Medical mistrust in the context of Ebola: Implications for intended care-seeking and quarantine policy support in the United States

Association between beliefs in medical conspiracy theories and health behaviors among medical and healthcare students. Implications for professional practice

BACKGROUND

While conspiracy theories cover many different themes, medical conspiracy theories (MCTs) have become particularly prevalent in modern societies. As beliefs in MCTs can become a source of "infodemics", influence individual health behaviors and cause distrust in medical institutions and personnel, healthcare workers must find ways to overturn patients' conspiracy thinking. However, as the medical world is not free of these beliefs, in this study, we investigated beliefs in MCTs among medical and health science students and their association with reported health behaviors.

METHODS

Our sample was derived from a self-administered, anonymized, computer-assisted web survey conducted among 1,175 medical and health science students enrolled at the Poznan University of Medical Sciences, Poland.

RESULTS

From a set of twenty different MCTs, one-third of students rejected all of them, 18% believed in one, 15% in two, 10% in three, and 24% supported four or more conspiracy theories. In addition, many students were hesitant or unsure about MCTs. We also found that nursing and midwifery students were the most likely to believe in MCTs, while medical and dental students were the least supportive. Support for MCTs was higher among students in the early years of their studies and who declared themselves religious and conservative. This study also highlights the association between students' support for MCTs and their reported health behaviors, including avoiding vaccinations, using alternative medicine, taking vitamin C, or using social media as an essential source of health information.

CONCLUSIONS

As medical and health science students are prone to conspiratorial thinking, they should be trained to act as a trusted and reliable source of medical information, to mitigate conspiratorial beliefs, and to act as role models for their patients and society, effectively shaping health behaviors in the population.

The Roles of Social Media Use and Medical Mistrust in Black Americans' COVID-19 Vaccine Hesitancy: The RISP Model Perspective

The COVID-19 pandemic has brought unprecedented challenges to healthcare and public health messaging in the United States. One area of focus has been vaccination uptake among Black Americans, who have experienced COVID-19 deaths disproportionate to their share of the United States population, raising questions about the processes involved in vaccination perceptions and behaviors. Guided by the Risk Information Seeking and Processing model, this study explored the roles of medical mistrust and social media as a source of risk information in Black Americans' vaccine hesitancy. Survey results from a YouGov panel sample of Black Americans (n = 1,136; 53.5% female) showed that social media use and medical mistrust were positively associated with belief in misinformation related to the COVID-19 vaccine, which, in turn, was positively related to vaccine hesitancy through perceived information insufficiency and information seeking intentions. Furthermore, we found that belief in misinformation and subjective norms toward anti-vaccination also serially mediated the association between social media use and medical mistrust with vaccine hesitancy. Theoretical and practical implications are discussed.

Relationship Between Fear of Monkeypox and Intention to be Vaccinated Against Monkeypox in a Peruvian Sample. The Mediating Role of Conspiracy Beliefs About Monkeypox

The present study evaluated the predictive capacity of fear of Monkeypox (MPX) on the intention to be vaccinated against MPX and the influence of conspiracy beliefs as a mediating variable in this relationship in 516 Peruvian sample with an average age of 27.10 years participated. Monkeypox Fear Scale, MPX Conspiracy Beliefs Scale and a single item of intention to be vaccinated against MPX were used. Statistical analyses have included estimation of descriptive statistics for all variables in the model tested and Structural Equation Modeling to predict intention to be vaccinated against monkeypox. It has been found that fear has a positive impact on conspiracy beliefs about MPX and intention to be vaccinated against MPX. Finally, conspiracy beliefs are negatively related to intention to be vaccinated. As for indirect effects, both are statistically significant. The model explains 11.4% of the variance in beliefs and 19.1% in intention to be vaccinated. It is concluded that fear of MPX played an important role, both directly and indirectly, in the intention to be vaccinated against MPX, having conspiratorial beliefs about MPX as a mediating variable. The results have important implications for public health practices aimed at combating doubts about MPX vaccination.

Effective health communication depends on the interaction of message source and content: two experiments on adherence to COVID-19 measures in Türkiye

OBJECTIVE

Following the COVID-19 outbreak, authorities recommended preventive measures to reduce infection rates. However, adherence to calls varied between individuals and across cultures. To determine the characteristics of effective health communication, we investigated three key features: message source, content, and audience.

METHODS

Using a pre-test and two experiments, we tested how message content (emphasizing personal or social benefit), audience (individual differences), message source (scientists or state officials), and their interaction influence adherence to preventive measures. Using fliers advocating preventive measures, Experiment 1 investigated the effects of message content and examined the moderator role of individual differences. Experiment 2 presented the messages using news articles and manipulated sources.

RESULTS

Study 1 found decreasing adherence over time, with no significant impact from message content or individual differences. Study 2 found messages emphasizing 'protect yourself' and 'protect your country' to increase intentions for adherence to preventive measures. It also revealed an interaction between message source and content whereby messages emphasizing personal benefit were more effective when they came from healthcare professionals than from state officials. However, message source and content did not affect vaccination intentions or donations for vaccine research.

CONCLUSION

Effective health communication requires simultaneous consideration of message source and content.

Do media objectivity and frequency of informing mediate the relationship between traditionalist social attitudes and COVID-19 conspiracy beliefs?

