube, and Facebook varied significantly in supportive and aggressive communication prevalence. Reddit users more frequently provided social support than did YouTube and Facebook users. Additionally, Reddit users engaged in aggressive communication significantly less than both YouTube and Facebook users. These findings support predictions from the SIDE model, as Reddit both offers users greater anonymity than YouTube and Facebook and codifies supportive, civil communication norms in a rules system called, "Reddiquette."

Should I buy or not? Revisiting the concept and measurement of panic buying

Following various precautionary measures as executed by the government to curb the transmission of COVID-19, erratic changes in the form of temporary lockdowns and movement restrictions have created an emergency phenomenon-panic buying. While such consequence has emerged as a timely and relevant topic, reviewed literature indicate an apparent oversight for portraying panic buying through the perspectives of impulsive and compulsive consumptions. Given the gap in the association between panic buying and consumers' emotional aspects within the context of the COVID-19 pandemic, this study aspires to develop a contemporary measurement that accurately defines panic buying as a research variable. A combined methodology was hereby adopted, with the employment of qualitative inquiries towards the scale development of panic buying. Following this, quantitative data as collected from a total sample of 600 respondents through an online survey was analysed via both SPSS and AMOS statistical software towards scale assessment and hypothesis testing. Obtained findings uncovered the direct significance of both personal (fear, perceived risk, and perceived scarcity) and social (word-of-mouth and social media) factors on panic buying during the pandemic, whilst having indirect significance on the ensuing post-purchase regret. Impulsivity was further confirmed to exert a substantial moderating impact on the correlation between panic consumption and post-purchase emotional distress. Implications of the study are ultimately discussed.

Keeping Citizens Informed and Engaged During the COVID-19 Pandemic Using #YoMeInformoPMA: A Case from Latin America

Social media platforms contribute to the dissemination of information and encourage communication between health agencies and the public, especially during health crises. Public health agencies must engage in carefully crafted educational, communicative, and interactive practices to be effective in their messaging to build relationships with the public. Using quantitative content, social network, and thematic analysis, this study examined 2,500 tweets from April to August 2020 that included the hashtag #YoMeInformoPMA. Panama's Public Health Ministry created the #YoMeInformoPMA hashtag to keep citizens informed and engaged during the COVID-19 pandemic. Research on social media use and implementation in Latin America during the COVID-19 pandemic, to inform and engage the public, is limited. Therefore, the aim of this investigation was to analyze strategies, themes, multimedia formats, key actors, and overall communications patterns of a Latin American health community hashtag. Our results determined that actors using the hashtag #YoMeInformoPMA mainly used an interactive strategy, a message that aims to promote casual conversations, advice, and problem-solving. Findings highlighted evidence of a communication strategy by specific actors in this network, supporting recent studies that indicate engagement between the public and health agencies can take place on social media. Practical implications and recommendations for communication preparation via social media for future health crises are discussed.

Rapid review of virus risk communication interventions: Directions for COVID-19

OBJECTIVE

In response to COVID-19, we conducted a rapid review of risk communication interventions to mitigate risk from viruses to determine if such interventions are efficacious.

METHODS

We searched for risk communication interventions in four databases: Medline, PsycInfo, the ProQuest Coronavirus Research Database, and CENTRAL. The search produced 1572 articles. Thirty-one articles were included in the final review.

RESULTS

Results showed risk communication interventions can produce cognitive and behavior changes around viruses. Results were more consistently positive for interventions focused on HIV/AIDS as compared to influenza. There was no consistent best intervention approach when comparing peer health, audio/visual, and intensive multi-media interventions. Tailoring risk communication toward a target population, in comparison to not tailoring, was related to better outcomes.

CONCLUSION

The results suggest that risk communication interventions can be efficacious at reducing risk from viruses. They also highlight the complexity of risk communication interventions. Additional research is needed to understand the mechanisms that lead risk communication to reduce risk from viruses.

PRACTICAL VALUE

Results support risk communication interventions to reduce risk from viruses.

Communication vs evidence: What hinders the outreach of science during an infodemic? A narrative review

Background

The COVID-19 pandemic is placing significant pressure on national and international health organizations and the measures taken to combat it are having many impacts beyond health. At the same time, misleading communication practices and what has been called an “infodemic” by the World Health Organization have been hampering the uptake of coronavirus-related scientific information. Moreover, public awareness about the dangers of the infodemic remains poor, and misinformation may lead to hazardous behaviours. We therefore analysed factors potentially undermining communication of scientific evidence and proposed strategies to counteract this phenomenon.

Methods

We sought official academic and institutional publications of any type, published in English and analyzed their approaches to communication used during the pandemic.

