Exposure Effects or Confirmation Bias? Examining Reciprocal Dynamics of Misinformation, Misperceptions, and Attitudes Toward COVID-19 Vaccines

Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey

BACKGROUND

Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination-related behaviors.

OBJECTIVE

This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors.

METHODS

A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon's Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest.

RESULTS

Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=-1.09, SE=.17; P<.001; OR .33, 95% CI 0.23-0.47) and attitudes toward vaccination (B=- 2.33, SE=.09; P=.02; OR 0.79, 95% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=-.84, SE=.17; P<.001; OR 48, 95% CI 0.32-0.62), and influenza vaccination practice (B=-1.14, SE=.17; P<.001; OR .31, 95% CI 0.22-0.45).

CONCLUSIONS

Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions.

The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation

BACKGROUND

Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation.

OBJECTIVE

This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination.

METHODS

We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general.

RESULTS

The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (χ21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (χ21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups.

CONCLUSIONS

Exposure to a news article conveying misinformation may not be sufficient to change an individual's level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals' perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one's opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/41012.

A decade of PrEP: the evolution of HIV pre-exposure prophylaxis content and sentiments in South African print news media, 2012-2021

After nearly a decade of HIV pre-exposure prophylaxis (PrEP) rollout in sub-Saharan Africa, there has been limited study of PrEP messaging in news media. We selected twenty South African newspapers with the highest circulation volumes to retrieve articles published in 2012-2021 mentioning PrEP (N = 249). Using inductive content analysis, we developed a structured codebook to characterise PrEP-related content and sentiments, as well as their evolution over time, in the South African press. Many articles espoused favourable attitudes towards PrEP (52%), but a sizeable fraction espoused unfavourable attitudes (11%). Relative to PrEP-favourable articles, PrEP-unfavourable articles were significantly more likely to emphasise the drawbacks/consequences of PrEP use, including adherence/persistence requirements (52% vs. 24%, p = .007), cost (48% vs. 11%, p < .001), and risk compensation (52% vs. 5%, p < .001). Nevertheless, the presence of these drawbacks/consequences in print media largely declined over time. Key populations (e.g. adolescents, female sex workers) were frequently mentioned potential PrEP candidates. Despite message variations over time, prevention effectiveness and adherence/persistence requirements were the most widely cited PrEP benefits and drawbacks, respectively. Study findings demonstrate the dynamic nature of PrEP coverage in the South African press, likely in response to PrEP scale-up and real-world PrEP implementation during the study period.

Predicting Health Misperceptions: The Role of eHealth Literacy and Situational Perceptions

This study sought to understand how health misperceptions develop among individuals after exposure to misinformation messages, and how eHealth literacy and situational motivation in problem solving are associated with the negative effects of misinformation exposure. We also sought to understand the differentiated effects of misinformation exposure on the four misinformation-susceptible publics. Results from two studies revealed that situational motivation was positively associated with the formation of misperceptions after misinformation exposure as well as individuals' likelihood of amplifying the misinformation message. However, eHealth literacy does not reduce misperceptions, as had been hypothesized. In fact, eHealth literacy was not significantly associated with misperceptions or with misinformation amplification likelihood. Results also provide support for the typology of misinformation-susceptible publics as misinformation-amplifying publics were the most susceptible to misinformation messages.

Calculated Comparisons: Manufacturing Societal Causal Judgments by Implying Different Counterfactual Outcomes

How do people come to opposite causal judgments about societal problems, such as whether a public health policy reduced COVID-19 cases? The current research tests an understudied cognitive mechanism in which people may agree about what actually happened (e.g., that a public health policy was implemented and COVID-19 cases declined), but can be made to disagree about the counterfactual, or what would have happened otherwise (e.g., whether COVID-19 cases would have declined naturally without intervention) via comparison cases. Across two preregistered studies (total N = 480), participants reasoned about the implementation of a public policy that was followed by an immediate decline in novel virus cases. Study 1 shows that people's judgments about the causal impact of the policy could be pushed in opposite directions by emphasizing comparison cases that imply different counterfactual outcomes. Study 2 finds that people recognize they can use such information to influence others. Specifically, in service of persuading others to support or reject a public health policy, people systematically showed comparison cases implying the counterfactual outcome that aligned with their position. These findings were robust across samples of U.S. college students and politically and socioeconomically diverse U.S. adults. Together, these studies suggest that implied counterfactuals are a powerful tool that individuals can use to manufacture others' causal judgments and warrant further investigation as a mechanism contributing to belief polarization.

