Misinformation During COVID: How Should Nurse Practitioners Respond?

Abstract

Misinformation has been plaguing health care for centuries. The rise of social media has allowed misinformation to flourish and spread at unprecedented rates. The COVID-19 pandemic has highlighted the need for nurse practitioners to understand misinformation and methods to address this issue. Professional medical organizations have called on social media companies to quell the spread of misinformation. Research on how to best address antivaccine misinformation and other forms of misinformation can help nurse practitioners address misinformation on social media and at the bedside. By leveraging the patient–provider relationship, nurse practitioners can combat misinformation one-on-one in the practice setting.

“Professor, may I ask a question?”

“Yes, of course,” I replied. Expecting a simple question regarding that day’s content or an upcoming assignment. Instead, I was asked the following:

“How should we respond to a patient who doesn’t believe in coronavirus?”

This loaded question was asked in week 13 of a 14-week term and in the last few minutes of the live session. Over the span of a few seconds, I internally struggled with how to respond. Unfortunately, this was not a quick 5-minute topic. What salient points could I make in that 5 minutes? How should a nurse practitioner respond to a patient who is voicing misinformation? This question, posed to me in December 2020, is one that I have been aiming to answer ever since.

Anyone who has been in health care for a great length of time knows that health misinformation is not unique to the current pandemic. Unfortunately, the COVID-19 pandemic has only been made more disastrous because of the dueling messaging and the rate with which misinformation spreads in the age of social media.

Many of us have theories on why misinformation has become so widespread in the era of coronavirus, laying the blame on social media, politicians, and lack of health literacy.¹ The truth is all of these things have played a role in spreading misinformation. But, as I said before, these things are not unique to the COVID-19 pandemic, and the health care field has prior experience with handling misinformation.

We can look to the lessons and research of decades past to address the misinformation crisis in which we currently find ourselves. Before coronavirus, misinformation and disinformation spread by antivaxxers was a common threat to health. So much so that in 2019 the World Health Organization deemed vaccine hesitancy one of the top threats to global health.²

The antivax movement was able to proliferate due to politics and social media campaigns. Yes, the movement was amplified by a since-retracted piece in The Lancet ³ that linked the MMR vaccine to autism, but it was able to globally flourish because some politicians used vaccine hesitancy to enhance populist messages and argue that parents should have the freedom to determine what is best for their children.¹ Even in the United States, we have politicians and powerful voices who express damaging sentiments about the safety of vaccines, including former President Donald Trump and Robert F. Kennedy Jr,⁴ who heads the nonprofit Children’s Health Defense, an organization responsible for funding a large portion of the antivax misinformation on Facebook.⁵

Although social media companies were slow to respond to misinformation in the past, they have since made a concerted effort to address this problem in the age of COVID, with platforms like Instagram blocking misinformation “superspreaders” like Kennedy.⁵ This move is in line with demands from professional medical associations, like the editors of leading cardiovascular journals who wrote a joint editorial in 2019 calling on social media platforms to stem the tide of misinformation.⁶

Social media certainly has a role in spreading misinformation. Lies and false information spread like wildfire. A recent study from MIT found that false stories are 70 times more likely to be shared on Twitter than true stories.⁷ Subsequently, it takes true stories 6 times longer to reach 1,500 people. Removing these tweets or flagging them is one way to address misinformation. But simple fact-checking is not enough, and research has shown this to be a failing strategy.¹

I used to think that misinformation could be offset with facts. I believed that education and logic were the way to convince people. Unfortunately, medical misinformation is a complicated beast, and facts alone are not enough. Misinformation and pseudoscience are attractive because they present information in absolutes; there is no ambiguity as there often is with real science. This firm stance is comforting and helps to allay fears of those with health concerns. Clinicians should learn how to message more clearly and to use social media to our advantage, mimicking the strategies of misinformation.⁸ The Association for Healthcare Social Media was developed to help clinicians leverage social media to combat misinformation and advance public health.⁹

Low health literacy may not always be a variable for purveyors of misinformation; nonetheless, Americans do need expanded education on how to recognize misinformation online. Simple strategies such as pausing before sharing allows people to get beyond the emotional response and critically appraise what it is they are sharing and why they feel compelled to do so.¹⁰ Share Verified is a misinformation initiative from the United Nations that provides information and strategies on how to reduce the spread of misinformation.¹¹

Most important, health care providers should leverage the patient–provider relationship to address misinformation one-on-one at the bedside or in the clinic. According to experts changing someone’s mind who believes in a false narrative is most effective on “an individual basis, with people who know each other well.”¹² A primary care provider has the opportunity to know someone intimately and become a trusted authority on health. Listening with empathy is a key strategy when discussing vaccine hesitancy with parents.¹ Citing a litany of facts will not result in changing someone’s mind because logic and emotion are not always compatible.

Maybe this is how we deal with misinformation and COVID. Remembering to be empathetic. Trying to understand the root cause for someone’s belief and trying to engage them in conversation. Perhaps that conversation will continue to foster trust and the patient–provider relationship. And maybe, just maybe, it will result in changing minds. At least this is how I responded to my student. As I stated, I am still searching for answers. That’s the thing with misinformation, it’s complicated. The issue cannot begin to be addressed in 5 minutes or even in this 1,000 words, but at least it’s the beginning of the conversation.

Biography

Naila Russell, DNP, FNP-BC, is an assistant professor of nursing at Simmons University. She is a Health Policy and Media Fellow at the George Washington University Center for Health Policy and Media Engagement. She also practices in dermatology in Maryland and can be contacted at nailarussell@gmail.com.