Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study

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Abstract

Background

Online misinformation proliferation during the COVID-19 pandemic has become a major public health concern.

Objective

We aimed to assess the prevalence of COVID-19 misinformation exposure and beliefs, associated factors including psychological distress with misinformation exposure, and the associations between COVID-19 knowledge and number of preventive behaviors.

Methods

A cross-sectional online survey was conducted with 1049 South Korean adults in April 2020. Respondents were asked about receiving COVID-19 misinformation using 12 items identified by the World Health Organization. Logistic regression was used to compute adjusted odds ratios (aORs) for the association of receiving misinformation with sociodemographic characteristics, source of information, COVID-19 misinformation belief, and psychological distress, as well as the associations of COVID-19 misinformation belief with COVID-19 knowledge and the number of COVID-19 preventive behaviors among those who received the misinformation. All data were weighted according to the Korea census data in 2018.

Results

Overall, 67.78% (n=711) of respondents reported exposure to at least one COVID-19 misinformation item. Misinformation exposure was associated with younger age, higher education levels, and lower income. Sources of information associated with misinformation exposure were social networking services (aOR 1.67, 95% CI 1.20-2.32) and instant messaging (aOR 1.79, 1.27-2.51). Misinformation exposure was also associated with psychological distress including anxiety (aOR 1.80, 1.24-2.61), depressive (aOR 1.47, 1.09-2.00), and posttraumatic stress disorder symptoms (aOR 1.97, 1.42-2.73), as well as misinformation belief (aOR 7.33, 5.17-10.38). Misinformation belief was associated with poorer COVID-19 knowledge (high: aOR 0.62, 0.45-0.84) and fewer preventive behaviors (≥7 behaviors: aOR 0.54, 0.39-0.74).

Conclusions

COVID-19 misinformation exposure was associated with misinformation belief, while misinformation belief was associated with fewer preventive behaviors. Given the potential of misinformation to undermine global efforts in COVID-19 disease control, up-to-date public health strategies are required to counter the proliferation of misinformation.

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Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

Emily A. Holmes, Rory C O'Connor, V. Perry … (2020)

Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

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Mental health problems and social media exposure during COVID-19 outbreak

Junling Gao, Pinpin Zheng, Yingnan Jia … (2020)

Huge citizens expose to social media during a novel coronavirus disease (COVID-19) outbroke in Wuhan, China. We assess the prevalence of mental health problems and examine their association with social media exposure. A cross-sectional study among Chinese citizens aged≥18 years old was conducted during Jan 31 to Feb 2, 2020. Online survey was used to do rapid assessment. Total of 4872 participants from 31 provinces and autonomous regions were involved in the current study. Besides demographics and social media exposure (SME), depression was assessed by The Chinese version of WHO-Five Well-Being Index (WHO-5) and anxiety was assessed by Chinese version of generalized anxiety disorder scale (GAD-7). multivariable logistic regressions were used to identify associations between social media exposure with mental health problems after controlling for covariates. The prevalence of depression, anxiety and combination of depression and anxiety (CDA) was 48.3% (95%CI: 46.9%-49.7%), 22.6% (95%CI: 21.4%-23.8%) and 19.4% (95%CI: 18.3%-20.6%) during COVID-19 outbroke in Wuhan, China. More than 80% (95%CI:80.9%-83.1%) of participants reported frequently exposed to social media. After controlling for covariates, frequently SME was positively associated with high odds of anxiety (OR = 1.72, 95%CI: 1.31–2.26) and CDA (OR = 1.91, 95%CI: 1.52–2.41) compared with less SME. Our findings show there are high prevalence of mental health problems, which positively associated with frequently SME during the COVID-19 outbreak. These findings implicated the government need pay more attention to mental health problems, especially depression and anxiety among general population and combating with “infodemic” while combating during public health emergency.

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Public responses to the novel 2019 coronavirus (2019‐nCoV) in Japan: Mental health consequences and target populations

Jun Shigemura, Robert Ursano, Joshua Morganstein … (2020)

