Infodemic and Risk Communication in the Era of CoV-19

'What we lacked was the courage to take decisions that differed from the rest of the world': expert perspectives on the role of evidence in COVID-19 policymaking in Iraq

INTRODUCTION

Iraq reported its first COVID-19 case on 24 February 2020 and formed a national committee and advisory committees to support its response. While global experts have suggested that the COVID-19 pandemic provided an exceptional opportunity for advancing evidence-informed policymaking (EIPM), no research has examined this in Iraq. Therefore, this study aimed to examine evidence use in COVID-19 policymaking in Iraq.

METHODS

This qualitative study employed semi-structured interviews with 20 Iraqi policymakers and researchers. Data were analysed thematically in Arabic using inductive coding.

FINDINGS

Participants described COVID-19 policy in Iraq as based on research conducted in other countries, with poor access and quality of routine data and lack of national research priorities and academic freedom as barriers to national research production. Most researchers influenced policy individually, with universities and other research bodies not seen as contributing to policy development. Public non-compliance could be traced to mistrust in both political and healthcare systems and became particularly problematic during the pandemic. Proposed strategies to increase national research production included dedicated funding, establishing communication and collaboration for research priority setting, and protection of academic freedom.

CONCLUSION

Sociopolitical and economic realities in Iraq were unsupportive of national or subnational evidence generation even before the COVID-19 pandemic, and government relied on international evidence and policy transfer rather than contextually informed EIPM. Strengthening evidence-informed infectious disease policymaking and policy transfer would thus require governmental focus on improving the quality and relevance of Iraqi research, engagement between researchers and policymakers, and processes of evidence use and policy transfer.

Communication to promote and support physical distancing for COVID-19 prevention and control

BACKGROUND

This review is an update of a rapid review undertaken in 2020 to identify relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control. The rapid review was published when little was known about transmission, treatment or future vaccination, and when physical distancing measures (isolation, quarantine, contact tracing, crowd avoidance, work and school measures) were the cornerstone of public health responses globally. This updated review includes more recent evidence to extend what we know about effective pandemic public health communication. This includes considerations of changes needed over time to maintain responsiveness to pandemic transmission waves, the (in)equities and variable needs of groups within communities due to the pandemic, and highlights again the critical role of effective communication as integral to the public health response.

OBJECTIVES

To update the evidence on the question 'What are relevant, feasible and effective communication approaches to promote acceptance, uptake and adherence to physical distancing measures for COVID-19 prevention and control?', our primary focus was communication approaches to promote and support acceptance, uptake and adherence to physical distancing.

SECONDARY OBJECTIVE

to explore and identify key elements of effective communication for physical distancing measures for different (diverse) populations and groups.

SEARCH METHODS

We searched MEDLINE, Embase and Cochrane Library databases from inception, with searches for this update including the period 1 January 2020 to 18 August 2021. Systematic review and study repositories and grey literature sources were searched in August 2021 and guidelines identified for the eCOVID19 Recommendations Map were screened (November 2021).

SELECTION CRITERIA

Guidelines or reviews focusing on communication (information, education, reminders, facilitating decision-making, skills acquisition, supporting behaviour change, support, involvement in decision-making) related to physical distancing measures for prevention and/or control of COVID-19 or selected other diseases (sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, Ebola virus disease (EVD) or tuberculosis (TB)) were included. New evidence was added to guidelines, reviews and primary studies included in the 2020 review.

DATA COLLECTION AND ANALYSIS

Methods were based on the original rapid review, using methods developed by McMaster University and informed by Cochrane rapid review guidance. Screening, data extraction, quality assessment and synthesis were conducted by one author and checked by a second author. Synthesis of results was conducted using modified framework analysis, with themes from the original review used as an initial framework.

