%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e73062 %T Impact of Social Media Influencers on Amplifying Positive Public Health Messages %A Flaherty,Gerard Thomas %A Mangan,Ryan Michael %+ School of Medicine, College of Medicine, Nursing and Health Sciences, Ollscoil na Gaillimhe – University of Galway, University Road, Galway, H91TK33, Ireland, 353 91495469, gerard.flaherty@universityofgalway.ie %K social media %K COVID-19 %K vaccination %K personal brands %K public health %K wellness %K global health %K pandemic %K Twitter %K tweets %K vaccine %K longitudinal design %K wellness influencers %K hand annotation %K antivaccination %K infodemiology %D 2025 %7 21.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40117580 %R 10.2196/73062 %U https://www.jmir.org/2025/1/e73062 %U https://doi.org/10.2196/73062 %U http://www.ncbi.nlm.nih.gov/pubmed/40117580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64679 %T Quantifying Public Engagement With Science and Malinformation on COVID-19 Vaccines: Cross-Sectional Study %A Grimes,David Robert %A Gorski,David H %+ TCD Biostatistics Unit, School of Medicine, Trinity College Dublin, Trinity College Institute of Population Health, Russell Centre, 7th Fl, Tallaght Cross West, Tallaght, Dublin, D24 DH74, Ireland, 353 19861075, davidrobert.grimes@tcd.ie %K misinformation %K altmetrics %K disinformation %K malinformation %K public engagement %K medical journals %K medicoscientific %K public health %K altmetric analysis %K comparative analysis %K social media %K Twitter %K vaccine %K digital health %K mHealth %K mobile health %K health informatics %D 2025 %7 21.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Medical journals are critical vanguards of research, and previous years have seen increasing public interest in and engagement with medicoscientific findings. How findings propagate and are understood and what harms erroneous claims might cause to public health remain unclear, especially on publicly contentious topics like COVID-19 vaccines. Gauging the engagement of the public with medical science and quantifying propagation patterns of medicoscientific papers are thus important undertakings. In contrast to misinformation and disinformation, which pivot on falsehood, the more nuanced issue of malinformation, where ostensibly true information is presented out of context or selectively curated to cause harm and misconception, has been less researched. As findings and facts can be selectively marshaled to present a misleading picture, it is crucial to consider this issue and its potential ramifications. Objective: This study aims to quantify patterns of public engagement with medical research and the vectors of propagation taken by a high-profile incidence of medical malinformation. Methods: In this work, we undertook an analysis of all altmetric engagements over a decade for 5 leading general-purpose medical journals, constituting approximately 9.8 million engagements with 84,529 papers. We identify and examine the proliferation of sentiment concerning a high-profile publication containing vaccine-negative malinformation. Engagement with this paper, with the highest altmetric score of any paper in an academic journal ever released, was tracked across media outlets worldwide and in social media users on Twitter (subsequently rebranded as X). Vectoring media sources were analyzed, and manual sentiment analysis on high-engagement Twitter shares of the paper was undertaken, contrasted with users’ prior vaccine sentiment. Results: Results of this analysis suggested that this COVID-19 scientific malinformation was much more likely to be engaged and amplified with negative by vaccine-negative Twitter accounts than neutral ones (odds ratio 58.2, 95% CI 9.7-658.0; P<.001), often alluding to the ostensible prestige of medical journals. Malinformation was frequently invoked by conspiracy theory websites and non-news sources (71/181 citations, 39.2%) on the internet to cast doubt on the efficacy of vaccination, many of whom tended to cite the paper repeatedly (51/181, 28.2%). Conclusions: Our findings suggest growing public interest in medical science and present evidence that medical and scientific journals need to be aware of not only the potential overt misinformation but also the more insidious impact of malinformation. Also, we discuss how journals and scientific communicators can reduce the influence of malinformation on public understanding. %M 40116851 %R 10.2196/64679 %U https://www.jmir.org/2025/1/e64679 %U https://doi.org/10.2196/64679 %U http://www.ncbi.nlm.nih.gov/pubmed/40116851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66010 %T Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (“So Much Contradictory Evidence”): Qualitative Document Analysis of Reddit Forums %A Watkins,Shannon Lea %A Snodgrass,Katherine %A Fahrion,Lexi %A Shaw,Emily %+ Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA, 52242, United States, 1 3194671489, shannon-watkins@uiowa.edu %K vaping %K nicotine %K tobacco %K health communication %K social media %K new media %D 2025 %7 20.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. Objective: This study aims to characterize and contextualize e-cigarette–related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. Methods: We conducted a qualitative analysis of COVID-19–related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. Results: e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette–related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Conclusions: Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions. %M 40112286 %R 10.2196/66010 %U https://www.jmir.org/2025/1/e66010 %U https://doi.org/10.2196/66010 %U http://www.ncbi.nlm.nih.gov/pubmed/40112286 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e62913 %T Beliefs in Misinformation About COVID-19 and the Russian Invasion of Ukraine Are Linked: Evidence From a Nationally Representative Survey Study %A Grygarová,Dominika %A Havlík,Marek %A Adámek,Petr %A Horáček,Jiří %A Juríčková,Veronika %A Hlinka,Jaroslav %A Kesner,Ladislav %+ , Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany, 25067, Czech Republic, 420 283088264, dominika.grygarova@nudz.cz %K misinformation %K COVID-19 %K war in Ukraine %K political trust %K digital media %K belief rigidity %K vaccine hesitancy %K war %K political %K trust %K belief %K survey %K questionnaire %K national %K false %K association %K correlation %K correlation analysis %K public opinion %K media %K news %K health information %K public health %K COVID %K misinformation %K propaganda %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Detrimental effects of misinformation were observed during the COVID-19 pandemic. Presently, amid Russia’s military aggression in Ukraine, another wave of misinformation is spreading on the web and impacting our daily lives, with many citizens and politicians embracing Russian propaganda narratives. Despite the lack of an objective connection between these 2 societal issues, anecdotal observations suggest that supporters of misinformation regarding COVID-19 (BM-C) have also adopted misinformation about the war in Ukraine (BM-U) while sharing similar media use patterns and political attitudes. Objective: The aim of this study was to determine whether there is a link between respondents’ endorsement of the 2 sets of misinformation narratives, and whether some of the selected factors (media use, political trust, vaccine hesitancy, and belief rigidity) are associated with both BM-C and BM-U. Methods: We conducted a survey on a nationally representative sample of 1623 individuals in the Czech Republic. Spearman correlation analysis was performed to identify the relationship between BM-C and BM-U. In addition, multiple linear regression was used to determine associations between the examined factors and both sets of misinformation. Results: We discovered that BM-C and BM-U were moderately correlated (Spearman ρ=0.57; P<.001). Furthermore, increased trust in Russia and decreased trust in the local government, public media, and Western allies of the Czech Republic predicted both BM-C and BM-U. Media use indicating frustration with and avoidance of public or mainstream media, consumption of alternative information sources, and participation in web-based discussions indicative of epistemic bubbles predicted beliefs in misinformation narratives. COVID-19 vaccine refusal predicted only BM-C but not BM-U. However, vaccine refusers were overrepresented in the BM-U supporters (64/161, 39.8%) and undecided (128/505, 25.3%) individuals. Both beliefs were associated with belief rigidity. Conclusions: Our study provides empirical evidence that supporters of COVID-19 misinformation were susceptible to ideological misinformation aligning with Russian propaganda. Supporters of both sets of misinformation narratives were primarily linked by their shared trust or distrust in the same geopolitical actors and their distrust in the local government. %R 10.2196/62913 %U https://infodemiology.jmir.org/2025/1/e62913 %U https://doi.org/10.2196/62913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70108 %T Effects of the Modern Digital Information Environment on Maternal Health Care Professionals, the Role of Midwives, and the People in Their Care: Scoping Review %A Wilhelm,Elisabeth %A Vivilaki,Victoria %A Calleja-Agius,Jean %A Petelos,Elena %A Tzeli,Maria %A Giaxi,Paraskevi %A Triantiafyllou,Elena %A Asimaki,Eleni %A Alevizou,Faye %A Purnat,Tina D %+ Department of Midwifery, School of Healthcare and Care Sciences, University of West Attica, Agiou Spiridonos 28, Egaleo, Athens, 122 43, Greece, 30 21 0538 510, ewilhelm@uniwa.gr %K digital health %K midwifery %K misinformation %K information-seeking midwifery %K health information seeking %K social media %K medical misinformation %D 2025 %7 25.2.2025 %9 Review %J J Med Internet Res %G English %X Background: The digital information environment poses challenges for pregnant women and other people seeking care, as well as for their midwives and other health care professionals (HCPs). They can encounter questions, concerns, information gaps, and misinformation, which can influence health care decisions. Objective: This scoping review examines how HCPs are affected by the modern digital information environment including health misinformation, its effects on the women and people they care for, and its implications for care provision. Methods: English-language peer-reviewed literature, published from January 1, 2020, to May 31, 2024, with keywords related to midwifery, misinformation, and health equity collected and analyzed by a team of midwives and maternal care professionals and mapped onto a patient-centered conceptual model. Results: A total of 105 studies were ultimately included. Further, 95 papers identified specific digital information environment issues that affected clients; 58 specifically highlighted digital information environment issues impacting HCPs; 91 papers identified specific topics of common questions, concerns, misinformation, information voids, or narratives; 57 papers identified patient or population vulnerability; and 75 included mentions of solutions or recommendations for addressing a digital information environment issue around clients seeking care from midwives and other HCPs. When mapped onto the Journey to Health model, the most prominent barrier was access to care and information. Individual-level issues dominate the step related to knowledge, awareness, and belief, with more social norms and wider engagement appearing at steps related to intent. Client-specific themes dominate the left-hand side of the model and provider-specific issues dominate the right-hand side of the model. Conclusions: Misinformation, information voids, unaddressed questions and concerns, and lack of access to high-quality health information are worldwide prevalent barriers that affect both patients and HCPs. We identified individual, provider-level, health systems, and societal-level strategies that can be used to promote healthier digital information environments. %M 39998875 %R 10.2196/70108 %U https://www.jmir.org/2025/1/e70108 %U https://doi.org/10.2196/70108 %U http://www.ncbi.nlm.nih.gov/pubmed/39998875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63763 %T Evaluating the Knowledge and Information-Seeking Behaviors of People Living With Multiple Sclerosis: Cross-Sectional Questionnaire Study %A Duguay,Véronique %A Comeau,Dominique %A Turgeon,Tiffany %A Bouhamdani,Nadia %A Belanger,Mathieu %A Weston,Lyle %A Johnson,Tammy %A Manzer,Nicole %A Giberson,Melissa %A Chamard-Witkowski,Ludivine %+ , Centre de Formation Médicale du Nouveau-Brunswick, Université de Sherbrooke, 50 De la Francophonie Street, Moncton, NB, E1A 7R1, Canada, 1 5062261627, veronique.duguay2@usherbrooke.ca %K multiple sclerosis %K chronic illness %K misinformation %K web-based searches %K education %K health information %K social media %K health literacy %K patient-doctor relationship %K health-related information %K information-seeking behavior %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet has emerged as a primary source of health-related information for people living with multiple sclerosis (MS). However, given the abundance of misinformation found on the web, this behavior may pose a significant threat to internet users. Objective: This study aims to explore the knowledge and information-seeking behavior of people living with MS followed at a specialized MS clinic where education is a cornerstone of care. Methods: This cross-sectional survey–based study comprised 20 true or false statements, covering both scientific facts and popular misinformation about MS treatments. A “scientific fact score” and a “misinformation score” were calculated by attributing a scoring system to each point in the survey: +1 point was attributed to correct answers, –1 point was attributed to incorrect answers, and 0 point was attributed to “I don’t know.” Furthermore, the survey inquired about participants’ health-seeking behaviors. Results: The mean age of the 69 participants was 48.4 (SD 10.9) years, 78% (54/69) were female, 81% (56/69) were highly educated, 90% (62/69) were receiving a disease-modifying therapy, and 52% (30/58) had experimented with alternative therapies. The mean score for answering the scientific and misinformation questions correctly was 69% (SD 2.4%) and 22% (SD 4.5%), respectively (P<.001). Notably, when questioned about misinformation, answering correctly dropped significantly (P<.001), while indecision (P<.001) and answering incorrectly (P=.02) increased. Sociodemographic factors and medical questions were not significantly associated with scientific and misinformation scores (all P>.05); however, misinformation scores did significantly correlate with levels of education (P=.04). The main sources of health-related information were from expert-led MS websites (48/58, 82%) and health care professionals (34/58, 59%). Low-reliability sources were less used; however, word of mouth seemed to be prevalent (14/58, 24%), followed by Facebook (10/58, 17%). On average, people with MS reported having consulted 3 high- to moderate-quality sources and only 1 low-quality source. Conclusions: Education at the clinic and consulting primarily moderate- to high-quality sources did not safeguard against misinformation, indicating a need for more misinformation-geared education at the clinic. Notably, there is a need to proactively educate patients about misinformation commonly found on the web, and more importantly, create space for them to discuss the information without prejudice. As novel educational methods may be relatively more time-consuming, implementing change may be challenging. Furthermore, age, sex, education level, and health literacy might not safeguard against misinformation. Herein, we were unable to identify correlations associated with scores obtained on the questionnaire other than educational level. Although the educational level did seem to impact the misinformation score, this did not stop participants from experimenting with alternative therapies. Although studies are exploring novel ways to effectively deal with health misinformation on the web, more research is needed to fully understand this highly complex social phenomenon. %M 39998866 %R 10.2196/63763 %U https://www.jmir.org/2025/1/e63763 %U https://doi.org/10.2196/63763 %U http://www.ncbi.nlm.nih.gov/pubmed/39998866 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e56831 %T Transformer-Based Tool for Automated Fact-Checking of Online Health Information: Development Study %A Bayani,Azadeh %A Ayotte,Alexandre %A Nikiema,Jean Noel %+ , Laboratoire Transformation Numérique en Santé, LabTNS, 7101 Av. du Parc, Montréal,, Montreal, QC, H3N 1X9, Canada, 1 4389980241, azadeh.bayani@umontreal.ca %K fact-checking automation %K transformers %K infodemic %K credible health information %K machine learning %K automated %K online health information %K misinformation %K natural language processing %K epidemiology %K health domain %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Many people seek health-related information online. The significance of reliable information became particularly evident due to the potential dangers of misinformation. Therefore, discerning true and reliable information from false information has become increasingly challenging. Objective: This study aimed to present a pilot study in which we introduced a novel approach to automate the fact-checking process, leveraging PubMed resources as a source of truth using natural language processing transformer models to enhance the process. Methods: A total of 538 health-related web pages, covering 7 different disease subjects, were manually selected by Factually Health Company. The process included the following steps: (1) using transformer models of bidirectional encoder representations from transformers (BERT), BioBERT, and SciBERT, and traditional models of random forests and support vector machines, to classify the contents of web pages into 3 thematic categories (semiology, epidemiology, and management), (2) for each category in the web pages, a PubMed query was automatically produced using a combination of the “WellcomeBertMesh” and “KeyBERT” models, (3) top 20 related literatures were automatically extracted from PubMed, and finally, (4) the similarity checking techniques of cosine similarity and Jaccard distance were applied to compare the content of extracted literature and web pages. Results: The BERT model for the categorization of web page contents had good performance, with F1-scores and recall of 93% and 94% for semiology and epidemiology, respectively, and 96% for both the recall and F1-score for management. For each of the 3 categories in a web page, 1 PubMed query was generated and with each query, the 20 most related, open access articles within the category of systematic reviews and meta-analyses were extracted. Less than 10% of the extracted literature was irrelevant; those were deleted. For each web page, an average of 23% of the sentences were found to be very similar to the literature. Moreover, during the evaluation, it was found that cosine similarity outperformed the Jaccard distance measure when comparing the similarity between sentences from web pages and academic papers vectorized by BERT. However, there was a significant issue with false positives in the retrieved sentences when compared with accurate similarities, as some sentences had a similarity score exceeding 80%, but they could not be considered similar sentences. Conclusions: In this pilot study, we have proposed an approach to automate the fact-checking of health-related online information. Incorporating content from PubMed or other scientific article databases as trustworthy resources can automate the discovery of similarly credible information in the health domain. %M 39812653 %R 10.2196/56831 %U https://infodemiology.jmir.org/2025/1/e56831 %U https://doi.org/10.2196/56831 %U http://www.ncbi.nlm.nih.gov/pubmed/39812653 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e59317 %T A Model of Trust in Online COVID-19 Information and Advice: Cross-Sectional Questionnaire Study %A Sillence,Elizabeth %A Branley-Bell,Dawn %A Moss,Mark %A Briggs,Pam %+ Department of Psychology, Northumbria University, Ellison Terrace, Newcastle upon Tyne, NE1 8ST, United Kingdom, 44 1912437251, elizabeth.sillence@northumbria.ac.uk %K eHealth %K electronic health %K digital intervention %K trust %K online information seeking %K scientific credibility %K digital resources %K COVID-19 %K SARS-CoV-2 %K respiratory %K infectious %K pulmonary %K pandemic %K public health %K health information %K global health %K surveys %K social media %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, many people sought information from websites and social media. Understanding the extent to which these sources were trusted is important in relation to health communication. Objective: This study aims to identify the key factors influencing UK citizens’ trust and intention to act on advice about COVID-19 found via digital resources and to test whether an existing model of trust in eHealth provided a good fit for COVID-19–related information seeking online. We also wished to identify any differences between the evaluation of general information and information relating specifically to COVID-19 vaccines. Methods: In total, 525 people completed an online survey in January 2022 encompassing a general web trust questionnaire, measures of information corroboration, coping perceptions, and intention to act. Data were analyzed using principal component analysis and structural equation modeling. The evaluation responses of general information and COVID-19 vaccine information were also compared. Results: The principal component analysis revealed 5 trust factors: (1) credibility and impartiality, (2) familiarity, (3) privacy, (4) usability, and (5) personal experiences. In the final structural equation modeling model, trust had a significant direct effect on intention to act (β=.65; P<.001). Of the trust factors, credibility and impartiality had a significant positive direct effect on trust (β=.82; P<.001). People searching for vaccination information felt less at risk, less anxious, and more optimistic after reading the information. We noted that most people sought information from “official” sources. Finally, in the context of COVID-19, “credibility and impartiality” remain a key predictor of trust in eHealth resources, but in comparison with previous models of