Connect with the public where they live to help dispel misinformation and disinformation.

With seemingly unlimited access to digital information, the spread of healthcare-related misinformation and disinformation (mis/disinformation) has become a pressing concern. Reliable organizations such as the World Health Organization, the Centers for Disease Control and Prevention, and the American Nurses Association dedicate significant time and resources to address the issue.

As respected professionals who play an integral role on healthcare teams, nurses can help combat mis/disinformation by promoting facts, debunking myths, advocating for evidence-based practices, addressing patient concerns, and facilitating informed decision-making. However, when confronted with false or misleading information, nurses sometimes find themselves in challenging conversations with patients and families, which may disrupt their ability to provide safe, high-quality care. These emotionally charged conversations can erode the nurse–patient relationship, compromise the quality of care, and lead to verbal or physical abuse from patients and their families.

An urgent need exists to incorporate opportunities for nurses to develop skills to respond to mis/disinformation. Community outreach and nurse education play important roles.

Define the terms and their impact

Let’s begin with the terminology used to discuss healthcare-related mis/disinformation, especially regarding vaccinations. “Vaccine confidence” refers to the widespread belief that vaccines are safe, effective, and advised by a trustworthy medical system. “Vaccine hesitancy,” on the other hand, occurs when individuals have concerns about vaccine safety, which can ultimately lead to their refusal to receive vaccinations.

Although we frequently use misinformation and disinformation interchangeably, an inherent difference exists in their meaning and intent. “Misinformation” refers to the accidental sharing of false or misleading information with no malicious intent. “Disinformation” denotes false information that’s spread purposefully to deceive others. Some use disinformation to achieve political or monetary gains.

The United States has been fighting a battle against vaccine hesitancy for decades. However, the COVID-19 pandemic amplified the issue as a result of the spread of mis/disinformation via social media and increasing distrust in public health institutions. In addition, current political tensions have detracted from the original intent of public health, including a primary focus on preventive vaccinations. Polarized U.S. politics have allowed for a vaccine debate based on false narratives to become a normalized aspect of the mainstream political system, including on social media and in mainstream news.

Social media has increased the availability of information (the credibility of which can be hard to assess) and the speed with which it spreads. In a literature review regarding the spread of mis/disinformation on social media, Wang and colleagues discovered that an abundance of false information exists online and that many view it as more accurate and truthful than evidence-based information. Some use disinformation in social media to exploit emotions, which can have detrimental effects.

Bernard and colleagues assert that disinformation has placed the world in a state of biowarfare. Anti-vaccination and anti-science propaganda negatively impact public health and cause some to view medical and science professionals as untrustworthy and illegitimate.

In addition to affecting individual health outcomes, healthcare mis/disinformation also can have a broader impact on public health. For example, false claims about the safety and efficacy of certain treatments or interventions can lead individuals to forgo evidence-based care or demand unproven therapies, which can lead to poor outcomes and high healthcare costs. Researchers also report that nurses who encounter patients who believe COVID-19 mis/disinformation are more likely to experience verbal abuse and physical violence from patients and their families. Clearly, we need to implement interventions to support nurses and healthcare professionals who confront these challenges.

Reach out to the community

In a call to action for nurses to respond to mis/disinformation, Villarruel and James recommend partnering with community groups to provide clarity about health information. ESTAR Sanos (Education, Support, Training, Awareness, Resources), a comprehensive community outreach program led by Tennessee Tech interprofessional students and faculty, was created through state and national grant funding to combat mis/disinformation. This boots-on-the-ground community outreach approach targets two local historically under-vaccinated populations (rural low-income and Hispanic).

ESTAR Sanos serves as a platform for fostering meaningful conversations with vaccine-hesitant individuals. Meeting people where they congregate, recruiting team members from the target populations, and using motivational interviewing (MI) techniques allow the outreach team to engage one-on-one with community members, dispel mis/disinformation, and build trust. (See Build community outreach.)

ESTAR Sanos team members have participated in 40 events by partnering with local churches, community centers, schools, and nonprofit organizations. Team members have discussed health-related topics (most related to COVID-19) with approximately 2,000 individuals.

Cultural competence

Because of the importance of cultural competence and language proficiency, the program prioritizes the inclusion of Hispanic team members. Serving as cultural ambassadors, they facilitate conversations, address specific concerns, and build rapport with individuals who may harbor mistrust as a result of historical or systemic factors. In addition, ESTAR’s bilingual colleagues provide much-needed trans­lation support for our partner organizations, which helps create goodwill, instill a collaborative mindset, and lay the foundation for future initiatives.

The program also includes team members from rural low-income backgrounds. These students know firsthand the unique challenges experienced by rural communities, such as limited healthcare infrastructure, geographical barriers, and a higher prevalence of belief in mis/disinformation. These team members leverage their experiences and understandings to establish a genuine connection with the community and reinforce trust. They can empathize with the concerns and apprehensions in rural areas and address them in a relatable and meaningful way. This shared background breaks down barriers and fosters a sense of solidarity between the outreach team and community members, leading to more effective conversations.

