|Year : 2020 | Volume
| Issue : 5 | Page : 31-37
COVID-19 infodemic: Unveiling the root causes through public perspectives
Jose Jom Thomas, Praveen Kulkarni, D Sunil Kumar, B Prakash, M R Narayana Murthy
Department of Community Medicine, JSS Medical College, Mysore, Karnataka, India
|Date of Submission||05-May-2020|
|Date of Decision||05-May-2020|
|Date of Acceptance||11-May-2020|
|Date of Web Publication||04-Jun-2020|
Dr. Jose Jom Thomas
Department of Community Medicine, JSS Medical College, Mysore, Karnataka
Source of Support: None, Conflict of Interest: None
INTRODUCTION: The novel coronavirus pandemic raises great concern due to its spread and collateral effects on the society. Nearly 30,000 cases are reported from India by the beginning of May 2020. The current pandemic is associated with a sudden surge of false information termed as infodemic. This study attempts to understand the root causes of COVID-19 infodemic.
METHODS: This cross-sectional online study was conducted from April 20, 2020, to April 30, 2020, to collect information on the possible causes of COVID-19 infodemic. A fishbone diagram was developed from the data through iterative process to illustrate the root causes of the infodemic.
RESULTS: The total of 179 people responded to the online survey. Among them, 99 were health-care professionals and 75 were representatives of the general public. The mean age of the respondents was 28.93 ± 9.99 years. The root causes for the COVID-19 infodemic were classified into five domains, namely, social media-associated causes, behavioral aspects, the novelty of the virus and related challenges, causes due to lacunae in policies and health systems, and difficulties in the verification of information.
CONCLUSION: A comprehensive action plan has to be developed to contain the infodemic through adequate education of all stakeholders, warnings and legal actions, improvements in policy and health systems. The authorities should brainstorm to design activities that contain the spread of false information through social media at the origin itself.
Keywords: COVID-19, infodemic, root cause analysis
|How to cite this article:|
Thomas JJ, Kulkarni P, Kumar D S, Prakash B, Murthy M R. COVID-19 infodemic: Unveiling the root causes through public perspectives. Int J Health Allied Sci 2020;9, Suppl S1:31-7
|How to cite this URL:|
Thomas JJ, Kulkarni P, Kumar D S, Prakash B, Murthy M R. COVID-19 infodemic: Unveiling the root causes through public perspectives. Int J Health Allied Sci [serial online] 2020 [cited 2020 Jul 13];9, Suppl S1:31-7. Available from: http://www.ijhas.in/text.asp?2020/9/5/31/285977
| Introduction|| |
With more than 3 million cases worldwide and over 22,000 deaths by the 1st week of May, COVID-19 has become a major health emergency modern world has seldom witnessed. First reported in Wuhan city of China, COVID-19 has affected 215 countries, areas, or territories across the world in a relatively short span of 4 months. The novelty of the virus along with its high infection rates, lack of knowledge about its specific symptoms, and varying mortality rates has caused severe stress on public health systems across the world. India reported the first confirmed case of COVID-19 on January 30, 2020, from Kerala state, following which nearly 30,000 cases are reported from various states and union territories as on the 1st week of May.
The inevitable preventive measures such as country-wide lockdown and containment efforts have exacerbated the economic crisis in the country. The falling market and rising unemployment rates along with the panic about the pandemic further added to this crisis. Along with the COVID-19 pandemic, we are facing an unusual phenomenon of “infodemic” which is an epidemic of false information. Experts consider social media as one of the most important channels of infodemic. The easy access and the higher amplification rates of information in social media make its transmission dynamics difficult to tackle.
Researchers have identified the rise of “misinformation: unintentionally false information,” “dis-information: deliberately misleading information,” and “mal-information: reconfigured true information” regarding COVID-19. The spread of misinformation is associated with fear, panic, loss of confidence on health-care delivery system; following of irrational practices which can further spread the disease, and provision of false sense of security among people.
Thus, it is important to understand the nature of the information and reasons for spreading such information for the effective management of infodemic. The initial surveys show unsatisfactory levels of awareness and attitudes even among health-care professionals., The rise if infodemic will have an add on effect to this, making the already-exhausting containment measures even more difficult.