trust in online health information, checking and corroborating information did not form a significant part of trust evaluations. Conclusions: In times of uncertainty, when faced with a global emergent health concern, people place their trust in familiar websites and rely on the perceived credibility and impartiality of those digital sources above other trust factors. %M 39946705 %R 10.2196/59317 %U https://infodemiology.jmir.org/2025/1/e59317 %U https://doi.org/10.2196/59317 %U http://www.ncbi.nlm.nih.gov/pubmed/39946705 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e62703 %T Identifying Misinformation About Unproven Cancer Treatments on Social Media Using User-Friendly Linguistic Characteristics: Content Analysis %A Fridman,Ilona %A Boyles,Dahlia %A Chheda,Ria %A Baldwin-SoRelle,Carrie %A Smith,Angela B %A Elston Lafata,Jennifer %+ Lineberger Comprehensive Cancer Center, University of North Carolina, 450 West Dr, Chapel Hill, NC, 27599, United States, 1 6469028137, ilona_fridman@med.unc.edu %K linguistic characteristics %K linguistic features %K cancer %K Linguistic Inquiry and Word Count %K misinformation %K X %K Twitter %K cancer %K alternative therapy %K oncology %K social media %K natural language processing %K machine learning %K synthesis %K review methodology %K search %K literature review %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Health misinformation, prevalent in social media, poses a significant threat to individuals, particularly those dealing with serious illnesses such as cancer. The current recommendations for users on how to avoid cancer misinformation are challenging because they require users to have research skills. Objective: This study addresses this problem by identifying user-friendly characteristics of misinformation that could be easily observed by users to help them flag misinformation on social media. Methods: Using a structured review of the literature on algorithmic misinformation detection across political, social, and computer science, we assembled linguistic characteristics associated with misinformation. We then collected datasets by mining X (previously known as Twitter) posts using keywords related to unproven cancer therapies and cancer center usernames. This search, coupled with manual labeling, allowed us to create a dataset with misinformation and 2 control datasets. We used natural language processing to model linguistic characteristics within these datasets. Two experiments with 2 control datasets used predictive modeling and Lasso regression to evaluate the effectiveness of linguistic characteristics in identifying misinformation. Results: User-friendly linguistic characteristics were extracted from 88 papers. The short-listed characteristics did not yield optimal results in the first experiment but predicted misinformation with an accuracy of 73% in the second experiment, in which posts with misinformation were compared with posts from health care systems. The linguistic characteristics that consistently negatively predicted misinformation included tentative language, location, URLs, and hashtags, while numbers, absolute language, and certainty expressions consistently predicted misinformation positively. Conclusions: This analysis resulted in user-friendly recommendations, such as exercising caution when encountering social media posts featuring unwavering assurances or specific numbers lacking references. Future studies should test the efficacy of the recommendations among information users. %M 39938078 %R 10.2196/62703 %U https://infodemiology.jmir.org/2025/1/e62703 %U https://doi.org/10.2196/62703 %U http://www.ncbi.nlm.nih.gov/pubmed/39938078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70071 %T Social Media Use and Oral Health–Related Misconceptions in Saudi Arabia: Cross-Sectional Study %A BinHamdan,Rahaf Hamdan %A Alsadhan,Salwa Abdulrahman %A Gazzaz,Arwa Zohair %A AlJameel,AlBandary Hassan %+ Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Diriyah 12372, Riyadh, 11545, Saudi Arabia, 966 0114677743, rahafbinhamdan@gmail.com %K social media %K oral health %K health misinformation %K digital health %K Saudi Arabia %K public health %K Instagram %K Snapchat %K TikTok %K Twitter %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has become a central tool in health communication, offering both opportunities and challenges. In Saudi Arabia, where platforms like WhatsApp, Snapchat, and Instagram are widely used, the quality and credibility of oral health information shared digitally remain critical issues. Misconceptions about oral health can negatively influence individuals’ behaviors and oral health outcomes. Objective: This study aimed to describe the patterns of social media use and estimate the prevalence of oral health–related misconceptions among adults in Saudi Arabia. Additionally, it assessed the associations between engagement with oral health information, self-reported oral health, and the presence and count of these misconceptions. Methods: A cross-sectional survey was conducted over 10 weeks, targeting adults aged 15 years and older in Saudi Arabia. Data were collected from a total sample size (n=387) via a questionnaire distributed through targeted advertisements on Instagram, TikTok, Snapchat, and X (Twitter). The prevalence of oral health–related misconceptions was estimated using descriptive statistics, including counts and percentages. Chi-square tests described sociodemographic, social media engagement, and self-reported oral health. Logistic and Poisson regression analyses were used to assess associations between engagement and self-reported oral health with misconceptions. Logistic regression models provided odds ratios and adjusted odds ratios with 95% CI to assess the presence of oral health misconceptions. Poisson regression was used to calculate mean ratios and adjusted mean ratios (AMRs) for the count of misconceptions. Results: WhatsApp (n=344, 89.8%) and Instagram (n=304, 78.9%) were the most frequently used social media platforms daily. Common oral health misconceptions included beliefs that “Pregnancy causes calcium loss in teeth” (n=337, 87%) and “Dental treatment should be avoided during pregnancy” (n=245, 63.3%). Following dental-specific accounts was significantly associated with lower odds of having any misconceptions (adjusted odds ratio 0.41, 95% CI 0.22-0.78) and a lower count of misconceptions (AMR 0.87, 95% CI 0.77-0.98). Conversely, trust in social media as a source of oral health information was associated with a higher count of misconceptions (AMR 1.16, 95% CI 1.02-1.31). Conclusions: Social media platforms are essential yet double-edged tools for oral health information dissemination in Saudi Arabia. Participants who followed dental-specific accounts had significantly lower misconceptions, while trust in social media as a source of information was linked to higher counts of misconceptions. These findings highlight the importance of promoting credible content from verified sources to combat misconceptions. Strategic collaborations with dental professionals are necessary to enhance the dissemination of accurate oral health information and public awareness and reduce the prevalence of oral health–related misconceptions. %M 39928937 %R 10.2196/70071 %U https://formative.jmir.org/2025/1/e70071 %U https://doi.org/10.2196/70071 %U http://www.ncbi.nlm.nih.gov/pubmed/39928937 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e55642 %T When Infodemic Meets Epidemic: Systematic Literature Review %A Asaad,Chaimae %A Khaouja,Imane %A Ghogho,Mounir %A Baïna,Karim %+ TICLab, College of Engineering and Architecture, International University of Rabat, Shore Rocade, Rocade S, Rabat, Salé, 11103, Morocco, 212 (5)30112063, chaimae.asaad@uir.ac.ma %K epidemics %K social media %K epidemic surveillance %K misinformation %K mental health %D 2025 %7 3.2.2025 %9 Review %J JMIR Public Health Surveill %G English %X Background: Epidemics and outbreaks present arduous challenges, requiring both individual and communal efforts. The significant medical, emotional, and financial burden associated with epidemics creates feelings of distrust, fear, and loss of control, making vulnerable populations prone to exploitation and manipulation through misinformation, rumors, and conspiracies. The use of social media sites has increased in the last decade. As a result, significant amounts of public data can be leveraged for biosurveillance. Social media sites can also provide a platform to quickly and efficiently reach a sizable percentage of the population; therefore, they have a potential role in various aspects of epidemic mitigation. Objective: This systematic literature review aimed to provide a methodical overview of the integration of social media in 3 epidemic-related contexts: epidemic monitoring, misinformation detection, and the relationship with mental health. The aim is to understand how social media has been used efficiently in these contexts, and which gaps need further research efforts. Methods: Three research questions, related to epidemic monitoring, misinformation, and mental health, were conceptualized for this review. In the first PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) stage, 13,522 publications were collected from several digital libraries (PubMed, IEEE Xplore, ScienceDirect, SpringerLink, MDPI, ACM, and ACL) and gray literature sources (arXiv and ProQuest), spanning from 2010 to 2022. A total of 242 (1.79%) papers were selected for inclusion and were synthesized to identify themes, methods, epidemics studied, and social media sites used. Results: Five main themes were identified in the literature, as follows: epidemic forecasting and surveillance, public opinion understanding, fake news identification and characterization, mental health assessment, and association of social media use with psychological outcomes. Social media data were found to be an efficient tool to gauge public response, monitor discourse, identify misleading and fake news, and estimate the mental health toll of epidemics. Findings uncovered a need for more robust applications of lessons learned from epidemic “postmortem documentation.” A vast gap exists between retrospective analysis of epidemic management and result integration in prospective studies. Conclusions: Harnessing the full potential of social media in epidemic-related tasks requires streamlining the results of epidemic forecasting, public opinion understanding, and misinformation detection, all while keeping abreast of potential mental health implications. Proactive prevention has thus become vital for epidemic curtailment and containment. %R 10.2196/55642 %U https://publichealth.jmir.org/2025/1/e55642 %U https://doi.org/10.2196/55642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65631 %T Predicting User Engagement in Health Misinformation Correction on Social Media Platforms in Taiwan: Content Analysis and Text Mining Study %A Kuo,Hsin-Yu %A Chen,Su-Yen %+ Department of Educational Psychology and Counseling, National Tsing Hua University, 101, Section 2, Kuang-Fu Road, Hsinchu, 300044, Taiwan, 886 3 571 5131 ext 34510, kuohy@mx.nthu.edu.tw %K health misinformation %K misinformation correction %K fact-checking %K content analysis %K text mining %K fuzzy-trace theory %K social media %K large language models %K user engagement %K health communication %D 2025 %7 23.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Health misinformation undermines responses to health crises, with social media amplifying the issue. Although organizations work to correct misinformation, challenges persist due to reasons such as the difficulty of effectively sharing corrections and information being overwhelming. At the same time, social media offers valuable interactive data, enabling researchers to analyze user engagement with health misinformation corrections and refine content design strategies. Objective: This study aimed to identify the attributes of correction posts and user engagement and investigate (1) the trend of user engagement with health misinformation correction during 3 years of the COVID-19 pandemic; (2) the relationship between post attributes and user engagement in sharing and reactions; and (3) the content generated by user comments serving as additional information attached to the post, affecting user engagement in sharing and reactions. Methods: Data were collected from the Facebook pages of a fact-checking organization and a health agency from January 2020 to December 2022. A total of 1424 posts and 67,378 corresponding comments were analyzed. The posts were manually annotated by developing a research framework based on the fuzzy-trace theory, categorizing information into “gist” and “verbatim” representations. Three types of gist representations were examined: risk (risks associated with misinformation), awareness (awareness of misinformation), and value (value in health promotion). Furthermore, 3 types of verbatim representations were identified: numeric (numeric and statistical bases for correction), authority (authority from experts, scholars, or institutions), and facts (facts with varying levels of detail). The basic metrics of user engagement included shares, reactions, and comments as the primary dependent variables. Moreover, this study examined user comments and classified engagement as cognitive (knowledge-based, critical, and bias-based) or emotional (positive, negative, and neutral). Statistical analyses were performed to explore the impact of post attributes on user engagement. Results: On the basis of the results of the regression analysis, risk (β=.07; P=.001), awareness (β=.09; P<.001), and facts (β=.14; P<.001) predicted higher shares; awareness (β=.07; P=.001) and facts (β=.24; P<.001) increased reactions; and awareness (β=.06; P=.005), numeric representations (β=.06; P=.02), and facts (β=.19; P<.001) increased comments. All 3 gist representations significantly predicted shares (risk: β=.08; P<.001, awareness: β=.08; P<.001, and value: β=.06; P<.001) and reactions (risk: β=.04; P=.007, awareness: β=.06; P<.001, and value: β=.05; P<.001) when considering comment content. In addition, comments with bias-based engagement (β=–.11; P=.001) negatively predicted shares. Generally, posts providing gist attributes, especially awareness of misinformation, were beneficial for user engagement in misinformation correction. Conclusions: This study enriches the theoretical understanding of the relationship between post attributes and user engagement within web-based communication efforts to correct health misinformation. These findings provide a foundation for designing more effective content approaches to combat misinformation and strengthen public health communication. %M 39847418 %R 10.2196/65631 %U https://www.jmir.org/2025/1/e65631 %U https://doi.org/10.2196/65631 %U http://www.ncbi.nlm.nih.gov/pubmed/39847418 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e50021 %T Unraveling the Use of Disinformation Hashtags by Social Bots During the COVID-19 Pandemic: Social Networks Analysis %A Suarez-Lledo,Victor %A Ortega-Martin,Esther %A Carretero-Bravo,Jesus %A Ramos-Fiol,Begoña %A Alvarez-Galvez,Javier %+ Computational Social Science DataLab, University Institute of Research for Sustainable Social Development (INDESS), University of Cadiz, Avda. de la Universidad, 4, Jerez de la Frontera, 11406, Spain, 34 956167216, victor.sanz@uca.es %K social media %K misinformation %K COVID-19 %K bot %K hashtags %K disinformation %K network analysis %K community detection %K dissemination %K decision-making %K social bot %K infodemics %K tweets %K social media network %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, social media platforms have been a venue for the exchange of messages, including those related to fake news. There are also accounts programmed to disseminate and amplify specific messages, which can affect individual decision-making and present new challenges for public health. Objective: This study aimed to analyze how social bots use hashtags compared to human users on topics related to misinformation during the outbreak of the COVID-19 pandemic. Methods: We selected posts on specific topics related to infodemics such as vaccines, hydroxychloroquine, military, conspiracy, laboratory, Bill Gates, 5G, and UV. We built a network based on the co-occurrence of hashtags and classified the posts based on their source. Using network analysis and community detection algorithms, we identified hashtags that tend to appear together in messages. For each topic, we extracted the most relevant subtopic communities, which are groups of interconnected hashtags. Results: The distribution of bots and nonbots in each of these communities was uneven, with some sets of hashtags being more common among accounts classified as bots or nonbots. Hashtags related to the Trump and QAnon social movements were common among bots, and specific hashtags with anti-Asian sentiments were also identified. In the subcommunities most populated by bots in the case of vaccines, the group of hashtags including #billgates, #pandemic, and #china was among the most common. Conclusions: The use of certain hashtags varies depending on the source, and some hashtags are used for different purposes. Understanding these patterns may help address the spread of health misinformation on social media networks. %M 39786891 %R 10.2196/50021 %U https://infodemiology.jmir.org/2025/1/e50021 %U https://doi.org/10.2196/50021 %U http://www.ncbi.nlm.nih.gov/pubmed/39786891 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e65521 %T Understanding and Combating Misinformation: An Evolutionary Perspective %A Bragazzi,Nicola Luigi %A Garbarino,Sergio %+ Division of Human Nutrition Unit, Department of Food and Drugs, University of Parma, Via Volturno 39, Parma, 43125, Italy, 39 0521 903121, robertobragazzi@gmail.com %K misinformation %K infodemics %K evolutionary theory %K fake news %K spoof news %K fact-checking %K digital platform %K behavioral research %K social cohesion %K extrapolation %K deformation %K fabrication %K disinformation %K evolutionary paradox %K adaptive qualities %K strategic deception %K intrapolation %K health information %K public health %D 2024 %7 27.12.2024 %9 Viewpoint %J JMIR Infodemiology %G English %X Misinformation represents an evolutionary paradox: despite its harmful impact on society, it persists and evolves, thriving in the information-rich environment of the digital age. This paradox challenges the conventional expectation that detrimental entities should diminish over time. The persistence of misinformation, despite advancements in fact-checking and verification tools, suggests that it possesses adaptive qualities that enable it to survive and propagate. This paper explores how misinformation, as a blend of truth and fiction, continues to resonate with audiences. The role of narratives in human history, particularly in the evolution of Homo narrans, underscores the enduring influence of storytelling on cultural and social cohesion. Despite the increasing ability of individuals to verify the accuracy of sources, misinformation remains a significant challenge, often spreading rapidly through digital platforms. Current behavioral research tends to treat misinformation as completely irrational, static, finite entities that can be definitively debunked, overlooking their dynamic and evolving nature. This approach limits our understanding of the behavioral and societal factors driving the transformation of misinformation over time. The persistence of misinformation can be attributed to several factors, including its role in fostering social cohesion, its perceived short-term benefits, and its use in strategic deception. Techniques such as extrapolation, intrapolation, deformation, cherry-picking, and fabrication contribute to the production and spread of misinformation. Understanding these processes and the evolutionary advantages they confer is crucial for developing effective strategies to counter misinformation. By promoting transparency, critical thinking, and accurate information, society can begin to address the root causes of misinformation and create a more resilient information environment. %M 39466077 %R 10.2196/65521 %U https://infodemiology.jmir.org/2024/1/e65521 %U https://doi.org/10.2196/65521 %U http://www.ncbi.nlm.nih.gov/pubmed/39466077 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e57748 %T The Complex Interaction Between Sleep-Related Information, Misinformation, and Sleep Health: Call for Comprehensive Research on Sleep Infodemiology and Infoveillance %A Bragazzi,Nicola Luigi %A Garbarino,Sergio %+ Human Nutrition Unit, Department of Food and Drugs, University of Parma, Via Volturno 39, Parma, 43125, Italy, 39 0521 903121, robertobragazzi@gmail.com %K sleep health %K sleep-related clinical public health %K sleep information %K health information %K infodemiology %K infoveillance %K social media %K myth %K misconception %K circadian %K chronobiology %K insomnia %K eHealth %K digital health %K public health informatics %K sleep data %K health data %K well-being %K patient information %K lifestyle %D 2024 %7 13.12.2024 %9 Viewpoint %J JMIR Infodemiology %G English %X The complex interplay between sleep-related information—both accurate and misleading—and its impact on clinical public health is an emerging area of concern. Lack of awareness of the importance of sleep, and inadequate information related to sleep, combined with misinformation about sleep, disseminated through social media, nonexpert advice, commercial interests, and other sources, can distort individuals’ understanding of healthy sleep practices. Such misinformation can lead to the adoption of unhealthy sleep behaviors, reducing sleep quality and exacerbating sleep disorders. Simultaneously, poor sleep itself impairs critical cognitive functions, such as memory consolidation, emotional regulation, and decision-making. These impairments can heighten individuals’ vulnerability to misinformation, creating a vicious cycle that further entrenches poor sleep habits and unhealthy behaviors. Sleep deprivation is known to reduce the ability to critically evaluate information, increase suggestibility, and enhance emotional reactivity, making individuals more prone to accepting persuasive but inaccurate information. This cycle of misinformation and poor sleep creates a clinical public health issue that goes beyond individual well-being, influencing occupational performance, societal productivity, and even broader clinical public health decision-making. The