Closing the Gap Between Decision Analysis and Policy Analysts Before the Next Pandemic

Decision analysis (DA) is an explicitly prescriptive discipline that separates beliefs about uncertainties from value preferences in modeling to support decision making. Researchers have been advancing DA tools for the last 60 years to support decision makers handling complex decisions requiring subjective judgments. Recently, some DA researchers and practitioners wondered whether the difficult decisions made during the COVID-19 pandemic regarding testing, masking, closing and reopening businesses, allocating ventilators, and prioritizing vaccines would have been improved with more DA involvement. With its focus on quantifying uncertainties, value trade-offs, and risk attitudes, DA should have been a valuable tool for decision makers during the pandemic. To influence decisions, DA applications require interactions with policymakers and experts to construct formal representations of the decision frame, elicit uncertainties, and assess risk tolerances and trade-offs among competing objectives. Unfortunately, such involvement of decision analysts in the process of decision making and policy setting did not occur during much of the COVID-19 pandemic. This lack of participation may have been partly because many decision makers were unaware of when DA could be valuable in helping with the challenges of the COVID-19 pandemic. In addition, decision analysts were perhaps not sufficiently adept at inserting themselves into the policy process at critical junctures when their expertise could have been helpful.

Funding: This research was partially supported by the U.S. Department of Homeland Security through the Center for Accelerating Operational Efficiency at Arizona State University.

Opinion Leaders and Structural Hole Spanners Influencing Echo Chambers in Discussions About COVID-19 Vaccines on Social Media in China: Network Analysis

BACKGROUND

Social media provide an ideal medium for breeding and reinforcing vaccine hesitancy, especially during public health emergencies. Algorithmic recommendation-based technology along with users' selective exposure and group pressure lead to online echo chambers, causing inefficiency in vaccination promotion. Avoiding or breaking echo chambers largely relies on key users' behavior.

OBJECTIVE

With the ultimate goal of eliminating the impact of echo chambers related to vaccine hesitancy on social media during public health emergencies, the aim of this study was to develop a framework to quantify the echo chamber effect in users' topic selection and attitude contagion about COVID-19 vaccines or vaccinations; detect online opinion leaders and structural hole spanners based on network attributes; and explore the relationships of their behavior patterns and network locations, as well as the relationships of network locations and impact on topic-based and attitude-based echo chambers.

METHODS

We called the Sina Weibo application programming interface to crawl tweets related to the COVID-19 vaccine or vaccination and user information on Weibo, a Chinese social media platform. Adopting social network analysis, we examined the low echo chamber effect based on topics in representational networks of information, according to attitude in communication flow networks of users under different interactive mechanisms (retweeting, commenting). Statistical and visual analyses were used to characterize behavior patterns of key users (opinion leaders, structural hole spanners), and to explore their function in avoiding or breaking topic-based and attitude-based echo chambers.

RESULTS

Users showed a low echo chamber effect in vaccine-related topic selection and attitude interaction. For the former, the homophily was more obvious in retweeting than in commenting, whereas the opposite trend was found for the latter. Speakers, replicators, and monologists tended to be opinion leaders, whereas common users, retweeters, and networkers tended to be structural hole spanners. Both leaders and spanners tended to be "bridgers" to disseminate diverse topics and communicate with users holding cross-cutting attitudes toward COVID-19 vaccines. Moreover, users who tended to echo a single topic could bridge multiple attitudes, while users who focused on diverse topics also tended to serve as bridgers for different attitudes.

CONCLUSIONS

This study not only revealed a low echo chamber effect in vaccine hesitancy, but further elucidated the underlying reasons from the perspective of users, offering insights for research about the form, degree, and formation of echo chambers, along with depolarization, social capital, stakeholder theory, user portraits, dissemination pattern of topic, and sentiment. Therefore, this work can help to provide strategies for public health and public opinion managers to cooperate toward avoiding or correcting echo chamber chaos and effectively promoting online vaccine campaigns.