MAIN RESULTS

This review update includes 68 studies, with 17 guidelines and 20 reviews added to the original 31 studies. Synthesis identified six major themes, which can be used to inform policy and decision-making related to planning and implementing communication about a public health emergency and measures to protect the community. Theme 1: Strengthening public trust and countering misinformation: essential foundations for effective public health communication Recognising the key role of public trust is essential. Working to build and maintain trust over time underpins the success of public health communications and, therefore, the effectiveness of public health prevention measures. Theme 2: Two-way communication: involving communities to improve the dissemination, accessibility and acceptability of information Two-way communication (engagement) with the public is needed over the course of a public health emergency: at first, recognition of a health threat (despite uncertainties), and regularly as public health measures are introduced or adjusted. Engagement needs to be embedded at all stages of the response and inform tailoring of communications and implementation of public health measures over time. Theme 3: Development of and preparation for public communication: target audience, equity and tailoring Communication and information must be tailored to reach all groups within populations, and explicitly consider existing inequities and the needs of disadvantaged groups, including those who are underserved, vulnerable, from diverse cultural or language groups, or who have lower educational attainment. Awareness that implementing public health measures may magnify existing or emerging inequities is also needed in response planning, enactment and adjustment over time. Theme 4: Public communication features: content, timing and duration, delivery Public communication needs to be based on clear, consistent, actionable and timely (up-to-date) information about preventive measures, including the benefits (whether for individual, social groupings or wider society), harms (likewise) and rationale for use, and include information about supports available to help follow recommended measures. Communication needs to occur through multiple channels and/or formats to build public trust and reach more of the community. Theme 5: Supporting behaviour change at individual and population levels Supporting implementation of public health measures with practical supports and services (e.g. essential supplies, financial support) is critical. Information about available supports must be widely disseminated and well understood. Supports and communication related to them require flexibility and tailoring to explicitly consider community needs, including those of vulnerable groups. Proactively monitoring and countering stigma related to preventive measures (e.g. quarantine) is also necessary to support adherence. Theme 6: Fostering and sustaining receptiveness and responsiveness to public health communication Efforts to foster and sustain public receptiveness and responsiveness to public health communication are needed throughout a public health emergency. Trust, acceptance and behaviours change over time, and communication needs to be adaptive and responsive to these changing needs. Ongoing community engagement efforts should inform communication and public health response measures.

AUTHORS' CONCLUSIONS

Implications for practice Evidence highlights the critical role of communication throughout a public health emergency. Like any intervention, communication can be done well or poorly, but the consequences of poor communication during a pandemic may mean the difference between life and death. The approaches to effective communication identified in this review can be used by policymakers and decision-makers, working closely with communication teams, to plan, implement and adjust public communications over the course of a public health emergency like the COVID-19 pandemic. Implications for research Despite massive growth in research during the COVID-19 period, gaps in the evidence persist and require high-quality, meaningful research. This includes investigating the experiences of people at heightened COVID-19 risk, and identifying barriers to implementing public communication and protective health measures particular to lower- and middle-income countries, and how to overcome these.

Strengthening adolescents' critical health literacy and scientific literacy to tackle mis- and dis-information. A feasibility study in Switzerland

Objectives

We aimed to develop and test the feasibility of a critical health literacy (CHL) and science literacy (SL) training course targeting secondary school students in Switzerland.

Methods

Using a community-based participatory approach, we developed a two-block training program, the first centered on argumentation skills and the second on scientific skills. We combined an ex-cathedra and a flipped-classroom approach, providing students with a deep understanding of CHL and SL concepts and the translational capability of implementing theoretical notions to real case scenarios. The feasibility study was designed as a one-group pretest-posttest quasi-experiment. Beyond socio-demographics, questionnaires included measures of CHL, SL, trust in science, and perceived quality of the course.

Results

The curriculum was feasible and well-accepted by the target groups, teachers, and students. Students convincingly specified their perceived personal benefits associated with a positive change in CHL and SL scores after the training course.

Conclusion

Training CHL and SL in secondary school students is feasible and can improve their competencies. Results from present study can inform a large-scale study.

Digital Mixed Content Analysis for the Study of Digital Platform Social Data: An Illustration from the Analysis of COVID-19 Risk Perception in the Italian Twittersphere

The explosion of platform social data as digital secondary data, collectable through sophisticated and automatized query systems or algorithms, makes it possible to accumulate huge amounts of dense and miscellaneous data. The challenge for social researchers becomes how to extract meaning and not only trends in a quantitative and in a qualitative manner. Through the application of a digital mixed content analysis design, we present the potentiality of a hybrid digitalized approach to social content applied to a very tricky question: the recognition of risk perception during the first phase of COVID-19 in the Italian Twittersphere. The contribution of our article to mixed methods research consists in the extension of the existing definitions of content analysis as a mixed approach by combining hermeneutic and automated procedures, and by creating a design model with vast application potential, especially when applied to the digital scenario.

COVID-19 related information seeking: The impact of media on parental concerns

The expansion of information sources and their use has accelerated since the beginning of the COVID-19 pandemic, sometimes provoking significant concern in the daily lives of parents. The objective of this study was to investigate the association between COVID-19 related information sources and the level of concern about COVID-19 among parents of school-aged children. Using factor analysis and hierarchical ascending classification, we constructed groups according to the information sources they used. We performed ANOVA analysis and then binomial logistic regression to compare concern levels among the groups created. Overall, the 3,459 participants were mainly women (79.2%) and 59.5% reported being between 35 and 44 years old. The mean concern score in our sample was 9.5/15 (s.d. = 3.87). The whole sample fell into three groups: (1) Traditional Media (n = 1,610), who mainly used newspapers; (2) Online Social Networks and Entourage (n = 776), who mostly consulted online social media as well as friends and family; and (3) the Unplugged (n = 1,073), who consulted few or no information sources. Compared to the Unplugged, individuals in the other two groups had a higher risk of being concerned (Traditional Media, OR = 2.2; p < 0.001; Social Networks and Entourage, OR = 3.1; p < 0.001). Communication about pandemic risk should be conveyed based on reliable information and at moderate intervals to safeguard the mental health of individuals.