effects are felt across various sectors, from health care systems burdened by sleep-related issues to workplaces impacted by decreased productivity due to sleep deficiencies. The need for comprehensive clinical public health initiatives to combat this cycle is critical. These efforts must promote sleep literacy, increase awareness of sleep’s role in cognitive resilience, and correct widespread sleep myths. Digital tools and technologies, such as sleep-tracking devices and artificial intelligence–powered apps, can play a role in educating the public and enhancing the accessibility of accurate, evidence-based sleep information. However, these tools must be carefully designed to avoid the spread of misinformation through algorithmic biases. Furthermore, research into the cognitive impacts of sleep deprivation should be leveraged to develop strategies that enhance societal resilience against misinformation. Sleep infodemiology and infoveillance, which involve tracking and analyzing the distribution of sleep-related information across digital platforms, offer valuable methodologies for identifying and addressing the spread of misinformation in real time. Addressing this issue requires a multidisciplinary approach, involving collaboration between sleep scientists, health care providers, educators, policy makers, and digital platform regulators. By promoting healthy sleep practices and debunking myths, it is possible to disrupt the feedback loop between poor sleep and misinformation, leading to improved individual health, better decision-making, and stronger societal outcomes. %M 39475424 %R 10.2196/57748 %U https://infodemiology.jmir.org/2024/1/e57748 %U https://doi.org/10.2196/57748 %U http://www.ncbi.nlm.nih.gov/pubmed/39475424 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56651 %T Wellness Influencer Responses to COVID-19 Vaccines on Social Media: A Longitudinal Observational Study %A O'Brien,Gabrielle %A Ganjigunta,Ronith %A Dhillon,Paramveer S %+ School of Information, University of Michigan, 105 S. State Street, Ann Arbor, MI, 48103, United States, 1 (734) 764 1555, elleobri@umich.edu %K social media, COVID-19, vaccination %K personal brands %K public health %K wellness %K global health %K pandemic %K Twitter %K tweets %K vaccine %K longitudinal design %K wellness influencers %K hand-annotation %K anti-vaccination %K infodemiology %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Online wellness influencers (individuals dispensing unregulated health and wellness advice over social media) may have incentives to oppose traditional medical authorities. Their messaging may decrease the overall effectiveness of public health campaigns during global health crises like the COVID-19 pandemic. Objective: This study aimed to probe how wellness influencers respond to a public health campaign; we examined how a sample of wellness influencers on Twitter (rebranded as X in 2023) identified before the COVID-19 pandemic on Twitter took stances on the COVID-19 vaccine during 2020-2022. We evaluated the prevalence of provaccination messaging among wellness influencers compared with a control group, as well as the rhetorical strategies these influencers used when supporting or opposing vaccination. Methods: Following a longitudinal design, wellness influencer accounts were identified on Twitter from a random sample of tweets posted in 2019. Accounts were identified using a combination of topic modeling and hand-annotation for adherence to influencer criteria. Their tweets from 2020-2022 containing vaccine keywords were collected and labeled as pro- or antivaccination stances using a language model. We compared their stances to a control group of noninfluencer accounts that discussed similar health topics before the pandemic using a generalized linear model with mixed effects and a nearest-neighbors classifier. We also used topic modeling to locate key themes in influencer’s pro- and antivaccine messages. Results: Wellness influencers (n=161) had lower rates of provaccination stances in their on-topic tweets (20%, 614/3045) compared with controls (n=242 accounts, with 42% or 3201/7584 provaccination tweets). Using a generalized linear model of tweet stance with mixed effects to model tweets from the same account, the main effect of the group was significant (β1=–2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals (β=–0.9591, SE=0.2917; P=.001) but not social network position. A complementary modeling exercise of stance within user accounts showed a significant difference in the proportion of antivaccination users by group (χ21[N=321]=36.1, P<.001). While nearly half of the influencer accounts were labeled by a K-nearest neighbor classifier as predominantly antivaccination (48%, 58/120), only 16% of control accounts were labeled this way (33/201). Topic modeling of influencer tweets showed that the most prevalent antivaccination themes were protecting children, guarding against government overreach, and the corruption of the pharmaceutical industry. Provaccination messaging tended to encourage followers to take action or emphasize the efficacy of the vaccine. Conclusions: Wellness influencers showed higher rates of vaccine opposition compared with other accounts that participated in health discourse before the pandemic. This pattern supports the theory that unregulated wellness influencers have incentives to resist messaging from establishment authorities such as public health agencies. %M 39602782 %R 10.2196/56651 %U https://www.jmir.org/2024/1/e56651 %U https://doi.org/10.2196/56651 %U http://www.ncbi.nlm.nih.gov/pubmed/39602782 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56761 %T Age Variation Among US Adults’ Social Media Experiences and Beliefs About Who Is Responsible for Reducing Health-Related Falsehoods: Secondary Analysis of a National Survey %A Galinkala,Prathyusha %A Atkinson,Elise %A Campos-Castillo,Celeste %K social media %K health misinformation %K gray digital divide %K United States %K older adults %K aging %K health information %K false information %K falsehoods %D 2024 %7 27.11.2024 %9 %J JMIR Aging %G English %X Background: We live in a digital age where social media has become an essential part of people’s lives. It is also one of the leading platforms responsible for spreading health-related falsehoods. This study explores who adults of different age groups perceive as responsible for reducing health-related falsehoods on social media. Objective: Despite growing concern over older adults’ exposure to false health information on social media, little research examines their beliefs on how to address the problem. This study examines how the age of US adults is associated with their reported experiences with health-related falsehoods on social media and their beliefs about who should be tasked with reducing such falsehoods. Methods: This study is a secondary analysis of data from the 2022 Health Information National Trends Survey, a nationally representative survey of US adults (18 years and older). Multivariable logistic regressions estimated how a respondent’s age was associated with their self-reported social media use, their difficulty to detect health-related falsehoods on social media, their discussion of health information found on social media with medical providers, and their beliefs regarding who should be responsible for reducing health-related falsehoods on social media. Regression estimates were adjusted for respondents’ sociodemographic and health characteristics. Results: Daily social media use decreased with respondents’ age. Respondents aged 50‐64 years (b=0.515, P=.01) and 65‐74 years (b=0.697, P=.002) were more likely than respondents aged 18‐34 years to report they strongly agree that it is difficult for them to detect health-related falsehoods on social media. Compared to younger adults, older adults (65‐74 years: b=0.818, P=.002; 75 years and older: b=1.058, P<.001) were more likely to believe medical providers should be responsible for reducing online falsehoods. Conclusions: In addition to ongoing efforts by social media platforms to detect and remove falsehoods, the findings suggest medical providers should be tasked with discrediting health-related falsehoods on social media for older adults. However, time during the clinical visit is limited. Future research is needed to discover new approaches and tools tailored to older adults to assist with filtering and discrediting health-related falsehoods on social media. %R 10.2196/56761 %U https://aging.jmir.org/2024/1/e56761 %U https://doi.org/10.2196/56761 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e56675 %T Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study %A Helgeson,Scott A %A Mudgalkar,Rohan M %A Jacobs,Keith A %A Lee,Augustine S %A Sanghavi,Devang %A Moreno Franco,Pablo %A Brooks,Ian S %A , %+ Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, United States, 1 9049532000, helgeson.scott@mayo.edu %K social media %K infodemic %K COVID-19 %K healthcare utilization %K misinformation %K disinformation %K Twitter %K hydroxychloroquine %K X %K drugs %K pharmacy %K pharmacology %K pharmacotherapy %K pharmaceuticals %K medication %K prescription %K sentiment %K SARS-CoV-2 %K pandemic %K respiratory %K infectious %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information. Objective: We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting. Methods: In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter’s data, and focused on mentions of “hydroxychloroquine” and “Plaquenil.” Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch’s sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression. Results: A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study’s period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates. Conclusions: During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms. %M 39556417 %R 10.2196/56675 %U https://infodemiology.jmir.org/2024/1/e56675 %U https://doi.org/10.2196/56675 %U http://www.ncbi.nlm.nih.gov/pubmed/39556417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55086 %T Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis %A Chandrasekaran,Ranganathan %A Sadiq T,Muhammed %A Moustakas,Evangelos %+ University of Illinois at Chicago, 601 S Morgan Street, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K health misinformation %K digital divide %K racial disparities %K social media %K national survey-based analysis %K health information %K interventions %D 2024 %7 6.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals’ cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61% (1740/4959) of respondents reported encountering “a lot” of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing “some” amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. %M 39504121 %R 10.2196/55086 %U https://www.jmir.org/2024/1/e55086 %U https://doi.org/10.2196/55086 %U http://www.ncbi.nlm.nih.gov/pubmed/39504121 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e49366 %T Effects of COVID-19 Illness and Vaccination Infodemic Through Mobile Health, Social Media, and Electronic Media on the Attitudes of Caregivers and Health Care Providers in Pakistan: Qualitative Exploratory Study %A Kazi,Abdul Momin %A Ahsan,Nazia %A Jabeen,Rawshan %A Allana,Raheel %A Jamal,Saima %A Mughal,Muhammad Ayub Khan %A Hopkins,Kathryn L %A Malik,Fauzia Aman %+ Aga Khan University, Stadium Road, Karachi, Pakistan, 92 3002139610, momin.kazi@aku.edu %K infodemics %K mHealth %K social media %K electronic media %K Pakistan %K vaccination %K misinformation %K infodemiology %K mobile phone %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has had a significant impact on different countries because of which various health and safety measures were implemented, with digital media playing a pivotal role. However, digital media also pose significant concerns such as misinformation and lack of direction. Objective: We aimed to explore the effects of COVID-19–related infodemics through digital, social, and electronic media on the vaccine-related attitudes of caregivers and health care providers in Pakistan. Methods: This study employs a qualitative exploratory study design with purposive sampling strategies, and it was conducted at 3 primary health care facilities in the province of Sindh, Pakistan. Seven focus group discussions with health care providers and 60 in-depth interviews with caregivers were conducted using semistructured interviews through virtual platforms (ConnectOnCall and Zoom). Transcripts were analyzed through thematic analysis. Results: Our study reveals the pivotal role of electronic media, mobile health (mHealth), and social media during the COVID-19 pandemic. Four major themes were identified: (1) sources of information on COVID-19 and its vaccination, (2) electronic media value and misleading communication, (3) mHealth leveraging and limitations during COVID-19, and (4) social media influence and barriers during COVID-19. Health care providers and caregivers reported that the common sources of information were electronic media and mHealth, followed by social media. Some participants also used global media for more reliable information related to COVID-19. mHealth solutions such as public awareness messages, videos, call ringtones, and helplines promoted COVID-19 prevention techniques and vaccine registration. However, the overwhelming influx of news and sociobehavioral narratives, including misinformation/disinformation through social media such as WhatsApp, Facebook, and Twitter, were found to be the primary enablers of vaccine-related infodemics. Electronic media and mHealth were utilized more widely to promote information and communication on the COVID-19 pandemic and vaccination. However, social media and electronic media–driven infodemics were identified as the major factors for misinformation related to COVID-19 and vaccine hesitancy. Further, we found a digital divide between the urban and rural populations, with the use of electronic media in rural settings and social media in urban settings. Conclusions: In a resource-constrained setting like Pakistan, the usage of mHealth, social media, and electronic media for information spread (both factual and mis/disinformation) related to COVID-19 and its vaccination had a significant impact on attitudes toward COVID-19 vaccination. Based on the qualitative findings, we generated a model of digital communications and information dissemination to increase knowledge about COVID-19 and its prevention measures, including vaccination, which can be replicated in similar settings for other disease burdens and related infodemics. Further, to mitigate the infodemics, both digital and nondigital interventions are needed at a larger scale. %M 39231430 %R 10.2196/49366 %U https://infodemiology.jmir.org/2024/1/e49366 %U https://doi.org/10.2196/49366 %U http://www.ncbi.nlm.nih.gov/pubmed/39231430 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51328 %T Descriptions of Scientific Evidence and Uncertainty of Unproven COVID-19 Therapies in US News: Content Analysis Study %A Watson,Sara %A Benning,Tyler J %A Marcon,Alessandro R %A Zhu,Xuan %A Caulfield,Timothy %A Sharp,Richard R %A Master,Zubin %+ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Suite 310, Winston-Salem, NC, 27157, United States, 1 3367164289, zmaster@wakehealth.edu %K COVID-19 %K COVID-19 drug treatment %K information dissemination %K health communication %K uncertainty %K content analysis %K information sources %K therapy %K misinformation %K communication %K scientific evidence %K media analysis %K news report %K COVID-19 therapy %K treatment %K public awareness %K public trepidation %K therapeutic %K therapeutics %K vaccine %K vaccines %K pandemic %K United States %K media analysis %K safety %K efficacy %K evidence %K news %K report %K reports %D 2024 %7 29.8.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Politicization and misinformation or disinformation of unproven COVID-19 therapies have resulted in communication challenges in presenting science to the public, especially in times of heightened public trepidation and uncertainty. Objective: This study aims to examine how scientific evidence and uncertainty were portrayed in US news on 3 unproven COVID-19 therapeutics, prior to the development of proven therapeutics and vaccines. Methods: We conducted a media analysis of unproven COVID-19 therapeutics in early 2020. A total of 479 discussions of unproven COVID-19 therapeutics (hydroxychloroquine, remdesivir, and convalescent plasma) in traditional and online US news reports from January 1, 2020, to July 30, 2020, were systematically analyzed for theme, scientific evidence, evidence details and limitations, safety, efficacy, and sources of authority. Results: The majority of discussions included scientific evidence (n=322, 67%) although only 24% (n=116) of them mentioned publications. “Government” was the most frequently named source of authority for safety and efficacy claims on remdesivir (n=43, 35%) while “expert” claims were mostly mentioned for convalescent plasma (n=22, 38%). Most claims on hydroxychloroquine (n=236, 79%) were offered by a “prominent person,” of which 97% (n=230) were from former US President Trump. Despite the inclusion of scientific evidence, many claims of the safety and efficacy were made by nonexperts. Few news reports expressed scientific uncertainty in discussions of unproven COVID-19 therapeutics as limitations of evidence were infrequently included in the body of news reports (n=125, 26%) and rarely found in headlines (n=2, 2%) or lead paragraphs (n=9, 9%; P<.001). Conclusions: These results highlight that while scientific evidence is discussed relatively frequently in news reports, scientific uncertainty is infrequently reported and rarely found in prominent headlines and lead paragraphs. %M 39207825 %R 10.2196/51328 %U https://infodemiology.jmir.org/2024/1/e51328 %U https://doi.org/10.2196/51328 %U http://www.ncbi.nlm.nih.gov/pubmed/39207825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56931 %T A Comprehensive Analysis of COVID-19 Misinformation, Public Health Impacts, and Communication Strategies: Scoping Review %A Kisa,Sezer %A Kisa,Adnan %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, Oslo, 0130, Norway, 47 92501403, sezerkisa@hotmail.com %K communication strategies %K COVID-19 %K infodemic %K misinformation %K public health %D 2024 %7 21.8.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic was marked by an infodemic, characterized by the rapid spread of both accurate and false information, which significantly affected public health. This infodemic led to confusion, mistrust in health authorities, noncompliance with health guidelines, and engagement in risky health behaviors. Understanding the dynamics of misinformation during the pandemic is crucial for developing effective public health communication strategies. Objective: This comprehensive analysis aimed to examine the complexities of COVID-19 misinformation. Specifically, it sought to identify the sources and themes of misinformation, the target audiences most affected, and the effectiveness of various public health communication strategies in mitigating misinformation. Methods: This scoping review used the MEDLINE (PubMed), Embase, and Scopus databases to identify relevant studies. An established, methodical framework for scoping reviews was used to review literature published between December 2019 and September 2023. The inclusion criteria focused on peer-reviewed studies published in English that address COVID-19 misinformation and its sources, themes, and target audiences, as well as the effectiveness of public health communication strategies. Results: The scoping review identified that misinformation significantly impacted mental health, vaccine hesitancy, and health care decision-making. Social media and traditional media were major conduits for spreading misinformation. Key misinformation themes included the origins of the virus, ineffective treatments, and misunderstandings about public health measures. Misinformation sources ranged from social media platforms to traditional media outlets and informal networks. The impact of misinformation was found to vary across different regions and demographic groups, with vulnerable populations being disproportionately affected. Effective strategies to counter misinformation included enhancing health literacy; using digital technology; promoting clear, authoritative communication; and implementing fact-checking mechanisms. In addition, community engagement and targeted health campaigns played a crucial role in addressing misinformation. Conclusions: The review emphasizes the critical need for accurate and consistent messaging to combat misinformation. Cooperative efforts among policy makers, health professionals, and communication experts are essential for developing effective interventions. Addressing the infodemic is vital for building a well-informed, health-literate society capable of handling misinformation in future global health crises. The study provides valuable insights into the dynamics of misinformation and highlights the importance of robust public health communication strategies. These findings can guide future efforts to mitigate the impact of misinformation during health emergencies. %M 39167790 %R 10.2196/56931 %U https://www.jmir.org/2024/1/e56931 %U https://doi.org/10.2196/56931 %U http://www.ncbi.nlm.nih.gov/pubmed/39167790 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51094 %T Mediterranean Diet Information on TikTok and Implications for Digital Health Promotion Research: Social Media Content Analysis %A Raber,Margaret %A Allen,Haley %A Huang,Sophia %A Vazquez,Maria %A Warner,Echo %A Thompson,Debbe %+ Department of Health Disparities Research, MD Anderson Cancer Center, 1400 Pressler Street Dr., Houston, TX, 77030, United States, 1 713 702 4801, mpraber@mdanderson.org %K misinformation %K social media %K Mediterranean Diet %K content analysis %K health communication %K communication %K TikTok %K diet %K cardiometabolic disease %K cardiometabolic %K consumer %K eating %K social media %K quality %K mHealth %K mobile health %K digital health %K promotion research %K nutrition therapy %K healthy diet %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Mediterranean diet has been linked to reduced risk for several cardiometabolic diseases. The lack of a clear definition of the Mediterranean diet in the scientific literature and the documented proliferation of nutrition misinformation on the internet suggest the potential