Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health

Ethical Considerations in Infodemic Management: Systematic Scoping Review

BACKGROUND

During health emergencies, effective infodemic management has become a paramount challenge. A new era marked by a rapidly changing information ecosystem, combined with the widespread dissemination of misinformation and disinformation, has magnified the complexity of the issue. For infodemic management measures to be effective, acceptable, and trustworthy, a robust framework of ethical considerations is needed.

OBJECTIVE

This systematic scoping review aims to identify and analyze ethical considerations and procedural principles relevant to infodemic management, ultimately enhancing the effectiveness of these practices and increasing trust in stakeholders performing infodemic management practices with the goal of safeguarding public health.

METHODS

The review involved a comprehensive examination of the literature related to ethical considerations in infodemic management from 2002 to 2022, drawing from publications in PubMed, Scopus, and Web of Science. Policy documents and relevant material were included in the search strategy. Papers were screened against inclusion and exclusion criteria, and core thematic areas were systematically identified and categorized following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed the literature to identify substantive ethical principles that were crucial for guiding actions in the realms of infodemic management and social listening, as well as related procedural ethical principles. In this review, we consider ethical principles that are extensively deliberated upon in the literature, such as equity, justice, or respect for autonomy. However, we acknowledge the existence and relevance of procedural practices, which we also consider as ethical principles or practices that, when implemented, enhance the efficacy of infodemic management while ensuring the respect of substantive ethical principles.

RESULTS

Drawing from 103 publications, the review yielded several key findings related to ethical principles, approaches, and guidelines for practice in the context of infodemic management. Community engagement, empowerment through education, and inclusivity emerged as procedural principles and practices that enhance the quality and effectiveness of communication and social listening efforts, fostering trust, a key emerging theme and crucial ethical principle. The review also emphasized the significance of transparency, privacy, and cybersecurity in data collection.

CONCLUSIONS

This review underscores the pivotal role of ethics in bolstering the efficacy of infodemic management. From the analyzed body of literature, it becomes evident that ethical considerations serve as essential instruments for cultivating trust and credibility while also facilitating the medium-term and long-term viability of infodemic management approaches.

Role of information sources in adherence to COVID-19-related safety measures among college students in the USA

OBJECTIVE

During the COVID-19 pandemic, information sources such as public officials, national/international media, social media, public health agencies, college/university officials, etc., played a vital role in adherence to safety measures, including hygiene practices, social distancing, and mask-wearing. We analyze the role of trusted sources of information in adherence to safety measures and explore potential disparities among US college students during the pandemic.

METHODS

We analyze Healthy Minds Study (HMS) 2020-2021 COVID Module data and utilize multivariable logistic regressions controlling for sociodemographic and COVID-19-related factors. Subgroup analyses were conducted by gender, citizenship status, race, and educational level.

RESULTS

Significant differences were found in adherence to safety measures when information was received from different sources. Demographic subgroups within the college student population depended on different sources of COVID-19-related information. Adherence to COVID-19-related safety measures also differed by demographic characteristics.

CONCLUSION

This analysis supports the necessity for targeted health-related messaging among US college students.

The impact of social media influencers on health outcomes: Systematic review

A fast emerging area of public health interest is the potential role of social media influencers in spreading health information and affecting health behaviour. The aim of this research was to systematically synthesise evidence on the impact of social media influencers on health outcomes. A systematic search of six databases (Medline, Embase, PsycINFO, CINAHL, Science Citation Index and Sociology Collection) was conducted in October 2021, with an update search in January 2023. Two reviewers independently screened titles and abstracts. We included interventional study designs which examined the effect of social media influencer as the primary or only exposure on a quantified health outcome. We used narrative synthesis to summarise the characteristics and main findings of studies within each of four main topic areas. We assessed quality using a critical appraisal checklist for quasi-experimental studies. We identified twelve studies across four areas that met the inclusion criteria: children's dietary behaviour (n = 5), body image dissatisfaction (n = 4), influenza and COVID-19 (n = 2), and social comparison and anxiety (n = 1). Influencer marketing of unhealthy foods had a statistically significant effect on increasing children's immediate energy intake, but no effect was found for influencer promotion of vegetables. When an unhealthy food is marketed by an influencer of unhealthy appearance, this led to an increased preference for healthy snacks. Exposure to idealised influencer body imagery had statistically significant negative impacts on body image and mood. Anxiety caused by viewing idealised portrayals of motherhood was the same whether or not the portrayal was by an influencer. Public health campaigns harnessing influencers to promote hygiene habits in the context of COVID-19 and influenza showed some positive changes in health behaviours. Most of the published studies are of poor methodological quality with poor generalisability and statistical weaknesses. We conclude that social media influencers have both negative and positive impacts on health outcomes, with negative impacts seen consistently in studies of body image dissatisfaction. Further research is needed to harness the potential positive health impact of social media influencers, while mitigating against harmful effects.

