The Landscape of Disinformation on Health Crisis Communication During the COVID-19 Pandemic in Ukraine: Hybrid Warfare Tactics, Fake Media News and Review of Evidence

"Why would we?" A qualitative study on COVID-19 vaccination decision making among Ukrainian economic female migrants in Poland

Background

Ukraine has one of the lowest COVID-19 vaccination rates in Europe. This may pose a significant epidemiological risk in the context of the refugee crisis and the fact that, since 2020, SARS-CoV-2 has been spreading and changing globally.

Objective

To evaluate determinants of vaccination decision making among Ukrainian female migrants (UFMs).

Methods

A qualitative study with 45 UFMs was conducted between December 2021 and January 2022. UFMs, from 2 Polish provinces, differing in age, education and length of stay were invited with the use of the snowball technique. Using a semi-structured topic guide, eight focus groups were conducted in person, recorded and transcribed. Thematic, qualitative analysis was made; key themes which emerged from the data (with the help of the Working Group Determinants of Vaccine Hesitancy Matrix), were related to contextual, individual/group and contextual vaccine/vaccination-specific influences.

Results

Mothers were found to be playing a crucial role in children and adolescent COVID-19 vaccine decision-making process. Universal trust in the Polish healthcare system and vaccination procedures, employer requirements and willingness to preserve jobs, desire to get back to normal and social influences were paramount prerequisites to let UFMs make a decision to get vaccinated. However, COVID-19 vaccines also faced backlash among UFMs. Negative experiences with vaccines provided in Ukraine, doubts about the rapid vaccine development, combined with lack of confidence in vaccine safety, specifically regarding child vaccination, might have a bearing on UFMs' decision about declining COVID-19 vaccine while on migration. Discrimination through HCWs during vaccination visits was also reported. Corrupted Ukrainian healthcare system, which facilitates proof forgery regarding vaccination certificates, could act as a negative influencer of UFMs' vaccine decision-making.

Conclusion

The results provide the novel information, expressed in economic UFMs' own words. Findings show that influencers of the decision-making process regarding the COVID-19 vaccination are complex and polarized; elements of hesitancy may persist after migration. Any continuation of UFMs' vaccination with COVID-19 vaccine should be subject to designing accessible information to address modifiable demotivators of the vaccine decision-making process identified in this study.

Intervening on Global Emergencies: The Value of Human Interactions for People's Health

Literature about global emergencies and their impact on people's health underlines the need to improve the social cohesion of human community and the availability of tools to support people and foster community interactions. This paper illustrates research aimed at describing and measuring human interactions in the Veneto community and its changing during the COVID-19 pandemic. 50,000 text occurrences from social media and newspapers about these topics were analyzed between December 2021 and January 2022. People present themselves as members of different teams, pursuing conflicting aims, and attributing the decision-making responsibility of emergencies management exclusively to governments, without considering themselves as active parts of the community. This delegation process on citizens' behalf can affect their health: by taking minor responsibility in handling the repercussions of these events on the community and by arguing over the most effective way to deal with them, they risk freezing and waiting for action by third parties, thus leaving mutual interactions and the promotion of their own health at a standstill. Local institutions can use these data to shape prevention policies to manage the community's emergencies and use them as opportunities to promote public health.

Defining Misinformation and Related Terms in Health-Related Literature: Scoping Review

BACKGROUND

Misinformation poses a serious challenge to clinical and policy decision-making in the health field. The COVID-19 pandemic amplified interest in misinformation and related terms and witnessed a proliferation of definitions.

OBJECTIVE

We aim to assess the definitions of misinformation and related terms used in health-related literature.

METHODS

We conducted a scoping review of systematic reviews by searching Ovid MEDLINE, Embase, Cochrane, and Epistemonikos databases for articles published within the last 5 years up till March 2023. Eligible studies were systematic reviews that stated misinformation or related terms as part of their objectives, conducted a systematic search of at least one database, and reported at least 1 definition for misinformation or related terms. We extracted definitions for the terms misinformation, disinformation, fake news, infodemic, and malinformation. Within each definition, we identified concepts and mapped them across misinformation-related terms.

