Correcting Misinformation by Health Organizations during Measles Outbreaks: A Controlled Experiment

New media health communication - including the issue of how to implement effective activities to correct false information on social media - presents a challenge for health organisations worldwide. This Israeli study sought to examine participants' different responses to the correction of misinformation by constructing an experiment that simulates a Health Ministry's response on social networks. Specific objectives included: (i) to examine the types of reactions of 2 subgroups (pro-vaccination, hesitant) to misinformation correction and (ii) to examine the effect of misinformation correction on these 2 subgroups regarding reliability, satisfaction, self-efficacy, and intentions.

The context of the study is that, from January to March 2017, no cases of measles were reported in Israel, but in March of that year, a measles outbreak began, and 130 cases were detected in the country. The outbreak in Israel generated discussion on the social networks. Parents, healthcare experts, and health organisations issued posts and reactions about the measles and vaccination, which generated debates, especially between the pro-vaccination and hesitant groups. As reported here, this type of discourse of doubts and concerns, as well as explicitly anti-vaccination messages, may influence vaccination decisions and increase vaccination hesitancy and refusal trends among parents. Hesitancy and refusal are increasingly contributing to suboptimal vaccination coverage and the resurgence of vaccine-preventable diseases (VPDs).

According to the researchers, over the past decade, international health organisations and local governments have been working to mitigate the communication gaps between the organisations and the public that have been conspicuous in previous health crises by offering greater presence in social media. The most common way health organisations approach the correction of social media information is by calling it "myths", as opposed to the information originating in the organisations, which is called "facts". This form of correction has been found to be ineffective; people often tend to reject information corrections that contradict their attitudes, share content that is consistent with their own narratives while ignoring the rest, and allow the mistaken information to continue to shape their conclusions, even when they admit the information is incorrect.

As part of the experiment, participants (243 graduate students from the Faculty of Social Welfare and Health Sciences at Israel's Haifa University) were presented with several simulations and then asked to answer a series of questions. The first simulation presented a dilemma of parents whether to send their children to kindergarten during a measles outbreak, knowing that some of the kindergarten children were not vaccinated because of their parents' objection. In the next simulation, they were shown a post by the mother of one of the kindergarten children, containing misinformation about measles and the ways it is contracted. In the following simulation, experiment participants in "Condition 1" (control group) were shown a response from the official health authority featuring the tone and wording that can be found on Health Ministries' websites. This attempt to correct the misinformation in the mother's post was formulated as a common statement comprised of a brief, unequivocal message that did not address the emotional element (empathy, referring to fears and concerns) of the mother and other parents. Meanwhile, participants in "Condition 2" (experimental group) were shown a correction based on the theory of health and risk communication. This response provided full transparency about information on the disease and how it is contracted while addressing the emotional element (empathy, referring to fears and concerns) of the mother who wrote the post and other parents.

A statistically significant difference was found in the reliability level attributed to information correction by the Health Ministry between the conditions, with the average reliability level of the subjects in Condition 2 (M = 5.68) being considerably higher than the average reliability level of subjects in Condition 1 (4.64). Furthermore, the average satisfaction from the Health Ministry's response of Condition 2 subjects (M = 5.75) was significantly higher than the average satisfaction level of Condition 1 subjects (4.66).

These findings were also reinforced by the qualitative analysis. For example, 43 (34.1%) participants in Condition 1 noted that the Health Ministry's response did not address their concerns and did not provide scientific and sufficient information. One participant said, "Most of the Health Ministry’s response is intimidation and causing parents anxiety without providing detailed information about the efficacy and benefits of the vaccination and side effects, if there are any." In contrast, only 12 (10.3%) participants in Condition 2 noted that the Health Ministry's response was unsatisfactory; 43 (36.8%) called it persuasive. One of them explained, "I am pro-vaccination, I vaccinate my children and will continue to do so by the book. But the ministry's position on this definitely reinforces my position towards vaccinations."

When the researchers tested the pro and hesitant groups separately, they found that both preferred the response presented in Condition 2. Even the pro-vaccination group preferred to receive full information that addresses emotions and concerns and expressed less satisfaction with a response that does not address those aspects. This means that it is possible that participants who maintain pro-vaccination positions and are not happy with the responses of the Health Ministry might in certain situations in the future become hesitant. Similarly, when the researchers examined the hesitant group in the experiment, they found that the participants who received a theory-based response from the Health Ministry showed higher satisfaction than members in the group who did not receive such a response. This indicates that a credible response by a health organisation can increase the feeling of reliability and satisfaction of those who are hesitant, which provides an opening for 2-way communication between the hesitant group and the organisation.

The study also found that in the 2 conditions of the experiment, participants reported they would continue searching for information even after the Health Ministry's response to a post on the social network. This indicates that the organisation's conversation on social networks should not be limited to a time-limited dialogue but must be a circular and continuous dialogue. The public seems to want to receive information as new questions come up and is not satisfied with a single response, no matter how detailed.

In short, the findings of the study indicate that the experiment's participants who received a Health Ministry response in keeping with the theory expressed a higher level of satisfaction, trust, and self-efficacy than those who received a common Health Ministry response. These findings support the assumptions of the approach of risk communication - namely, that when health organisations provide full and transparent information and address the emotional element, they are more effective than when they deliver one-dimensional, partial responses that do not address the public's fears and concerns.