COVID-19 vaccine literacy: A scoping review

To address vaccine hesitancy, specific self-rated tools have been developed to assess vaccine literacy (VL) related to COVID-19, including additional variables, such as beliefs, behavior, and willingness to be vaccinated. To explore the recent literature a search was performed selecting articles published between January 2020 and October 2022: 26 papers were identified using these tools in the context of COVID-19. Descriptive analysis showed that the levels of VL observed in the studies were generally in agreement, with functional VL score often lower than the interactive-critical dimension, as if the latter was stimulated by the COVID-19-related infodemic. Factors associated with VL included vaccination status, age, educational level, and, possibly, gender. Effective communication based on VL when promoting vaccination is critical to sustaining immunization against COVID-19 and other communicable diseases. The VL scales developed to date have shown good consistency. However, further research is needed to improve these tools and develop new ones.

Information dissemination during public health emergencies: analysing the international flow of COVID-19-related news

A large-scale exchange of information between media across national borders is frequently observed when a worldwide public health emergency occurs. This study investigated the global news citation network in the early stage of the COVID-19 pandemic by analysing the network structure at different levels to identify important nodes and the relationships among news organisations. The results show that COVID-19-related international news flow had a complex and unequal pattern, with a few countries and media outlets occupying a prominent place in the network and three media groups played key but different roles in disseminating the news. It was jointly influenced by national traits, the relatedness between countries, and the pandemic emergency with public health risks. From a global perspective, the media of the United States, mainland China, and the United Kingdom played the most important parts in collaboration within the world media system in the early stage of the COVID-19 pandemic.

Understanding Trust Determinants in a Live Chat Service on Familial Cancer: Qualitative Triangulation Study With Focus Groups and Interviews in Germany

BACKGROUND

In dealing with familial cancer risk, seeking web-based health information can be a coping strategy for different stakeholder groups (ie, patients, relatives, and those suspecting an elevated familial cancer risk). In the vast digital landscape marked by a varied quality of web-based information and evolving technologies, trust emerges as a pivotal factor, guiding the process of health information seeking and interacting with digital health services. This trust formation in health information can be conceptualized as context dependent and multidimensional, involving 3 key dimensions: information seeker (trustor), information provider (trustee), and medium or platform (application). Owing to the rapid changes in the digital context, it is critical to understand how seekers form trust in new services, given the interplay among these different dimensions. An example of such a new service is a live chat operated by physicians for the general public with personalized cancer-related information and a focus on familial cancer risk.

OBJECTIVE

To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigates the 3 dimensions of trust-trustor, trustee, and application-and their respective relevant characteristics based on a model of trust in web-based health information. In addition, the study aims to compare these characteristics across the 3 different stakeholder groups, with the goal to enhance the service's trustworthiness for each group.

METHODS

This qualitative study triangulated the different perspectives of medical cancer advisers, advisers from cancer support groups, and members of the public in interviews and focus group discussions to explore the 3 dimensions of trust-trustor, trustee, and application-and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service.

RESULTS

The results indicate that experience with familial cancer risk is the key trustor characteristic to using, and trusting information provided by, the live chat service. The live chat might also be particularly valuable for people from minority groups who have unmet needs from physician-patient interactions. Participants highlighted trustee characteristics such as ability, benevolence, integrity, and humanness (ie, not a chatbot) as pivotal in a trustworthy cancer live chat service. Application-related characteristics, including the reputation of the institution, user-centric design, modern technology, and visual appeal, were also deemed essential. Despite the different backgrounds and sociodemographics of the 3 stakeholder groups, many overlaps were found among the 3 trust dimensions and their respective characteristics.

CONCLUSIONS

Trust in a live chat for cancer information is formed by different dimensions and characteristics of trust. This study underscores the importance of understanding trust formation in digital health services and suggests potential enhancements for effective, trustworthy interactions in live chat services (eg, by providing biographies of the human medical experts to differentiate them from artificial intelligence chatbots).