Impact of social media on public fear, adoption of precautionary behaviors, and compliance with health regulations during COVID-19 pandemic

Social media has become an essential source of information during the coronavirus disease 2019 (COVID-19) pandemic. This study aims to understand social media's effect on the general public's fear, degree of adopting precautionary behaviors, and compliance with health authorities' regulations during the pandemic. A cross-sectional online survey was conducted in Jordan during the early period of COVID-19 pandemic. 827 individuals completed the questionnaire. Factors that had a significant association with increased fear included female gender (OR 2.6, 95% CI: 1.8-3.7), married status (OR 1.9, 95% CI: 1.2-3.4), following medical pages on social media (OR 1.6, 95% CI: 1.04, 2.42), and sharing of COVID-19 information on social media (OR 3.6, 95% CI: 1.8-7.1). The variables that were significantly associated with higher levels of precautionary behaviors were knowledge score (OR 1.2, 95% CI: 1.07-1.3), feeling of fear (OR 2.6, 95% CI: 1.71-3.), and following medical pages on social media (OR 2.8, 95% CI: 1.8-4.24). Regarding compliance with health officials' regulations, social media as a source of information and sharing information were significantly associated with lower odds of compliance with the Ministry of Health's regulations (OR 0.27, 95% CI: 0.13-0.5 and OR 0.46, 95% CI: 0.25-0.8, respectively). Social media is an essential platform for risk communication during pandemics. It plays a positive role in spreading knowledge and promotes certain preventive behaviors among the public. However, it may spread fear and encourage disruptive behaviors, which might be propagated by sharing the pandemic's news.

Public Emotional and Coping Responses to the COVID-19 Infodemic: A Review and Recommendations

Since its onset in early 2020, the coronavirus disease 2019 (COVID-19) pandemic has adversely affected not only the physical but also the mental health of people worldwide. Healthcare professionals and laypersons have sought to learn more about this novel and highly transmissible disease to better understand its etiology, treatment, and prevention. However, information overload and misinformation related to COVID-19 have elicited considerable public anxiety and created additional health threats. Collectively, these problems have been recognized by the World Health Organization as an "infodemic." This review provides an overview of the global challenges posed by the COVID-19 infodemic, and used the psychological entropy model as a guiding framework to explicate the potential causes of the infodemic and identify potential solutions to mitigate impacts on public health. We first examine the role of anxiety in information processing and then delineate the adverse impacts of the infodemic. Finally, we propose strategies to combat the infodemic at the public, community, and individual levels.

Assessing the impact of knowledge communication and dissemination strategies targeted at health policy-makers and managers: an overview of systematic reviews

Background

The use of research evidence as an input for health decision-making is a need for most health systems. There are a number of approaches for promoting evidence use at different levels of the health system, but knowledge of their effectiveness is still scarce. The objective of this overview was to evaluate the effectiveness of knowledge communication and dissemination interventions, strategies or approaches targeting policy-makers and health managers.

Methods

This overview of systematic reviews used systematic review methods and was conducted according to a predefined and published protocol. A comprehensive electronic search of 13 databases and a manual search in four websites were conducted. Both published and unpublished reviews in English, Spanish or Portuguese were included. A narrative synthesis was undertaken, and effectiveness statements were developed, informed by the evidence identified.

Results

We included 27 systematic reviews. Three studies included only a communication strategy, while eight only included dissemination strategies, and the remaining 16 included both. None of the selected reviews provided “sufficient evidence” for any of the strategies, while four provided some evidence for three communication and four dissemination strategies. Regarding communication strategies, the use of tailored and targeted messages seemed to successfully lead to changes in the decision-making practices of the target audience. Regarding dissemination strategies, interventions that aimed at improving only the reach of evidence did not have an impact on its use in decisions, while interventions aimed at enhancing users’ ability to use and apply evidence had a positive effect on decision-making processes. Multifaceted dissemination strategies also demonstrated the potential for changing knowledge about evidence but not its implementation in decision-making.