In this study, we hypothesized that traditionalist social attitudes (conservatism, religiousness, and authoritarianism) significantly predict COVID-19 conspiracy beliefs (Hiding Information and Harmless Virus), as well as conspiracy mentality in general. We also hypothesized that these relationships are mediated by the objectivity of the media through which individuals inform themselves, and the frequency with which people informed themselves about the pandemic. The sample consisted of 341 participants from Serbia (mean age 33.51 years), of which 40.5% were women. The results revealed that conservatism predicts both conspiracy belief sets and conspiracy mentality, authoritarianism only COVID-19 conspiracy beliefs, and religiousness only beliefs that the virus is harmless. Media objectivity does not mediate these relationships. The frequency of informing is a significant mediator only of the relationships between authoritarianism, and conspiracy beliefs and conspiracy mentality, indicating that the role of seeking information is in reducing the threat perceived by more authoritarian individuals. The study reveals that media objectivity might not play a role in reducing conspiracy beliefs. An explanation might be found in the importance of the perceived credibility of the media.

From Conspiracy to Hesitancy: The Longitudinal Impact of COVID-19 Vaccine Conspiracy Theories on Perceived Vaccine Effectiveness

The embrace of coronavirus disease 2019 (COVID-19) vaccine conspiracies has been linked to vaccine hesitancy. This study aimed to investigate the relationship between COVID-19 vaccine conspiracy theories and perceived vaccine effectiveness. The study utilized a longitudinal follow-up study in which adults in Chile completed surveys in December 2020 (T1) and May 2021 (T2). The psychometric properties of the five-item instrument on conspiracy theories for the COVID-19 vaccine were evaluated using data from T1 (n = 578). A confirmatory one-factor structure with suitable indicators of reliability was found. The longitudinal analysis (n = 292) revealed that conspiracy theories about the COVID-19 vaccine in T1 were associated with lower beliefs in its effectiveness in T2. However, no significant association was found between beliefs in effectiveness in T1 and conspiracy theories in T2. The study suggests that beliefs in conspiracy theories may temporally precede beliefs in vaccine effectiveness for COVID-19. The results have implications for strategies to address vaccine conspiracy beliefs and their implementation at the public policy level.

Conspiratorial Attitude of the General Public in Jordan towards Emerging Virus Infections: A Cross-Sectional Study Amid the 2022 Monkeypox Outbreak

Conspiracy theories accompany the emergence of infectious diseases and the 2022 multi-country monkeypox (MPX) outbreak is no exception. It is possible that the adoption of conspiracy beliefs negatively impacts health behavior. We aimed to assess the prevalence of conspiratorial attitudes towards emerging virus infections (EVIs) and the response measures aiming to control these infections among the general public in Jordan. In addition, we assessed MPX knowledge and the belief in the role of men who have sex with men (MSM) in virus spread. The online survey data were collected during 24 May 2022-28 June 2022. The survey instrument was based on previously published scales designed to measure MPX knowledge and EVI conspiracies. A total of 611 respondents formed the final study sample, with a mean age of 44 years and a majority of females (n = 433, 70.9%). On a scale ranging from -10 to +10, the median MPX knowledge score in the study sample was +3 (interquartile range: +1 to +5). Educational level was a determinant of MPX knowledge in multivariate analysis. More than 50% of the participants agreed at least to some extent with 9 out of 12 of the EVI conspiracy items. Multivariate analysis showed that embracing conspiracy beliefs about EVIs was associated with being female, and agreeing with or having no opinion regarding the role of MSM in MPX spread. The current study revealed the high prevalence of belief in conspiracies surrounding EVIs, and its accompanying intervention measures, among the general public in Jordan. In addition, a lower level of MPX knowledge was observed compared to previous studies among university students and health professionals in the country. We recommend evaluating the impact of the widely prevalent conspiracy beliefs on health aspects in future studies. This aim is particularly relevant in the Middle Eastern countries where embracing specific conspiracy ideas is a common occurrence.

Conspiracy beliefs, regulatory self-efficacy and compliance with COVID-19 health-related behaviors: The mediating role of moral disengagement

Although recent studies on the 2019 coronavirus disease (COVID-19) have highlighted the negative effects of moral disengagement on intentions to comply with COVID-19 containment measures, little is known about the mediating role of moral disengagement in the relationship between regulatory self-efficacy in complying with the containment measures, beliefs in conspiracy theories and compliance with COVID-19 health-related behaviors. Data were collected from 1164 young adults (women, N = 796; 68.4%; mean age 25.60 ± 4.40 years) who completed an online survey from 15th May to 22nd June 2021. Results of the multi-group path analyses indicated that higher beliefs in conspiracy theories were associated with lower compliance with COVID-19 health-related behaviors, whereas higher self-efficacy beliefs in complying with the containment measures were associated with higher compliance with COVID-19 health-related behaviors. Moral disengagement significantly mediated the associations between beliefs in conspiracy theories, regulatory self-efficacy, and compliance with COVID-19 health-related behaviors. Finally, the tested model was gender-invariant. Findings suggest that public health authorities and social care professionals should promote interventions aimed at improving regulatory self-efficacy, emphasizing the moral significance of respecting or ignoring the recommended COVID-19 measures (e.g., physical distance in public), and enhancing people's concern for the potential harms of their immoral actions.

[Conspiracy theories and COVID-19: How do conspiracy beliefs arise?]

The COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 has caused an unprecedented global crisis, and a proliferation of conspiracy theories. These conspiratorial beliefs has contributed to weakening the credibility of government public health measures, limiting citizens' access to reliable sources of information, and disrupting the response of health systems to the crisis. Several hypotheses have been proposed in psychology and social science to understand the genesis of these beliefs during a pandemic, including generational, socio-cultural and political characteristics of individuals, and psychological factors such as the desire to preserve one's safety, to maintain a positive self-image, or even to strengthen its social role. However, recent discoveries in cognitive science about belief updating mechanisms offer new insights into the generation of conspiratorial beliefs across time and culture. In this paper, we offer a definition of conspiracy theory and a classification of conspiracy beliefs during the COVID-19 pandemic. We show how the mechanisms of belief updating may explain the genesis of conspiracy theories, and we propose several hypotheses supported by contemporary research in cognitive and social science.

An Investigation of Associations Between Race, Ethnicity, and Past Experiences of Discrimination with Medical Mistrust and COVID-19 Protective Strategies

This study investigates the associations between three forms of discrimination, race and ethnicity, general medical mistrust, health-specific COVID-19 conspiracy beliefs, and adherence to COVID-19 protective behaviors. Participants (n = 963) completed an online survey during May 2020, when stay-at-home orders and other government mandates were implemented in many states. Results indicate that everyday discrimination and healthcare discrimination were associated with significantly higher general medical mistrust, and healthcare discrimination and structural discrimination were associated with higher endorsement of health-specific COVID-19 conspiracy beliefs. Higher endorsement of health-specific COVID-19 conspiracy beliefs, but not general medical mistrust, was associated with significantly lower engagement in health-specific COVID-19 conspiracy beliefs. This study helps to contextualize racial health disparities during the COVID-19 pandemic and the widespread impact of everyday, structural, and healthcare discrimination in society.

COVID-19 Related Stresses, Conspiracy Beliefs, Uncertainty, and Non-adherence to Safety Guidelines

INTRODUCTION

Inconsistent use of protective preventive measures and nonadherence of the guidelines set by the World Health Organization regarding the coronavirus are associated with increased morbidity and mortality, as well as increased health care costs.

OBJECTIVE

The purpose of this study was to examine the role of COVID-19 related worries, conspiracy beliefs, and uncertainty in adherence to preventative measures in Iran.

METHOD

In a large survey with data collected online from a volunteer sample of 599 individuals, assessments were made of the distress associated with the anticipated potential consequences associated with the COVID-19 pandemic and the lockdown, extent of agreement with conspiracy beliefs, level of situation-specific uncertainty, and self-reports of compliance with preventive measures. Data were analyzed to explore paths leading to nonadherence to safety guidelines proposed by the medical authorities.

RESULTS

A large majority of individuals report significant distress and worry associated with the COVID-19 pandemic. Results indicate that increasing levels of situation-specific uncertainty intolerance, as well as conspiracy beliefs regarding the coronavirus, are associated with non-compliance with the advised protocols. Specifically, the results show that worries related to the COVID-19 pandemic are linked to non-compliance with preventive measures through conspiracy beliefs and feelings of uncertainty associated with the COVID-19 situation even after gender, education, and perceived socioeconomic status were controlled.

CONCLUSIONS

Findings imply that emotional exhaustion is likely to have set in and become counterproductive as people choose to violate safety guidelines. The authors discuss the theoretical and practical implications of these results.

[Causes of belief in conspiracy narratives and recommendations for successful risk communication in healthcare]

Throughout the COVID-19 pandemic, the belief in conspiracy narratives within the population strongly influenced the implementation of containment measures and medical recommendations. Conspiracy narratives involve the belief that a group perceived as powerful would pursue secret plans to harm society, which distinguishes them from misinformation or disinformation. This paper presents findings from the research literature on the causes of conspiracy beliefs, their effects on individual health behaviors, and ways to counteract their spread.In situations where people have less capacity and motivation for deeper information processing, they form their opinions more heuristically, which increases vulnerability to cognitive biases. People become particularly susceptible to receiving misinformation or disinformation, which are frequently linked to the emotionalization of facts and simplistic responses. Belief in conspiracy narratives may become more easily established, with additional issues of personal identity and various psychological motives playing a role, among others. A general distrust of people who are perceived as "powerful," such as representatives from science, medicine, and politics, can arise. Digital networks additionally contribute to the spread of conspiracy narratives.There are several ways that healthcare institutions can reduce the emergence and spread of misinformation, disinformation, and conspiracy narratives through their risk and crisis communications. The Crisis and Emergency Risk Communication Model (CERC) provides important approaches in this regard.

Do conspiracy theory and mistrust undermine people's intention to receive the COVID-19 vaccine in Austria?

Conspiracy theories flourish during the coronavirus disease 2019 (COVID-19) pandemic especially regarding vaccinations. As the vaccination reluctancy in Austria is high, it is important to understand the antecedents of vaccination intention at the preapproval stage of the vaccination process. An online survey was conducted in August 2020 in Austria with 217 primarily younger, female, educated participants. A two-step cluster analysis resulted in a sceptics cluster with a clear antivaccination tendency along with a right-wing political position, lower trust in general vaccines and lower education levels and the reference cluster. A considerable percentage of participants reported their reluctancy to have a COVID-19 vaccine. Although vaccination intention can be explained by attitude and subjective norm, this decision-making process is undermined by underlying factors such as conspiracy ideation and political position. Policy makers and health interventionists should take political background into consideration in efforts to increase vaccine compliance.

