There’s an adage in the healthcare industry: Meet your patients where they are. And healthcare consumers—particularly mothers, who make the bulk of healthcare decisions—are increasingly online. Many are turning to internet celebrities and social media, where misinformation proliferates, to make choices about their health.
Healthcare organizations and local governments want to be the primary sources for practical health information, but the technical nature of public health messaging makes it difficult for them to compete in the influencer era.
The healthcare system is going to have to harness the power of people with large online audiences and more closely monitor disinformation campaigns to be competitive, said Denise Scannell, chief strategist for health communication at the MITRE Corp.
Big-name institutions have hooked up with social media platforms to make health research and information more accessible and to combat misinformation, but their reach has proven limited.
Mass General Brigham in Boston, the Mayo Clinic in Rochester, Minnesota, the American Public Health Association and the New England Journal of Medicine have all announced partnerships with YouTube to publish health-related content. The video platform is prioritizing that content among its search algorithms and flagging it as “authoritative” for viewers, said Garth Graham, director and global head of healthcare and public health at Google, which operates YouTube.
“The question is, how can we be a part of people’s daily lives and how can they be engaged and find consumers where they are committed and people on their phone,” Graham said. “How can we be a part of that ecosystem as opposed to waiting for them to show up in our institutions?”
The allure of falsehoods
Content creation alone won’t solve the problem, however.
The most-watched video on Mass General’s YouTube page about COVID-19 vaccines received approximately 50,000 views.
By comparison, rapper Nicki Minaj’s Twitter post claiming her cousin’s friend from Trinidad becoming impotent and his testicles swelling after getting the COVID-19 vaccine—a claim widely refuted by scientists, including the health minister of Trinidad and Tobago—was seen by millions via Twitter and in subsequent media coverage.
“People don’t get information from their providers. They get it from influencers or people that they’re attracted to,” Scannell said. “But the providers have a responsibility to fine tune their engagement, and wouldn’t it be great if we had insights fed to them about their local population?”
Proactively monitoring health literacy and online misinformation can prepare clinicians for what they should be discussing during patient visits, Scannel said. Public health surveillance could also help determine how misinformation manifests in different communities and make it easier to create targeted interventions, according to a report from the Centers for Disease Control and Prevention.
Falsehoods proliferate faster and further than empirically supported facts, and that has negative implications for public health. The main perpetrators include social media influencers with large online followings and the social media platforms that host them. A 2021 report from the Center for Countering Digital Hate linked 65% of anti-vaccine content on Facebook and Twitter to just 12 users. Researchers also tracked 425 accounts that actively disseminated anti-vaccine sentiments, and found that a collective 59.2 million users followed them.
“Despite repeatedly violating Facebook, Instagram and Twitter’s terms of service agreements, nine of the Disinformation Dozen remain on all three platforms, while just three have been comprehensively removed from just one platform,” the report says. “This is an extension of platforms’ failure to act on vaccine misinformation.”
Other Center for Countering Digital Hate research found that platforms such as Facebook, Instagram and Twitter failed to act on 95% of COVID-19 and vaccine misinformation users reported. The center also singled out Instagram for employing an algorithm that promoted false information to users.
The Nicki Minaj effect
Social media facilitates the spread of misinformation at unprecedented speed and scale, according to the office of the U.S. Surgeon General. The public health office called for additional research into how that impacts health. The conundrum has both the public and private sectors playing defense in the health information game, and as a result, the population’s already abysmal health literacy is weakening.
Widely cited data from the National Assessment of Adult Literacy suggests only 12% of U.S. adults are armed with good health literacy. Those most impacted also face other social determinants of health, such as a lack of insurance or educational opportunities and higher rates of chronic disease and smoking. But healthcare companies can flip the script.
“A lot of what we do today with misinformation is keeping the boat from sinking. It would be much better if we built a better boat,” Scannell said.
Scannell recommends tackling misinformation by influencing the influencers. She conducts trainings for people with large virtual followings on how to avoid spreading falsehoods, model good health practices and strategize public health messaging that is culturally competent and aligns with empirical research.
Influencers can also provide insights into why certain behaviors happen within certain communities in the first place, such as refusing to get vaccinated or turning to unverified alternative options, Scannell said.
The right voices
Healthcare organizations often utilize trusted messengers for on-the-ground COVID-19 vaccine efforts, such as partnering with pastors and school workers to facilitate conversations with community members. It’s no different online, Scannel said. Health systems need to be active members of the virtual world and work to improve community-wide health literacy through training and education of people with great influence in the space, she said.
This is particularly important because misinformation is as local as it is global. “The way that information trickles down from the national level to the state level to the local level and how people consume that information is different,” Scannell said. “We need to consider those differences among different populations.”
Regional healthcare organizations are uniquely qualified to identify and address those intricacies at the community level, and to provide educational outreach to those who influence their patient’s health decisions.
Individual healthcare workers can be key amplifiers, too.
The Mayo Clinic has launched social media training sessions for its staff to increase online engagement while staying in compliance with medical privacy laws. Researchers and clinicians are carving out their own influencing niche, such Dr. Glaucomflecke’s satirical sketches of clinical stereotypes in U.S. hospitals to Uché and Oni Blackstock’s advocacy for racial and health equity.
Raven Baxter, a molecular biologist, educator and science influencer who goes by the moniker Dr. Raven the Science Maven uses rap videos and fashion to teach people about science, technology, engineering and mathematics.
For example, Baxter recreates popular hip-hop songs in videos that explain topics such as the immunology behind vaccines and COVID-19 mitigation efforts. She has more than 219,000 followers across YouTube, Twitter, Tik Tok and Instagram. Baxter also has partnerships with major media companies and publishing houses such as Netflix and Ada Twist Scientists, where she incorporates science into children’s television programs.
Baxter says prioritizing joy and celebrating individuality makes highly technical concepts more attractive to a general audience, and research from the National Cancer Institute backs her up. Straightforward efforts to provide accurate information are often ineffective. As healthcare organizations reconfigure their content strategies creativity and representation need to be top-of-mind, she said.
“You can never lose when you’re creative in education strategies. There are best practices, but my rule of thumb is getting creative is always a great way. I think that they should be open to new ideas — it could very well be that the thing that works best for the partnership is something that they’ve never seen or heard of before.”