Motivational interviewing

ESTAR Sanos nurses and students use MI techniques during community outreach events to guide conversations with participants. “Elicit-provide-elicit,” a fundamental MI approach, involves eliciting an individual’s perspective and concerns, impartially providing accurate information, and then eliciting their thoughts and reactions. Following this approach, the team empowers community members to participate in decisions related to their healthcare by arming them with resources and methods for obtaining accurate information.

The outreach team developed response scripts to ensure consistency and effectiveness when engaging with the community. These scripts serve as guidelines for addressing common vaccine-related concerns and debunking prevalent mis/disinformation. However, team members are encouraged to tailor their responses based on individual conversations. This flexibility allows for personalized and meaningful interactions, which enhance the impact of outreach events. (See Follow the script.)

Train the nurses

The ESTAR Sanos program also offers an elective course at Tennessee Tech to help community health workers combat mis/disinformation. The course addresses the topics of public health, community activism, health mis/disinformation, and MI within modules that span the semester.

The hybrid course is offered to interprofessional students over the 15-week semester. Online modules cover multiple sources of information on each main topic with a short assignment to evaluate learning. A Community Toolkit for Addressing Health Misinformation, produced by the Office of the U.S. Surgeon General in response to vaccine hesitancy, provides practical infographics to explain specific strategies students can use to combat inaccurate health information.

The culminating assignment challenges student groups with common interests, such as vaccine hesitancy, to create and present a social media post. The assignments immerse students in the environment of healthcare mis/disinformation, which provides them with opportunities to recognize and respond to false claims made on social media and traditional news and entertainment channels.

Rebuild trust

Health mis/disinformation continues to spread at alarming rates with detrimental effects for nurses and healthcare workers at an individual level, as well as on the broader institution of public health. Individuals who encounter mis/disinformation may mistrust the healthcare system, deny preventive health measures, and seek treatments without any basis in evidence. In addition, nurses and healthcare workers fear the potential verbal and physical abuse they may experience when challenged by a patient who believes the untruthful information they’ve encountered. Continued interventions to improve vaccine confidence and combat health mis/disinformation are essential to help rebuild the trust and confidence Americans have in their healthcare system.

Melissa J. Geist is a professor of nursing at Tennessee Tech University in Cookeville, and a pediatric nurse practitioner at Kids Kare Pediatric Clinic in Cookeville. Jennifer L. Mabry is an associate professor of nursing at Tennessee Tech University. Tai G. Hintz is a cardiovascular intensive care unit staff nurse and an MSN-FNP graduate student at Tennessee Tech University.

American Nurse Journal. 2024; 19(2). Doi: 10.51256/ANJ022414

References

American Nurses Association. Americans continue to rank nurses most honest and ethical professionals. January 10, 2023. nursingworld.org/news/news-releases/2022-news-releases/americans-continue-to-rank-nurses-most-honest-and-ethical-professionals

Bernard R, Bowsher G, Sullivan R, Gibson-Fall F. Disin­formation and epidemics: Anticipating the next phase of biowarfare. Health Secur. 2021;19(1):3-10. doi:10.1089/hs.2020.0038

Centers for Disease Control and Prevention. What is vaccine confidence? February 7, 2022. cdc.gov/vaccines/covid-19/vaccinate-with-confidence/building-trust.html

Larkin H. Navigating attacks against health care workers in the COVID-19 era. JAMA. 2021;325(18):1822-4. doi:10.1001/jama.2021.2701

Office of the U.S. Surgeon General. A community toolkit for addressing health misinformation. 2021. hhs.gov/sites/default/files/health-misinformation-toolkit-english.pdf

Ortega AN, McKenna RM, Kemmick Pintor J, et al. Health care access and physical and behavioral health among undocumented Latinos in California. Med Care. 2018;56(11):
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Pulido CM, Ruiz-Eugenio L, Redondo-Sama G, Villarejo-Carballido BA. New application of social impact in social media for overcoming fake news in health. Int J Environ Res Public Health. 2020;17(7):2430. doi:10.3390/ijerph17072430

Tiesman HM, Hendricks SA, Wiegand DM, et al. Workplace violence and the mental health of public health workers during COVID-19. Am J Prev Med. 2023;64(3):315-25. doi:10.1016/j.amepre.2022.10.004

Tjilos M, Tamlyn AL, Ragan EJ, et al. “Community members have more impact on their neighbors than celebrities”: Leveraging community partnerships to build COVID-19 vaccine confidence. BMC Public Health. 2023;23(1):350. doi:10.1186/s12889-023-15198-6

Villarruel AM, James R. Preventing the spread of misinformation. Am Nurse J. 2022;17(2):23-6.

Wang Y, McKee M, Torbica A, Stuckler D. Systematic literature review on the spread of health-related misinformation on social media. Soc Sci Med. 2019;240:112552. doi:10.1016/j.socscimed.2019.112552

World Health Organization. Highlighting a population’s health information needs during health emergencies through new infodemic management tools and frameworks. Published April 13, 2023. who.int/news/item/13-04-2023-highlighting-a-population-s-health-information-needs-during-health-emergencies-through-new-infodemic-management-tools-and-frameworks

Key words: misinformation, disinformation, community outreach