for confusion among consumers seeking web-based Mediterranean diet information. Objective: We conducted a social media content analysis of information about the Mediterranean diet on the influential social media platform, TikTok, to examine public discourse about the diet and identify potential areas of misinformation. We then analyzed these findings in the context of health promotion to identify potential challenges and opportunities for the use of TikTok in promoting the Mediterranean diet for healthy living. Methods: The first-appearing 202 TikTok posts that resulted from a search of the hashtag #mediterraneandiet were downloaded and qualitatively examined. Post features and characteristics, poster information, and engagement metrics were extracted and synthesized across posts. Posts were categorized as those created by health professionals and those created by nonhealth professionals based on poster-reported credentials. In addition to descriptive statistics of the entire sample, we compared posts created by professionals and nonprofessionals for content using chi-square tests. Results: TikTok posts varied in content, but posts that were developed by health professionals versus nonprofessionals were more likely to offer a definition of the Mediterranean diet (16/106, 15.1% vs 2/96, 2.1%; P=.001), use scientific citations to support claims (26/106, 24.5% vs 0/96, 0%; P<.001), and discuss specific nutrients (33/106, 31.1% vs 6/96, 6.3%; P<.001) and diseases related to the diet (27/106, 25.5% vs 5/96, 5.2%; P<.001) compared to posts created by nonhealth professionals. Conclusions: Social media holds promise as a venue to promote the Mediterranean diet, but the variability in information found in this study highlights the need to create clear definitions about the diet and its components when developing Mediterranean diet interventions that use new media structures. %M 38896841 %R 10.2196/51094 %U https://formative.jmir.org/2024/1/e51094 %U https://doi.org/10.2196/51094 %U http://www.ncbi.nlm.nih.gov/pubmed/38896841 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e54663 %T TikTok as a Source of Health Information and Misinformation for Young Women in the United States: Survey Study %A Kirkpatrick,Ciera E %A Lawrie,LaRissa L %+ College of Journalism & Mass Communications, University of Nebraska-Lincoln, 331 Andersen Hall, Lincoln, NE, 68588, United States, 1 3165594397, ciera.kirkpatrick@unl.edu %K credibility perceptions %K health information %K health misinformation %K information seeking %K misinformation perceptions %K public health %K social media %K strategic communication %K third-person effect %K TikTok %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: TikTok is one of the most-used and fastest-growing social media platforms in the world, and recent reports indicate that it has become an increasingly popular source of news and information in the United States. These trends have important implications for public health because an abundance of health information exists on the platform. Women are among the largest group of TikTok users in the United States and may be especially affected by the dissemination of health information on TikTok. Prior research has shown that women are not only more likely to look for information on the internet but are also more likely to have their health-related behaviors and perceptions affected by their involvement with social media. Objective: We conducted a survey of young women in the United States to better understand their use of TikTok for health information as well as their perceptions of TikTok’s health information and health communication sources. Methods: A web-based survey of US women aged 18 to 29 years (N=1172) was conducted in April-May 2023. The sample was recruited from a Qualtrics research panel and 2 public universities in the United States. Results: The results indicate that the majority of young women in the United States who have used TikTok have obtained health information from the platform either intentionally (672/1026, 65.5%) or unintentionally (948/1026, 92.4%). Age (959/1026, 93.47%; r=0.30; P<.001), education (959/1026, 93.47%; ρ=0.10; P=.001), and TikTok intensity (ie, participants’ emotional connectedness to TikTok and TikTok’s integration into their daily lives; 959/1026, 93.47%; r=0.32; P<.001) were positively correlated with overall credibility perceptions of the health information. Nearly the entire sample reported that they think that misinformation is prevalent on TikTok to at least some extent (1007/1026, 98.15%), but a third-person effect was found because the young women reported that they believe that other people are more susceptible to health misinformation on TikTok than they personally are (t1025=21.16; P<.001). Both health professionals and general users were common sources of health information on TikTok: 93.08% (955/1026) of the participants indicated that they had obtained health information from a health professional, and 93.86% (963/1026) indicated that they had obtained health information from a general user. The respondents showed greater preference for health information from health professionals (vs general users; t1025=23.75; P<.001); the respondents also reported obtaining health information from health professionals more often than from general users (t1025=8.13; P<.001), and they were more likely to act on health information from health professionals (vs general users; t1025=12.74; P<.001). Conclusions: The findings suggest that health professionals and health communication scholars need to proactively consider using TikTok as a platform for disseminating health information to young women because young women are obtaining health information from TikTok and prefer information from health professionals. %M 38772020 %R 10.2196/54663 %U https://infodemiology.jmir.org/2024/1/e54663 %U https://doi.org/10.2196/54663 %U http://www.ncbi.nlm.nih.gov/pubmed/38772020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51910 %T Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment %A Zhao,Rui %A Lu,Xuerong %A Yang,Jiayi %A Li,Biao %+ School of Journalism, Renmin University of China, 19 Zhong Guancun Street, Beijing, 100081, China, 86 18810386586, libiao@ruc.edu.cn %K information uncertainty %K health communication %K uncertainty management %K COVID-19 %K public health perception %K health information %D 2024 %7 14.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners. Objective: The aim of this study was to investigate the impact of communicating uncertainty about COVID-19–related threats and solutions on individuals’ risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions. Methods: A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses. Results: Individuals were more susceptible to believing false COVID-19–related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals’ perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention. Conclusions: Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals’ cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public’s expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis. %M 38743940 %R 10.2196/51910 %U https://www.jmir.org/2024/1/e51910 %U https://doi.org/10.2196/51910 %U http://www.ncbi.nlm.nih.gov/pubmed/38743940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51331 %T Latino Parents’ Reactions to and Engagement With a Facebook Group–Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study %A González-Salinas,Anna I %A Andrade,Elizabeth L %A Abroms,Lorien C %A Gómez,Kaitlyn %A Favetto,Carla %A Gómez,Valeria M %A Collins,Karen K %+ George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 (202) 994 7400, agonzalez985@gwmail.gwu.edu %K COVID-19 %K misinformation %K social media %K Latino parents %K Spanish %K vaccines %K digital intervention %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants’ reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ≤18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants’ exposure, reactions, and engagement, we used participants’ responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine–related health promotion. %M 38483457 %R 10.2196/51331 %U https://formative.jmir.org/2024/1/e51331 %U https://doi.org/10.2196/51331 %U http://www.ncbi.nlm.nih.gov/pubmed/38483457 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e45546 %T A Serious Game (“Fight With Virus”) for Preventing COVID-19 Health Rumors: Development and Experimental Study %A Xiong,Shuo %A Zuo,Long %A Chen,Qiwei %A Zeliang,Zhang %A Nor Akmal Khalid,Mohd %+ Philosophy and Social Sciences Laboratory of Big Data and National Communication Strategy, Huazhong University of Science and Technology, Building 6, No 1037, Luoyu Road, Wuhan, 430074, China, 86 15927188806, xiongshuo@hust.edu.cn %K serious game %K COVID-19 %K health rumor %K game communication %K game TCP model %K Transmission Control Protocol %K gaming %K misinformation %K disinformation %K rumor %K health communication %K false information %K elder %K older adult %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors. Objective: This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders. Methods: This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named “Fight With Virus” as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved. Results: We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games. Conclusions: Compared to traditional media, serious games can effectively improve midelders’/elders’ cognitive abilities while they face a health rumor. The gameplay effect is related to the individual’s age and educational background, while income and gender have no impact. %M 38407954 %R 10.2196/45546 %U https://games.jmir.org/2024/1/e45546 %U https://doi.org/10.2196/45546 %U http://www.ncbi.nlm.nih.gov/pubmed/38407954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44726 %T Identification of Myths and Misinformation About Treatment for Opioid Use Disorder on Social Media: Infodemiology Study %A ElSherief,Mai %A Sumner,Steven %A Krishnasamy,Vikram %A Jones,Christopher %A Law,Royal %A Kacha-Ochana,Akadia %A Schieber,Lyna %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 (617) 373 2462, m.elsherif@northeastern.edu %K addiction treatment %K machine learning %K misinformation %K natural language processing %K opioid use disorder %K social media %K substance use %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health misinformation and myths about treatment for opioid use disorder (OUD) are present on social media and contribute to challenges in preventing drug overdose deaths. However, no systematic, quantitative methodology exists to identify what types of misinformation are being shared and discussed. Objective: We developed a multistage analytic pipeline to assess social media posts from Twitter (subsequently rebranded as X), YouTube, Reddit, and Drugs-Forum for the presence of health misinformation about treatment for OUD. Methods: Our approach first used document embeddings to identify potential new statements of misinformation from known myths. These statements were grouped into themes using hierarchical agglomerative clustering, and public health experts then reviewed the results for misinformation. Results: We collected a total of 19,953,599 posts discussing opioid-related content across the aforementioned platforms. Our multistage analytic pipeline identified 7 main clusters or discussion themes. Among a high-yield data set of posts (n=303) for further public health expert review, these included discussion about potential treatments for OUD (90/303, 29.8%), the nature of addiction (68/303, 22.5%), pharmacologic properties of substances (52/303, 16.9%), injection drug use (36/303, 11.9%), pain and opioids (28/303, 9.3%), physical dependence of medications (22/303, 7.2%), and tramadol use (7/303, 2.3%). A public health expert review of the content within each cluster identified the presence of misinformation and myths beyond those used as seed myths to initialize the algorithm. Conclusions: Identifying and addressing misinformation through appropriate communication strategies could be an increasingly important component of preventing overdose deaths. To further this goal, we developed and tested an approach to aid in the identification of myths and misinformation about OUD from large-scale social media content. %M 38393772 %R 10.2196/44726 %U https://formative.jmir.org/2024/1/e44726 %U https://doi.org/10.2196/44726 %U http://www.ncbi.nlm.nih.gov/pubmed/38393772 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e47677 %T Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates %A Koskan,Alexis M %A Sivanandam,Shalini %A Roschke,Kristy %A Irby,Jonathan %A Helitzer,Deborah L %A Doebbeling,Bradley %+ College of Health Solutions, Arizona State University, 425 N. 5th Street, Phoenix, AZ, 85004, United States, 1 480 884 2533 ext 42533, alexis.koskan@asu.edu %K COVID-19 %K coronavirus %K pandemic %K infodemic %K misinformation %K social media %K qualitative research %K public health %K health communication %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. Objective: This work explores highly knowledgeable information advocates’ perspectives, behaviors, and information-related practices. Methods: To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. Results: Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants’ responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. Conclusions: This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors. %M 37862066 %R 10.2196/47677 %U https://infodemiology.jmir.org/2023/1/e47677 %U https://doi.org/10.2196/47677 %U http://www.ncbi.nlm.nih.gov/pubmed/37862066 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e48620 %T The Role of Social Media in Health Misinformation and Disinformation During the COVID-19 Pandemic: Bibliometric Analysis %A Adebesin,Funmi %A Smuts,Hanlie %A Mawela,Tendani %A Maramba,George %A Hattingh,Marie %+ Department of Informatics, University of Pretoria, Information Technology Building, Level 5, Lynwood Road, Pretoria, 0028, South Africa, 27 12 420 5667 ext 5667, funmi.adebesin@up.ac.za %K bibliometric analysis %K COVID-19 %K fake news %K health disinformation %K health misinformation %K social media %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The use of social media platforms to seek information continues to increase. Social media platforms can be used to disseminate important information to people worldwide instantaneously. However, their viral nature also makes it easy to share misinformation, disinformation, unverified information, and fake news. The unprecedented reliance on social media platforms to seek information during the COVID-19 pandemic was accompanied by increased incidents of misinformation and disinformation. Consequently, there was an increase in the number of scientific publications related to the role of social media in disseminating health misinformation and disinformation at the height of the COVID-19 pandemic. Health misinformation and disinformation, especially in periods of global public health disasters, can lead to the erosion of trust in policy makers at best and fatal consequences at worst. Objective: This paper reports a bibliometric analysis aimed at investigating the evolution of research publications related to the role of social media as a driver of health misinformation and disinformation since the start of the COVID-19 pandemic. Additionally, this study aimed to identify the top trending keywords, niche topics, authors, and publishers for publishing papers related to the current research, as well as the global collaboration between authors on topics related to the role of social media in health misinformation and disinformation since the start of the COVID-19 pandemic. Methods: The Scopus database was accessed on June 8, 2023, using a combination of Medical Subject Heading and author-defined terms to create the following search phrases that targeted the title, abstract, and keyword fields: (“Health*” OR “Medical”) AND (“Misinformation” OR “Disinformation” OR “Fake News”) AND (“Social media” OR “Twitter” OR “Facebook” OR “YouTube” OR “WhatsApp” OR “Instagram” OR “TikTok”) AND (“Pandemic*” OR “Corona*” OR “Covid*”). A total of 943 research papers published between 2020 and June 2023 were analyzed using Microsoft Excel (Microsoft Corporation), VOSviewer (Centre for Science and Technology Studies, Leiden University), and the Biblioshiny package in Bibliometrix (K-Synth Srl) for RStudio (Posit, PBC). Results: The highest number of publications was from 2022 (387/943, 41%). Most publications (725/943, 76.9%) were articles. JMIR published the most research papers (54/943, 5.7%). Authors from the United States collaborated the most, with 311 coauthored research papers. The keywords “Covid-19,” “social media,” and “misinformation” were the top 3 trending keywords, whereas “learning systems,” “learning models,” and “learning algorithms” were revealed as the niche topics on the role of social media in health misinformation and disinformation during the COVID-19 outbreak. Conclusions: Collaborations between authors can increase their productivity and citation counts. Niche topics such as “learning systems,” “learning models,” and “learning algorithms” could be exploited by researchers in future studies to analyze the influence of social media on health misinformation and disinformation during periods of global public health emergencies. %M 37728981 %R 10.2196/48620 %U https://infodemiology.jmir.org/2023/1/e48620 %U https://doi.org/10.2196/48620 %U http://www.ncbi.nlm.nih.gov/pubmed/37728981 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49255 %T Psychological Inoculation for Credibility Assessment, Sharing Intention, and Discernment of Misinformation: Systematic Review and Meta-Analysis %A Lu,Chang %A Hu,Bo %A Li,Qiang %A Bi,Chao %A Ju,Xing-Da %+ School of Psychology, Northeast Normal University, Northeast Normal University, No. 5268, Renmin Street, Nanguan District, Changchun City, Jilin Province, 130024, China, 86 13086868264, juxd513@nenu.edu.cn %K psychological inoculation %K misinformation %K discernment %K sharing %K meta-analysis %D 2023 %7 29.8.2023 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of misinformation poses a substantial threat to individuals’ daily lives, necessitating the deployment of effective remedial approaches. One promising strategy is psychological inoculation, which pre-emptively immunizes individuals against misinformation attacks. However, uncertainties remain regarding the extent to which psychological inoculation effectively enhances the capacity to differentiate between misinformation and real information. Objective: To reduce the potential risk of misinformation about digital health, this study aims to examine the effectiveness of psychological inoculation in countering misinformation with a focus on several factors, including misinformation credibility assessment, real information credibility assessment, credibility discernment, misinformation sharing intention, real information sharing intention, and sharing discernment. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a meta-analysis by searching 4 databases (Web of Science, APA PsycINFO, Proquest, and PubMed) for empirical studies based on inoculation theory and outcome measure–related misinformation published in the English language. Moderator analyses were used to examine the differences in intervention strategy, intervention type, theme, measurement time, team, and intervention design. Results: Based on 42 independent studies with 42,530 subjects, we found that psychological inoculation effectively reduces misinformation credibility assessment (d=–0.36, 95% CI –0.50 to –0.23; P<.001) and improves real information credibility assessment (d=0.20, 95% CI 0.06-0.33; P=.005) and real information sharing intention (d=0.09, 95% CI 0.03-0.16; P=.003). However, psychological inoculation does not significantly influence misinformation sharing intention (d=–0.35, 95% CI –0.79 to 0.09; P=.12). Additionally, we find that psychological inoculation effectively enhances credibility discernment (d=0.20, 95% CI 0.13-0.28; P<.001) and sharing discernment (d=0.18, 95% CI 0.12-0.24; P<.001). Regarding health misinformation, psychological inoculation effectively decreases misinformation credibility assessment and misinformation sharing intention. The results of the moderator analyses showed that content-based, passive inoculation was more effective in increasing credibility and sharing intention. The theme of climate change demonstrates a stronger effect on real information credibility. Comparing intervention types showed that pre-post interventions are more effective for misinformation credibility assessment, while post-only interventions are better for credibility discernment. Conclusions: This study indicated that psychological inoculation enhanced individuals’ ability to discern real information from misinformation and share real information. Incorporating psychological inoculation to cultivate an informed public is crucial for societal resilience against misinformation threats in an age of information proliferation. As a scalable and cost-effective intervention strategy, institutions can apply psychological inoculation to mitigate potential misinformation crises. %M 37560816 %R 10.2196/49255 %U https://www.jmir.org/2023/1/e49255 %U https://doi.org/10.2196/49255 %U http://www.ncbi.nlm.nih.gov/pubmed/37560816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41134 %T Interdisciplinary Approach to Identify and Characterize COVID-19 Misinformation on Twitter: Mixed Methods Study %A Isip Tan,Iris Thiele %A Cleofas,Jerome %A Solano,Geoffrey %A Pillejera,Jeanne Genevive %A Catapang,Jasper Kyle %+ English Language and Linguistics, University of Birmingham, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0 121 414 3344, jxc1354@student.bham.ac.uk %K COVID-19 %K misinformation %K natural language processing %K Twitter %K biterm topic modeling %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Studying COVID-19 misinformation on Twitter presents methodological challenges. A computational approach can analyze large data sets, but it is limited when interpreting context. A qualitative approach allows for a deeper analysis of content, but it is labor-intensive and feasible only for smaller data sets. Objective: We aimed to identify and characterize tweets containing COVID-19 misinformation. Methods: Tweets geolocated to the Philippines (January 1 to March 21, 2020) containing the words coronavirus, covid, and ncov were mined using the GetOldTweets3 Python library. This primary corpus (N=12,631) was subjected to biterm topic modeling. Key informant interviews were conducted to elicit examples of COVID-19 misinformation and determine keywords. Using NVivo (QSR International) and a combination of word frequency and text search using key informant interview keywords, subcorpus A (n=5881) was constituted and manually coded to identify misinformation. Constant comparative, iterative, and consensual analyses were used to further characterize these tweets. Tweets containing key informant interview keywords were extracted from the primary corpus and processed to constitute subcorpus B (n=4634), of which 506 tweets were manually labeled as misinformation. This training set was subjected to natural language processing to identify tweets with misinformation in the primary corpus. These tweets were further manually coded to confirm labeling. Results: Biterm topic modeling of the primary corpus revealed the following topics: uncertainty, lawmaker’s response, safety measures, testing, loved ones, health standards, panic buying, tragedies other than COVID-19, economy, COVID-19 statistics, precautions, health measures, international issues, adherence to guidelines, and frontliners. These were categorized into 4 major topics: nature of COVID-19, contexts and consequences, people and agents of COVID-19, and COVID-19 prevention and management. Manual coding of subcorpus A identified 398 tweets with misinformation in the following formats: misleading content (n=179), satire and/or parody (n=77), false connection (n=53), conspiracy (n=47), and false context (n=42). The discursive strategies identified were humor (n=109), fear mongering (n=67), anger and disgust (n=59), political commentary (n=59), performing credibility (n=45), overpositivity (n=32), and marketing (n=27). Natural language processing identified 165 tweets with misinformation. However, a manual review showed that 69.7% (115/165) of tweets did not contain misinformation. Conclusions: An interdisciplinary approach was used to identify tweets with COVID-19 misinformation. Natural language processing mislabeled tweets, likely due to tweets written in Filipino or a combination of the Filipino and English languages. Identifying the formats and discursive strategies of tweets with misinformation required iterative, manual, and emergent coding by human coders with experiential and cultural knowledge of Twitter. An interdisciplinary team composed of experts in health, health informatics, social science, and computer science combined computational and qualitative methods to gain a better understanding of COVID-19 misinformation on Twitter. %M 37220196 %R 10.2196/41134 %U https://formative.jmir.org/2023/1/e41134 %U https://doi.org/10.2196/41134 %U http://www.ncbi.nlm.nih.gov/pubmed/37220196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44356 %T Tweeting for Health Using Real-time Mining and Artificial Intelligence–Based Analytics: Design and Development of a Big Data Ecosystem for Detecting and Analyzing Misinformation on Twitter %A Morita,Plinio Pelegrini %A Zakir Hussain,Irfhana %A Kaur,Jasleen %A Lotto,Matheus %A Butt,Zahid Ahmad %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K big data %K deep learning %K infodemics %K misinformation %K social media %K infoveillance %D 2023 %7 9.