A lecture discussing the challenge of health misinformation and information ecosystem in public health, how this impacts demand promotion in health, and how this then relates to responding to misinformation and infodemics in health emergencies. Appended with lots of tools, guidance and resources for people who want to do more reading.

1. AN OUNCE OF PREVENTION
= A POUND OF CURE
PREVENTING AND RESPONDING TO HEALTH
MISINFORMATION AND OTHER
INFORMATION ENVIRONMENT CHALLENGES
This presentation © 2024 by Tina D Purnat is licensed under Attribution-NonCommercial-ShareAlike
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6. Health topic areas that are represented in health misinformation research:

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11. 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.

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13. Tells a story Uses humor or satire
Pushes emotional buttons and
appeals to audience values
Contains images or video
specifically formatted for a
particular audience and
channel
Provides a simple explanation
for a complex problem
Uses language that is
appealing to the audience
(e.g. slang, memes)

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Purnat T, John O, Pundir P, Ishizumi A, Murthy S, Rajwar E. et al. https://bit.ly/evidencegapmapinfodemic. Open Science Framework. 2022.

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“Mistrust is the outgrowth of
the perception that promises
were broken and values were
violated.”
--Dr. Barbara Reynolds

21. Issuing confusing guidance that is not
appropriate for specific populations, such as
people who are immunocompromised or
pregnant.

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23. health x information environment
Different ideas
of trust
Trust in health system,
health product or
service, health
guidance, the
messenger, the
platform...
Who to trust?
What to trust?
Trust is mediated
through awareness
and perception
identity,
culture
experience
access
literacies

24. access to health services and products
access to health information
trust in health system, health workers and recommended
health behaviors
Communities on the continuum that:
Disparities in health services and products go hand in hand
with health information inequalities and with trust
disparities towards the government, health system, health
workers and health guidance.
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25. Creating and promoting demand
concurrently focuses on three components
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

26. The directionality of the demand components
can differ
same direction
different directions
Examples: Example:

27. 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

28. • 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?

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The psychology of emergencies shows that people
process information differently in a crisis.
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34. Routinize infodemic management process in a health
authority

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Health misinformation affects all levels of
society

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Acting within the health system broadly
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Partnering outside the health system
Emergency
preparedness
and
prevention
(routine
capacity, must
be ready to
surge and to
be executed
faster during
an emergency)
and response
• Build capacity for conducting social listening/
infodemic monitoring
• Conduct integrated analysis of diverse data
sources
• Conduct risk assessment and provide timely
recommendations
• Rapidly published and disseminated data and
health information
• Monitor popular reaction to health guidance
• Address points of confusion
• Translate science
• Involve communities to cocreate appropriate
messages, services, and health guidance
• Empower health workers to address health
misinformation and questions and concerns of
patients
• Establish partnerships with factcheckers and media
organizations to factcheck health claims
• Collaborate with technology platforms to promote
content moderation and promotion of credible and
accurate health information
• Expand networks with community organizations,
academic institutions, faith communities, world of
work, professional associations, other communities,
and the private sector to disseminate health
information and address misinformation
• Promote ways in which community members can
factcheck misinformation, and promote media and
information literacy
• Work with trusted messengers in trusted spaces
(where people work, pray, play, live, study and
gather)
• Cocreate digital strategies with communities and
health professionals