Conclusions

There is limited evidence regarding the effectiveness of interventions targeting health managers and policy-makers, as well as the mechanisms required for achieving impact. More studies are needed that are informed by theoretical frameworks or specific tools and using robust methods, standardized outcome measures and clear descriptions of the interventions. We found that passive communication increased access to evidence but had no effect on uptake. Some evidence indicated that the use of targeted messages, knowledge-brokering and user training was effective in promoting evidence use by managers and policy-makers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00780-4.

Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization's conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Understanding the dynamics emerging from infodemics: a call to action for interdisciplinary research

Research on infodemics, i.e., the rapid spread of (mis)information related to a hazardous event, such as the COVID-19 pandemic, requires integrating a multiplicity of scientific disciplines. The dynamics emerging from infodemics have the potential to generate complex behavioral patterns. To react appropriately, it is of ultimate importance for the fields of Business and Economics to understand these dynamics. In the short run, they might lead to an adaptation in household spending or to a shift in buying behavior towards online providers. In the long run, changes in investments, consumer behavior, and markets are to be expected. We argue that the dynamics emerge from complex interactions among multiple factors, such as information and misinformation accessible to individuals and the formation and revision of beliefs. (Mis)information accessible to individuals is, amongst others, affected by algorithms specifically designed to provide personalized information, while automated fact-checking algorithms can help reduce the amount of circulating misinformation. The formation and revision of individual (and probably false) beliefs and individual fact-checking and interpretation of information are heavily affected by linguistic patterns inherent to information during pandemics and infodemics and further factors, such as affect, intuition, and motives. We argue that, to get a deep(er) understanding of the dynamics emerging from infodemics, the fields of Business and Economics should integrate the perspectives of Computer Science and Information Systems, (Computational) Linguistics, and Cognitive Science into the wider context of economic systems (e.g., organizations, markets or industries) and propose a way to do so. As research on infodemics is a strongly interdisciplinary field and the integration of the above-mentioned disciplines is a first step towards a holistic approach, we conclude with a call to action which should encourage researchers to collaborate across scientific disciplines and unfold collective creativity, which will substantially advance research on infodemics.

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.

Demographics and topics impact on the co-spread of COVID-19 misinformation and fact-checks on Twitter

Correcting misconceptions and false beliefs are important for injecting reliable information about COVID-19 into public discourse, but what impact does this have on the continued proliferation of misinforming claims? Fact-checking organisations produce content with the aim of reducing misinformation spread, but our knowledge of its impact on misinformation for particular topics and demographics is limited. In this article, we explore the relation between misinformation and fact-checking spread during the COVID-19 pandemic for different topics, user demographics and attributes. We specifically follow misinformation and fact-checks emerging from December 2019 until the 4th of January 2021 on Twitter. Using a combination of spread variance analysis, impulse response modelling and causal analysis, we highlight the bidirectional, weak causation spread behaviour between misinformation and fact-checks. Although we observe that fact-checks about COVID-19 are appearing fairly quickly after misinformation is circulated, its ability to reduce overall misinformation spread appears to be limited. This is especially visible for misinformation about conspiracy theories and the causes of the virus.

Psychological distress in the context of the COVID-19 pandemic: the joint contribution of intolerance of uncertainty and cyberchondria

OBJECTIVE

To explore the direct and indirect associations between intolerance of uncertainty, health anxiety (HA), and psychological distress through problematic internet use (PIU) and cyberchondria, both before and during the first months of the COVID-19 pandemic.

DESIGN

Two Italian samples were enrolled via an online questionnaire. Sample 1 (N = 556; 69.3% females, M_age 29.6 years, SD = 13.2) was recruited in non-pandemic times, whereas Sample 2 (N = 575; 74% females, M_age 31.9 years, SD = 13.4) was recruited during the COVID-19 lockdown.

MAIN OUTCOME MEASURES

Self-report measures assessing HA and psychological distress.

RESULTS

Two distinct path analyses showed that intolerance of uncertainty was directly associated with HA and psychological distress in both samples. Moreover, cyberchondria partially mediated the relationship between intolerance of uncertainty and HA and PIU partially mediated the relationship between intolerance of uncertainty and psychological distress in both samples. The link between cyberchondria and psychological distress was significant in Sample 2 but non-significant in Sample 1. The model accounted for a substantial variance of HA and psychological distress in both samples.

CONCLUSION

Our findings suggest that problematic online behaviors might exacerbate the negative consequences of intolerance of uncertainty in terms of higher levels of HA and psychological distress both in pandemic and non-pandemic contexts.

Effect of exposure to COVID-19 infodemic on infection-preventive intentions among Korean adults

Aim

This study determined the effect of exposure to coronavirus disease 2019 (COVID‐19) infodemic on infection‐preventive intentions among Korean adults.