In December 2019, cases of life‐threatening pneumonia were reported in Wuhan, China. A novel coronavirus (2019‐nCoV) was identified as the source of infection. The number of reported cases has rapidly increased in Wuhan as well as other Chinese cities. The virus has also been identified in other parts of the world. On 30 January 2020, the World Health Organization (WHO) declared this disease a ‘public health emergency of international concern.’ As of 3 February 2020, the Chinese government had reported 17 205 confirmed cases in Mainland China, and the WHO had reported 146 confirmed cases in 23 countries outside China.1 The virus has not been contained within Wuhan, and other major cities in China are likely to experience localized outbreaks. Foreign cities with close transport links to China could also become outbreak epicenters without careful public health interventions.2 In Japan, economic impacts and social disruptions have been reported. Several Japanese individuals who were on Japanese‐government‐chartered airplanes from Wuhan to Japan were reported as coronavirus‐positive. Also, human‐to‐human transmission was confirmed in Nara Prefecture on 28 January 2020. Since then, the public has shown anxiety‐related behaviors and there has been a significant shortage of masks and antiseptics in drug stores.3 The economic impact has been substantial. Stock prices have dropped in China and Japan, and other parts of the world are also showing some synchronous decline. As of 3 February 2020, no one had died directly from coronavirus infection in Japan. Tragically, however, a 37‐year‐old government worker who had been in charge of isolated returnees died from apparent suicide.4 This is not the first time that the Japanese people have experienced imperceptible‐agent emergencies – often dubbed as ‘CBRNE’ (i.e., chemical, biological, radiological, nuclear, and high‐yield explosives). Japan has endured two atomic bombings in 1945, the sarin gas attacks in 1995, the H1N1 influenza pandemic in 2009, and the Fukushima nuclear accident in 2011: all of which carried fear and risk associated with unseen agents. All of these events provoked social disruption.5, 6 Overwhelming and sensational news headlines and images added anxiety and fear to these situations and fostered rumors and hyped information as individuals filled in the absence of information with rumors. The affected people were subject to societal rejection, discrimination, and stigmatization. Fukushima survivors tend to attribute physical changes to the event (regardless of actual exposure) and have decreased perceived health, which is associated with decreased life expectancy.7, 8 Fear of the unknown raises anxiety levels in healthy individuals as well as those with preexisting mental health conditions. For example, studies of the 2001 anthrax letter attacks in the USA showed long‐term mental health adversities as well as lowered health perception of the infected employees and responders.9 Public fear manifests as discrimination, stigmatization, and scapegoating of specific populations, authorities, and scientists.10 As we write this letter, the coronavirus emergency is rapidly evolving. Nonetheless, we can more or less predict expected mental/physical health consequences and the most vulnerable populations. First, peoples' emotional responses will likely include extreme fear and uncertainty. Moreover, negative societal behaviors will be often driven by fear and distorted perceptions of risk. These experiences might evolve to include a broad range of public mental health concerns, including distress reactions (insomnia, anger, extreme fear of illness even in those not exposed), health risk behaviors (increased use of alcohol and tobacco, social isolation), mental health disorders (post‐traumatic stress disorder, anxiety disorders, depression, somatization), and lowered perceived health. It is essential for mental health professionals to provide necessary support to those exposed and to those who deliver care. Second, particular effort must be directed to vulnerable populations, which include: (i) the infected and ill patients, their families, and colleagues; (ii) Chinese individuals and communities; (iii) individuals with pre‐existing mental/physical conditions; and, last but not least, (iv) health‐care and aid workers, especially nurses and physicians working directly with ill or quarantined persons. If nothing else, the death of the government quarantine worker must remind us to recognize the extent of psychological stress associated with imperceptible agent emergencies and to give paramount weight to the integrity and rights of vulnerable populations. Disclosure statement The authors declare no conflicts of interest. Supporting information File S1 Online health information sources for the novel coronavirus (2019‐nCoV). Click here for additional data file.

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Author and article information

Contributors

Sunhwa Shin:

ORCID: https://orcid.org/0000-0003-4052-9542

College of NursingSahmyook University815 Hwarang-ro, Nowon-guSeoul, 01795Republic of Korea82 2 3399 1595shinsh@syu.ac.kr

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J Med Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: November 2020

Publication date (Electronic): 13 November 2020

Publication date PMC-release: 13 November 2020

Volume: 22

Issue: 11

Electronic Location Identifier: e22205

Affiliations

[1 ] School of Nursing University of Hong Kong Hong Kong China (Hong Kong)

[2 ] College of Nursing Sahmyook University Seoul Republic of Korea

[3 ] School of Health in Social Science The University of Edinburgh Edinburgh United Kingdom

[4 ] School of Medicine, Medical Sciences and Nutrition University of Aberdeen Aberdeen United Kingdom

Author notes

Corresponding Author: Sunhwa Shin shinsh@ 123456syu.ac.kr

Author information

Jung Jae Lee https://orcid.org/0000-0001-9704-2116

Kyung-Ah Kang https://orcid.org/0000-0002-3799-9554

Man Ping Wang https://orcid.org/0000-0003-4000-2388

Sheng Zhi Zhao https://orcid.org/0000-0003-3024-0956

Janet Yuen Ha Wong https://orcid.org/0000-0002-3000-4577

Siobhan O'Connor https://orcid.org/0000-0001-8579-1718

Sook Ching Yang https://orcid.org/0000-0001-9003-0518

Sunhwa Shin https://orcid.org/0000-0003-4052-9542

Article

Publisher ID: v22i11e22205

DOI: 10.2196/22205

PMC ID: 7669362

PubMed ID: 33048825

SO-VID: d1179662-5a4d-4bc5-ba3c-a63498dedcf4

Copyright © ©Jung Jae Lee, Kyung-Ah Kang, Man Ping Wang, Sheng Zhi Zhao, Janet Yuen Ha Wong, Siobhan O'Connor, Sook Ching Yang, Sunhwa Shin. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.11.2020.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 6 July 2020

Date revision requested : 11 August 2020

Date revision received : 12 September 2020

Date accepted : 8 October 2020

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