Why Do Patients Seek Diagnose Dis-accordance With Hierarchical Medical System Related Policies in Tertiary Hospitals? A Qualitative Study in Shanghai From the Perspective of Physicians

Background

Although the Hierarchical Medical System has been utilized in China for many years, it is inadequate for guiding patients in adopting appropriate diagnose-seeking behaviors in accordance with related policies. This study examined how patients' diagnose-seeking behavior in tertiary hospitals that is dis-accordance with Hierarchical Medical System related policy (“DSB-dis-accordance”) arise and ways to guide patients away from such behaviors, both from the perspective of physicians.

Methods

A qualitative study based on a mixed method including in-depth interviews and grounded theory. Twenty-seven physicians with more than 2 years of experience serving in tertiary hospitals of Shanghai were involved after reviewing the related purposes and requirements. Patients' “DSB-dis-accordance” was studied from the perspective of physicians.

Results

Patient-related factors (habits, trust, and knowledge), physician-related factors (conservative preference, risk avoidance), and system-related factors (accessibility, operability) affected patients' diagnose-seeking behavior.

Conclusions

Patient-related, physician-related, and system-related factors affecting patients' diagnose-seeking behaviors in tertiary hospitals should be addressed by investing more health resources in lower-level hospitals, enhancing dissemination of health-related and policy-related knowledge, refining the classification of diseases, incentivizing physicians, and developing appropriate follow-up measures. Physicians could then become more involved in guiding patients' “DSB-dis-accordance,” thereby benefitting development of the Hierarchical Medical System in China.

Systematic review on the association of COVID-19-related conspiracy belief with infection-preventive behavior and vaccination willingness

BACKGROUND

In times of a pandemic, not only infections but also conspiracy narratives spread among people. These have the potential to influence the course of the pandemic. Here we summarize and critically evaluate studies from the first year of the pandemic presenting findings on the association between COVID-19-related conspiracy belief and infection-preventive behavior and vaccination willingness.

METHOD

A systematic literature search was conducted using the databases COVID-19 Data Portal, APA PsycArticles, Psychology and Behavioral Sciences, Scopus, and PubMed. After removing duplicates, studies meeting the previously defined inclusion and exclusion criteria were subjected to title and abstract screening and content reviewed and analyzed subsequently.

RESULTS AND CONCLUSION

The systematic literature search yielded 17 studies meeting our pre-specified inclusion criteria. Twelve studies examined infection-preventive behavior (N = 16,485), and ten studies vaccination willingness (N = 20,210). In summary, belief in COVID-19-related conspiracy narratives was negatively associated with vaccination willingness and infection-preventive behavior. The results point to the importance of the content of the conspiracy narratives. Various explanatory approaches and possible moderator variables are discussed, referencing the state of research on conspiracy beliefs and health-related preventive behavior after the first year of the pandemic. We argue that future studies should strive for a consistent operationalization and use of the term conspiracy belief.

Impact of infectious disease epidemics on xenophobia: a systematic review

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Xenophobia has a significant impact on the health of international migrants.

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During an infectious disease outbreak, stigma and prejudice are highly pronounced.

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Migrants, often seen as disease carriers, are socially rejected during epidemics.

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Ensure an equal treatment and healthcare assistance for migrants is imperative.

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Educational interventions are urgently needed to prevent xenophobic tendencies.

Background Globally, xenophobia towards out-groups is frequently increased in times of economic and political instability, such as in infectious disease outbreaks. This systematic review aims to: (1) assess the xenophobic attitudes and behaviors towards migrants during disease outbreaks; and (2) identify adverse health outcomes linked to xenophobia. Methods We searched nine scientific databases to identify studies measuring xenophobic tendencies towards international migrants during disease outbreaks and evaluated the resulting adverse health effects. Results Eighteen articles were included in the review. The findings were grouped into: (1) xenophobia-related outcomes, including social exclusion, out-group avoidance, support for exclusionary health policies, othering, and germ aversion; and (2) mental health problems, such as anxiety and fear. Depending on the disease outbreak, different migrant populations were negatively affected, particularly Asians, Africans, and Latino people. Factors such as perceived vulnerability to disease, disgust sensitivity, medical mistrust individualism, collectivism, disease salience, social representation of disease and beliefs in different origins of disease were associated with xenophobia. Conclusions Overall, migrants can be a vulnerable population frequently blamed for spreading disease, promoting irrational fear, worry and stigma in various forms, thus leading to health inequities worldwide. It is urgent that societies adopt effective support strategies to combat xenophobia and structural forms of discrimination against migrants.

An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts)

BACKGROUND

Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health-recommended protective measures.

OBJECTIVE

We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health-recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect.

METHODS

SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor-delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern.

RESULTS

The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022.

CONCLUSIONS

The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/34381.

Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa

We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.