RESULTS

We included 41 eligible systematic reviews, out of which 32 (78%) reviews addressed the topic of public health emergencies (including the COVID-19 pandemic) and contained 75 definitions for misinformation and related terms. The definitions consisted of 20 for misinformation, 19 for disinformation, 10 for fake news, 24 for infodemic, and 2 for malinformation. "False/inaccurate/incorrect" was mentioned in 15 of 20 definitions of misinformation, 13 of 19 definitions of disinformation, 5 of 10 definitions of fake news, 6 of 24 definitions of infodemic, and 0 of 2 definitions of malinformation. Infodemic had 19 of 24 definitions addressing "information overload" and malinformation had 2 of 2 definitions with "accurate" and 1 definition "used in the wrong context." Out of all the definitions, 56 (75%) were referenced from other sources.

CONCLUSIONS

While the definitions of misinformation and related terms in the health field had inconstancies and variability, they were largely consistent. Inconstancies related to the intentionality in misinformation definitions (7 definitions mention "unintentional," while 5 definitions have "intentional"). They also related to the content of infodemic (9 definitions mention "valid and invalid info," while 6 definitions have "false/inaccurate/incorrect"). The inclusion of concepts such as "intentional" may be difficult to operationalize as it is difficult to ascertain one's intentions. This scoping review has the strength of using a systematic method for retrieving articles but does not cover all definitions in the extant literature outside the field of health. This scoping review of the health literature identified several definitions for misinformation and related terms, which showed variability and included concepts that are difficult to operationalize. Health practitioners need to exert caution before labeling a piece of information as misinformation or any other related term and only do so after ascertaining accurateness and sometimes intentionality. Additional efforts are needed to allow future consensus around clear and operational definitions.

Parents' Attitudes towards Vaccinations Regarding the Ukrainian Migration to Poland in 2022

Background: Russia's aggression against Ukraine in early 2022 resulted in a large migration of refugees to many countries, including Poland. Vaccination coverage for some infectious diseases in Ukraine is lower than in Poland; consequently, the incidence of infectious diseases-including measles, poliomyelitis, tuberculosis, and COVID-19-is higher. We aimed to investigate whether the migration of Ukrainians had influenced decisions of Polish parents on having their children vaccinated and to examine their attitudes towards vaccinations. Material and methods: A cross-sectional online survey study was designed. Data on parents' demographics, attitudes toward vaccination, and knowledge of the current epidemiological situation in Poland were collected. Parents participating in the study were divided into two subgroups for further analysis according to their decisions to have their children vaccinated. Results: A total of 568 questionnaires were collected, of which 21 did not meet the inclusion criteria for the analysis (respondents were not parents). The Ukrainian immigrants' influx affected 54 (9.87%) participants in their decision of having their children vaccinated. Respondents in this group were more likely to have a positive attitude toward recommended vaccinations (p = 0.0428); in addition, they more often had their children vaccinated with recommended vaccinations (p = 0.0063), believed the vaccination coverage with mandatory vaccinations was higher in Poland than in Ukraine (p = 0.0014), and believed the incidence of diseases covered by mandatory (p = 0.0472) and recommended (p = 0.0097) vaccinations was higher in Ukraine. In addition, parents who declared that the migration had affected their decision regarding their children's vaccinations had more often been vaccinated due to the influx of Ukrainian immigrants (p < 0.00001) and were more likely to be aware of how migration had impacted the current epidemiological situation in Poland (p = 0.0021). Moreover, the survey more often made these participants think about getting additional vaccinations for themselves (p < 0.0001) and their children (p < 0.0001). Conclusions: The Ukrainian immigrants' influx affected nearly one tenth of surveyed parents in their decision of having their children vaccinated. This group was more aware of the differences between infectious diseases' epidemiology in Poland and Ukraine. In addition, they also had a more positive attitude toward vaccinations.