The reasons for infodemic have to be analyzed in the Indian context for better management of the misinformation. The initial attempt by Kulkarni et al. illustrates the root causes of COVID-19 infodemic under the themes of social media usage, epidemiological factors including the novelty of disease and associated limitations, behavioral issues, and policy and health-care system aspects. Analyzing the perspectives of both technically sound population such as medical professionals and less technically informed general public on the origin and spread of misinformation will provide better insight into the root causes of Infodemic. In this background, the current study was undertaken to understand perspectives of the public as well as the medical community on possible causes, consequences, and ways to prevent the Infodemic.
| Methods|| |
This cross-sectional study was conducted through an online survey to collect the perspectives about information handling and factors associated with information sharing among the general public and health-care professionals for a period of 11 days from April 20–30, 2020. The information was retrieved through convenient sampling using a questionnaire prepared using Google Forms, which was circulated among the people from nonmedical and medical backgrounds, in the contacts of the principal investigator. All the respondents above the age of 18 years were considered for data acquisition.
Responses were collected using a semi-structured questionnaire which was face validated by subject experts, and content validation was done by a pilot study among ten respondents representing the medical community and the general public. Based on the inputs from the pilot study, suitable modifications were made. The final 30-item questionnaire was divided into three sections. The first section included demographic characters such as age, gender, residence, education, and occupation of the respondents. The second section was containing questions regarding the social media usage patterns, frequency of sharing information, fact-checking, behavioral aspects of information sharing, frequency and hindrances in information verification, etc., The final section was consisting of seven questions designed as Likert's scale. Respondents' views about policy and health system factors in infodemic were assessed in the third section. Both section two and three were provided with a final column for the respondents to describe their additional views and perspectives on the respective sections.
The Google Forms' link was shared in different social media platforms including WhatsApp, Facebook, Instagram, and E-mails. A description of the pandemic, concept of infodemic, and purpose of the study was attached with the link. The researchers shared the link through their accounts and used the help of others in sharing to attain a wider reach for the survey. The first page of the Google survey sheet contained a detailed description of the study including the time required for filling the survey form. The respondents could proceed to the questionnaire only after marking their informed consent. All the questions were made compulsory to avoid the submission of incomplete responses. A note of thanks and acknowledgment was provided to each respondent after filling the details. The link was allowed to be shared for 11 days, a total of 174 responses were obtained, and all the responses were considered for further analysis.
The data were collected as a.csv file and were later coded and recorded in a Microsoft Excel sheet. The analysis was performed using SPSS-version 23 licensed to JSS Academy of Higher Education and Research, Mysuru. The categorical data were measured in percentages and were represented using tables and a multiple bar diagram. The continuous variable such as age was represented using mean and standard deviation. Few categorical data were compared across the general public and health professionals by Chi-square test or Fisher's exact test.
A fishbone diagram was developed from the data through iterative process to illustrate the root causes of the infodemic.
| Results|| |
Among the 174 respondents, 99 (56.89%) were health-care professionals and 75 (43.10%) represented the general public. There was almost an equal representation of both the genders. The mean age of the respondents was 28.93 ± 9.99 years. Majority of the respondents were graduates (57.47%), and half of the respondents were professionals (35.63%). More than two-thirds of the respondents were belonging to Kerala (67.24%), while 17.81% belonged to Karnataka, 4.59% belonged to Tamil Nadu, and 7.47% to rest of the Indian states. Five respondents were either nonresidential Indians or overseas citizen of India [Table 1].
Patterns of media usage and handling of information
The major sources of information regarding COVID-19 were social media (68%), online or printed news sources (66.6%), and television (TV) (65.3%) for the general public. Only 29.3% of the respondents representing the general public used official resources by the government or international agencies. For the health-care professionals and health science students, news agencies followed by official websites were the main sources of information. Among the 104 respondents who used social media as one of the sources of information, WhatsApp followed by Facebook and Instagram were the main resources. Two of the respondents commented that “TikTok” also is a potential source of information as the videos show and share the perspectives of the users [Table 2].
|Table 2: The sources of information regarding COVID-19 based on multiple responses by the study participants|
Click here to view
Nearly 68.9% (70.2% of the general public and 68.6% of the health-care professionals) reported an increase in social media usage after the announcement of lockdown [Table 3]. Among the respondents, 2.8% always, while 2.8% often, 33.9% sometimes, and 43.1% rarely share messages in social media. A significant difference was observed between the general public and health-care professionals in the pattern of message sharing in social media [Table 4].