Merging public health and automated approaches to address online hate speech

The COVID-19 pandemic sparked a rise in misinformation from various media sources, which contributed to the heightened severity of hate speech. The upsurgence of hate speech online has devastatingly translated to real-life hate crimes, which saw an increase of 32% in 2020 in the United States alone (U.S. Department of Justice 2022). In this paper, I explore the current effects of hate speech and why hate speech should be widely recognized as a public health issue. I also discuss current artificial intelligence (AI) and machine learning (ML) strategies to mitigate hate speech along with the ethical concerns with using these technologies. Future considerations to improve AI/ML are also examined. Through analyzing these two contrasting methodologies (public health versus AI/ML), I argue that these two approaches applied by themselves are not efficient or sustainable. Therefore, I propose a third approach that combines both AI/ML and public health. With this proposed approach, the reactive side of AI/ML and the preventative nature of public health measures are united to develop an effective manner of addressing hate speech.

Quality of Information for Post-Prostatectomy Incontinence Treatments on YouTube

OBJECTIVE

To assess the quality of information on YouTube regarding post-prostatectomy incontinence treatments. The 2019 American Urological Association(AUA)/(SUFU) Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction guidelines recommend the placement of a male sling or artificial urinary sphincter. Patient education is essential for appropriate expectations and patient satisfaction.

METHODS

The top 100 most relevant (default setting) YouTube videos searched with terms "post-prostatectomy incontinence" and "male stress incontinence" were assessed using the validated DISCERN instrument, Patient Education Materials Assessment Tool for Audiovisual Materials, and a misinformation Likert Scale. Videos with poor video/audio quality, duplicates, and non-English videos were excluded. Four independent raters were randomly assigned such that each video had 2 raters. Data was analyzed using multivariate linear regression, and inter-rater reliability was measured using Cohen's kappa.

RESULTS

The median DISCERN score was 2.5 with 71% of videos scoring <=3. The median PEMAT Actionability and Understandability scores were 64.6 (range 0-100) and 79.9 (range 52-100), respectively. The median misinformation Likert score was 1 range (1-4). Less than half of the videos discussed realistic treatment outcomes or the risks (39% and 24%, respectively). PEMAT Actionability and risk discussion significantly predicted average DISCERN score (p < .001). There were no significant disagreements between raters.

CONCLUSION

Our study shows most videos on post-prostatectomy incontinence had moderate to low quality information and were published by medical professionals. The majority did not sufficiently discuss realistic outcomes and risks, which are hallmarks of informed decision making. This provides an opportunity for the urologic community to create educational materials that adequately supplement shared-decision making for patients treated for post-prostatectomy incontinence.

Rainbows over the world's public health: determinants of health models in the past, present, and future

The need to visualise the complexity of the determinants of population health and their interactions inspired the development of the rainbow model. In this commentary we chronicle how variations of this model have emerged, including the initial models of Haglund and Svanström (1982), Dahlgren and Whitehead (1991), and the Östgöta model (2014), and we illustrate how these models have been influential in both public health and beyond. All these models have strong Nordic connections and are thus an important Nordic contribution to public health. Further, these models have underpinned and facilitated other examples of Nordic leadership in public health, including practical efforts to address health inequalities and design new health policy approaches.

Apart from documenting the emergence of rainbow models and their wide range of contemporary uses, we examine a range of criticisms levelled at these models – including limitations in methodological development and in scope. We propose the time is ripe for an updated generic determinants of health model, one that elucidates and preserves the core value in older models, while recognising the developments that have occurred over the past decades in our understanding of the determinants of health. We conclude with an example of a generic model that fulfills the general purposes of a determinants of health model while maintaining the necessary scope for further adjustments to be made in the future, as well as adjustments to location or context-specific purposes, in education, research, health promotion and beyond.

Health-Related Rumor Control through Social Collaboration Models: Lessons from Cases in China during the COVID-19 Pandemic

Widely spread health-related rumors may mislead the public, escalate social panic, compromise government credibility, and threaten public health. Social collaboration models that maximize the functions and advantages of various agents of socialization can be a promising way to control health-related rumors. Existing research on health-related rumors, however, is limited in studying how various agents collaborate with each other to debunk rumors. This study utilizes content analysis to code the text data of health-related rumor cases in China during the COVID-19 pandemic. The study found that socialized rumor-debunking models could be divided into the following five categories: the government-led model, the media-led model, the scientific community-led model, the rumor-debunking platform-led model, and the multi-agent collaborative model. In addition, since rumors in public health crises often involve different objects, rumor refutation requires various information sources; therefore, different rumor-debunking models apply. This study verifies the value of socialized collaborative rumor debunking, advocates and encourages the participation of multiple agents of socialization and provides guidance for establishing a collaborative rumor-debunking model, thereby promoting efficient rumor-debunking methods and improving the healthcare of society.