45. Thankyouvery
much!
me@tinapurnat.com
Resources for
infodemic managers

47. Infodemic insights
analysis and reporting
TOOLS
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50. Mpox Infodemic Insights: Key themes and recommendations based on integrated analysis (22 Nov - 6 Dec 2022)
Recommendations for action
Key themes (by social listening taxonomy)
*Level of risk to public health (impact on uptake of PHSM, vaccines, treatments, diagnostics) as
determined by type of narrative, reach, dissemination, affected communities: high; moderate; low; positive
WHO's decision to rename the disease from monkeypox to mpox emerged as a key driver of
conversation over the monitoring period. Pockets of conversation online considered the name
change to be racist given perceptions it assumes that the public makes an implicit connection
between a monkey and an individual’s race. Meanwhile others interpreted the name change as
a move to disassociate monkeys from being the source of the virus. Parallel conversations
revealed confusion on why ‘monkeypox’ was deemed racist if the virus originated from
monkeys. Some conspiracy theories suggested mpox originates from mRNA COVID-19
vaccines. (Narratives observed in USA, UK, Philippines and English-language).
THE CAUSE & ORIGIN – NAME CHANGE FROM MONKEYPOX TO MPOX
GENERATES A MIXED RECEPTION
INTERVENTIONS – ENDURING PUBLIC DISTRUST AND CONFUSION
AROUND PUBLIC HEALTH AUTHORITIES’ RESPONSE TO MPOX
• Monitor the development of conversations around this topic to pre-emptively identify
any emerging misinformation or more confusion around the origin of the virus; use
these insights to inform pre-bunking or timely debunking.
• Review and update talking points to address these specific questions or associated
concerns on the name change; distribute through media or factchecking networks.
• Continue to update metadata and all web/social content that mention monkeypox and
re-label to mpox; ensure that IMST staff use mpox for consistency in language.
• Continue to mark all webpages that have been updated with the new name and set up
new URL redirect from the old monkeypox URL to the new URL.
THE ILLNESS & TRANSMISSION – INFORMATION VOID AND QUESTIONS
AROUND MPOX IN WOMEN
• Clarify how policy decisions were made regarding how limited mpox vaccine supply
would be distributed and who would be prioritized for vaccination.
• Develop information materials (e.g. talking points) explaining the rationale behind the
decision to include HCW as a priority group for vaccination.
• Conduct rapid online community assessments to better characterize these
concerns especially around vaccine delivery programs in LMICs and investigate this in
the upcoming WHO deep dive report on mpox and HCWs.
• Use these insights to update information packages for at-risk communities, including
HCW and work with organizations serving LGBTQI+ communities to address specific
concerns questions.
• Train, prepare, and work with HCWs to address offline or online questions about mpox
transmission among women.
• Develop key messages addressing the concerns or questions of women to be used for
talking points and information materials for HCWs.
• Review and update existing health guidance, talking points, and FAQs with
information addressing concerns of women, such as risk of mpox transmission and
prevention in women.
Public mistrust, including questions about when and to whom mpox vaccines will be delivered
were prominent in discussions over the past two weeks. In Mexico and Colombia, users
questioned their governments’ response strategies towards addressing mpox, while some
alleged that members of the LGBTQI+ community were specifically denied access to vaccines.
In response to news reports that 50,000 vaccines would be sent to DRC, Ghana and Nigeria
to address healthcare workers and the most vulnerable, there were polarized discussions on
the need to vaccinate HCWs. (Narratives observed in the USA, Mexico, Colombia)
Data from a new study in Spain had conclusions similar to studies discussed in the previous
reporting period which described a lack of access to diagnosis and treatment among cis-,
non-binary, and trans women. Users expressed questions about whether sexual contact is
the only mode of transmission for women. Users were searching for additional information
about transmission among women. Some male online users suggested that women should
reduce sexual contact to prevent mpox transmission. Female users responded by pointing to
recent data reportedly showing that only 65% of infected women got mpox from sexual
contact. (Narratives observed in English and Spanish language conversation).

51. Other tools that might be helpful
TOOLS

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56. Moreinformation
andresourcesat
tinapurnat.com
Resources for
infodemic managers

58. BEFORE AN EMERGENCY, MAINTAIN
AND DEVELOP TRUST AND RESILIENCE.

59. EXAMPLES

60. DURING EMERGENCY, LEVERAGE EXISTING
TRUST AND PREVENT EROSION OF TRUST.

61. EXAMPLES

62. AFTER EMERGENCY, LEARN FROM GAPS IN
TRUST AND REINFORCE RESILIENCE.

63. EXAMPLES