|Table 3: Distribution of respondents based social media usage and spread of infodemic|
Click here to view
|Table 4: Frequency of information sharing and fact verification by the respondents|
Click here to view
False information sharing and fact verification practices
Out of the 174 respondents, 14.8% of the public respondents and 14.1% of the health-care professionals admitted that they have forwarded at least one piece of information and later realized that it was false. An alarmingly high proportion of 45.3% of the public and 42.4% of the health-care professionals believed messages spread by unauthentic sources at least once during the pandemic period [Table 3]. The fact-checking pattern among health-care professionals was significantly different from that of the general public. Only 36% of the public respondents reported a habit of doing fact-checking always. Almost 10.6% of the respondents in the general public category never did a fact-checking. More than 50% of the health-care professionals verify all the information they receive in nonacademic channels of information [Table 4].
The common site for fact checking for medical professionals was government or WHO websites and guidelines and that for general public was TV/newspaper followed by Google search and official websites. Other sources include social media pages run by the authorities and direct clarification from health professionals [Figure 1]. On an inquiry on the common hindering factors for fact checking, majority opined that it is difficult to do a fact checking using the available resources (57.1%). Few of the respondents observed it time-consuming (31.4%), while two respondents considered it unnecessary due to various factors such as trust in social media and lack of trust in the official resources of information (25.7%).
|Figure 1: The sources for verification of received information used by the study respondents (based on multiple responses)|
Click here to view
Behavioral aspects of the infodemic
A total of 122 (84.7%) respondents mentioned that they share the COVID-19-related information on social media platforms because it benefits others as it is a “good deed” (70%). Others' intension of sharing information was entertainment (4%), habitual practice (3.4%), method of socializing (6.32%), wish for appreciation (2.3%) from the receivers, and popularity (1.72%). The behavioral pattern of social media message sharing was similar in the both categories. The common reason for believing unauthentic sources of information among the general public was lack of epidemiological data to correctly explain the disease dynamics by the authorities (65.2%) and lack of adequate scientific knowledge 39%. Nearly 7% reported a lack of trust in modern medicine as it is not able to provide a vaccine or specific treatment for the disease.
Majority of the respondents agreed that the health systems and policy factors such as the lack of uniform guidelines, the difference in practice between the states, lack of preparedness by the public health systems, need for legal actions to control infodemic, misunderstanding of preventive measures by the public, need for more efficient communication strategies by the governments, and the lack of community involvement are contributing to the infodemic [Table 5].
|Table 5: Distribution of responses based on the policy-related reasons for infodemic|
Click here to view
Preventing the infodemic
Among the study participants, 64% of the general public and 70% of the health-care professionals opined that all the information about the disease should be handled by the government alone. The points suggested by the respondents to prevent the infodemic can be classified into three domains. A total of 120 (68.9%) respondents suggested health educational measures, 98 (56.32%) mentioned warnings and freezing of social media accounts if proved of sharing false information, and 102 (58.6%) suggested legal actions to contain the infodemic.
Qualitative inputs from the respondents
The descriptions and narratives given by the participants align in par with the already-discussed findings of the study. The fear, panic, and confusions associated with the pandemic were shown as a root cause for infodemic by majority of the participants. A respondent suggested that ”the false information has to be identified and managed at the origin itself as controlling a message later in social media is very difficult.” Another was of opinion that the scope of artificial intelligence in identification of false information should also be examined. The banning on social media was generally discouraged by the respondents. One of the responses was ”There are a lot of mimetic going on in social media. The ban on it would make people go crazy since it's the only one keeping them sane during this isolation.”
| Discussion|| |
The results of the study can be discussed under six broad themes. We attempt to classify the root causes under these themes and derive at a fishbone diagram illustrating the root causes of COVID-19 infodemic.
The unchecked spread of information through social media
The increased access and usage of social media platforms is an opportunity for the unchecked proliferation of infodemic. Majority of the times, general public heavily depends on social media for the updates on pandemic. As the information rolling through social media is difficult to track, fact check, and regulate, it definitely increases the chances of the infodemic.