Intégrer l’infosurveillance, l’infodémiologie et une recherche interventionnelle conséquente dans nos systèmes de santé publique pour mieux protéger et promouvoir la santé de la population au Canada : idées et perspectives

There is no longer any doubt that exposure to the tsunami of health information which is sometimes evidence-based and sometimes unfounded and even misleading, is a public health issue. The term infodemic is used to describe this phenomenon. Research conducted over the past two decades has provided a measure of the extent of information overload and of the quality of information to which populations are exposed. Selected harmful effects have also been observed. It is urgent to mobilize and structure public health systems by involving all the required expertise to combat health misinformation and better manage the infodemic. Towards this end, we are launching a call for critical thinking around three themes: the infosphere as a social determinant of health, the development of skills in infodemiology, and finally, the development, cocreation, and evaluation of consequential interventions to better manage the infodemic and combat disinformation. We believe that lessons learned collectively from the successful integration of infoveillance, infodemiology, and consequential intervention research in our public health systems will serve to better address issues emerging from infodemics.

Making a Cocoon: The Social Factors of Pandemic Misinformation Evaluation

This study explores the social factors that may impact individuals' evaluation process of pandemic-related misinformation through a socio-cognitive lens. We conducted eight semi-structured interviews to collect data from individuals. Content analysis was guided by framework analysis of the interview transcripts. The social factors revealed in the study are social identity, social groups, social authorities, social spaces, social media, and social algorithms. These factors work together and isolate individuals from heterogeneous information. Social identity may decide other factors; correspondingly, the information filtered by social groups, authorities, spaces, media, and algorithms reinforces individuals' social identity. The tendency may reinforce bias on pandemic information and put people at risk. The research may provide an implication to information platforms to reconsider their algorithm designs and a direction for information literacy training programs to break the deficit assumption on individuals.

Views of healthcare consumer representatives on defensive practice: 'We are your biggest advocate and supporter… not the enemy'

Background

The patient–clinician interaction is a site at which defensive practice could occur, when clinicians provide tests, procedures and treatments mainly to reduce perceived legal risks, rather than to advance patient care. Defensive practice is a driver of low‐value care and exposes patients to the risks of unnecessary interventions. To date, patient perspectives on defensive practice and its impacts on them are largely missing from the literature. This exploratory study conducted in Australia aimed to examine the views and experiences of healthcare consumer representatives in this under‐examined area.

Methods

Semi‐structured interviews were conducted with healthcare consumer representatives involved in healthcare consumer advocacy organisations in Australia. Data were transcribed and analysed thematically.

Results

Nine healthcare consumer representatives participated. Most had over 20 years of involvement and advocacy in healthcare, including personal experiences as a patient or carer and/or formal service roles on committees or complaint bodies for healthcare organisations. Participants uniformly viewed defensive practice as having a negative impact on the clinician–patient relationship. Themes identified the importance of fostering patient–clinician partnership, effective communication and informed decision‐making. The themes support a shift from the concept of defensive practice to preventive practice in partnership, which focuses on the shared interests of patients and clinicians in achieving safe and high‐value care.

Conclusion

This Australian study offers healthcare consumers' perspectives on the impacts of defensive practice on patients. The findings highlight the features of clinician–patient partnership that will help to improve communication and decision‐making, and prevent the defensive provision of low‐value care.

Patient or Public Contribution

Healthcare consumer representatives were involved as participants in this study.

The causes, impacts and countermeasures of COVID-19 "Infodemic": A systematic review using narrative synthesis

An unprecedented infodemic has been witnessed to create massive damage to human society. However, it was not thoroughly investigated. This systematic review aims to (1) synthesize the existing literature on the causes and impacts of COVID-19 infodemic; (2) summarize the proposed strategies to fight with COVID-19 infodemic; and (3) identify the directions for future research. A systematic literature search following the PRISMA guideline covering 12 scholarly databases was conducted to retrieve various types of peer-reviewed articles that reported causes, impacts, or countermeasures of the infodemic. Empirical studies were assessed for risk of bias using the Mixed-Methods Appraisal Tool. A coding theme was iteratively developed to categorize the causes, impacts, and countermeasures found from the included studies. Social media usage, low level of health/eHealth literacy, and fast publication process and preprint service are identified as the major causes of the infodemic. Besides, the vicious circle of human rumor-spreading behavior and the psychological issues from the public (e.g., anxiety, distress, fear) emerges as the characteristic of the infodemic. Comprehensive lists of countermeasures are summarized from different perspectives, among which risk communication and consumer health information need/seeking are of particular importance. Theoretical and practical implications are discussed and future research directions are suggested.

Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence-Based Infodemiology Study

Background

Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines.

Objective

Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence–based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications.

Methods

The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy.

Results

We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: “flu,” “influenza,” “vaccination,” “vaccine,” and “vaxx.” We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that “flu” and “covid” occurrences were inversely correlated as “flu” disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: “health and medicine (biological and clinical aspects),” “protection and responsibility,” and “politics.” By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events.

Conclusions

This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations’ engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process.

Breaking out: the turning point in learning using mobile technology

Despite considerable research on YouTube as a digital media platform, little research to date has quantified the device-type used to access that online media. Analyzing access-device data for videos on one YouTube video channel—Scientific Animations Without Borders (SAWBO), which produces educational content specifically accessible to low- or non-literate, poor, or geographically isolated learners in less developed areas of the world—the results identify the historical moments between 2015 and 2017 when mobile/smartphones, both globally and by region, crossed a tipping point to surpass all other ICT devices (including desktop PCs, laptops, and other Internet-accessing technologies) as the primary device-type for accessing SAWBO videos. Specifically, data from January 2013 to June 2018 obtained for SAWBO's YouTube channel were sampled to capture and distinguish the access device-type used and then summarized in broad global and regional categories. The tipping point, as the date where the percentage of views from mobile phones was equivalent to the percentage of views from computers, were also calculated globally and by region. Besides documenting this critical global-historical moment, the results also have implications for mass digital-messaging generally and mobile-based public service learning specifically.

Reasons for Taking the COVID-19 Vaccine by US Social Media Users

Political and public health leaders promoting COVID-19 vaccination should identify the most relevant criteria driving the vaccination decision. Social media is increasingly used as a source of vaccination data and as a powerful communication tool to increase vaccination. In December 2020, we performed a cross-sectional social media-based survey addressing personal sentiments toward COVID-19 vaccination in the USA. Our primary research objective is to identify socio-demographic characteristics and the reasons for the 1644 survey participants’ attitudes regarding vaccination. We present clear evidence that, contrary to the prevailing public perceptions, young audiences using social media have mostly a positive attitude towards COVID-19 vaccination (81.5%). These younger individuals want to protect their families and their relatives (96.7%); they see vaccination as an act of civic responsibility (91.9%) and express strong confidence in their healthcare providers (87.7%). Another critical factor is the younger population’s fear of personal COVID-19 infection (88.2%); moreover, the greater the number of children the participants have, the greater is their intent to get the COVID-19 vaccine. These results enable a practical public-messaging pathway to reinforce vaccination campaigns addressing the younger population.

Epistemic responsibilities in the COVID-19 pandemic: Is a digital infosphere a friend or a foe?

Digital technologies have a significant role in collecting, filtering and disseminating information, allowing for social, healthcare and economic activities even in the context of highly restrictive public health measures in the current COVID-19 pandemic. As personal contact is greatly reduced, they also create a shared informational landscape, allowing for a shared threat response. This is a difficult task, since truthfulness of content that leads to actionable knowledge is impossible to consistently validate. So, not only that curation of information is rarely congruent with pressing health issues, but digital spaces may also become fertile ground for misinformation and disinformation, contributing to the devastating effects of an infodemic.

Digital intermediaries are useful exactly because their representation of reality is not a true construct, but a result of purposely curated information. However, they are active, dynamic epistemological agents with their own logic and aim. In dealing with a pandemic, we should reconsider the ways how our digital informational landscapes are created and sustained. This urges us to consider ethical governance of digital data curation and dissemination, alongside forms of control of the truthfulness and reach of its content.

Some of the most fundamental issues in dealing with the COVID-19 pandemic, including the newly available vaccines are reliant on digital information and data sharing among experts, and the role of informing the general public. The need to create a reproducible, valid and truthful informational landscape is paramount, while allowing for free and rational, behavioral individual choices oriented toward preserving and promoting healthy behavior. These are issues at the heart of dealing with any pandemic, as well as a well-organized health care policy.