This lecture was prepared for Grand Rounds in the Department of Emergency Medicine at Brown University on January 18, 2023. It reviews the impact of health misinformation, strategies to address COVID-19 health misinformation in clinical encouters and online, and recommendations for research on this topic.

1. M I C H A E L A . G I S O N D I , M D
A S S O C I A T E P R O F E S S O R A N D V I C E C H A I R O F E D U C A T I O N
D E P A R T M E N T O F E M E R G E N C Y M E D I C I N E
S T A N F O R D S C H O O L O F M E D I C I N E
COMBATING HEALTH
MISINFORMATION

2. @MikeGisondi
Presented at:
Brown University, Department of Emergency Medicine, Grand Rounds, January 18, 2023.
I have no pertinent disclosures to report, financial or otherwise.
Views are my own and not endorsed by Stanford University.
Learning Objectives:
At the end of this presentation, engaged participants will be able to:
1. 1. Define the terms misinformation, disinformation, and infodemic.
2. 2. Explain how to use motivational interviewing to address misinformation.
3. 3. List the 5 steps to address health misinformation online.
4. 4. Identify opportunities for resident scholarship about health misinformation.

4. Four Questions to Answer Today:
What is the impact of health misinformation?
What are best practices for addressing misinformation with your patients?
How can we leverage social media to combat health misinformation?
What can your residency program do to address misinformation?

5. What is the impact of
health misinformation?

7. “ALTERNATIVE FACTS”

9. HEALTH MISINFORMATION

10. Vaccine Hesitancy
Vaccination Rates
Preventable Deaths

11. Vaccine Hesitancy
Vaccination Rates
Preventable Deaths

14. Prolonged Pandemic
New Variants
Vaccine Fatigue
Mental Illness

16. Celebrities on Social Media
70% of Attention
20% of Misinformation

20. INFODEMIC:
TOO MUCH INFORMATION…
(1) confusion
(2) mistrust
(3) lengthens outbreaks
WHO

21. INFORMATION OVERLOAD
Decision-Making
Anxiety, Stress
Depression
Quality of Life

29. What are best practices for
addressing misinformation
with your patients?

30. 7 TIPS FOR THE ED

31. Spend Time with
Patients Deliberating Vaccines

33. Spend Time with
Patients Deliberating Vaccines
“Have you received other vaccines?”
“May I ask why not the COVID vaccine?”

34. Engage Patients
With Empathy
“I understand why you’re concerned.”
“May I share some information with you?”
“Thank you for letting me share what I know.”

36. Personalize
the Message
“Let’s focus on how the vaccine can help you.”
“You’re healthy, yet COVID can still make you sick.”
“The vaccine can prevent you from getting seriously sick.”
“You won’t need to worry as much.”

37. Describe How
Misinformation Happens
“I understand your worry about side effects.”
“The vaccine has been safely administered to half of the world.”
“Inevitably some people will get sick from another illness.”
“It doesn’t mean the vaccine caused them to get sick.”

38. Learner-Centered
Educational Frameworks
 Safe learning environments
 Internal Learner Motivation
 Scaffolding and Framing
 Social Acceptability
Sheng et al. AEM ET. 2021

39. 6-Step Myth
Debunking Strategy
1. State the misinformation once.
2. Immediately state a fact.
3. Explain why the fallacy was once considered true.
4. Explain why we know it to be false.
5. Explain why the alternative is correct.
6. Close by stating the fact again.

40. 6-Step Myth
Debunking Strategy
1. The vaccine was made too quickly and its unsafe.
2. The vaccine is among the safest ever made.
3. Some worried that vaccine testing was rushed.
4. Vaccine was tested in an appropriately large population.
5. It has since been given safely to half the world.
6. The vaccine is among the safest ever made.

41. Make COVID-19
Vaccination Routine Health Care
DO: “You are overdue for your COVID-19 booster.”
“I order boosters for all my patients who are overdue.”
DON’T: “Would you like to get a COVID-19 shot today?”