The Paradox of Conspiracy Theory: The Positive Impact of Beliefs in Conspiracy Theories on Preventive Actions and Vaccination Intentions during the COVID-19 Pandemic

This study aims to analyze the direct and indirect impact of beliefs in conspiracy theories on COVID-19-related preventive actions and vaccination intentions. The dominant theory in the literature is that beliefs in conspiracy theories have negative consequences. In particular, strong beliefs in conspiracy theories lower people’s intentions to engage in preventive actions and get vaccinated. Previous studies indicated that this dominant theory applies in Korea as well. However, we find that this dominant theory does not apply in Korea. Based on an analysis of survey data, we find that beliefs in conspiracy theories have positive impact on preventive actions and vaccination intentions. In addition, beliefs in conspiracy theories play indirect roles in these two responses to COVID-19. Specifically, when perceived benefits and trust in the government or science enhance preventive actions or increase vaccination intentions, strong beliefs in conspiracy theories promote this effect. This positive role of conspiracy theories is paradoxical because they are generally viewed as negative.

Perceptions of blame on social media during the coronavirus pandemic

The outbreak of the coronavirus (COVID-19) disease is overwhelming resources, economies and countries around the world. Millions of people have been infected and hundreds of thousands have succumbed to the virus. Research regarding the coronavirus pandemic is published every day. However, there is limited discourse regarding societal perception. Thus, this paper examines blame attribution concerning the origin and propagation of the coronavirus crisis according to public perception. Specifically, data were extracted from the social media platform Twitter concerning the coronavirus during the early stages of the outbreak and further investigated using thematic analysis. The findings revealed the public predominantly blames national governments for the coronavirus pandemic. In addition, the results documented the explosion of conspiracy theories among social media users regarding the virus' origin. In the early stages of the pandemic, the blame tendency was most frequent to conspiracy theories and restriction of information from the government, whilst in the later months, responsibility had shifted to political leaders and the media. The findings indicate an emerging government mistrust that may result in disregard of preventive health behaviours and the amplification of conspiracy theories, and an evolving dynamic of blame. This study argues for a transparent, continuing dialogue between governments and the public to stop the spread of the coronavirus.

Analytic thinking predicts accuracy ratings and willingness to share COVID-19 misinformation in Australia

The classical account of reasoning posits that analytic thinking weakens belief in COVID-19 misinformation. We tested this account in a demographically representative sample of 742 Australians. Participants completed a performance-based measure of analytic thinking (the Cognitive Reflection Test) and were randomized to groups in which they either rated the perceived accuracy of claims about COVID-19 or indicated whether they would be willing to share these claims. Half of these claims were previously debunked misinformation, and half were statements endorsed by public health agencies. We found that participants with higher analytic thinking levels were less likely to rate COVID-19 misinformation as accurate and were less likely to be willing to share COVID-19 misinformation. These results support the classical account of reasoning for the topic of COVID-19 misinformation and extend it to the Australian context.

Conspiracy beliefs and attitudes toward COVID-19 vaccinations

During the coronavirus pandemic, this study aimed to investigate the impact of conspiracy beliefs on Finnish attitudes toward vaccinations in general and COVID-19 vaccinations in particular. This study was a conceptual replication in Finland of a study by Pivetti et al. (2021) . Some 529 Finnish participants responded to a self-report questionnaire during the partial lockdown in Finland in spring 2020. The hypothesized relationships between variables of interest were integrated in a serial multiple mediation model via structural equation modelling. Results showed that endorsing general conspiracy beliefs directly predicted (1) general attitudes toward vaccines and (2) COVID-19 conspiracy beliefs, and indirectly predicted (3) attitudes toward COVID-19 vaccines via the serial mediation of COVID-19 conspiracy beliefs and general attitudes toward vaccines. As for the antecedents of beliefs in conspiracy theories, political orientation and moral purity predicted beliefs in COVID-19 conspiracy theories. Trust in science was inversely related to general conspiracy beliefs. As for the consequences of conspiracy beliefs, COVID-19 conspiracy beliefs directly predicted support for governmental restrictions (negatively) and the perception of informational contamination (positively).

Coronavirus conspiracy beliefs and distrust of science predict risky public health behaviours through optimistically biased risk perceptions in Ukraine, Turkey, and Germany

The present paper examines the extent to which conspiracy beliefs about the COVID-19 outbreak and distrust of epidemiological science are likely to predict optimistically biased risk perceptions at the individual and group levels. We explored the factor structure of coronavirus conspiracy beliefs and their associations with trust in science in predicting risk perceptions using survey data collected in Ukraine ( N = 390), Turkey ( N = 290), and Germany ( N = 408). We further expected conspiracy beliefs and distrust of science to predict people’s willingness to attend public gatherings versus maintaining preventive physical distancing through optimistically biased risk perceptions. Metric noninvariance for key constructs across the samples was observed so the samples were analysed separately. In Ukraine, a two-factor structure of conspiracy beliefs was found wherein COVID-19 bioweapon (but not COVID-19 profit) beliefs were negatively associated with public gathering through optimistically biased individual risk perceptions. In Turkey and Germany, conspiracy beliefs showed a single-factor solution that was negatively associated with preventive distancing and positively related to public gathering through optimistically biased public risk metaperceptions. The hypothesis about the direct and indirect effects of trust in science on risky health behaviour was partially confirmed in all three samples. The observed discrepancies in our findings are discussed.

