Health misinformation for healthcare management professionals.pptx

I presented on mitigating health misinformation and building resilience to it to a group of fantastic healthcare management professionals from University of Lahore.

I discussed three concrete takeaways for healthcare management professionals:

How to have quality conversations with patients

How to address health misinformation

How to build resilience to health misinformation

1. Preventing and responding to health misinformation and other information environment challenges Tina D Purnat Prajna Leadership Fellow and Doctor of Public Health student TH Chan School of Public Health, Harvard University Advanced Leadership Course at Imperial College London, July 2024 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. Protecting public health relies on people behaving in a certain way... Smoking in public places Vaccination Handwashing Healthy eating Contact tracing and quarantine ... and i ndividual health decisions have population level impacts. Safe sexual practices

4. 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:

5. Stewart, R., Madonsela, A., Tshabalala, N., Etale, L., & Theunissen, N. (2022). The importance of social media users’ responses in tackling digital COVID-19 misinformation in Africa.  Digital Health ,  8 , 20552076221085070. Domain of impact - harms Consequence Physical Limited accurate knowledge about available treatments Misplaced actions Social Victimization and stigma Economic Falling for scams Panic buying Political Limited trust in officials Rejection of official guidelines Disregard of government-led responses Psychological Mental health epidemic Extreme anxiety Long-term depression Types of harm health misinformation can contribute to

6. HEALTH WORKERS CAN BE SUPERHEROES IN MITIGATING HEALTH MISINFORMATION Most trusted source of health information Have pre-existing relationships with patients and community Can translate health guidance and evidence Empower patients with health education Provide empathetic care

7. CHALLENGES PATIENTS FACE FINDING AND USING HEALTH INFORMATION Circulating misinformation Deceptive marketing tactics Low knowledge/awareness Concerns going unaddressed Absence of pro-health voices in online space Influencers promoting inaccurate information Can't find health information Lack of social support in digital spaces for vaccination Absence of credible, accurate health information available Low digital literacy Lack of access to digital spaces and information Health workers unable to address concerns and misinformation effectively Media amplifies misinformation on social media

8. “Believer” I am deeply connected to an online community that is pushing false, misleading claims. I believe the information being shared by the community is true and I want to share it with others. “Hoaxster” I create hoaxes to fool people, sometimes to make money. THERE ARE DIFFERENT MOTIVATIONS FOR PEOPLE SHARING HEALTH MISINFORMATION “Disinformer” I deliberately create harmful misinformation. “Mischief-maker” I create false of misleading information to see if I can fool people for the fun of it. “Oversharer” When I see something online that seems helpful or worrying I like to share without checking because I’d rather people have as much information as possible. “Enthusiast” I post misinformation frequently in support of a person or cause. “Casual sharer” I tend to spend a lot of time online, and can sometimes share carelessly while waiting in line, or scrolling late at night in bed. Creators Sharers Source: US Surgeon General Health Misinformation Toolkit

9. Memes (fun, colorful images or graphics) that were created as a joke, but people started resharing thinking it was true. Cherry-picked statistics. Too often we see people choosing the number that supports what they want to argue, but without all the data, they haven’t provided all the context. Websites that look professional (often designed to look like news sites) but the stories are all false or misleading. They have sensational headlines designed to make us click on them. Misleading graphs or diagrams that look official but don’t tell the whole story COMMON TYPES OF HEALTH MISINFORMATION Source: US Surgeon General Health Misinformation Toolkit

10. COMMON TYPES OF HEALTH MISINFORMATION Source: US Surgeon General Health Misinformation Toolkit Quotations where the beginning or end have been deleted to change the meaning. The person did say that, but without the full context it’s not a fair representation of what they said. Old images that recirculate as if they are actually very recent. Videos that have been edited to change the meaning.