42. Motivational Interviewing:
Respectful Dialogue
Listen and Validate
Provide Facts
Patient Draws Conclusions

43. How can we leverage
social media to combat
health misinformation?

44. ENGAGING ONLINE

46. Healthcare Provider
Social Media Hesitancy
Physicians not using their platform =
Public health threat

47. Common Barriers to
Social Media Engagement
 Lack of measurable outcomes
 Harassment and bullying
 Lack of institutional support
 Lack of social media training

48. Facilitators of
Social Media Engagement
 Misinformation training
 Social media training
 Building social media presence

50. 5-Step Method to Combat
Misinformation Online
1. Identify and Label Misinformation
2. Provide Correct Information
3. Reference a Source
4. Repeat the Correct Information
5. Respond Immediately

51. Things that might happen
after a COVID-19 vaccine

52. Fact
Fact repeated
Explanation
Reference
Falsehood

53. Falsehood
Fact
Explanation
Fact
Reference

54. Prebunking

55. Prebunking
Misinformation
1. Provide Correct Information
2. Identify and Label Misinformation
3. Explain the Fallacy
4. Repeat the Correct Information

57. Digital Brand
Confession
I Broke My
Twitter Rules
in 2020

58. A Stanford Conference on Social Media and COVID-19 Misinformation
Stanfordinfodemic.org
August 26, 2021

61. The COVID-19 INFODEMIC:
COMPLEX and CONTRADICTORY INFORMATION…
(1) origins of the virus
(2) treatment options
(3) lifesaving vaccines
Gisondi et al. JMIR. 2022

63. Engage patients online
Partner with:
Online influencers
Social media companies
Mass media

66. Engage in public health
education online
Use social media to connect to
new strategic partners

67. Use Your Platform:
Engage in Social Media
Identify Misinformation
Provide Facts
Partner with Stakeholders

68. Role Models

69. What can your
residency program do to
address misinformation?

70. RESIDENCY OPPORTUNITIES

71. ("social media" [tw] OR "social media" [mesh] OR twitter [ti] OR Instagram
[ti] OR facebook [ti]) AND ("covid 19" [tw] OR covid [tw] OR covid19 [tw]
OR "ncov 2019" [tw] OR "novel coronavirus" [tw] OR "sars cov 2" [tw] OR
"sars cov-2" [tw] OR "ncov 2019" [tw] OR sarscov2 [tw] OR (wuhan [tw]
AND coronavirus* [tw]) OR "corona virus*" [tw] OR "coronavirus disease
2019" [tw] OR "coronavirus disease 19" [tw] OR "2019 ncov" [tw] OR
2019nCoV [tw] OR "coronavirus 2" [tw] OR "Coronavirus"[Mesh:NoExp]
OR "SARS-CoV-2"[Mesh] OR "COVID-19 Testing"[Mesh] OR "COVID-19"
[mesh] OR "COVID-19 Vaccines"[Mesh] OR "Receptors,
Coronavirus"[Mesh] OR "Spike Glycoprotein, Coronavirus"[Mesh] OR
"SARS-CoV-2 variants" [Supplementary Concept]) AND ("Patient
Education as Topic"[Mesh] OR "Patient Education Handout" [Publication
Type] OR "health literacy" [tw] OR "patient education" [tw] OR "Health
Literacy"[Mesh] OR "Health Promotion"[Mesh])

73. Residents launched an
awareness campaign about
health inequities on Twitter

75. Residents filmed
60 TikToks about COVID
600,000 views

76. Residents made health
infographics, videos in Chinese
WeChat group of 500 patients

78. Provider-moderated
Online Health Communities
 Disproportionately young people
 High demand for health-related content
 Susceptible to unreliable content

81. Educators and
Educational Institutions
 Evidence-based Educational Programs
 Information Literacy Metrics

82. Health Professionals
Healthcare Institutions
 Proactively Engage with the Public
 Use Technology to Share Information
 Partner with Community Groups

83. Researchers
Research Institutions
 Assess the Impact of Misinformation
 Target Interventions to Communities
 Evaluate Interventions and Policies

84. Use Social Media in New Ways:
Support social media use
Develop new policies
Teach best practices
Find research opportunities

85. Surgeon General Murthy, 2021
“Limiting the spread of
health misinformation is a
moral and civic imperative
that will require a
whole-of-society effort.”

86. Thank You!
Slides:
Available at Slideshare.net