Results

The factors that might undermine appropriate communication include but are not limited to (a) the exponential increase of COVID-19-related publications, often including biases in the peer-review and editorial process; (b) the role of traditional media; (c) politicization of the virus; and (d) the impact of social media. We argue that evidence synthesis and knowledge translation are useful tools to communicate accurate scientific evidence to decision-makers.

Conclusion

Clear and concise messages in this form can help decision-makers to interpret data correctly, take consequent actions, and avoid being compromised by low-quality or even misleading information.

Characteristics of Misinformation Spreading on Social Media During the COVID-19 Outbreak in China: A Descriptive Analysis

Background

During a public health emergency, social media is a major conduit or vector for spreading health misinformation. Understanding the characteristics of health misinformation can be a premise for rebuking and purposefully correcting such misinformation on social media.

Methods

Using samples of China’s misinformation on social media related to the COVID-19 outbreak (N=547), the objective of this article was to illustrate the characteristics of said misinformation on social media in China by descriptive analysis, including the typology, the most-mentioned information, and a developmental timeline.

Results

The results reveal that misinformation related to preventive and therapeutic methods is the most-mentioned type. Other types of misinformation associated with people’s daily lives are also widespread. Moreover, cultural and social beliefs have an impact on the perception and propaganda of misinformation, and changes in the crisis situation are relevant to the type variance of misinformation.

Conclusion

Following research results, strategies of health communication for managing misinformation on social media are given, such as credible sources and expert sources. Also, traditional beliefs or perceptions play the vital role in health communication. To sum up, combating misinformation on social media is likely not a single effort to correct misinformation or to prevent its spread. Instead, scholars, journalists, educators, and citizens must collaboratively identify and correct any misinformation.

How do Canadian public health agencies respond to the COVID-19 emergency using social media: a protocol for a case study using content and sentiment analysis

INTRODUCTION

Keeping Canadians safe requires a robust public health (PH) system. This is especially true when there is a PH emergency, like the COVID-19 pandemic. Social media, like Twitter and Facebook, is an important information channel because most people use the internet for their health information. The PH sector can use social media during emergency events for (1) PH messaging, (2) monitoring misinformation, and (3) responding to questions and concerns raised by the public. In this study, we ask: what is the Canadian PH risk communication response to the COVID-19 pandemic in the context of social media?

METHODS AND ANALYSIS

We will conduct a case study using content and sentiment analysis to examine how provinces and provincial PH leaders, and the Public Health Agency of Canada and national public heath leaders, engage with the public using social media during the first wave of the pandemic (1 January-3 September 2020). We will focus specifically on Twitter and Facebook. We will compare findings to a gold standard during the emergency with respect to message content.

ETHICS AND DISSEMINATION

Western University's research ethics boards confirmed that this study does not require research ethics board review as we are using social media data in the public domain. Using our study findings, we will work with PH stakeholders to collaboratively develop Canadian social media emergency response guideline recommendations for PH and other health system organisations. Findings will also be disseminated through peer-reviewed journal articles and conference presentations.

A Novel Machine Learning Framework for Comparison of Viral COVID-19-Related Sina Weibo and Twitter Posts: Workflow Development and Content Analysis

Background

Social media plays a critical role in health communications, especially during global health emergencies such as the current COVID-19 pandemic. However, there is a lack of a universal analytical framework to extract, quantify, and compare content features in public discourse of emerging health issues on different social media platforms across a broad sociocultural spectrum.

Objective

We aimed to develop a novel and universal content feature extraction and analytical framework and contrast how content features differ with sociocultural background in discussions of the emerging COVID-19 global health crisis on major social media platforms.

Methods

We sampled the 1000 most shared viral Twitter and Sina Weibo posts regarding COVID-19, developed a comprehensive coding scheme to identify 77 potential features across six major categories (eg, clinical and epidemiological, countermeasures, politics and policy, responses), quantified feature values (0 or 1, indicating whether or not the content feature is mentioned in the post) in each viral post across social media platforms, and performed subsequent comparative analyses. Machine learning dimension reduction and clustering analysis were then applied to harness the power of social media data and provide more unbiased characterization of web-based health communications.

Results

There were substantially different distributions, prevalence, and associations of content features in public discourse about the COVID-19 pandemic on the two social media platforms. Weibo users were more likely to focus on the disease itself and health aspects, while Twitter users engaged more about policy, politics, and other societal issues.

Conclusions

We extracted a rich set of content features from social media data to accurately characterize public discourse related to COVID-19 in different sociocultural backgrounds. In addition, this universal framework can be adopted to analyze social media discussions of other emerging health issues beyond the COVID-19 pandemic.