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital misinformation, primarily on social media, has led to harmful and costly beliefs in the general population. Notably, these beliefs have resulted in public health crises to the detriment of governments worldwide and their citizens. However, public health officials need access to a comprehensive system capable of mining and analyzing large volumes of social media data in real time. Objective: This study aimed to design and develop a big data pipeline and ecosystem (UbiLab Misinformation Analysis System [U-MAS]) to identify and analyze false or misleading information disseminated via social media on a certain topic or set of related topics. Methods: U-MAS is a platform-independent ecosystem developed in Python that leverages the Twitter V2 application programming interface and the Elastic Stack. The U-MAS expert system has 5 major components: data extraction framework, latent Dirichlet allocation (LDA) topic model, sentiment analyzer, misinformation classification model, and Elastic Cloud deployment (indexing of data and visualizations). The data extraction framework queries the data through the Twitter V2 application programming interface, with queries identified by public health experts. The LDA topic model, sentiment analyzer, and misinformation classification model are independently trained using a small, expert-validated subset of the extracted data. These models are then incorporated into U-MAS to analyze and classify the remaining data. Finally, the analyzed data are loaded into an index in the Elastic Cloud deployment and can then be presented on dashboards with advanced visualizations and analytics pertinent to infodemiology and infoveillance analysis. Results: U-MAS performed efficiently and accurately. Independent investigators have successfully used the system to extract significant insights into a fluoride-related health misinformation use case (2016 to 2021). The system is currently used for a vaccine hesitancy use case (2007 to 2022) and a heat wave–related illnesses use case (2011 to 2022). Each component in the system for the fluoride misinformation use case performed as expected. The data extraction framework handles large amounts of data within short periods. The LDA topic models achieved relatively high coherence values (0.54), and the predicted topics were accurate and befitting to the data. The sentiment analyzer performed at a correlation coefficient of 0.72 but could be improved in further iterations. The misinformation classifier attained a satisfactory correlation coefficient of 0.82 against expert-validated data. Moreover, the output dashboard and analytics hosted on the Elastic Cloud deployment are intuitive for researchers without a technical background and comprehensive in their visualization and analytics capabilities. In fact, the investigators of the fluoride misinformation use case have successfully used the system to extract interesting and important insights into public health, which have been published separately. Conclusions: The novel U-MAS pipeline has the potential to detect and analyze misleading information related to a particular topic or set of related topics. %M 37294603 %R 10.2196/44356 %U https://www.jmir.org/2023/1/e44356 %U https://doi.org/10.2196/44356 %U http://www.ncbi.nlm.nih.gov/pubmed/37294603 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43646 %T Establishing Infodemic Management in Germany: A Framework for Social Listening and Integrated Analysis to Report Infodemic Insights at the National Public Health Institute %A Boender,T Sonia %A Schneider,Paula Helene %A Houareau,Claudia %A Wehrli,Silvan %A Purnat,Tina D %A Ishizumi,Atsuyoshi %A Wilhelm,Elisabeth %A Voegeli,Christopher %A Wieler,Lothar H %A Leuker,Christina %+ Risk Communication Unit, Robert Koch Institute, Nordufer 20, Berlin, 13353, Germany, 49 030 187540, p1@rki.de %K infodemic %K social listening %K communication %K infodemiology %K public health %K health promotion %K misinformation %K integrated analysis %K infodemic insights %D 2023 %7 1.6.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: To respond to the need to establish infodemic management functions at the national public health institute in Germany (Robert Koch Institute, RKI), we explored and assessed available data sources, developed a social listening and integrated analysis framework, and defined when infodemic management functions should be activated during emergencies. Objective: We aimed to establish a framework for social listening and integrated analysis for public health in the German context using international examples and technical guidance documents for infodemic management. Methods: This study completed the following objectives: identified (potentially) available data sources for social listening and integrated analysis; assessed these data sources for their suitability and usefulness for integrated analysis in addition to an assessment of their risk using the RKI’s standardized data protection requirements; developed a framework and workflow to combine social listening and integrated analysis to report back actionable infodemic insights for public health communications by the RKI and stakeholders; and defined criteria for activating integrated analysis structures in the context of a specific health event or health emergency. Results: We included and classified 38% (16/42) of the identified and assessed data sources for social listening and integrated analysis at the RKI into 3 categories: social media and web-based listening data, RKI-specific data, and infodemic insights. Most data sources can be analyzed weekly to detect current trends and narratives and to inform a timely response by reporting insights that include a risk assessment and scalar judgments of different narratives and themes. Conclusions: This study identified, assessed, and prioritized a wide range of data sources for social listening and integrated analysis to report actionable infodemic insights, ensuring a valuable first step in establishing and operationalizing infodemic management at the RKI. This case study also serves as a roadmap for others. Ultimately, once operational, these activities will inform better and targeted public health communication at the RKI and beyond. %M 37261891 %R 10.2196/43646 %U https://infodemiology.jmir.org/2023/1/e43646 %U https://doi.org/10.2196/43646 %U http://www.ncbi.nlm.nih.gov/pubmed/37261891 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43548 %T Advertising Alternative Cancer Treatments and Approaches on Meta Social Media Platforms: Content Analysis %A Zenone,Marco %A Snyder,Jeremy %A Bélisle-Pipon,Jean-Christophe %A Caulfield,Timothy %A van Schalkwyk,May %A Maani,Nason %+ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 1 7789086246, marco.zenone@lshtm.ac.uk %K cancer %K advertising %K misinformation %K false hope %K Meta %K Facebook %K Instagram %K Messenger %K social media %K exploitation %K infodemiology %K cancer treatment %K online health information %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Alternative cancer treatment is associated with a greater risk of death than cancer patients undergoing conventional treatments. Anecdotal evidence suggests cancer patients view paid advertisements promoting alternative cancer treatment on social media, but the extent and nature of this advertising remain unknown. This context suggests an urgent need to investigate alternative cancer treatment advertising on social media. Objective: This study aimed to systematically analyze the advertising activities of prominent alternative cancer treatment practitioners on Meta platforms, including Facebook, Instagram, Messenger, and Audience Network. We specifically sought to determine (1) whether paid advertising for alternative cancer treatment occurs on Meta social media platforms, (2) the strategies and messages of alternative cancer providers to reach and appeal to prospective patients, and (3) how the efficacy of alternative treatments is portrayed. Methods: Between December 6, 2021, and December 12, 2021, we collected active advertisements from alternative cancer clinics using the Meta Ad Library. The information collected included identification number, URL, active/inactive status, dates launched/ran, advertiser page name, and a screenshot (image) or recording (video) of the advertisement. We then conducted a content analysis to determine how alternative cancer providers communicate the claimed benefits of their services and evaluated how they portrayed alternative cancer treatment efficacy. Results: We identified 310 paid advertisements from 11 alternative cancer clinics on Meta (Facebook, Instagram, or Messenger) marketing alternative treatment approaches, care, and interventions. Alternative cancer providers appealed to prospective patients through eight strategies: (1) advertiser representation as a legitimate medical provider (n=289, 93.2%); (2) appealing to persons with limited treatments options (n=203, 65.5%); (3) client testimonials (n=168, 54.2%); (4) promoting holistic approaches (n=121, 39%); (5) promoting messages of care (n=81, 26.1%); (6) rhetoric related to science and research (n=72, 23.2%); (7) rhetoric pertaining to the latest technology (n=63, 20.3%); and (8) focusing treatment on cancer origins and cause (n=43, 13.9%). Overall, 25.8% (n=80) of advertisements included a direct statement claiming provider treatment can cure cancer or prolong life. Conclusions: Our results provide evidence alternative cancer providers are using Meta advertising products to market scientifically unsupported cancer treatments. Advertisements regularly referenced “alternative” and “natural” treatment approaches to cancer. Imagery and text content that emulated evidence-based medical providers created the impression that the offered treatments were effective medical options for cancer. Advertisements exploited the hope of patients with terminal and poor prognoses by sharing testimonials of past patients who allegedly were cured or had their lives prolonged. We recommend that Meta introduce a mandatory, human-led authorization process that is not reliant upon artificial intelligence for medical-related advertisers before giving advertising permissions. Further research should focus on the conflict of interest between social media platforms advertising products and public health. %M 37256649 %R 10.2196/43548 %U https://infodemiology.jmir.org/2023/1/e43548 %U https://doi.org/10.2196/43548 %U http://www.ncbi.nlm.nih.gov/pubmed/37256649 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43001 %T The Quality, Readability, and Accuracy of the Information on Google About Cannabis and Driving: Quantitative Content Analysis %A Josey,Maria %A Gaid,Dina %A Bishop,Lisa D %A Blackwood,Michael %A Najafizada,Maisam %A Donnan,Jennifer R %+ School of Pharmacy, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 3587, jennifer.donnan@mun.ca %K cannabis %K driving %K quality %K readability %K accuracy %K public education %K internet %K Google search %K analysis %K accessibility %K information %K evaluation %K tool %K data %K misinterpretation %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The public perception of driving under the influence of cannabis (DUIC) is not consistent with current evidence. The internet is an influential source of information available for people to find information about cannabis. Objective: The purpose of this study was to assess the quality, readability, and accuracy of the information about DUIC found on the internet using the Google Canada search engine. Methods: A quantitative content analysis of the top Google search web pages was conducted to analyze the information available to the public about DUIC. Google searches were performed using keywords, and the first 20 pages were selected. Web pages or web-based resources were eligible if they had text on cannabis and driving in English. We assessed (1) the quality of information using the Quality Evaluation Scoring Tool (QUEST) and the presence of the Health on the Net (HON) code; (2) the readability of information using the Gunning Fox Index (GFI), Flesch Reading Ease Scale (FRES), Flesch-Kincaid Grade Level (FKGL), and Simple Measure of Gobbledygook (SMOG) scores; and (3) the accuracy of information pertaining to the effects of cannabis consumption, prevalence of DUIC, DUIC effects on driving ability, risk of collision, and detection by law enforcement using an adapted version of the 5Cs website evaluation tool. Results: A total of 82 web pages were included in the data analysis. The average QUEST score was 17.4 (SD 5.6) out of 28. The average readability scores were 9.7 (SD 2.3) for FKGL, 11.4 (SD 2.9) for GFI, 12.2 (SD 1.9) for SMOG index, and 49.9 (SD 12.3) for FRES. The readability scores demonstrated that 8 (9.8%) to 16 (19.5%) web pages were considered readable by the public. The accuracy results showed that of the web pages that presented information on each key topic, 96% (22/23) of them were accurate about the effects of cannabis consumption; 97% (30/31) were accurate about the prevalence of DUIC; 92% (49/53) were accurate about the DUIC effects on driving ability; 80% (41/51) were accurate about the risk of collision; and 71% (35/49) were accurate about detection by law enforcement. Conclusions: Health organizations should consider health literacy of the public when creating content to help prevent misinterpretation and perpetuate prevailing misperceptions surrounding DUIC. Delivering high quality, readable, and accurate information in a way that is comprehensible to the public is needed to support informed decision-making. %R 10.2196/43001 %U https://infodemiology.jmir.org/2023/1/e43001 %U https://doi.org/10.2196/43001 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44491 %T Enhancing Public Health Communication Regarding Vaccine Trials: Design and Development of the Pan-European VACCELERATE Toolkit %A Argyropoulos,Christos D %A Leckler,Janina %A Salmanton-García,Jon %A Constantinou,Marinos %A Alexandrou,Alexandra %A Themistocleous,Sophia %A Noula,Evgenia %A Shiamakkides,George %A Nearchou,Andria %A Stewart,Fiona A %A Albus,Kerstin %A Koniordou,Markela %A Kopsidas,Ioannis %A Spivak,Orly %A Hellemans,Margot %A Hendrickx,Greet %A Davis,Ruth Joanna %A Azzini,Anna Maria %A Simon,Paula Valle %A Carcas-Sansuan,Antonio Javier %A Askling,Helena Hervius %A Vene,Sirkka %A Prellezo,Jana Baranda %A Álvarez-Barco,Elena %A Macken,Alan J %A Di Marzo,Romina %A Luís,Catarina %A Olesen,Ole F %A Frias Iniesta,Jesus A %A Barta,Imre %A Tóth,Krisztina %A Akova,Murat %A Bonten,Marc M J %A Cohen-Kandli,Miriam %A Cox,Rebecca Jane %A Součková,Lenka %A Husa,Petr %A Jancoriene,Ligita %A Launay,Odile %A Lundgren,Jens %A Mallon,Patrick %A Armeftis,Charis %A Marques,Laura %A Naucler,Pontus %A Ochando,Jordi %A Tacconelli,Evelina %A van Damme,Pierre %A Zaoutis,Theoklis %A Hofstraat,Sanne %A Bruijning-Verhagen,Patricia %A Zeitlinger,Markus %A Cornely,Oliver A %A Pana,Zoi Dorothea %+ School of Medicine, European University Cyprus, 6 Diogenis Str, Egkomi, Nicosia, 2404, Cyprus, 357 94049474, z.pana@euc.ac.cy %K vaccine trials %K volunteer registry %K educational material %K promotional material %K patient education %K health communication %K health promotion %K public health %K COVID-19 %K coronavirus %K SARS-CoV-2 %K pandemic %K vaccine %K vaccination %K hesitancy %K campaign %K misinformation %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The pan-European VACCELERATE network aims to implement the first transnational harmonized and sustainable vaccine trial Volunteer Registry, being a single entry point for potential volunteers of large-scale vaccine trials across Europe. This work exhibits a set of harmonized vaccine trial–related educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network. Objective: This study primarily aimed to design and develop a standard toolkit to increase positive attitudes and access to trustworthy information for better access and increased recruitment to vaccine trials for the public. More specifically, the produced tools are focused on inclusiveness and equity, and are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (older individuals, migrants, children, and adolescents). The promotional and educational material is aligned with the main objectives of the Volunteer Registry to increase public literacy and awareness regarding vaccine-related clinical research or trials and trial participation, including informed consent and legal issues, side effects, and frequently asked questions regarding vaccine trial design. Methods: Tools were developed per the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity, and are adjusted to local country-wise requirements to improve public health communication. The produced tools are selected based on the cognitive theory, inclusiveness, and equity of differently aged and underrepresented groups, and standardized material from several official trustworthy sources (eg, COVID-19 Vaccines Global Access; the European Centre for Disease Prevention and Control; the European Patients’ Academy on Therapeutic Innovation; Gavi, the Vaccine Alliance; and the World Health Organization). A team of multidisciplinary specialists (infectious diseases, vaccine research, medicine, and education) edited and reviewed the subtitles and scripts of the educational videos, extended brochures, interactive cards, and puzzles. Graphic designers selected the color palette, audio settings, and dubbing for the video story-tales and implemented QR codes. Results: This study presents the first set of harmonized promotional and educational materials and tools (ie, educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (eg, COVID-19 vaccines). These tools inform the public about possible benefits and disadvantages of trial participation and build confidence among participants about the safety and efficacy of COVID-19 vaccines and the health care system. This material has been translated into several languages and is intended to be freely and easily accessible to facilitate dissemination among VACCELERATE network participant countries and the European and global scientific, industrial, and public community. Conclusions: The produced material could help fill knowledge gaps of health care personnel, providing the appropriate future patient education for vaccine trials, and tackling vaccine hesitancy and parents’ concerns for potential participation of children in vaccine trials. %M 36878478 %R 10.2196/44491 %U https://publichealth.jmir.org/2023/1/e44491 %U https://doi.org/10.2196/44491 %U http://www.ncbi.nlm.nih.gov/pubmed/36878478 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43694 %T The Early Detection of Fraudulent COVID-19 Products From Twitter Chatter: Data Set and Baseline Approach Using Anomaly Detection %A Sarker,Abeed %A Lakamana,Sahithi %A Liao,Ruqi %A Abbas,Aamir %A Yang,Yuan-Chi %A Al-Garadi,Mohammed %+ Department of Biomedical Informatics, School of Medicine, Emory University, 101 Woodruff Circle, Suite 4101, Atlanta, GA, 30030, United States, 1 6024746203, abeed@dbmi.emory.edu %K coronavirus %K COVID-19 drug treatment %K social media %K infodemiology %K public health