Most of the respondents share information through social media with a good dead. However, it has the potential to lead to the infodemic of “misinformation” unless some mechanism to do the fact check is implemented. Other behavioral aspects such as entertainment, habitual practice, method of socializing, wish for appreciation from the receivers, and seeking popularity also lead to the spread of information through social media. The fear, panic, and confusion among the public is also a reason for the fast spreading of information.
The novelty of the virus/disease
The lack of epidemiological data and evidence on disease dynamics and unavailability of vaccine and specific treatment has led to the rise of conspiracy theories and affected the trust of the general public in modern medicine to a certain extend. People's faith on home remedies in alternative systems of medicine also encourages the rapid spread of unverified information.
Health system and policy
The lacunae in public health systems and lack of preparedness have affected the public's trust in the system. The fast upgrading guidelines and different practices across different territories/states can cause confusions about the ideal practices among the general public and medical community. Majority opine that the communications of the governments have to improve to transfer the correct information to the public. Community involvement of larger extent is required to manage this crisis.
Easing the process of fact checking
Easy and more accessible sources should be available to the public for better fact checking. At least a few respondents find the true information through the existing sources as exhaustive and time-consuming. More innovative methods should be introduced from the perspectives of the general public who are the main stakeholders.
The major preventive checks for the infodemic according to the respondents are the education of the public, legal actions, and warnings. The information should be checked and verified at the origin as the containment of the spread of information in social media is a difficult task.
[Figure 2] shows the fishbone diagram in the root cause analysis of the COVID-19 infodemic from the study. The fishbone diagram unveiled through the perspectives of the general public and the health-care professionals is comparable to that of Kulkarni et al. The study also categorizes the causes under the headings of epidemiological, behavioral, policy, and health system factors. Thus, our study findings are affirmative of the descriptions in a previous study.
|Figure 2: Version of fishbone diagram developed by Kulkarni et al. showing the root causes of COVID-19 infodemic testified by the observations from the study|
Click here to view
A scientific calculation of the sample size could not be done and the study was limited to a small sample size and short study period due to the pandemic situation. The study should be reproduced in a wider sample population with more rigorous sampling techniques to generate more solid evidence on the subject. Even though the study reveals the root causes of the infodemic, the degree and mechanisms of causality cannot be assumed from our findings and hence the policy implications of the study are limited. A more detailed qualitative inquiry will be required for the same.
| Conclusions|| |
The root causes for the COVID-19 infodemic can be classified into five domains of social media-associated causes, behavioral aspects, the novelty of the virus and related challenges, causes due to lacunae in policies and health systems, and difficulties in the verification of information. A comprehensive action plan has to be developed to contain the infodemic through adequate education of all stakeholders, warnings and legal actions, and improvements in policy and health systems. The authorities should brainstorm to design activities that contain the spread of false information through social media at the origin itself.
We thank the Department of Community Medicine, JSS Medical College, for their support for the study. We also acknowledge Dr. Maria Jai Joseph and Mr. Davy Stephen for helping us sincerely to reach out to our respondents. We also thank our respondents for their active participation and valuable inputs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Allahverdipour H. Global challenge of health communication: Infodemia in the coronavirus disease (COVID-19) pandemic. J Educ Community Health 2020.
Zarocostas J. How to fight an infodemic. Lancet 2020;395:676.
Baines D, Elliott R. Defining Misinformation, Disinformation and Malinformation: An Urgent Need for Clarity during the COVID-19 Infodemic; 2020.
Kamate SK, Sharma S, Thakar S, Srivastava D, Sengupta K, Hadi AJ, et al.
Assessing knowledge, attitudes and practices of dental practitioners regarding the COVID-19 pandemic: A multinational study. Dent Med Probl 2020;57:11-7.
Gupta L, Agarwal V, Davalbhakta S, Agarwal V, Misra D. A Survey-Based Study on the Knowledge, Attitude, and the Practices Pertaining to the 2019 Novel Corona Virus Infection amongst Undergraduate Medical students In India. medRxiv; 01 January, 2020.
Kulkarni P, Prabhu S, Dumar SD, Ramraj B. COVID -19-infodemic overtaking pandemic? Time to disseminate facts over fear. Indian J Commun Health 2020;32:264-8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]