A pharmacist's contribution to community resilience

A talk to pharmacists on strengthening community resilience to address health misinformation

1. PHARMACISTS AS FRONTLINE DEFENDERS: STRENGTHENING COMMUNITY RESILIENCE TO HEALTH MISINFORMATION TINA D PURNAT Prajna Leadership Fellow and Doctor of Public Health student TH Chan School of Public Health, Harvard University Fellow of the Australasian Institute of Digital Health Visiting Scholar, University of Memphis School of Public Health tinapurnat.com This presentation  © 2024 by  Tina D Purnat  is licensed under  Attribution- NonCommercial - ShareAlike 4.0 International        

2. How you can use this slide deck Thanks for your interest in this topic. I developed this deck to support public health efforts and have made it available for others to use it as well. I’ve made full effort to acknowledge sources of information and adaptation of slides from other people. You are welcome to adapt the slide deck as per the license below. Please make an effort to properly credit the efforts of others that you use. This presentation  © 2024 by  Tina D Purnat  is licensed under  Attribution- NonCommercial - ShareAlike 4.0 International         You are free to: Share  — copy and redistribute the material in any medium or format Adapt  — remix, transform, and build upon the material The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution  - You must give  appropriate credit  , provide a link to the license, and  indicate if changes were made  . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial   - You may not use the material for  commercial purposes  . ShareAlike   - If you remix, transform, or build upon the material, you must distribute your contributions under the  same license  as the original. No additional restrictions  - You may not apply legal terms or  technological measures  that legally restrict others from doing anything the license permits. Creator: https://www.linkedin.com/in/tinadpurnat/ Work is published at: https://tinapurnat.com

3. C urrent information environment challenges access and use of credible and accurate health information https://www.pbs.org/newshour/show/social-media-companies-face-legal-scrutiny-over-deteriorating-mental-health-among-teens https://www.mmm-online.com/home/channel/tiktok-patient-influencer/ https://www.npr.org/2023/09/28/1202110410/how-rumors-and-conspiracy-theories-got-in-the-way-of-mauis-fire-recovery https://www.npr.org/2023/09/28/1202110410/how-rumors-and-conspiracy-theories-got-in-the-way-of-mauis-fire-recovery https://www.npr.org/2023/09/28/1202110410/how-rumors-and-conspiracy-theories-got-in-the-way-of-mauis-fire-recovery

4. Information environment also challenges the work of pharmacists

5. Vaccinations Alternative Medicine Nutrition and Diet Mental Health Sexual and Reproductive Health Chronic Diseases HIV/AIDS Cancer Exercise and Fitness Allergies and Intolerances Chronic Pain Substance Abuse Sleep Health Aging and Anti-Aging Genetic Testing and Personalized Medicine Environmental Health Harmful narratives are found in many areas of health Health topic areas that are represented in health misinformation research:

6. Only few categories of health misinformation narratives can be addressed by a health authority directly Adapted from: FirstDraft https://firstdraftnews.org/wp-content/uploads/2020/11/FirstDraft_Underthesurface_Fullreport_Final.pdf?x21167 Development, provision and access of healthcare services and products Safety, efficacy and necessity of diagnostics, therapeutics and vaccines Political and economic motives Conspiracy theories Liberty and freedom Morality and religion Can be addressed by a health authority

7. By the time we react to misinformation, we’ve missed the opportunities to prevent such narratives from sticking Questions Concerns Information voids Misinformation Disinformation More common, easier to address PREVENTIVE action Less common, harder to address REACTIVE action Left unaddressed, these can contribute to erosion of trust in health guidance, health interventions, health workers and health systems, reduce risk perception, discourage healthy behaviors. This can be prevented.

8. Infodemic management has been introduced as a new capacity in health emergency preparedness and response An infodemic is an overabundance of information, accurate or not, in the digital and physical space, accompanying an acute health event such as an outbreak or epidemic. Infodemic management is the systematic use of risk- and evidence-based analysis and approaches to promote a healthier information environment and resilience against infodemic impacts on health behaviours during health emergencies.