11. COMMON TYPES OF HEALTH MISINFORMATION Source: US Surgeon General Health Misinformation Toolkit Quotations where the beginning or end have been deleted to change the meaning. The person did say that, but without the full context it’s not a fair representation of what they said. Old images that recirculate as if they are actually very recent. Videos that have been edited to change the meaning.

12. COMMON TACTICS TO PROMOTE HEALTH MISINFORMATION Source: US Surgeon General Health Misinformation Toolkit Professional visual cues Logos Good looking website Close relation reference Personal experience Rare terms’ search

13. COMMON HEALTH MISINFORMATION NARRATIVES Source: 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

14. WHERE HEALTH WORKERS CAN MAKE A DIFFERENCE IN THE INFORMATION ENVIRONMENT Questions Concerns Information Voids Mis- and disinformation

15. HOW TO BUILD RESILIENCE TO HEALTH MISINFORMATION OVERVIEW HOW TO HAVE QUALITY CONVERSATIONS WITH PATIENTS HOW TO ADDRESS HEALTH MISINFORMATION

16. HOW TO HAVE QUALITY CONVERSATIONS WITH PATIENTS

17. 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.

18. 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.

19. STEPS FOR MOTIVATIONAL INTERVIEWING Be polite, even if you disagree 2. Welcome patient warmly 3. Encourage patients to express ideas and fears 4. Use empathy to demonstrate understanding 5. Show appreciation for patient’s knowledge and questions 6. Keep messages simple and clear 7. Avoid interrupting patient when they speak 8. Avoid assumption that patient doesn’t want to follow health advice 9. Use appropriate body language, facial expressions and eye contact 10. Listen actively to promote discussion 11. User respectful terms of address 12. Check for understanding at end of discussion Adapted from source: UNICEF Interpersonal Communications for Immunization Package; https://ipc.unicef.org/package-components

20. HOW TO ADDRESS HEALTH MISINFORMATION

21. 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

22. 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.

23. 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)

24. 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

25. THINKING SYSTEMATICALLY ABOUT BUILDING RESILIENCE TO HEALTH MISINFORMATION

26. Trustworthy public health and health system Health systems and pandemic preparedness need to focus on building trust, acceptance and uptake of services, products and health guidance. “Mistrust is the outgrowth of the perception that promises were broken and values were violated .” --Dr. Barbara Reynolds

27. People make d ecisions about their health over time - their accumulative effect depends on trust in government, health services, products and health workers Health system Health workers Trust in p olicies and governance related to health care, supply, service delivery Asymmetries in demand for care and prevention Asymmetries in demand for supplies and health technologies Trust in health workers; doxing and harassment Health worker own confidence in products and services, in own knowledge about guidance and information Health behaviors Risk perception of disease Trust in and acceptability of recommended behaviors and public health and social measures Trust in, safety and acceptability of devices, diagnostics, treatments and vaccines Social cohesion

28. 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/

29. Generate infodemic insights to understand questions, concerns, information needs Be truly open to addressing the issues people talk about and they are concerned about. Listen better Build people into processes Equip and support health workers Protect people from harm Promote deliberative engagement with individuals and communities in their interaction with the health system. Promote transparency and deliberative discussions to diffuse polarization in communities seeking, discussing and using health information. Equip health workers with the skills to cope with and thrive within the digital information environment where their patients also live. Protect consumers from deceptive marketing, protect health workers form doxing and harassment, enforce policies that protect patient and data privacy, Regularly reevaluate policies in light of new health challenges and changes in the information environment. Quick wins What can we start doing now? See: https://www.linkedin.com/posts/tinadpurnat_discussion-of-information-environment-and-activity-7193248822653792256-x2ET

30. FOR TEACHING, LEARNING AND RESEARCH https://iris.who.int/handle/10665/339192 https://iris.who.int/handle/10665/376026 https://iris.who.int/handle/10665/345207 https://infodemiology.jmir.org/2023/1/e44207

31. 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.

32. THANK YOU [email protected] tinapurnat.com