Explaining Conspiracy Beliefs and Scepticism around the COVID-19 Pandemic

Public opinion on COVID-19 provides new empirical evidence for the debate on the ideological contours of conspiracy theories. I report findings from a web survey in Greece where participants were recruited via paid advertising on Facebook and the study sample was adjusted for age, gender, education, domicile, and region of residence using a nationally representative reference sample. I find that beliefs about conspiracy theories are more correlated than the values associated with established political ideologies, and that conspiracy beliefs and scepticism about the pandemic are best explained by belief in unrelated political and medical conspiracy theories. No other demographic or attitudinal variable has such a strong influence, and the results are robust to different statistical specifications. In comparison, the effect of ideology measured by left-right self-placement is rather negligible and further moderated by trust in government. The results have implications for the strategies aimed at fighting disinformation during public health emergencies.

Misconceptions about COVID-19 among older Rohingya (forcefully displaced Myanmar nationals) adults in Bangladesh: findings from a cross-sectional study

OBJECTIVES

Due to low health literacy and adverse situation in the camps, there are possibilities of misconceptions related to COVID-19 among the older Rohingya (forcefully displaced Myanmar nationals or FDMNs) adults in Bangladesh. The present research aimed to assess the level of misconceptions and the factors associated with it among the older FDMNs in Bangladesh.

DESIGN

Cross-sectional.

SETTING

A selected Rohingya camp situated in Cox's Bazar, a southeastern district of Bangladesh.

PARTICIPANTS

Information was collected from 416 conveniently selected FDMNs who were aged 60 years and above.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was misconceptions related to the spread, prevention and treatment of COVID-19. Information on 14 different locally relevant misconceptions was gathered, each was scored as one, and obtained a cumulative score, ranging from 0 to 14, with a higher score indicating a higher level of misconceptions. A multiple linear regression model explored the factors associated with misconceptions.

RESULTS

The participants had an average of five misconceptions. The most prevalent misconceptions were: everyone should wear personal protective equipment when outside (84.6%) and its prevention by nutritious food (62.5%) and drinking water (59.3%). Other notable misconceptions included the spread of COVID-19 through mosquito bites (42%) and its transmissions only to the non/less religious person (31.4%). In regression analyses, memory or concentration problems, communication frequency with social networks, pre-existing conditions and receiving information from health workers were significantly associated with higher COVID-19 misconceptions. These misconceptions were less likely among those overwhelmed by COVID-19, having COVID-19 diagnosed friends or family members and receiving information from friends and family.

CONCLUSIONS

Overall, we found that misconceptions were prevalent among the older FDMNs in Bangladesh. The associations have important implications for programmes to prevent and manage COVID-19 in these settings. Health workers need to be adequately trained to provide clear communication and counter misconceptions.

Strengthening Culturally Competent Health Communication

Vulnerable refugee communities are disproportionately affected by the ongoing COVID-19 pandemic; existing longstanding health inequity in these communities is exacerbated by ineffective risk communication practices about COVID-19. Culturally and linguistically appropriate health communication following health literacy guidelines is needed to dispel cultural myths, social stigma, misinformation, and disinformation. For refugee communities, the physical, mental, and social-related consequences of displacement further complicate understanding of risk communication practices grounded in a Western cultural ethos. We present a case study of Clarkston, Georgia, the "most diverse square mile in America," where half the population is foreign born and majority refugee. Supporting marginalized communities in times of risk will require a multipronged, systemic approach to health communication including: (1) creating a task force of local leaders and community members to deal with emergent issues; (2) expanding English-language education and support for refugees; (3) including refugee perspectives on risk, health, and wellness into risk communication messaging; (4) improving cultural competence and health literacy training for community leaders and healthcare providers; and (5) supporting community health workers. Finally, better prepared public health programs, including partnerships with trusted community organizations and leadership, can ensure that appropriate and supportive risk communication and health education and promotion are in place long before the next emergency.

Adherence to Social Distancing Guidelines Throughout the COVID-19 Pandemic: The Roles of Pseudoscientific Beliefs, Trust, Political Party Affiliation, and Risk Perceptions

BACKGROUND

Adherence to COVID-19 social distancing guidelines varies across individuals.

PURPOSE

This study examined the relations of pseudoscientific and just world beliefs, generalized and institutional trust, and political party affiliation to adherence to COVID-19 social distancing guidelines over three months, as well as the explanatory role of COVID-19 risk perceptions in these relations.

METHODS

A U.S. nationwide sample of 430 adults (49.8% women; mean age = 40.72) completed a prospective online study, including an initial assessment (between March 27 and April 5, 2020), a 1 month follow-up (between April 27 and May 21, 2020), and a 3 month follow-up (between June 26 and July 15, 2020). We hypothesized that greater pseudoscientific and just world beliefs, lower governmental, institutional, and dispositional trust, and Republican Party affiliation would be associated with lower initial adherence to social distancing and greater reductions in social distancing over time and that COVID-19 risk perceptions would account for significant variance in these relations.

RESULTS

Results revealed unique associations of lower governmental trust, greater COVID-19 pseudoscientific beliefs, and greater trust in the Centers for Disease Control and Prevention (CDC) to lower initial adherence to social distancing. Whereas greater COVID-19 risk perceptions and CDC trust were associated with less steep declines in social distancing over time, both Republican (vs. Democratic) Party affiliation and greater COVID-19 pseudoscientific beliefs were associated with steeper declines in social distancing over time (relations accounted for by lower COVID-19 risk perceptions).