surveillance %K COVID-19 %K misinformation %K natural language processing %K neural network %K data mining %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has served as a lucrative platform for spreading misinformation and for promoting fraudulent products for the treatment, testing, and prevention of COVID-19. This has resulted in the issuance of many warning letters by the US Food and Drug Administration (FDA). While social media continues to serve as the primary platform for the promotion of such fraudulent products, it also presents the opportunity to identify these products early by using effective social media mining methods. Objective: Our objectives were to (1) create a data set of fraudulent COVID-19 products that can be used for future research and (2) propose a method using data from Twitter for automatically detecting heavily promoted COVID-19 products early. Methods: We created a data set from FDA-issued warnings during the early months of the COVID-19 pandemic. We used natural language processing and time-series anomaly detection methods for automatically detecting fraudulent COVID-19 products early from Twitter. Our approach is based on the intuition that increases in the popularity of fraudulent products lead to corresponding anomalous increases in the volume of chatter regarding them. We compared the anomaly signal generation date for each product with the corresponding FDA letter issuance date. We also performed a brief manual analysis of chatter associated with 2 products to characterize their contents. Results: FDA warning issue dates ranged from March 6, 2020, to June 22, 2021, and 44 key phrases representing fraudulent products were included. From 577,872,350 posts made between February 19 and December 31, 2020, which are all publicly available, our unsupervised approach detected 34 out of 44 (77.3%) signals about fraudulent products earlier than the FDA letter issuance dates, and an additional 6 (13.6%) within a week following the corresponding FDA letters. Content analysis revealed misinformation, information, political, and conspiracy theories to be prominent topics. Conclusions: Our proposed method is simple, effective, easy to deploy, and does not require high-performance computing machinery unlike deep neural network–based methods. The method can be easily extended to other types of signal detection from social media data. The data set may be used for future research and the development of more advanced methods. %M 37113382 %R 10.2196/43694 %U https://infodemiology.jmir.org/2023/1/e43694 %U https://doi.org/10.2196/43694 %U http://www.ncbi.nlm.nih.gov/pubmed/37113382 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40156 %T Lessons Learned From Interdisciplinary Efforts to Combat COVID-19 Misinformation: Development of Agile Integrative Methods From Behavioral Science, Data Science, and Implementation Science %A Myneni,Sahiti %A Cuccaro,Paula %A Montgomery,Sarah %A Pakanati,Vivek %A Tang,Jinni %A Singh,Tavleen %A Dominguez,Olivia %A Cohen,Trevor %A Reininger,Belinda %A Savas,Lara S %A Fernandez,Maria E %+ School of Biomedical Informatics, The University of Texas Health Science Center, 7000 Fannin St., Houston, TX, 77030, United States, 1 713 500 3900, tavleen.kaur.ranjit.singh@uth.tmc.edu %K COVID-19 %K misinformation %K social media %K health belief model %K deep learning %K community engagement %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Despite increasing awareness about and advances in addressing social media misinformation, the free flow of false COVID-19 information has continued, affecting individuals’ preventive behaviors, including masking, testing, and vaccine uptake. Objective: In this paper, we describe our multidisciplinary efforts with a specific focus on methods to (1) gather community needs, (2) develop interventions, and (3) conduct large-scale agile and rapid community assessments to examine and combat COVID-19 misinformation. Methods: We used the Intervention Mapping framework to perform community needs assessment and develop theory-informed interventions. To supplement these rapid and responsive efforts through large-scale online social listening, we developed a novel methodological framework, comprising qualitative inquiry, computational methods, and quantitative network models to analyze publicly available social media data sets to model content-specific misinformation dynamics and guide content tailoring efforts. As part of community needs assessment, we conducted 11 semistructured interviews, 4 listening sessions, and 3 focus groups with community scientists. Further, we used our data repository with 416,927 COVID-19 social media posts to gather information diffusion patterns through digital channels. Results: Our results from community needs assessment revealed the complex intertwining of personal, cultural, and social influences of misinformation on individual behaviors and engagement. Our social media interventions resulted in limited community engagement and indicated the need for consumer advocacy and influencer recruitment. The linking of theoretical constructs underlying health behaviors to COVID-19–related social media interactions through semantic and syntactic features using our computational models has revealed frequent interaction typologies in factual and misleading COVID-19 posts and indicated significant differences in network metrics such as degree. The performance of our deep learning classifiers was reasonable, with an F-measure of 0.80 for speech acts and 0.81 for behavior constructs. Conclusions: Our study highlights the strengths of community-based field studies and emphasizes the utility of large-scale social media data sets in enabling rapid intervention tailoring to adapt grassroots community interventions to thwart misinformation seeding and spread among minority communities. Implications for consumer advocacy, data governance, and industry incentives are discussed for the sustainable role of social media solutions in public health. %M 37113378 %R 10.2196/40156 %U https://infodemiology.jmir.org/2023/1/e40156 %U https://doi.org/10.2196/40156 %U http://www.ncbi.nlm.nih.gov/pubmed/37113378 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38390 %T Detecting Tweets Containing Cannabidiol-Related COVID-19 Misinformation Using Transformer Language Models and Warning Letters From Food and Drug Administration: Content Analysis and Identification %A Turner,Jason %A Kantardzic,Mehmed %A Vickers-Smith,Rachel %A Brown,Andrew G %+ Data Mining Lab, Department of Computer Science and Engineering, Speed School of Engineering, University of Louisville, Louisville, KY, 40292, United States, 1 859 302 0189, jason.turner@louisville.edu %K transformer %K misinformation %K deep learning %K COVID-19 %K infodemic %K pandemic %K language model %K health information %K social media %K Twitter %K content analysis %K cannabidiol %K sentence vector %K infodemiology %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: COVID-19 has introduced yet another opportunity to web-based sellers of loosely regulated substances, such as cannabidiol (CBD), to promote sales under false pretenses of curing the disease. Therefore, it has become necessary to innovate ways to identify such instances of misinformation. Objective: We sought to identify COVID-19 misinformation as it relates to the sales or promotion of CBD and used transformer-based language models to identify tweets semantically similar to quotes taken from known instances of misinformation. In this case, the known misinformation was the publicly available Warning Letters from Food and Drug Administration (FDA). Methods: We collected tweets using CBD- and COVID-19–related terms. Using a previously trained model, we extracted the tweets indicating commercialization and sales of CBD and annotated those containing COVID-19 misinformation according to the FDA definitions. We encoded the collection of tweets and misinformation quotes into sentence vectors and then calculated the cosine similarity between each quote and each tweet. This allowed us to establish a threshold to identify tweets that were making false claims regarding CBD and COVID-19 while minimizing the instances of false positives. Results: We demonstrated that by using quotes taken from Warning Letters issued by FDA to perpetrators of similar misinformation, we can identify semantically similar tweets that also contain misinformation. This was accomplished by identifying a cosine distance threshold between the sentence vectors of the Warning Letters and tweets. Conclusions: This research shows that commercial CBD or COVID-19 misinformation can potentially be identified and curbed using transformer-based language models and known prior instances of misinformation. Our approach functions without the need for labeled data, potentially reducing the time at which misinformation can be identified. Our approach shows promise in that it is easily adapted to identify other forms of misinformation related to loosely regulated substances. %M 36844029 %R 10.2196/38390 %U https://infodemiology.jmir.org/2023/1/e38390 %U https://doi.org/10.2196/38390 %U http://www.ncbi.nlm.nih.gov/pubmed/36844029 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38607 %T COVID-19–Associated Misinformation Across the South Asian Diaspora: Qualitative Study of WhatsApp Messages %A Sharma,Anjana E %A Khosla,Kiran %A Potharaju,Kameswari %A Mukherjea,Arnab %A Sarkar,Urmimala %+ Department of Family and Community Medicine, University of California San Francisco, 1001 Potrero Avenue, Zuckerberg San Francisco General Hospital, San Francisco, CA, 94143, United States, 1 628 206 4943, anjana.sharma@ucsf.edu %K misinformation %K COVID-19 %K South Asians %K disparities %K social media %K infodemiology %K WhatsApp %K messages %K apps %K health information %K reliability %K communication %K Asian %K English %K community %K health %K organization %K public health %K pandemic %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: South Asians, inclusive of individuals originating in India, Pakistan, Maldives, Bangladesh, Sri Lanka, Bhutan, and Nepal, comprise the largest diaspora in the world, with large South Asian communities residing in the Caribbean, Africa, Europe, and elsewhere. There is evidence that South Asian communities have disproportionately experienced COVID-19 infections and mortality. WhatsApp, a free messaging app, is widely used in transnational communication within the South Asian diaspora. Limited studies exist on COVID-19–related misinformation specific to the South Asian community on WhatsApp. Understanding communication on WhatsApp may improve public health messaging to address COVID-19 disparities among South Asian communities worldwide. Objective: We developed the COVID-19–Associated misinfoRmation On Messaging apps (CAROM) study to identify messages containing misinformation about COVID-19 shared via WhatsApp. Methods: We collected messages forwarded globally through WhatsApp from self-identified South Asian community members between March 23 and June 3, 2021. We excluded messages that were in languages other than English, did not contain misinformation, or were not relevant to COVID-19. We deidentified each message and coded them for one or more content categories, media types (eg, video, image, text, web link, or a combination of these elements), and tone (eg, fearful, well intentioned, or pleading). We then performed a qualitative content analysis to arrive at key themes of COVID-19 misinformation. Results: We received 108 messages; 55 messages met the inclusion criteria for the final analytic sample; 32 (58%) contained text, 15 (27%) contained images, and 13 (24%) contained video. Content analysis revealed the following themes: “community transmission” relating to misinformation on how COVID-19 spreads in the community; “prevention” and “treatment,” including Ayurvedic and traditional remedies for how to prevent or treat COVID-19 infection; and messaging attempting to sell “products or services” to prevent or cure COVID-19. Messages varied in audience from the general public to South Asians specifically; the latter included messages alluding to South Asian pride and solidarity. Scientific jargon and references to major organizations and leaders in health care were included to provide credibility. Messages with a pleading tone encouraged users to forward them to friends or family. Conclusions: Misinformation in the South Asian community on WhatsApp spreads erroneous ideas regarding disease transmission, prevention, and treatment. Content evoking solidarity, “trustworthy” sources, and encouragement to forward messages may increase the spread of misinformation. Public health outlets and social media companies must actively combat misinformation to address health disparities among the South Asian diaspora during the COVID-19 pandemic and in future public health emergencies. %M 37113380 %R 10.2196/38607 %U https://infodemiology.jmir.org/2023/1/e38607 %U https://doi.org/10.2196/38607 %U http://www.ncbi.nlm.nih.gov/pubmed/37113380 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38485 %T Negative COVID-19 Vaccine Information on Twitter: Content Analysis %A Yiannakoulias,Niko %A Darlington,J Connor %A Slavik,Catherine E %A Benjamin,Grant %+ School of Earth, Environment and Society, McMaster University, 1280 Main Street West, L8S4L8, Hamilton, ON, Canada, 1 905 525 9140 ext 20117, yiannan@mcmaster.ca %K vaccine acceptance %K vaccine hesitancy %K Twitter %K health communication %K COVID-19 %K social media %K infodemiology %K misinformation %K content analysis %K sentiment analysis %K vaccine misinformation %K web-based health information %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media platforms, such as Facebook, Instagram, Twitter, and YouTube, have a role in spreading anti-vaccine opinion and misinformation. Vaccines have been an important component of managing the COVID-19 pandemic, so content that discourages vaccination is generally seen as a concern to public health. However, not all negative information about vaccines is explicitly anti-vaccine, and some of it may be an important part of open communication between public health experts and the community. Objective: This research aimed to determine the frequency of negative COVID-19 vaccine information on Twitter in the first 4 months of 2021. Methods: We manually coded 7306 tweets sampled from a large sampling frame of tweets related to COVID-19 and vaccination collected in early 2021. We also coded the geographic location and mentions of specific vaccine producers. We compared the prevalence of anti-vaccine and negative vaccine information over time by author type, geography (United States, United Kingdom, and Canada), and vaccine developer. Results: We found that 1.8% (131/7306) of tweets were anti-vaccine, but 21% (1533/7306) contained negative vaccine information. The media and government were common sources of negative vaccine information but not anti-vaccine content. Twitter users from the United States generated the plurality of negative vaccine information; however, Twitter users in the United Kingdom were more likely to generate negative vaccine information. Negative vaccine information related to the Oxford/AstraZeneca vaccine was the most common, particularly in March and April 2021. Conclusions: Overall, the volume of explicit anti-vaccine content on Twitter was small, but negative vaccine information was relatively common and authored by a breadth of Twitter users (including government, medical, and media sources). Negative vaccine information should be distinguished from anti-vaccine content, and its presence on social media could be promoted as evidence of an effective communication system that is honest about the potential negative effects of vaccines while promoting the overall health benefits. However, this content could still contribute to vaccine hesitancy if it is not properly contextualized. %M 36348980 %R 10.2196/38485 %U https://infodemiology.jmir.org/2022/2/e38485 %U https://doi.org/10.2196/38485 %U http://www.ncbi.nlm.nih.gov/pubmed/36348980 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e37007 %T Investigation of COVID-19 Misinformation in Arabic on Twitter: Content Analysis %A Al-Rawi,Ahmed %A Fakida,Abdelrahman %A Grounds,Kelly %+ School of Communication, Simon Fraser University, Schrum Science Centre-K 9653, Burnaby, BC, V5A1S6, Canada, 1 7787824419, aalrawi@sfu.ca %K COVID-19 %K Arab world %K Twitter %K misinformation %K vaccination %K infodemiology %K vaccine hesitancy %K infoveillance %K health information %K social media %K social media content %K content analysis %K Twitter analysis %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has been occurring concurrently with an infodemic of misinformation about the virus. Spreading primarily on social media, there has been a significant academic effort to understand the English side of this infodemic. However, much less attention has been paid to the Arabic side. Objective: There is an urgent need to examine the scale of Arabic COVID-19 disinformation. This study empirically examines how Arabic speakers use specific hashtags on Twitter to express antivaccine and antipandemic views to uncover trends in their social media usage. By exploring this topic, we aim to fill a gap in the literature that can help understand conspiracies in Arabic around COVID-19. Methods: This study used content analysis to understand how 13 popular Arabic hashtags were used in antivaccine communities. We used Twitter Academic API v2 to search for the hashtags from the beginning of August 1, 2006, until October 10, 2021. After downloading a large data set from Twitter, we identified major categories or topics in the sample data set using emergent coding. Emergent coding was chosen because of its ability to inductively identify the themes that repeatedly emerged from the data set. Then, after revising the coding scheme, we coded the rest of the tweets and examined the results. In the second attempt and with a modified codebook, an acceptable intercoder agreement was reached (Krippendorff α≥.774). Results: In total, we found 476,048 tweets, mostly posted in 2021. First, the topic of infringing on civil liberties (n=483, 41.1%) covers ways that governments have allegedly infringed on civil liberties during the pandemic and unfair restrictions that have been imposed on unvaccinated individuals. Users here focus on topics concerning their civil liberties and freedoms, claiming that governments violated such rights following the pandemic. Notably, users denounce government efforts to force them to take any of the COVID-19 vaccines for different reasons. This was followed by vaccine-related conspiracies (n=476, 40.5%), including a Deep State dictating pandemic policies, mistrusting vaccine efficacy, and discussing unproven treatments. Although users tweeted about a range of different conspiracy theories, mistrusting the vaccine’s efficacy, false or exaggerated claims about vaccine risks and vaccine-related diseases, and governments and pharmaceutical companies profiting from vaccines and intentionally risking the general public health appeared the most. Finally, calls for action (n=149, 12.6%) encourage individuals to participate in civil demonstrations. These calls range from protesting to encouraging other users to take action about the vaccine mandate. For each of these categories, we also attempted to trace the logic behind the different categories by exploring different types of conspiracy theories for each category. Conclusions: Based on our findings, we were able to identify 3 prominent topics that were prevalent amongst Arabic speakers on Twitter. These categories focused on violations of civil liberties by governments, conspiracy theories about the vaccines, and calls for action. Our findings also highlight the need for more research to better understand the impact of COVID-19 disinformation on the Arab world. %M 35915823 %R 10.2196/37007 %U https://infodemiology.jmir.org/2022/2/e37007 %U https://doi.org/10.2196/37007 %U http://www.ncbi.nlm.nih.gov/pubmed/35915823 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 3 %P e34979 %T Representing Physician Suicide Claims as Nanopublications: Proof-of-Concept Study Creating Claim Networks %A Leung,Tiffany I %A Kuhn,Tobias %A Dumontier,Michel %+ Care and Public Health Research Institute, Maastricht University, Postbus 5800, Maastricht, 6202AZ, Netherlands, 31 43 388 2222, t.leung@maastrichtuniversity.nl %K physician suicide %K suicide %K suicide prevention %K physician well-being %K physician mental health %K nanopublication %K physician %K doctor %K mental health %K semantic publishing %K bibliometrics %K claim network %K information distortion %K misinformation %D 2022 %7 1.7.2022 %9 Original Paper %J JMIRx Med %G English %X Background: In the poorly studied field of physician suicide, various factors can contribute to misinformation or information distortion, which in turn can influence evidence-based policies and prevention of suicide in this unique population. Objective: The aim of this paper is to use nanopublications as a scientific publishing approach to establish a citation network of claims in peer-reviewed publications about the rate of suicide among US physicians. Methods: A list of articles from a previously published scoping literature review on physician suicide was used to identify those articles that commented on or investigated suicidal behaviors of physician populations, including students, postgraduate trainees, and practicing physicians. The included articles were from peer-reviewed publications and asserted a claim about the annual rate of physician suicide. Manual data extraction was performed to collect article (or resource) type, title, authors, digital object identifier or URI, publication year, claim (about annual physician suicide rate), data of last access of the article (eg, for a webpage), and citations supporting the claim. Additional articles, websites, or other links were only added to the set of claims if they were cited by a peer-reviewed article already included in the data set. A nanopublication was created for each article or resource using Nanobench with an investigator-developed literature-based claim nanopublication template. Results: A set of 49 claims concerning the rate of US physician suicide was represented as nanopublications. Analysis of the claim network revealed that (1) the network is not fully connected, (2) no single primary source of the claim could be identified, and (3) all end-point citations had a claim with no further citation, had no apparent claim, or could not be accessed to verify the claim. The nanopublication strategy also enabled the capture of variant claims published on a website. Conclusions: Nanopublications remain to be adopted in broader scientific publishing in medicine, especially in publishing about physician mental health and suicide. This proof-of-concept study highlights an opportunity for more coordinated research efforts in the subject of physician suicide. Our work integrates these various claims and enables the verification of nonauthoritative assertions, thereby better equipping researchers to advance evidence-based knowledge and to make informed statements in the advocacy of physician suicide prevention. Representing physician suicide rate claims as nanopublications can be extended and improved in future work. %M 27725715 %R 10.2196/34979 %U https://med.jmirx.org/2022/3/e34979 %U https://doi.org/10.2196/34979 %U http://www.ncbi.nlm.nih.gov/pubmed/27725715 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35347 %T Misinformation in Italian Online Mental Health Communities During the COVID-19 Pandemic: Protocol for a Content Analysis Study %A Bizzotto,Nicole %A Morlino,Susanna %A Schulz,Peter Johannes %+ Faculty of Communication, Culture and Society, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 586 664 724, schulzp@usi.ch %K online communities %K social media %K mental health %K misinformation %K COVID-19 %K empowerment %K content analysis %D 2022 %7 20.