9. Source: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2023/report.html Strengthening health systems now can build more resilient communities in emergencies in the future (also for addressing information environment challenges)

10. What can pharmacists do to promote comunity resilience, especially to misinformation ? Ensure you provide accurate, evidence-based health information to counter misinformation and build trust with your patients. Be the Trusted Health Expert Spot and Stop Misinformation Early Empower Through Education Collaborate for Consistent Messaging Identify and address misinformation at the point of care to prevent its spread and report emerging trends to public health authorities. Actively educate patients on medications, vaccines, and treatments to improve health literacy and help them make informed decisions. Work with other health professionals and community leaders to deliver coordinated, unified health messages. Promote Prevention and Proactivity Advocate for preventive health measures, such as vaccinations and screenings, to reduce community vulnerability to health crises and misinformation.

11. Pharmacists as Trusted Health Communicators Pharmacists are often the most accessible healthcare professionals, trusted by patients to provide reliable health information. Recommendation : Leverage your position of trust by providing accurate, evidence-based information to patients. Misinformation can be countered by being a reliable source of correct information on medication safety, vaccine efficacy, and treatment guidelines.

12. QUALITY CONVERSATIONS MATTER Motivational interviewing is a psychology-based approach to counsel patients to help them find motivation to make positive behavior changes that can improve their health. Negative interpersonal interactions with healthcare workers can reduce patient and community trust and desire and likelihood to follow recommendations and return for future services. Motivational interviewing can build trust and help address information needs and connect with people’s values.

13. Core skill How to apply it Ask open‐ended questions Draw patient into conversation to understand their understanding, fears and questions about the health issue. Give affirmations Let the patient know you are hearing and understanding their frustrations and concerns without interrupting or dismissing. Provide reflection Demonstrate empathy and concern for the wellbeing of your patient, and ask follow-up questions to help patient clarify their thinking and answers. Summarize the conversation Recap the discussion to ensure that you interpreted the patient’s concerns accurately and have chosen next steps together. CORE SKILLS FOR MOTIVATIONAL INTERVIEWING Adapted from source: Breckenridge, L. A., Burns, D., & Nye, C. (2022). The use of motivational interviewing to overcome COVID‐19 vaccine hesitancy in primary care settings. Public Health Nursing, 39(3), 618-623.

14. Empower Patients Through Education Clear communication and education are crucial in guiding patients through complex health information. Recommendation : Use every patient interaction as an opportunity to educate on proper medication use, vaccine safety, and preventive care. Help patients distinguish reliable information from misinformation.

15. Health communication must be fully aligned with health service delivery and experience, and health guidance Demand for health information Demand for health services and products Adherence to health guidance PULL – people want something from the system PUSH - the system wants something from the people See: https://www.linkedin.com/pulse/demand-promotion-trust-trouble-information-tina-d-purnat-cw3of/

16. Spot and Stop Misinformation Early Pharmacists are on the front lines of healthcare and often hear concerns stemming from misinformation. Recommendation : Proactively address misinformation during patient consultations and share any emerging misinformation trends with public health agencies so they can address it systematically.

17. HOW TO IDENTIFY HEALTH MISINFORMATION Consider the source: Is it from a reputable news organization or health authority? Read the whole article: If a headline sounds sensationalist, click and read the whole article. Does it support with references to credible sources? Are medical or scientific claims supported with evidence? Check the date: When was it posted? Was it recent or is it old? Check your biases: Think about whether your own beliefs are interfering with you judging this content fairly. Check for unbelievable statements: Is there a claim made that seems too good or too horrible to be true? If so, what is the supporting evidence for the claim? Ask a health expert: Talk to subject matter experts in the area of health in question