What message appeal and messenger are most persuasive for COVID-19 vaccine uptake: Results from a 5-country survey in India, Indonesia, Kenya, Nigeria, and Ukraine

Effective strategies to encourage COVID-19 vaccination should consider how health communication can be tailored to specific contexts. Our study aimed to evaluate the influence of three specific messaging appeals from two kinds of messengers on COVID-19 vaccine acceptance in diverse countries. We surveyed 953 online participants in five countries (India, Indonesia, Kenya, Nigeria, and Ukraine). We assessed participants’ perceptions of three messaging appeals of vaccination—COVID-19 disease health outcomes, social norms related to COVID-19 vaccination, and economic impact of COVID-19—from two messengers, healthcare providers (HCP), and peers. We examined participants’ ad preference and vaccine hesitancy using multivariable multinomial logistic regression. Participants expressed a high level of approval for all the ads. The healthcare outcome–healthcare provider ad was most preferred among participants from India, Indonesia, Nigeria, and Ukraine. Participants in Kenya reported a preference for the health outcome–peer ad. The majority of participants in each country expressed high levels of vaccine hesitancy. However, in a final logistic regression model participant characteristics were not significantly related to vaccine hesitancy. These findings suggest that appeals related to health outcomes, economic benefit, and social norms are all acceptable to diverse general populations, while specific audience segments (i.e., mothers, younger adults, etc.) may have preferences for specific appeals over others. Tailored approaches, or approaches that are developed with the target audience’s concerns and preferences in mind, will be more effective than broad-based or mass appeals.

Infodemics and health misinformation: a systematic review of reviews

Objective

To compare and summarize the literature regarding infodemics and health misinformation, and to identify challenges and opportunities for addressing the issues of infodemics.

Methods

We searched MEDLINE®, Embase®, Cochrane Library of Systematic Reviews, Scopus and Epistemonikos on 6 May 2022 for systematic reviews analysing infodemics, misinformation, disinformation and fake news related to health. We grouped studies based on similarity and retrieved evidence on challenges and opportunities. We used the AMSTAR 2 approach to assess the reviews' methodological quality. To evaluate the quality of the evidence, we used the Grading of Recommendations Assessment, Development and Evaluation guidelines.

Findings

Our search identified 31 systematic reviews, of which 17 were published. The proportion of health-related misinformation on social media ranged from 0.2% to 28.8%. Twitter, Facebook, YouTube and Instagram are critical in disseminating the rapid and far-reaching information. The most negative consequences of health misinformation are the increase of misleading or incorrect interpretations of available evidence, impact on mental health, misallocation of health resources and an increase in vaccination hesitancy. The increase of unreliable health information delays care provision and increases the occurrence of hateful and divisive rhetoric. Social media could also be a useful tool to combat misinformation during crises. Included reviews highlight the poor quality of published studies during health crises.

Conclusion

Available evidence suggests that infodemics during health emergencies have an adverse effect on society. Multisectoral actions to counteract infodemics and health misinformation are needed, including developing legal policies, creating and promoting awareness campaigns, improving health-related content in mass media and increasing people's digital and health literacy.

Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study

OBJECTIVE

Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course.

DESIGN

Pretest/post-test quasi-experimental study.

SETTING

Mechnikov Hospital in Dnipro, Ukraine.

PARTICIPANTS

Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%).

INTERVENTIONS

The 5-day WHO-ICRC BEC course.

PRIMARY AND SECONDARY OUTCOME MEASURES

Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes.

RESULTS

Participant knowledge assessment scores improved from 19 (IQR 15-20) to 22 (IQR 19-23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1-2.8) to 2.9 (IQR 2.5-3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time.

CONCLUSIONS

This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.

Strategies to Counter Disinformation for Healthcare Practitioners and Policymakers

Medical disinformation has interfered with healthcare workers' ability to communicate with the general population in a wide variety of public health contexts globally. This has limited the effectiveness of evidence-based medicine and healthcare capacity. Disinformation campaigns often try to integrate or co-opt healthcare workers in their practices which hinders effective health communication. We describe a critical overview of issues health practitioners and communicators have experienced when dealing with medical disinformation online and offline as well as best practices to overcome these issues when disseminating health information. This article lists disinformation techniques that have yet to be used against the medical community but need to be considered in future communication planning as they may be highly effective. We also present broad policy recommendations and considerations designed to mitigate the effectiveness of medical disinformation campaigns.