Design

This was a cross‐sectional study that used structural equation model.

Methods

Data were collected between 14 April–7 July 2020 from 300 adults in their 20s to 60s residing in South Korea. Analysis was performed using SPSS 20.0 and AMOS 20.0.

Results

Exposure to COVID‐19 infodemic had a direct effect on the reduction of COVID‐19‐related knowledge and personal preventive health intentions. COVID‐19‐related knowledge had a direct impact on increased perceived severity, perceived vulnerability, perceived self‐efficacy, and personal preventive health intentions. Perceived severity, perceived vulnerability, and perceived self‐efficacy had a direct effect on increasing preventive intentions for personal health; and perceived severity had a direct effect on preventive intentions for public health.

Overcoming the challenge of COVID-19: A grounded theory approach to rural nurses' experiences

Introduction

This study inquires into nurses' changing perceptions with regard to the efforts in preparation for working in a COVID-19 ward in the rural Japanese context.

Methods

Data were collected using ethnographic methods and semi-structured interviews among 16 nurses working in the COVID-19 ward of a rural community hospital in Japan. A grounded theory approach was used for the qualitative analysis.

Results

In total, 70 hours' observation and participation were completed, and 27 pages of field notes were taken and used for the analysis. In addition, 32 interviews were conducted with 16 participants. Four themes emerged from the data: pre-COVID-work perceptions, overcoming fear, shadow cast by working in the COVID-19 ward, and an integrated approach to the fear of COVID-19. The nurses initially felt unpredictable fear. However, the establishment of standard approaches and practices for COVID-19 gave them confidence in their safety and helped them regain sympathy for patients. Nevertheless, working on COVID-19 cases negatively affected their activities outside of the ward, and some of them developed an identity crisis as they feared for the future.

Conclusion

Better teamwork, comprehensive understanding of COVID-19, and continuous provision of proper knowledge in rural hospitals should be driven by appropriate understanding and sympathy for nurses and patients in COVID-19 wards. The results of this study can be applied to mitigate nurses' fear, improve teamwork, and ensure understanding of COVID-19 by all medical staff in rural hospitals.

Risk communication during COVID-19: A descriptive study on familiarity with, adherence to and trust in the WHO preventive measures

BACKGROUND

Risk communication is a key component of public health interventions during an outbreak. As the coronavirus pandemic unfolded in late 2019, the World Health Organization (WHO) was at the forefront in the development of risk communication strategies. The WHO introduced a range of activities with the purpose of enabling the public to avail verified and timely information on COVID-19 prevention behaviors. Given the various WHO activities to protect the public health during COVID-19, it is important to investigate the extent of familiarity and uptake of the WHO recommendations among the public during the first wave of the pandemic.

METHODS

To do this, we conducted a large-scale Pan-European survey covering around 7500 individuals that are representative of populations from seven European countries, collected online during April 2-April 15, 2020. We use descriptive statistics including proportions and correlations and graphical representations such as bar charts to analyze and display the data.

RESULTS

Our findings suggest that information from the WHO in the context of COVID-19 is well trusted and acted upon by the public. Overall familiarity and adherence were quite high in most countries. Adherence was higher for social distancing recommendations compared to hygiene measures. Familiarity and adherence were higher among older, female, and highly educated respondents. However, country level heterogeneities were observed in the level of trust in information from the WHO, with countries severely affected by the pandemic reporting lower levels of trust.

CONCLUSION

Our findings call for efforts from health authorities to get regular feedback from the public on their familiarity and compliance with recommendations for preventive measures at all stages of the pandemic, to further develop and adapt risk communication as the pandemic evolves.