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media platforms are widely used by people suffering from mental illnesses to cope with their conditions. One modality of coping with these conditions is navigating online communities where people can receive emotional support and informational advice. Benefits have been documented in terms of impact on health outcomes. However, the pitfalls are still unknown, as not all content is necessarily helpful or correct. Furthermore, the advent of the COVID-19 pandemic and related problems, such as worsening mental health symptoms, the dissemination of conspiracy narratives, and medical distrust, may have impacted these online communities. The situation in Italy is of particular interest, being the first Western country to experience a nationwide lockdown. Particularly during this challenging time, the beneficial role of community moderators with professional mental health expertise needs to be investigated in terms of uncovering misleading information and regulating communities. Objective: The aim of the proposed study is to investigate the potentially harmful content found in online communities for mental health symptoms in the Italian language. Besides descriptive information about the content that posts and comments address, this study aims to analyze the content from two viewpoints. The first one compares expert-led and peer-led communities, focusing on differences in misinformation. The second one unravels the impact of the COVID-19 pandemic, not by merely investigating differences in topics but also by investigating the needs expressed by community members. Methods: A codebook for the content analysis of Facebook communities has been developed, and a content analysis will be conducted on bundles of posts. Among 14 Facebook groups that were interested in participating in this study, two groups were selected for analysis: one was being moderated by a health professional (n=12,058 members) and one was led by peers (n=5598 members). Utterances from 3 consecutive calendar years will be studied by comparing the months from before the pandemic, the months during the height of the pandemic, and the months during the postpandemic phase (2019-2021). This method permits the identification of different types of misinformation and the context in which they emerge. Ethical approval was obtained by the Università della Svizzera italiana ethics committee. Results: The usability of the codebook was demonstrated with a pretest. Subsequently, 144 threads (1534 utterances) were coded by the two coders. Intercoder reliability was calculated on 293 units (19.10% of the total sample; Krippendorff α=.94, range .72-1). Aside from a few analyses comparing bundles, individual utterances will constitute the unit of analysis in most cases. Conclusions: This content analysis will identify deleterious content found in online mental health support groups, the potential role of moderators in uncovering misleading information, and the impact of COVID-19 on the content. International Registered Report Identifier (IRRID): PRR1-10.2196/35347 %M 35594142 %R 10.2196/35347 %U https://www.researchprotocols.org/2022/5/e35347 %U https://doi.org/10.2196/35347 %U http://www.ncbi.nlm.nih.gov/pubmed/35594142 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33827 %T Identifying Frames of the COVID-19 Infodemic: Thematic Analysis of Misinformation Stories Across Media %A Mohammadi,Ehsan %A Tahamtan,Iman %A Mansourian,Yazdan %A Overton,Holly %+ School of Information Sciences, University of South Carolina, Davis College, Room 207, 1501 Greene Street, Columbia, SC, 29208, United States, 1 803 777 2324, ehsan2@sc.edu %K COVID-19 %K pandemic %K misinformation %K fake news %K framing theory %K social media %K infodemic %K thematic analysis %K theme %K social media %K pattern %K prevalence %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The word “infodemic” refers to the deluge of false information about an event, and it is a global challenge for today’s society. The sheer volume of misinformation circulating during the COVID-19 pandemic has been harmful to people around the world. Therefore, it is important to study different aspects of misinformation related to the pandemic. Objective: This paper aimed to identify the main subthemes related to COVID-19 misinformation on various platforms, from traditional outlets to social media. This paper aimed to place these subthemes into categories, track the changes, and explore patterns in prevalence, over time, across different platforms and contexts. Methods: From a theoretical perspective, this research was rooted in framing theory; it also employed thematic analysis to identify the main themes and subthemes related to COVID-19 misinformation. The data were collected from 8 fact-checking websites that formed a sample of 127 pieces of false COVID-19 news published from January 1, 2020 to March 30, 2020. Results: The findings revealed 4 main themes (attribution, impact, protection and solutions, and politics) and 19 unique subthemes within those themes related to COVID-19 misinformation. Governmental and political organizations (institutional level) and administrators and politicians (individual level) were the 2 most frequent subthemes, followed by origination and source, home remedies, fake statistics, treatments, drugs, and pseudoscience, among others. Results indicate that the prevalence of misinformation subthemes had altered over time between January 2020 and March 2020. For instance, false stories about the origin and source of the virus were frequent initially (January). Misinformation regarding home remedies became a prominent subtheme in the middle (February), while false information related to government organizations and politicians became popular later (March). Although conspiracy theory web pages and social media outlets were the primary sources of misinformation, surprisingly, results revealed trusted platforms such as official government outlets and news organizations were also avenues for creating COVID-19 misinformation. Conclusions: The identified themes in this study reflect some of the information attitudes and behaviors, such as denial, uncertainty, consequences, and solution-seeking, that provided rich information grounds to create different types of misinformation during the COVID-19 pandemic. Some themes also indicate that the application of effective communication strategies and the creation of timely content were used to persuade human minds with false stories in different phases of the crisis. The findings of this study can be beneficial for communication officers, information professionals, and policy makers to combat misinformation in future global health crises or related events. %M 37113806 %R 10.2196/33827 %U https://infodemiology.jmir.org/2022/1/e33827 %U https://doi.org/10.2196/33827 %U http://www.ncbi.nlm.nih.gov/pubmed/37113806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e26335 %T Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content %A Sidani,Jaime E %A Hoffman,Beth %A Colditz,Jason B %A Wolynn,Riley %A Hsiao,Lily %A Chu,Kar-Hai %A Rose,Jason J %A Shensa,Ariel %A Davis,Esa %A Primack,Brian %+ Center for Social Dynamics and Community Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 412 383 0733, jaime.sidani@pitt.edu %K COVID-19 %K coronavirus %K e-cigarette %K electronic nicotine delivery systems %K Twitter %K social media %K misinformation %K discussion %K public health %K communication %K concern %K severity %K conspiracy %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. %M 35311684 %R 10.2196/26335 %U https://formative.jmir.org/2022/4/e26335 %U https://doi.org/10.2196/26335 %U http://www.ncbi.nlm.nih.gov/pubmed/35311684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27945 %T Effect of Source Type and Protective Message on the Critical Evaluation of News Messages on Facebook: Randomized Controlled Trial in the Netherlands %A Folkvord,Frans %A Snelting,Freek %A Anschutz,Doeschka %A Hartmann,Tilo %A Theben,Alexandra %A Gunderson,Laura %A Vermeulen,Ivar %A Lupiáñez-Villanueva,Francisco %+ Open Evidence Research, Open Evidence, Avinguda Tibidabo 35, Barcelona, 08035, Spain, 34 31610948122, fransfolkvord@gmail.com %K health communication %K disinformation %K protective message %K source %K critical evaluation %K critical thinking %D 2022 %7 31.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Disinformation has become an increasing societal concern, especially due to the speed that news is shared in the digital era. In particular, disinformation in the health care sector can lead to serious casualties, as the current COVID-19 crisis clearly shows. Objective: The main aim of this study was to experimentally examine the effects of information about the source and a protective warning message on users’ critical evaluation of news items, as well as the perception of accuracy of the news item. Methods: A 3 (unreliable vs reliable vs no identified source) × 2 (with protective message vs without) between-subject design was conducted among 307 participants (mean age 29 (SD 10.9] years). Results: The results showed a significant effect of source information on critical evaluation. In addition, including a protective message did not significantly affect critical evaluation. The results showed no interaction between type of source and protective message on critical evaluation. Conclusions: Based on these results, it is questionable whether including protective messages to improve critical evaluation is a way to move forward and improve critical evaluation of health-related news items, although effective methodologies to tackle the spread of disinformation are highly needed. Trial Registration: ClinicalTrials.gov NCT05030883; https://clinicaltrials.gov/ct2/show/NCT05030883 %M 35357314 %R 10.2196/27945 %U https://www.jmir.org/2022/3/e27945 %U https://doi.org/10.2196/27945 %U http://www.ncbi.nlm.nih.gov/pubmed/35357314 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33587 %T Spread of COVID-19 Vaccine Misinformation in the Ninth Inning: Retrospective Observational Infodemic Study %A Calac,Alec J %A Haupt,Michael R %A Li,Zhuoran %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, Mail Code: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K infodemiology %K COVID-19 %K vaccine %K Twitter %K social listening %K social media %K misinformation %K spread %K observational %K hesitancy %K communication %K discourse %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Shortly after Pfizer and Moderna received emergency use authorizations from the Food and Drug Administration, there were increased reports of COVID-19 vaccine-related deaths in the Vaccine Adverse Event Reporting System (VAERS). In January 2021, Major League Baseball legend and Hall of Famer, Hank Aaron, passed away at the age of 86 years from natural causes, just 2 weeks after he received the COVID-19 vaccine. Antivaccination groups attempted to link his death to the Moderna vaccine, similar to other attempts misrepresenting data from the VAERS to spread COVID-19 misinformation. Objective: This study assessed the spread of misinformation linked to erroneous claims about Hank Aaron’s death on Twitter and then characterized different vaccine misinformation and hesitancy themes generated from users who interacted with this misinformation discourse. Methods: An initial sample of tweets from January 31, 2021, to February 6, 2021, was queried from the Twitter Search Application Programming Interface using the keywords “Hank Aaron” and “vaccine.” The sample was manually annotated for misinformation, reporting or news media, and public reaction. Nonmedia user accounts were also classified if they were verified by Twitter. A second sample of tweets, representing direct comments or retweets to misinformation-labeled content, was also collected. User sentiment toward misinformation, positive (agree) or negative (disagree), was recorded. The Strategic Advisory Group of Experts Vaccine Hesitancy Matrix from the World Health Organization was used to code the second sample of tweets for factors influencing vaccine confidence. Results: A total of 436 tweets were initially sampled from the Twitter Search Application Programming Interface. Misinformation was the most prominent content type (n=244, 56%) detected, followed by public reaction (n=122, 28%) and media reporting (n=69, 16%). No misinformation-related content reviewed was labeled as misleading by Twitter at the time of the study. An additional 1243 comments on misinformation-labeled tweets from 973 unique users were also collected, with 779 comments deemed relevant to study aims. Most of these comments expressed positive sentiment (n=612, 78.6%) to misinformation and did not refute it. Based on the World Health Organization Strategic Advisory Group of Experts framework, the most common vaccine hesitancy theme was individual or group influences (n=508, 65%), followed by vaccine or vaccination-specific influences (n=110, 14%) and contextual influences (n=93, 12%). Common misinformation themes observed included linking the death of Hank Aaron to “suspicious” elderly deaths following vaccination, claims about vaccines being used for depopulation, death panels, federal officials targeting Black Americans, and misinterpretation of VAERS reports. Four users engaging with or posting misinformation were verified on Twitter at the time of data collection. Conclusions: Our study found that the death of a high-profile ethnic minority celebrity led to the spread of misinformation on Twitter. This misinformation directly challenged the safety and effectiveness of COVID-19 vaccines at a time when ensuring vaccine coverage among minority populations was paramount. Misinformation targeted at minority groups and echoed by other verified Twitter users has the potential to generate unwarranted vaccine hesitancy at the expense of people such as Hank Aaron who sought to promote public health and community immunity. %M 35320982 %R 10.2196/33587 %U https://infodemiology.jmir.org/2022/1/e33587 %U https://doi.org/10.2196/33587 %U http://www.ncbi.nlm.nih.gov/pubmed/35320982 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32452 %T COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis %A Quinn,Emma K %A Fenton,Shelby %A Ford-Sahibzada,Chelsea A %A Harper,Andrew %A Marcon,Alessandro R %A Caulfield,Timothy %A Fazel,Sajjad S %A Peters,Cheryl E %+ Department of Occupational and Environmental Hygiene, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, T2T 1Z3, Canada, 1 403 809 1289, equinn99@student.ubc.ca %K COVID-19 %K vitamin D %K misinformation %K YouTube %K content analysis %K social media %K video %K infodemic %K risk %K prevention %K health information %K immunity %K immune system %K supplements %K natural medicine %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The “infodemic” accompanying the SARS-CoV-2 virus pandemic has the potential to increase avoidable spread as well as engagement in risky health behaviors. Although social media platforms, such as YouTube, can be an inexpensive and effective method of sharing accurate health information, inaccurate and misleading information shared on YouTube can be dangerous for viewers. The confusing nature of data and claims surrounding the benefits of vitamin D, particularly in the prevention or cure of COVID-19, influences both viewers and the general “immune boosting” commercial interest. Objective: The aim of this study was to ascertain how information on vitamin D and COVID-19 was presented on YouTube in 2020. Methods: YouTube video results for the search terms “COVID,” “coronavirus,” and “vitamin D” were collected and analyzed for content themes and deemed useful or misleading based on the accuracy or inaccuracy of the content. Qualitative content analysis and simple statistical analysis were used to determine the prevalence and frequency of concerning content, such as confusing correlation with causation regarding vitamin D benefits. Results: In total, 77 videos with a combined 10,225,763 views (at the time of data collection) were included in the analysis, with over three-quarters of them containing misleading content about COVID-19 and vitamin D. In addition, 45 (58%) of the 77 videos confused the relationship between vitamin D and COVID-19, with 46 (85%) of 54 videos stating that vitamin D has preventative or curative abilities. The major contributors to these videos were medical professionals with YouTube accounts. Vitamin D recommendations that do not align with the current literature were frequently suggested, including taking supplementation higher than the recommended safe dosage or seeking intentional solar UV radiation exposure. Conclusions: The spread of misinformation is particularly alarming when spread by medical professionals, and existing data suggesting vitamin D has immune-boosting abilities can add to viewer confusion or mistrust in health information. Further, the suggestions made in the videos may increase the risks of other poor health outcomes, such as skin cancer from solar UV radiation. %M 35310014 %R 10.2196/32452 %U https://infodemiology.jmir.org/2022/1/e32452 %U https://doi.org/10.2196/32452 %U http://www.ncbi.nlm.nih.gov/pubmed/35310014 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31793 %T (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic %A Kreps,Sarah %A George,Julie %A Watson,Noah %A Cai,Gloria %A Ding,Keyi %+ Department of Government, Cornell University, 313 White Hall, Ithaca, NY, 14853, United States, 1 703 403 6550, sarah.kreps@cornell.edu %K internet %K social media %K misinformation %K COVID-19 %K Twitter %K Weibo %K prevalence %K discourse %K content %K communication %K public health %K context %K content analysis %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo—the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a “public health emergency of international concern,” and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content—almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter. %M 36406147 %R 10.2196/31793 %U https://infodemiology.jmir.org/2022/1/e31793 %U https://doi.org/10.2196/31793 %U http://www.ncbi.nlm.nih.gov/pubmed/36406147 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29246 %T Constituents’ Inferences of Local Governments’ Goals and the Relationship Between Political Party and Belief in COVID-19 Misinformation: Cross-sectional Survey of Twitter Followers of State Public Health Departments %A Stevens,Hannah %A Palomares,Nicholas A %+ Department of Communication, College of Letters and Science, University of California, Davis, One Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K outbreak %K mass communication %K Twitter %K goal inferences %K political agendas %K misinformation %K infodemic %K partisanship %K health information %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Amid the COVID-19 pandemic, social media have influenced the circulation of health information. Public health agencies often use Twitter to disseminate and amplify the propagation of such information. Still, exposure to local government–endorsed COVID-19 public health information does not make one immune to believing misinformation. Moreover, not all health information on Twitter is accurate, and some users may believe misinformation and disinformation just as much as those who endorse more accurate information. This situation is complicated, given that elected officials may pursue a political agenda of re-election by downplaying the need for COVID-19 restrictions. The politically polarized nature of information and misinformation on social media in the United States has fueled a COVID-19 infodemic. Because pre-existing political beliefs can both facilitate and hinder persuasion, Twitter users’ belief in COVID-19 misinformation is likely a function of their goal inferences about their local government agencies’ motives for addressing the COVID-19 pandemic. Objective: We shed light on the cognitive processes of goal understanding that underlie the relationship between partisanship and belief in health misinformation. We investigate how the valence of Twitter users’ goal inferences of local governments’ COVID-19 efforts predicts their belief in COVID-19 misinformation as a function of their political party affiliation. Methods: We conducted a web-based cross-sectional survey of US Twitter users who followed their state’s official Department of Public Health Twitter account (n=258) between August 10 and December 23, 2020. Inferences about local governments’ goals, demographics, and belief in COVID-19 misinformation were measured. State political affiliation was controlled. Results: Participants from all 50 states were included in the sample. An interaction emerged between political party affiliation and goal inference valence for belief in COVID-19 misinformation (∆R2=0.04; F8,249=4.78; P<.001); positive goal inference valence predicted increased belief in COVID-19 misinformation among Republicans (β=.47; t249=2.59; P=.01) but not among