Investigation of Statistical Machine Learning Models for COVID-19 Epidemic Process Simulation: Random Forest, K-Nearest Neighbors, Gradient Boosting

COVID-19 has become the largest pandemic in recent history to sweep the world. This study is devoted to developing and investigating three models of the COVID-19 epidemic process based on statistical machine learning and the evaluation of the results of their forecasting. The models developed are based on Random Forest, K-Nearest Neighbors, and Gradient Boosting methods. The models were studied for the adequacy and accuracy of predictive incidence for 3, 7, 10, 14, 21, and 30 days. The study used data on new cases of COVID-19 in Germany, Japan, South Korea, and Ukraine. These countries are selected because they have different dynamics of the COVID-19 epidemic process, and their governments have applied various control measures to contain the pandemic. The simulation results showed sufficient accuracy for practical use in the K-Nearest Neighbors and Gradient Boosting models. Public health agencies can use the models and their predictions to address various pandemic containment challenges. Such challenges are investigated depending on the duration of the constructed forecast.

Vaccination of Ukrainian Refugees: Need for Urgent Action

The unprovoked aggression of Russian military forces on Ukraine in February 2022 has caused a high influx of refugees, including children, to neighboring countries, particularly Poland. This caused additional pressures on the healthcare system and the need to meet challenges for public health, such as those related to infectious diseases. Here, we discuss the potential epidemiological risks associated with the war-induced influx of refugees (coronavirus disease 2019, measles, pertussis, tetanus, and poliomyelitis) and highlight the need for their swift management through institutional support, educational campaigns, counteracting antiscience misinformation, and pursuing vaccinations of refugees but also improving or maintaining good levels of immunization in populations of countries welcoming them. These are necessary actions to avoid overlapping of war and infectious diseases and associated public health challenges.

COVID-19 Misinformation on Social Media: A Scoping Review

Social media allows for easy access and sharing of information in real-time. Since the beginning of the coronavirus disease (COVID-19) pandemic, social media has been used as a tool for public health officials to spread valuable information. However, many Internet users have also used it to spread misinformation, commonly referred to as "fake news." The spread of misinformation can lead to detrimental effects on the infrastructure of healthcare and society. The purpose of this scoping review was to identify the sources and impact of COVID-19 misinformation on social media and examine potential strategies for limiting the spread of misinformation. A systemized search of PubMed, Embase, and Web of Science electronic databases using search terms relevant to the COVID-19 pandemic, social media, misinformation, or disinformation was conducted. Identified titles and abstracts were screened to select original reports and cross-checked for duplications. Using both inclusion and exclusion criteria, results from the initial literature search were screened by independent reviewers. After quality assessment and screening for relevance, 20 articles were included in the final review. The following three themes emerged: (1) sources of misinformation, (2) impact of misinformation, and (3) strategies to limit misinformation about COVID-19 on social media. Misinformation was commonly shared on social media platforms such as Twitter, YouTube, Facebook, messaging applications, and personal websites. The utilization of social media for the dissemination of evidence-based information was shown to be beneficial in combating misinformation. The evidence suggests that both individual websites and social media networks play a role in the spread of COVID-19 misinformation. This practice may potentially exacerbate the severity of the pandemic, create mistrust in public health experts, and impact physical and mental health. Efforts to limit and prevent misinformation require interdisciplinary, multilevel approaches involving government and public health agencies, social media corporations, and social influencers.

COVID-19 health misinformation: using design-based research to develop a theoretical framework for intervention

Purpose

Because health misinformation pertaining to COVID-19 is a serious threat to public health, the purpose of this study is to develop a framework to guide an online intervention into some of the drivers of health misinformation online. This framework can be iterated upon through the use of design-based research to continue to develop further interventions as needed.

Design/methodology/approach

Using design-based research methods, in this paper, the authors develop a theoretical framework for addressing COVID-19 misinformation. Using a heuristic analysis of research on vaccine misinformation and hesitancy, the authors propose a framework for education interventions that use the narrative effect of transportation as a means to increase knowledge of the drivers of misinformation online.