18. Don’t interrupt. Make sure not to cut off, speak over or jump into correcting the other person. Help them feel empowered. Provide an empowering message. (e.g. “Once you learn more about healthy eating to prevent diabetes, you will feel more in control.”) Don’t focus on the myths. Focus on understanding the underlying worry or concern that may have caused this misinformation to “stick” with this person. (Use sandwich method to debunk on next slide.) HOW TO ADDRESS HEALTH-RELATED CONCERNS IN A CONVERSATION (AND ONLINE) Connect with the person’s values. Use active listening skills to maintain an empathetic connection and ask for further information.  Assume they will choose the recommended care or treatment. Establish a verbal default. (e.g. “It’s time to schedule your colonoscopy.”) Keep the door open. Some people’s opinions will not likely be changed in one conversation and stay open for further conversation.

19. Fact Warning Fallacy Fact Lead with the fact Make it clear, relevant and memorable Misinformation alert! Misleading tactics alert! Unintentional: Explain reasons why facts could have been misinterpreted Intentional: Flag tactics Undermine trust in authors Highlight misleading tactics Reveal hidden agenda Provide alternative correct information Must replace misinformation Make correct information more memorable than the misinformation ADDRESSING MISINFORMATION EFFECTIVELY: THE "TRUTH SANDWICH" (ALSO KNOWN AS DEBUNKING)

20. Fact Warning Fallacy Fact There’s no peer-reviewed research that supports the idea that apricot kernels cure cancer. However, some companies are happy to take your money by selling products that seem healthy and natural but don’t actually work. This health claim is one person’s experience who is not a medical professional and does not represent cancer patients as a whole. in fact, research has shown that patients with cancer who use alternative treatments are more likely to die earlier instead of those that use doctor-recommended treatments. EXAMPLE: CELEBRITY CLAIMS THAT BOILING APRICOT KERNELS TO MAKE TEA CURED HER BREAST CANCER

21. Collaborate for Unified Health Messaging Consistent, coordinated health messages across healthcare providers are vital to counter misinformation effectively Recommendation : Partner with healthcare teams and community organizations to deliver unified, clear, and evidence-based messaging, ensuring patients receive the same information from trusted sources.

22. Promote Prevention and Public Health Measures Preventive health actions, such as vaccinations and screenings, are key to reducing the impact of misinformation and health crises. Recommendation : Actively advocate for preventive measures and help patients understand the importance of vaccines, screenings, and healthy lifestyle choices to build long-term resilience.

23. Thank you very much! [email protected] Resources for infodemic managers

24. OpenWHO courses on the infodemic management channel Infodemic management 101 Infodemic management: addressing health misinformation Infodemic management: developing an infodemic insights report Infodemic management: using human-centered design good practices Infodemic management: designing strategies and using the toolbox Infodemic management: designing and testing messages for social marketing  Infodemic management: defining a taxonomy for social listening Infodemic management: working effectively as an infodemic manager in the field ©WHO/Sam Bradd https://https://openwho.org/channels/infodemic-management English Spanish French Arabic Farsi If you want to learn more:

25. See: https://www.who.int/teams/epi-win/infodemic-management/3rd-who-training-on-infodemic-management Free training videos WHO and partners Booket: https://www.who.int/news-room/articles-detail/call-for-applicants-for-comprehensive-training-for-promotion-of-vaccine-demand-to-maintain-and-restore-routine-immunization-and-promote-COVID-19-vaccination Videos: https://www.youtube.com/channel/UChNXDnWCc4bi9-bP6_LorHw

26. https://rootedintrust.org/wp-content/uploads/2023/08/Inequity-Driven-Mistrust-Paper-Web-2.pdf Infodemic management in humanitarian emergencies https://rootedintrust.org/wp-content/uploads/2023/11/Information-Ecosystem-Preparedness.pdf

27. https://centerforhealthsecurity.org/2024/center-launches-new-practice-oriented-playbook-for-addressing-health-misinformation https://centerforhealthsecurity.org/sites/default/files/2022-12/spars-pandemic-scenario.pdf https://centerforhealthsecurity.org/sites/default/files/2022-12/spars-pandemic-scenario.pdf