CONCLUSIONS

Results highlight the utility of public health interventions aimed at improving scientific literacy and emphasizing bipartisan support for social distancing guidelines.

Limited knowledge and distrust are important social factors of out-patient' s 'inappropriate diagnosed seeking behaviour': a qualitative research in Shanghai

AIMS

This study is designed to present out-patient's 'inappropriate diagnosed seeking behaviour' in tertiary hospitals and interpret its association with some potential social factors.

METHODS

A qualitative study based on grounded theory was designed in this paper. The participates were recruited by a two-stage process. The field observation and in-depth interview were adopted for data collection. Multi-round (five rounds) sampling and continuing data analysis were adopted as well.

RESULTS

Totally 26 out-patients from three tertiary hospitals in Shanghai were involved. Four focused codes, including 'limited policy-related knowledge', 'limited health-related knowledge', 'distrust on related policy' and 'distrust on medical networks', were identified. Then, a theoretical model about the association of out-patient's 'limited knowledge' with 'distrust' and its relationship with 'inappropriate first-diagnosed seeking behaviour' in tertiary hospitals was developed.

CONCLUSION

'Inappropriate first-diagnosed seeking behaviour' of the out-patients in tertiary hospitals is closely associated with their limited knowledge and related distrust. Great effort on improving publics' knowledge and rebuilding a benign trust relationship with out-patients and the medical networks is found to be essential for guiding publics' appropriate first-diagnosed health behaviour in various levels of medical institutions.

Searching for General Model of Conspiracy Theories and Its Implication for Public Health Policy: Analysis of the Impacts of Political, Psychological, Structural Factors on Conspiracy Beliefs about the COVID-19 Pandemic

Along with the spread of the COVID-19 pandemic, beliefs in conspiracy theories are spreading within and across countries. This study aims to analyze predictors of beliefs in conspiracy theories. Because previous studies have emphasized only specific political, psychological, or structural factors or variables, this study constructs an integrated analytical model that includes all three factors. We analyze data from a large-scale survey of Koreans (N = 1525) and find several results. First, political, psychological, and structural factors influence beliefs in conspiracy theories. Second, when we examine the specific influences of the variables, we find that authoritarianism, support for minority parties, religiosity, trust in SNS (social networking services), perceived risk, anxiety, negative emotions, blame attribution, the quantity of information, health status, and health after COVID-19, all positively influence beliefs in conspiracy theories. Conversely, support for President Moon Jae-In's government, Christianity, trust in the government, perceived control, analytic thinking, knowledge, the quality of information, and gender, all negatively impact these beliefs. Among the predictors, the quality of information, health status, support for President Moon Jae-In's government, perceived risk, and anxiety have the most decisive impacts on beliefs in conspiracy theories.

Local perspectives on Ebola during its tenth outbreak in DR Congo: A nationwide qualitative study

BACKGROUND

The Democratic Republic of Congo (DR Congo) struggled to end the tenth outbreak of Ebola virus disease (Ebola), which appeared in North Kivu in 2018. It was reported that rumors were hampering the response effort. We sought to identify any rumors that could have influenced outbreak containment and affected prevention in unaffected areas of DR Congo.

METHODS

We conducted a qualitative study in DR Congo over a period of 2 months (from August 1 to September 30, 2019) using in-depth interviews (IDIs) and focus group discussions (FGDs). The participants were recruited from five regional blocks using purposeful sampling. Both areas currently undergoing outbreaks and presently unaffected areas were included. We collected participants' opinions, views, and beliefs about the Ebola virus. The IDIs (n = 60) were performed with key influencers (schoolteachers, religious and political leaders/analysts, and Ebola-frontline workers), following a semi-structured interview guide. FGDs (n = 10) were conducted with community members. Interviews were recorded with a digital voice recorder and simultaneous note-taking. Participant responses were categorized in terms of their themes and subthemes.

RESULTS

We identified 3 high-level themes and 15 subthemes (given here in parentheses): (1) inadequate knowledge of the origin or cause of Ebola (belief in a metaphysical origin, insufficient awareness of Ebola transmission via an infected corpse, interpretation of disease as God's punishment, belief in nosocomial Ebola, poor hygiene, and bathing in the Congo River). Ebola was interpreted as (2) a plot by multinational corporations (fears of genocide, Ebola understood as a biological weapon, concerns over organ trafficking, and Ebola was taken to be the result of business actions). Finally Ebola was rumored to be subject to (3) politicization (political authorities seen as ambivalent, exclusion of some community leaders from response efforts, distrust of political authorities, and distrust in the healthcare system).

CONCLUSIONS

Due to the skepticism against Ebola countermeasures, it is critical to understand widespread beliefs about the disease to implement actions that will be effective, including integrating response with the unmet needs of the population.