Findings

This heuristic analysis determined that a key element of narrative transportation includes orientation towards particular audiences. Research indicates that mothers are the most significant household decision-makers with respect to vaccines and family health in general; the authors suggest narrative interventions should be tailored specifically to meet their interests and tastes, and that this may be different for mothers of different backgrounds and cultural communities.

Originality/value

While there is a significant body of literature on vaccine hesitancy and vaccine misinformation, more research is needed that helps people understand the ways in which misinformation works upon social media users. The framework developed in this research guided the development of an education intervention meant to facilitate this understanding.

Ações governamentais para enfrentamento da crise de desinformação durante a pandemia da Covid-19

RESUMO A profusão de notícias falsas disseminadas no contexto da pandemia da Covid-19 colocou novos desafios a governos, gestores e profissionais de saúde, mídia e entidades de defesa da saúde e da vida. As ações governamentais de diferentes países frente a esse problema são o objeto deste estudo de revisão integrativa, que analisou 16 artigos, após busca em três bases de dados bibliográficos, no período de novembro de 2020 a janeiro de 2021, utilizando critérios de inclusão e exclusão. Agrupados por continentes (Ásia, Europa e América Latina), os resultados apontaram: existência de dispositivos reguladores; criminalização da desinformação; regulamentação da comunicação digital; uso de tecnologias para aproximar governo e cidadãos; monitoramento e verificação de notícias falsas; uso de plataformas refutadoras; redes digitais para identificação e remoção de notícias e contas; crise de desinformação como fomento para a divergência política; entre outros. Diferenças e desigualdades marcam as ações governamentais frente à desinformação no contexto da pandemia da Covid-19, refletindo coesão social, liderança, confiança institucional ou força coercitiva. Sugerem-se estudos aprofundados, que permitam compreender como as sociedades, com diferentes tipos de governo, economias e regimes políticos, definem as ações desenvolvidas para o controle da desinformação e seu potencial de eficiência.

Government actions to address the disinformation crisis during the COVID-19 pandemic

ABSTRACT The profusion of fake news disseminated in the context of the COVID-19 pandemic posed new challenges to governments, health care managers and professionals, media and entities committed to protect health and life. Government actions from different countries faced with this problem are the object of this integrative review study which analyzed 16 articles, after searching three bibliographic databases, from November 2020 to January 2021 using inclusion and exclusion criteria. Grouped by continents (Asia, Europe and Latin America), the results pointed to: the existence of regulatory devices; criminalization of disinformation; digital communication regulation; use of technologies to bring closer government and citizens; monitoring and verification of fake news; creation of rebuttal news platforms; digital network approaches for identification and removal of news and accounts; disinformation crisis as a foment for political divergence; among other issues. Differences and inequalities marked government actions against disinformation in the context of the COVID-19 pandemic reflecting social cohesion, leadership, institutional trust or coercive force. In-depth studies are suggested to understand how societies with different types of government, economies, and political regimes define the actions taken to control disinformation and their potential effectiveness.

The relation between knowledge and concern: A global study of children and COVID-19

COVID-19 messages vary around the world, and populations receive these messages in different ways. Children are a vulnerable audience, especially in terms of risk communication. As messages are being developed, communicated, and disseminated about this pandemic, it is important to know the relation between COVID-19 knowledge and concern among preadolescents. In Spring 2020, children (N= 4,249) from 8 global regions completed an online survey (Mage= 11.0, 54% female, 46% male). We assessed children's COVID-19 knowledge by asking about prevention and symptoms, as well as myths about the virus. We also assessed children's concerns by asking about worries about self and others getting sick, missing school, and interruption of activities. Our analyses revealed different relations between knowledge and concern by region. Among children from Sub-Saharan Africa, the Arabian region, Asia, and North America, there was a positive relation between knowledge and concern. For those from Latin America, Oceania, Europe, and Southeast Asia, the relation was flat or negative. When producing messages for children during a public health crisis, health communicators must know that more knowledge is not always associated with less concern.