Percepção do medo de ser contaminado pelo novo coronavírus

RESUMO Objetivo: Avaliar a prevalência e os fatores associados à percepção do medo de ser contaminado pelo novo coronavírus. Métodos: Estudo transversal realizado em Passo Fundo, Rio Grande do Sul, com indivíduos de ambos os sexos e 18 ou mais anos de idade. Coleta on-line de dados sociodemográficos, de saúde, de comportamento e de conhecimento acerca do vírus. Análise estatística descritiva e cálculo de prevalência e de razões de prevalência (RP) brutas e ajustadas. Resultados: Amostrados 920 participantes, com 64% de prevalência de medo de contaminação, sendo maior em indivíduos que trabalham (RP = 1,10; IC95 1,02-1,20), com idosos no domicílio (RP = 1,18; IC95 1,17-1,19), percepção negativa da saúde (RP = 1,15; IC95 1,02-1,31), avaliação de elevado risco de contaminação (RP = 1,30; IC95 1,23-1,38), com no mínimo um dos principais sinais/sintomas na semana anterior (RP = 1,12; IC95 1,11-1,13), que realizam maior número de medidas preventivas (RP = 1,27; IC95 1,15-1,40), vacinados contra a gripe (RP = 1,08; IC95 1,07-1,10) e que sabem que pertencem ao grupo de risco (RP = 1,17; IC95 1,14-1,19). Menor probabilidade do desfecho observada em idosos (RP = 0,74; IC95 0,60-0,91), profissionais ou estudantes da saúde (RP = 0,82; IC95 0,81-0,83) e em não fumantes (RP = 0,86; IC95 0,79-0,94). Conclusões: Observou-se elevada proporção de medo entre os participantes, especialmente entre aqueles que se percebem sob maior risco. Considerando o importante papel do medo na saúde mental das pessoas, os achados indicam a importância de intensificar ações educativas e informativas, visando ampliar o esclarecimento da população e reduzir os impactos da pandemia nesse aspecto.

COVID-19-Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results

Background

The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics.

Objective

The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic.

Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot.

Results

The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities.

Conclusions

Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects.

Information challenges of COVID-19: A qualitative research

BACKGROUND

At the beginning of the COVID-19 pandemic, the Iranian Ministry of Health and Medical Education set up a 24-h call center, i.e., Center 4030, to mitigate people's worries and anxieties, create composure, increase people's trust, and answer their questions. This qualitative study aimed to identify the challenges of COVID-19-related-information among people in point of experts' views.

MATERIALS AND METHODS

This qualitative study was conducted to collect the opinions of experts on the identification of the Information challenges of COVID-19 during March-June 2020. The research population included all health professionals and experts. The sampling method was initially purposive and continued to saturate the data as snowball technique. In this study, 19 participants were interviewed. The data were collected using a semi-structured interview. After collecting the data, the audio files of the interviews were written down to extract their external and internal elements. MAXQDA version 12 software was used to organize qualitative analysis and coding data.

RESULTS

The results of this study involved eight themes, i.e., lack of planning, lack of social trust in government, lack of COVID-19-integrated scientific authority in the country, conflicts of interest, lack of integrated information sources, distracting public attention, infodemic, and poor information quality, classified into 16 categories.

CONCLUSIONS

The main information challenges that people in Iran faced included the lack of a scientific reference source to access accurate information, the existence of a large volume of information in virtual networks, and a huge volume of statistics from various information channels that caused confusion among people.

Considerações sobre o impacto da covid-19 na relação indivíduo-sociedade: da hesitação vacinal ao clamor por uma vacina

Resumo Desde março de 2020, quando a Organização Mundial de Saúde declarou que o mundo vivia uma pandemia de covid-19, acompanhamos um quadro sanitário sem precedentes nos últimos 100 anos. As medidas atuais contra a doença têm como objetivo o controle da transmissão e envolvem ações individuais e coletivas de higiene e distanciamento físico, enquanto a busca por uma vacina se apresenta como a esperança para vencer a pandemia. Considerando o contexto social de clamor por uma nova vacina, este ensaio crítico discute o paradoxo e as contradições da relação indivíduo-sociedade no contexto da covid-19 à luz da hesitação vacinal como fenômeno histórico e socialmente situado. Este ensaio aponta que as tomadas de decisão sobre (não) vacinar ou sobre (não) seguir as medidas preventivas e de controle da propagação da covid-19 são conformadas por pertencimentos sociais e atravessadas por desigualdades que tendem a se exacerbar. A infodemia que cerca a covid-19 e a hesitação vacinal refletem a tensão entre o risco cientificamente validado e o risco percebido subjetivamente, também influenciada pela crise de confiança na ciência. Percepções de risco e adesão a medidas de saúde extrapolam aspectos subjetivos e racionais e espelham valores e crenças conformados pelas dimensões política, econômica e sociocultural.

Is the press properly presenting the epidemiological data on COVID-19? An analysis of newspapers from 25 countries

We conducted a cross-sectional study to assess how the top 3 highest circulation newspapers from 25 countries are comparing and presenting COVID-19 epidemiological data to their readers. Of 75 newspapers evaluated, 51(68%) presented at their websites at least one comparison of cases and/or deaths between regions of their country and/or between countries. Quality assessment of the comparisons showed that only a minority of newspapers adjusted the data for population size in case comparisons between regions (37.2%) and between countries (25.6%), and the same was true for death comparisons between regions (27.3%) and between countries (27%). Of those making comparisons, only 13.7% explained the difference in the interpretation of cases and deaths. Of 17 that presented a logarithmic curve, only 29.4% explained its meaning. Although the press plays a key role in conveying correct medical information to the general public, we identified inconsistencies in the reporting of COVID-19 epidemiological data.