COVID-19 conspiracy beliefs, health behaviors, and policy support

Conspiracy theories have been proliferating during the COVID-19 pandemic. Evidence suggests that belief in conspiracy theories undermines engagement in pro-health behaviors and support for public health policies. Moreover, previous work suggests that inoculating messages from opinion leaders that expose conspiracy theories as false before people are exposed to them can help to prevent belief in new conspiracies. Goals of this study were to: (a) explore associations between COVID-19 conspiracy beliefs with SARS-CoV-2 vaccine intentions, cooperation with public health recommendations, and support for public health policies among U.S. adults and (b) investigate trusted sources of COVID-19 information to inform strategies to address conspiracy beliefs. A cross-sectional, online survey was conducted with 845 U.S. adults in April 2020. Data were analyzed using analyses of variance and multivariable regressions. One-third (33%) of participants believed one or more conspiracies about COVID-19. Participants who believed conspiracies reported that their intentions to vaccinate were 3.9 times lower and indicated less support for COVID-19 public health policies than participants who disbelieved conspiracies. There were no differences in cooperation with public health recommendations by conspiracy belief endorsement in the multivariable regression analysis. Although there were some key differences in trusted sources of COVID-19 information, doctor(s) were the most trusted source of information about COVID-19 overall with 90% of participants trusting doctor(s). Doctor(s) may play a role in addressing COVID-19 conspiracy theories before people are exposed to them to promote COVID-19 prevention efforts.

Lifting lockdown policies: A critical moment for COVID-19 stigma

COVID-19 'lockdown' policies may have unintended consequences for individuals, households and country economies. Hence lockdown may be unsustainable despite the risk of a resurgence of new COVID-19 infections. The repeal and alteration of lockdown policies mark a symbolic transfer of responsibility for epidemic control from state to individual. This has the potential to catalyse fear, blame and judgement within and between populations. We draw on experience from the HIV pandemic to show that this will worsen during later phases of the pandemic if COVID-19 stigma increases, as we fear it could. We suggest policy recommendations for 'lockdown lifting' to limit COVID-19 stigma. We suggest three policy priorities to minimise potential increases in COVID-19 stigma: limit fear by strengthening risk communication, engage communities to reduce the emergence of blaming, and emphasise social justice to reduce judgement. 'Lockdown' policies cannot continue uninterrupted. However, lifting lockdown without unintended consequences may prove harder than establishing it. This period has the potential to see the emergence of fear, blame and judgement, intersecting with existing inequalities, as governments seek to share responsibility for preventing further Sars-Cov-2 transmission. As we have learned from HIV, it is critical that a wave of COVID-19 stigma is prevented from flourishing.

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.

Cross-Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika Transmission

Perceptions of infectious diseases are important predictors of whether people engage in disease-specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and self-efficacy (i.e., control). The 2015-2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved cross-sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (March-May 2016) and one just after the first cases of local transmission (July-August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and self-efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.

Ubiquitous Yet Unclear: A Systematic Review of Medical Mistrust

Peer-reviewed articles (n = 124) examining associations between medical mistrust (MM) and health outcomes from four databases, between January 1998 and May 2018, were reviewed; 36 qualitative and 88 quantitative studies met the inclusion criteria. The Williams and Mohammed framework guided our narrative synthesis of the studies; it argues that basic causes (e.g., biased institutions) affect the social status of marginalized groups which in turn effects multiple proximal pathways leading to responses and poor health. Most studies were cross-sectional with US-based samples. The MM in qualitative studies were categorized as interpersonal (n = 30), systemic (n = 22), and/or vicarious (n = 18); 25% did not explicitly note the basic causes of MM and race/ethnicity was often confounded with socioeconomic status (SES). All but three studies discussed an association between MM and a behavior response; no study focused on an actual health outcome. Most quantitative studies used multivariate regression analyses; only 15 of the 88 utilized advanced modeling techniques (e.g., mediation). Most (75%) studies did not describe basic causes for MM and 43% utilized low income samples. MM was conceptualized as a predictor/proximal pathway (in 73 studies) associated with a variety of responses, most commonly behavioral (e.g., diminished adherence); 14 studies found an association between MM and a specific health measure. This review underscores the need for future qualitative studies to place MM central to their research questions as in-depth descriptions of MM were limited. Future quantitative studies should replicate findings using more advanced analytical strategies that examine the relationship between MM and health outcomes.

Towards a More Inclusive and Dynamic Understanding of Medical Mistrust Informed by Science

Mistrust of medical advances and the medical professions continues to persist, and is perhaps increasing. The popular press has documented the growing number of parents globally whose concerns around childhood vaccination, albeit based on faulty scientific information, has led to the anti-vax movement which has already resulted in outbreaks of measles in various parts of the U.S. In recent years, the AIDS Healthcare Foundation has increased speculation and mistrust with regard to the denialism of the effectiveness of pre-exposure prophylaxis (PrEP) to avert HIV infections, again based on misinformation. However, in other cases, medical mistrust reflects the very real historical and ongoing injustices experienced by socially and economically marginalized groups. Whether the genesis of the mistrust is based on fact or fallacy, the results may be similar. There are myriad negative consequences associated with medical mistrust, including lower utilization of healthcare and poorer management of health conditions. Mistrust is thought to provide a partial explanation for staggering health disparities, particularly among Black and African American people, and much of the public health and medical literature cites the infamous Tuskegee Study as a main catalyst for this persistent health-related mistrust among people of color and other groups who experience social and economic vulnerability. While mistrust is often referred to as a phenomenon existing within an individual or community, we must rethink this conceptualization and instead locate mistrust as a phenomenon created by and existing within a system that creates, sustains and reinforces racism, classism, homophobia and transphobia, and stigma. The purpose of this article is to briefly address the state of the medical mistrust literature, and to provide a summary of the articles included in this special issue on medical mistrust. Although the scholarship in this issue addresses diverse methodologies, outcomes and populations, they share a message: social inequality drives mistrust.