Democrats (β=.07; t249=0.84; P=.40). Conclusions: Our results reveal that favorable inferences about local governments’ COVID-19 efforts can accelerate belief in misinformation among Republican-identifying constituents. In other words, accurate COVID-19 transmission knowledge is a function of constituents' sentiment toward politicians rather than science, which has significant implications on public health efforts for minimizing the spread of the disease, as convincing misinformed constituents to practice safety measures might be a political issue just as much as it is a health one. Our work suggests that goal understanding processes matter for misinformation about COVID-19 among Republicans. Those responsible for future COVID-19 public health messaging aimed at increasing belief in valid information about COVID-19 should recognize the need to test persuasive appeals that address partisans’ pre-existing political views in order to prevent individuals’ goal inferences from interfering with public health messaging. %M 37113808 %R 10.2196/29246 %U https://infodemiology.jmir.org/2022/1/e29246 %U https://doi.org/10.2196/29246 %U http://www.ncbi.nlm.nih.gov/pubmed/37113808 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32378 %T Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale %A Chen,Emily %A Jiang,Julie %A Chang,Ho-Chun Herbert %A Muric,Goran %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, #1001, Marina del Rey, CA, 90292, United States, 1 310 448 8661, emiliofe@usc.edu %K social media %K social networks %K Twitter %K COVID-19 %K infodemics %K misinfodemics %K infodemiology %K misinformation %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The novel coronavirus, also known as SARS-CoV-2, has come to define much of our lives since the beginning of 2020. During this time, countries around the world imposed lockdowns and social distancing measures. The physical movements of people ground to a halt, while their online interactions increased as they turned to engaging with each other virtually. As the means of communication shifted online, information consumption also shifted online. Governing authorities and health agencies have intentionally shifted their focus to use social media and online platforms to spread factual and timely information. However, this has also opened the gate for misinformation, contributing to and accelerating the phenomenon of misinfodemics. Objective: We carried out an analysis of Twitter discourse on over 1 billion tweets related to COVID-19 over a year to identify and investigate prevalent misinformation narratives and trends. We also aimed to describe the Twitter audience that is more susceptible to health-related misinformation and the network mechanisms driving misinfodemics. Methods: We leveraged a data set that we collected and made public, which contained over 1 billion tweets related to COVID-19 between January 2020 and April 2021. We created a subset of this larger data set by isolating tweets that included URLs with domains that had been identified by Media Bias/Fact Check as being prone to questionable and misinformation content. By leveraging clustering and topic modeling techniques, we identified major narratives, including health misinformation and conspiracies, which were present within this subset of tweets. Results: Our focus was on a subset of 12,689,165 tweets that we determined were representative of COVID-19 misinformation narratives in our full data set. When analyzing tweets that shared content from domains known to be questionable or that promoted misinformation, we found that a few key misinformation narratives emerged about hydroxychloroquine and alternative medicines, US officials and governing agencies, and COVID-19 prevention measures. We further analyzed the misinformation retweet network and found that users who shared both questionable and conspiracy-related content were clustered more closely in the network than others, supporting the hypothesis that echo chambers can contribute to the spread of health misinfodemics. Conclusions: We presented a summary and analysis of the major misinformation discourse surrounding COVID-19 and those who promoted and engaged with it. While misinformation is not limited to social media platforms, we hope that our insights, particularly pertaining to health-related emergencies, will help pave the way for computational infodemiology to inform health surveillance and interventions. %M 35190798 %R 10.2196/32378 %U https://infodemiology.jmir.org/2022/1/e32378 %U https://doi.org/10.2196/32378 %U http://www.ncbi.nlm.nih.gov/pubmed/35190798 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29894 %T Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study %A Chejfec-Ciociano,Jonathan Matias %A Martínez-Herrera,Juan Pablo %A Parra-Guerra,Alexa Darianna %A Chejfec,Ricardo %A Barbosa-Camacho,Francisco José %A Ibarrola-Peña,Juan Carlos %A Cervantes-Guevara,Gabino %A Cervantes-Cardona,Guillermo Alonso %A Fuentes-Orozco,Clotilde %A Cervantes-Pérez,Enrique %A García-Reyna,Benjamín %A González-Ojeda,Alejandro %+ Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000, Guadalajara, 44349, Mexico, 52 3331294165, avygail5@gmail.com %K coronavirus %K COVID-19 %K Google Trends %K chlorine dioxide %K COVID-19 misinformation %K public health surveillance %K infodemiology %K internet behavior %K digital epidemiology %K internet %K mHealth %K mobile health %K pandemic %K tele-epidemiology %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance. Objective: The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic. Methods: We retrieved public query data for the Spanish equivalent of the term “chlorine dioxide” from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021. Results: From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, –71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001). Conclusions: Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information. %M 35155994 %R 10.2196/29894 %U https://infodemiology.jmir.org/2022/1/e29894 %U https://doi.org/10.2196/29894 %U http://www.ncbi.nlm.nih.gov/pubmed/35155994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27339 %T COVID-19–Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study %A Ning,Peishan %A Cheng,Peixia %A Li,Jie %A Zheng,Ming %A Schwebel,David C %A Yang,Yang %A Lu,Peng %A Mengdi,Li %A Zhang,Zhuo %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K COVID-19 %K rumor %K strategy %K China %K social media %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. Objective: We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. Methods: We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. Results: We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). Conclusions: Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors. %M 34806992 %R 10.2196/27339 %U https://www.jmir.org/2021/12/e27339 %U https://doi.org/10.2196/27339 %U http://www.ncbi.nlm.nih.gov/pubmed/34806992 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31774 %T COVID-19 Information Sources and Health Behaviors During Pregnancy: Results From a Prenatal App-Embedded Survey %A Bohnhoff,James %A Davis,Alexander %A Bruine de Bruin,Wändi %A Krishnamurti,Tamar %+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu %K COVID-19 %K health behavior %K health behaviour %K pregnancy %K obstetrics %K perinatal %K preventive %K preventative %K mHealth %K risk %K information source %K medical literacy %K media literacy %K information literacy %K protection %K protective %K harm %K women %K engagement %K online health information %K behavior %K information-seeking %K critical appraisal %K communication %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Pregnancy is a time of heightened COVID-19 risk. Pregnant individuals’ choice of specific protective health behaviors during pregnancy may be affected by information sources. Objective: This study examined the association between COVID-19 information sources and engagement in protective health behaviors among a pregnant population in a large academic medical system. Methods: Pregnant patients completed an app-based questionnaire about their sources of COVID-19 information and engagement in protective health behaviors. The voluntary questionnaire was made available to patients using a pregnancy app as part of their routine prenatal care between April 21 and November 27, 2020. Results: In total, 637 pregnant responders routinely accessed a median of 5 sources for COVID-19 information. The most cited source (79%) was the Centers for Disease Control and Prevention (CDC). Self-reporting evidence-based protective actions was relatively common, although 14% self-reported potentially harmful behaviors to avoid COVID-19 infection. The CDC and other sources were positively associated with engaging in protective behaviors while others (eg, US president Donald Trump) were negatively associated with protective behaviors. Participation in protective behaviors was not associated with refraining from potentially harmful behaviors (P=.93). Moreover, participation in protective behaviors decreased (P=.03) and participation in potentially harmful actions increased (P=.001) over the course of the pandemic. Conclusions: Pregnant patients were highly engaged in COVID-19–related information-seeking and health behaviors. Clear, targeted, and regular communication from commonly accessed health organizations about which actions may be harmful, in addition to which actions offer protection, may offer needed support to the pregnant population. %M 34926994 %R 10.2196/31774 %U https://infodemiology.jmir.org/2021/1/e31774 %U https://doi.org/10.2196/31774 %U http://www.ncbi.nlm.nih.gov/pubmed/34926994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27283 %T Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic %A Siedlikowski,Sophia %A Noël,Louis-Philippe %A Moynihan,Stephanie Anne %A Robin,Marc %+ Dialogue Health Technologies Inc, 390 Rue Notre-Dame Ouest #200, Montreal, QC, H2Y 1T9, Canada, 1 613 806 0671, marc.robin@dialogue.co %K chatbot %K COVID-19 %K conversational agents %K public health %K artificial intelligence %K infodemic %K infodemiology %K misinformation %K digital health %K virtual care %D 2021 %7 21.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X There is an unprecedented demand for infodemic management due to rapidly evolving information about the novel COVID-19 pandemic. This viewpoint paper details the evolution of a Canadian digital information tool, Chloe for COVID-19, based on incremental leveraging of artificial intelligence techniques. By providing an accessible summary of Chloe’s development, we show how proactive cooperation between health, technology, and corporate sectors can lead to a rapidly scalable, safe, and secure virtual chatbot to assist public health efforts in keeping Canadians informed. We then highlight Chloe’s strengths, the challenges we faced during the development process, and future directions for the role of chatbots in infodemic management. The information presented here may guide future collaborative efforts in health technology in order to enhance access to accurate and timely health information to the public. %M 34375299 %R 10.2196/27283 %U https://www.jmir.org/2021/9/e27283 %U https://doi.org/10.2196/27283 %U http://www.ncbi.nlm.nih.gov/pubmed/34375299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30800 %T Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Miller,Laura E %A Singh,Vandana %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 2148, iman.tahamtan@gmail.com %K COVID-19 %K framing %K Twitter %K social media %K public opinion %K engagement %K public attention %K thematic analysis %K public health %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although past research has focused on COVID-19–related frames in the news media, such research may not accurately capture and represent the perspectives of people from diverse backgrounds. Additionally, research on the public attention to COVID-19 as reflected through frames on social media is scarce. Objective: This study identified the frames about the COVID-19 pandemic in the public discourse on Twitter, which voices diverse opinions. This study also investigated the amount of public attention to those frames on Twitter. Methods: We collected 22 trending hashtags related to COVID-19 in the United States and 694,582 tweets written in English containing these hashtags in March 2020 and analyzed them via thematic analysis. Public attention to these frames was measured by evaluating the amount of public engagement with frames and public adoption of those frames. Results: We identified 9 frames including “public health guidelines,” “quarantine life,” “solidarity,” “evidence and facts,” “call for action,” “politics,” “post-pandemic life,” “shortage panic,” and “conflict.” Results showed that some frames such as “call for action” are more appealing than others during a global pandemic, receiving greater public adoption and engagement. The “call for action” frame had the highest engagement score, followed by “conflict” and “evidence and facts.” Additionally, “post-pandemic life” had the highest adoption score, followed by “call for action” and “shortage panic.” The findings indicated that the frequency of a frame on social media does not necessarily mean greater public adoption of or engagement with the frame. Conclusions: This study contributes to framing theory and research by demonstrating how trending hashtags can be used as new user-generated data to identify frames on social media. This study concludes that the identified frames such as “quarantine life” and “conflict” and themes such as “isolation” and “toilet paper panic” represent the consequences of the COVID-19 pandemic. The consequences could be (1) exclusively related to COVID-19, such as hand hygiene or isolation; (2) related to any health crisis such as social support of vulnerable groups; and (3) generic that are irrespective of COVID-19, such as homeschooling or remote working. %M 34406961 %R 10.2196/30800 %U https://www.jmir.org/2021/9/e30800 %U https://doi.org/10.2196/30800 %U http://www.ncbi.nlm.nih.gov/pubmed/34406961 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e26895 %T Public Attitudes and Factors of COVID-19 Testing Hesitancy in the United Kingdom and China: Comparative Infodemiology Study %A Lin,Leesa %A Song,Yi %A Wang,Qian %A Pu,Jialu %A Sun,Fiona Yueqian %A Zhang,Yixuan %A Zhou,Xinyu %A Larson,Heidi J %A Hou,Zhiyuan %+ School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K test %K public response %K sentiment %K social listening %K United Kingdom %K China %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Massive community-wide testing has become the cornerstone of management strategies for the COVID-19 pandemic. Objective: This study was a comparative analysis between the United Kingdom and China, which aimed to assess public attitudes and uptake regarding COVID-19 testing, with a focus on factors of COVID-19 testing hesitancy, including effectiveness, access, risk perception, and communication. Methods: We collected and manually coded 3856 UK tweets and 9299 Chinese Sina Weibo posts mentioning COVID-19 testing from June 1 to July 15, 2020. Adapted from the World Health Organization’s 3C Model of Vaccine Hesitancy, we employed social listening analysis examining key factors of COVID-19 testing hesitancy (confidence, complacency, convenience, and communication). Descriptive analysis, time trends, geographical mapping, and chi-squared tests were performed to assess the temporal, spatial, and sociodemographic characteristics that determine the difference in attitudes or uptake of COVID-19 tests. Results: The UK tweets demonstrated a higher percentage of support toward COVID-19 testing than the posts from China. There were much wider reports of public uptake of COVID-19 tests in mainland China than in the United Kingdom; however, uncomfortable experiences and logistical barriers to testing were more expressed in China. The driving forces for undergoing COVID-19 testing were personal health needs, community-wide testing, and mandatory testing policies for travel, with major differences in the ranking order between the two countries. Rumors and information inquiries about COVID-19 testing were also identified. Conclusions: Public attitudes and acceptance toward COVID-19 testing constantly evolve with local epidemic situations. Policies and information campaigns that emphasize the importance of timely testing and rapid communication responses to inquiries and rumors, and provide a supportive environment for accessing tests are key to tackling COVID-19 testing hesitancy and increasing uptake. %M 34541460 %R 10.2196/26895 %U https://infodemiology.jmir.org/2021/1/e26895 %U https://doi.org/10.2196/26895 %U http://www.ncbi.nlm.nih.gov/pubmed/34541460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26478 %T Using Machine Learning–Based Approaches for the Detection and Classification of Human Papillomavirus Vaccine Misinformation: Infodemiology Study of Reddit Discussions %A Du,Jingcheng %A Preston,Sharice %A Sun,Hanxiao %A Shegog,Ross %A Cunningham,Rachel %A Boom,Julie %A Savas,Lara %A Amith,Muhammad %A Tao,Cui %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St, #600, Houston, TX, 77030, United States, 1 713 500 981, cui.tao@uth.tmc.edu %K HPV vaccine %K social media %K misinformation %K infodemiology %K infoveillance %K deep learning %K Reddit %K machine learning %D 2021 %7 5.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid growth of social media as an information channel has made it possible to quickly spread inaccurate or false vaccine information, thus creating obstacles for vaccine promotion. Objective: The aim of this study is to develop and evaluate an intelligent automated protocol for identifying and classifying human papillomavirus (HPV) vaccine misinformation on social media using machine learning (ML)–based methods. Methods: Reddit posts (from 2007 to 2017, N=28,121) that contained keywords related to HPV vaccination were compiled. A random subset (2200/28,121, 7.82%) was manually labeled for misinformation and served as the gold standard corpus for evaluation. A total of 5 ML-based algorithms, including a support vector machine, logistic regression, extremely randomized trees, a convolutional neural network, and a recurrent neural network designed to identify vaccine misinformation, were evaluated for identification performance. Topic modeling was applied to identify the major categories associated with HPV vaccine misinformation. Results: A convolutional neural network model achieved the highest area under the receiver operating characteristic curve of 0.7943. Of the 28,121 Reddit posts, 7207 (25.63%) were classified as vaccine misinformation, with discussions about general safety issues identified as the leading type of misinformed posts (2666/7207, 36.99%). Conclusions: ML-based approaches are effective in the identification and classification of HPV vaccine misinformation on Reddit and may be generalizable to other social media platforms. ML-based methods may provide the capacity and utility to meet the challenge involved in intelligent automated monitoring and classification of public health misinformation on social media platforms. The timely identification of vaccine misinformation on the internet is the first step in misinformation correction and vaccine promotion. %M 34383667 %R 10.2196/26478 %U https://www.jmir.org/2021/8/e26478 %U https://doi.org/10.2196/26478 %U http://www.ncbi.nlm.nih.gov/pubmed/34383667 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e25357 %T The Value of Web-Based Patient Education Materials on Transarterial Chemoembolization: Systematic Review %A Sideris,Georgios Antonios %A Vyllioti,Aikaterini-Themis %A Dima,Danai %A Chill,Michael %A Njuguna,Njogu %+ Department of Radiology, Baystate Medical Center, University of Massachusetts Medical School, 759 Chestnut Street, Springfield, MA, 01199, United States, 1 4133029024, siderismd@gmail.com %K transarterial chemoembolization %K interventional radiology %K interventional oncology %K liver cancer %K hepatocellular carcinoma %K internet %K patient education %K systematic review %D 2021 %7 7.5.2021 %9 Review %J JMIR Cancer %G English %X Background: Thousands of web searches are performed related to transarterial chemoembolization (TACE), given its palliative role in the treatment of liver cancer. Objective: This study aims to assess the reliability, quality, completeness, readability, understandability, and actionability of websites that provide information on TACE for patients. Methods: The five most popular keywords pertaining to TACE were searched on Google, Yahoo, and Bing. General website characteristics and the presence of Health On the Net Foundation code certification were documented. Website assessment was performed using the following scores: DISCERN, Journal of the American Medical Association, Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Patient Education Materials Assessment Tool. A novel TACE content score was generated to evaluate website completeness. Results: The search yielded 3750 websites. In total, 81 website entities belonging to 78 website domains met the inclusion criteria. A medical disclaimer was not provided on 28% (22/78) of website domains. Health On the Net code certification was present on 12% (9/78) of website domains. Authorship was absent on 88% (71/81) of websites, and sources were absent on 83% (67/81) of websites. The date of publication or of the last update was not listed on 58% (47/81) of websites. The median DISCERN score was 47.0 (IQR 40.5-54.0). The median TACE content score was 35 (IQR 27-43). The median readability grade level was in the 11th grade. Overall, 61% (49/81) and 16% (13/81) of websites were deemed understandable and actionable, respectively. Not-for-profit websites fared significantly better on the Journal of the American Medical Association, DISCERN, and TACE content scores. Conclusions: The content referring to TACE that is currently available on the web is unreliable, incomplete, difficult to read, understandable but not actionable, and characterized by low overall quality. Websites need to revise their content to optimally educate consumers and support shared decision-making. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020202747; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020202747 %M 33960948 %R 10.2196/25357 %U https://cancer.jmir.org/2021/2/e25357 %U https://doi.org/10.2196/25357 %U http://www.ncbi.nlm.nih.gov/pubmed/33960948