Communicative Blame in Online Communication of the COVID-19 Pandemic: Computational Approach of Stigmatizing Cues and Negative Sentiment Gauged With Automated Analytic Techniques

BACKGROUND

Information about a new coronavirus emerged in 2019 and rapidly spread around the world, gaining significant public attention and attracting negative bias. The use of stigmatizing language for the purpose of blaming sparked a debate.

OBJECTIVE

This study aims to identify social stigma and negative sentiment toward the blameworthy agents in social communities.

METHODS

We enabled a tailored text-mining platform to identify data in their natural settings by retrieving and filtering online sources, and constructed vocabularies and learning word representations from natural language processing for deductive analysis along with the research theme. The data sources comprised of ten news websites, eleven discussion forums, one social network, and two principal media sharing networks in Taiwan. A synthesis of news and social networking analytics was present from December 30, 2019, to March 31, 2020.

RESULTS

We collated over 1.07 million Chinese texts. Almost two-thirds of the texts on COVID-19 came from news services (n=683,887, 63.68%), followed by Facebook (n=297,823, 27.73%), discussion forums (n=62,119, 5.78%), and Instagram and YouTube (n=30,154, 2.81%). Our data showed that online news served as a hotbed for negativity and for driving emotional social posts. Online information regarding COVID-19 associated it with China-and a specific city within China through references to the "Wuhan pneumonia"-potentially encouraging xenophobia. The adoption of this problematic moniker had a high frequency, despite the World Health Organization guideline to avoid biased perceptions and ethnic discrimination. Social stigma is disclosed through negatively valenced responses, which are associated with the most blamed targets.

CONCLUSIONS

Our sample is sufficiently representative of a community because it contains a broad range of mainstream online media. Stigmatizing language linked to the COVID-19 pandemic shows a lack of civic responsibility that encourages bias, hostility, and discrimination. Frequently used stigmatizing terms were deemed offensive, and they might have contributed to recent backlashes against China by directing blame and encouraging xenophobia. The implications ranging from health risk communication to stigma mitigation and xenophobia concerns amid the COVID-19 outbreak are emphasized. Understanding the nomenclature and biased terms employed in relation to the COVID-19 outbreak is paramount. We propose solidarity with communication professionals in combating the COVID-19 outbreak and the infodemic. Finding solutions to curb the spread of virus bias, stigma, and discrimination is imperative.

Mathematical Models for COVID-19 Pandemic: A Comparative Analysis

COVID-19 pandemic represents an unprecedented global health crisis in the last 100 years. Its economic, social and health impact continues to grow and is likely to end up as one of the worst global disasters since the 1918 pandemic and the World Wars. Mathematical models have played an important role in the ongoing crisis; they have been used to inform public policies and have been instrumental in many of the social distancing measures that were instituted worldwide. In this article, we review some of the important mathematical models used to support the ongoing planning and response efforts. These models differ in their use, their mathematical form and their scope.

COVID-19 and 'immune boosting' on the internet: a content analysis of Google search results

OBJECTIVE

The spread of misinformation has accompanied the coronavirus pandemic, including topics such as immune boosting to prevent COVID-19. This study explores how immune boosting is portrayed on the internet during the COVID-19 pandemic.

DESIGN

Content analysis.

METHODS

We compiled a dataset of 227 webpages from Google searches in Canada and the USA using the phrase 'boost immunity' AND 'coronavirus' on 1 April 2020. We coded webpages for typology and portrayal of immune boosting and supplements. We recorded mentions of microbiome, whether the webpage was selling or advertising an immune boosting product or service, and suggested strategies for boosting immunity.

RESULTS

No significant differences were found between webpages that appeared in the searches in Canada and the USA. The most common types of webpages were from news (40.5%) and commercial (24.7%) websites. The concept of immune boosting was portrayed as beneficial for avoiding COVID-19 in 85.5% of webpages and supplements were portrayed as beneficial in 40% of the webpages, but commercial sites were more likely to have these portrayals. The top immune boosting strategies were vitamin C (34.8%), diet (34.4%), sleep (34.4%), exercise (30.8%) and zinc (26.9%). Less than 10% of the webpages provide any critique of the concept of immune boosting.

CONCLUSIONS

Pairing evidence-based advice for maintaining one's health (eg, healthy diet, exercise, sleep) with the phrase immune boosting and strategies lacking in evidence may inadvertently help to legitimise the concept, making it a powerful marketing tool. Results demonstrate how the spread of misinformation is complex and often more subtle than blatant fraudulent claims.