Ebola and Localized Blame on Social Media: Analysis of Twitter and Facebook Conversations During the 2014-2015 Ebola Epidemic

This study aimed to analyze main groups accused on social media of causing or spreading the 2014-2016 Ebola epidemic in West Africa. In this analysis, blame is construed as a vehicle of meaning through which the lay public makes sense of an epidemic, and through which certain classes of people become "figures of blame". Data was collected from Twitter and Facebook using key word extraction, then categorized thematically. Our findings indicate an overall proximate blame tendency: blame was typically cast on "near-by" figures, namely national governments, and less so on "distant" figures, such as generalized figures of otherness ("Africans", global health authorities, global elites). Our results also suggest an evolution of online blame. In the early stage of the epidemic, blame directed at the affected populations was more prominent. However, during the peak of the outbreak, the increasingly perceived threat of inter-continental spread was accompanied by a progressively proximal blame tendency, directed at figures with whom the social media users had pre-existing biopolitical frustrations. Our study proposes that pro-active and on-going analysis of blame circulating in social media can usefully help to guide communications strategies, making them more responsive to public perceptions.

[Digital public health-an overview]

The rapid development and proliferation of digital health technologies have not only changed the medical professions, but offer great potential for public health, particularly in health promotion and disease prevention.At the same time, this emerging field is also characterized by conceptual and terminological fuzziness, a marked lack of high-quality evidence, and an absence of an honest discussion of unintended consequences and side effects. Further challenges for digital public health lie in the fact that the development of new health technologies is mainly driven by technological progress and less by evidence-based needs and research in public health.In this overview paper, we aim at conceptually denoting the field of digital public health, using principal public health functions as guiding principles. We discuss some current applications of digital health technologies in fulfilling public health functions and propose a needs-based development of digital health technologies.We will further address specific challenges to digital public health, in particular socio-economic differences in the usage of and profiting from digital health technologies, data protection and privacy issues, as well as ethical issues.

Public Health and Online Misinformation: Challenges and Recommendations

The internet has become a popular resource to learn about health and to investigate one's own health condition. However, given the large amount of inaccurate information online, people can easily become misinformed. Individuals have always obtained information from outside the formal health care system, so how has the internet changed people's engagement with health information? This review explores how individuals interact with health misinformation online, whether it be through search, user-generated content, or mobile apps. We discuss whether personal access to information is helping or hindering health outcomes and how the perceived trustworthiness of the institutions communicating health has changed over time. To conclude, we propose several constructive strategies for improving the online information ecosystem. Misinformation concerning health has particularly severe consequences with regard to people's quality of life and even their risk of mortality; therefore, understanding it within today's modern context is an extremely important task.

Global Emergency Medicine: A Review of the Literature from 2018

OBJECTIVES

The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM.

METHODS

An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores.

RESULTS

A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique.

CONCLUSIONS

In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.

Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey

Background

Several studies have been conducted to analyze the role social networks play in communication between patients and health professionals. However, there is a shortage of studies in relation to communication among primary health professionals, in a professional context, using the various mobile phone apps available.

Objective

The objective of our study was to explore mobile phone social networking app use among primary health care professionals for work-related purposes, by comparing the most widely used apps in the market.

Methods

We undertook a cross-sectional study using an anonymous Web survey among a convenience sample of 1635 primary health care professionals during August and September 2017.

Results

Of 483 participants in the survey, 474 (98.1%, 95% CI 97.1%-99.4%) were health professionals who commonly accessed social networking sites and 362 (74.9%, 95% CI 71.1%-78.8%) accessed the sites in a work-related context. Of those 362 respondents, 219 (96.7%, 95% CI 94.8%-98.5%) preferred WhatsApp for both personal and professional uses. Of the 362 respondents who used social networking sites in a work-related context, 276 (76.2%, 95% CI 71.9%-80.6%) rated social networking sites as useful or very useful to solve clinical problems, 261 (72.1%, 95% CI 67.5%-76.7%) to improve their professional knowledge, and 254 (70.2%, 95% CI 65.5%-74.9%) to speed up the transmission of clinical information. Most of them (338/362, 94.8%, 95% CI 92.5%-97.0%) used social networking sites for interprofessional communications, and 204 of 362 (56.4%, 95% CI 51.2%-61.5%) used them for pharmacological-related consultations.

Conclusions

Health professionals frequently accessed social networking sites using their mobile phones and often for work-related issues. This trend suggests that social networking sites may be useful tools in primary care settings, but we need to ensure the security of the data transfer process to make sure that social networking sites are used appropriately. Health institutions need to increase information and training activities to ensure the correct use of these tools.