Misinformation sharing and social media fatigue during COVID-19: An affordance and cognitive load perspective

Social media plays a significant role during pandemics such as COVID-19, as it enables people to share news as well as personal experiences and viewpoints with one another in real-time, globally. Building off the affordance lens and cognitive load theory, we investigate how motivational factors and personal attributes influence social media fatigue and the sharing of unverified information during the COVID-19 pandemic. Accordingly, we develop a model which we analyse using the structural equation modelling and neural network techniques with data collected from young adults in Bangladesh (N = 433). The results show that people, who are driven by self-promotion and entertainment, and those suffering from deficient self-regulation, are more likely to share unverified information. Exploration and religiosity correlated negatively with the sharing of unverified information. However, exploration also increased social media fatigue. Our findings indicate that the different use purposes of social media introduce problematic consequences, in particular, increased misinformation sharing.

Models for COVID-19 Pandemic: A Comparative Analysis

COVID-19 pandemic represents an unprecedented global health crisis in the last 100 years. Its economic, social and health impact continues to grow and is likely to end up as one of the worst global disasters since the 1918 pandemic and the World Wars. Mathematical models have played an important role in the ongoing crisis; they have been used to inform public policies and have been instrumental in many of the social distancing measures that were instituted worldwide. In this article we review some of the important mathematical models used to support the ongoing planning and response efforts. These models differ in their use, their mathematical form and their scope.

Exploratory study of the hoaxes spread via WhatsApp in Spain to prevent and/or cure COVID-19

Objective

To review the hoaxes’ characteristics spread through WhatsApp in Spain during COVID-19 lockdown and identify what kind of substances were promoted for consumption or application.

Method

A phone number was activated to receive hoaxes via WhatsApp. A total of 2353 messages were collected, and among those 584 different hoaxes were identified and validated, between March 18 and April 18, 2020. From these 584 hoaxes, a sub-sample of 126 was selected, exclusively related to the object of study, and a content analysis table with fourteen registration fields was applied. Besides, the averages and medians of the quantitative fields were extracted.

Results

Most of the messages received were texts (39%) and videos (30%). In the majority, the acting subject was presented as medical personnel (36.5%) or as an anonymous person (30.9%). The videos lasted between 2’ 40” and 18’ 18”, while the audios ranged between 1’ 35” and 7’ 48”. Regarding the gender of the informant, there was a significant difference, with 45.2% being male, and 13.5%, female and 41.3% non-identifiable.

Conclusions

One out of five false health claims received was about prevention or cure of the coronavirus, based on the principle of medical authority, and basically promoting the use and consumption of substances of natural origin.

On the dynamics emerging from pandemics and infodemics

This position paper discusses emerging behavioral, social, and economic dynamics related to the COVID-19 pandemic and puts particular emphasis on two emerging issues: First, delayed effects (or second strikes) of pandemics caused by dread risk effects are discussed whereby two factors which might influence the existence of such effects are identified, namely the accessibility of (mis-)information and the effects of policy decisions on adaptive behavior. Second, the issue of individual preparedness to hazardous events is discussed. As events such as the COVID-19 pandemic unfolds complex behavioral patterns which are hard to predict, sophisticated models which account for behavioral, social, and economic dynamics are required to assess the effectivity and efficiency of decision-making.

Coronavirus-Related Health Literacy: A Cross-Sectional Study in Adults during the COVID-19 Infodemic in Germany

There is an "infodemic" associated with the COVID-19 pandemic-an overabundance of valid and invalid information. Health literacy is the ability to access, understand, appraise, and apply health information, making it crucial for navigating coronavirus and COVID-19 information environments. A cross-sectional representative study of participants ≥ 16 years in Germany was conducted using an online survey. A coronavirus-related health literacy measure was developed (HLS-COVID-Q22). Internal consistency was very high (α = 0.940; ρ = 0.891) and construct validity suggests a sufficient model fit, making HLS-COVID-Q22 a feasible tool for assessing coronavirus-related health literacy in population surveys. While 49.9% of our sample had sufficient levels of coronavirus-related health literacy, 50.1% had "problematic" (15.2%) or "inadequate" (34.9%) levels. Although the overall level of health literacy is high, a vast number of participants report difficulties dealing with coronavirus and COVID-19 information. The participants felt well informed about coronavirus, but 47.8% reported having difficulties judging whether they could trust media information on COVID-19. Confusion about coronavirus information was significantly higher among those who had lower health literacy. This calls for targeted public information campaigns and promotion of population-based health literacy for better navigation of information environments during the infodemic, identification of disinformation, and decision-making based on reliable and trustworthy information.

In the Face of a Pandemic: The COVID-19 Infodemic

Editorial