%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e50536 %T Exploring Public Sentiment on the Repurposing of Ivermectin for COVID-19 Treatment: Cross-Sectional Study Using Twitter Data %A Kautsar,Angga Prawira %A Sinuraya,Rano Kurnia %A van der Schans,Jurjen %A Postma,Maarten Jacobus %A Suwantika,Auliya A %+ Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, The Netherlands, 31 0503611111, angga.prawira@unpad.ac.id %K COVID-19 %K ivermectin %K sentiment analysis %K Twitter %K social media %K public health %K misinformation %K geolocation analysis %D 2025 %7 27.3.2025 %9 Research Letter %J JMIR Form Res %G English %X A sentiment analysis of 5051 Twitter posts from January 2022 found that 53.4% of them expressed positive views on ivermectin as a COVID-19 treatment, 35.6% of them were neutral, and 11% of them were negative, highlighting the polarized public perception and the need for careful interpretation of social media data in health communication. %M 40146987 %R 10.2196/50536 %U https://formative.jmir.org/2025/1/e50536 %U https://doi.org/10.2196/50536 %U http://www.ncbi.nlm.nih.gov/pubmed/40146987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e73062 %T Impact of Social Media Influencers on Amplifying Positive Public Health Messages %A Flaherty,Gerard Thomas %A Mangan,Ryan Michael %+ School of Medicine, College of Medicine, Nursing and Health Sciences, Ollscoil na Gaillimhe – University of Galway, University Road, Galway, H91TK33, Ireland, 353 91495469, gerard.flaherty@universityofgalway.ie %K social media %K COVID-19 %K vaccination %K personal brands %K public health %K wellness %K global health %K pandemic %K Twitter %K tweets %K vaccine %K longitudinal design %K wellness influencers %K hand annotation %K antivaccination %K infodemiology %D 2025 %7 21.3.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 40117580 %R 10.2196/73062 %U https://www.jmir.org/2025/1/e73062 %U https://doi.org/10.2196/73062 %U http://www.ncbi.nlm.nih.gov/pubmed/40117580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66010 %T Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (“So Much Contradictory Evidence”): Qualitative Document Analysis of Reddit Forums %A Watkins,Shannon Lea %A Snodgrass,Katherine %A Fahrion,Lexi %A Shaw,Emily %+ Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA, 52242, United States, 1 3194671489, shannon-watkins@uiowa.edu %K vaping %K nicotine %K tobacco %K health communication %K social media %K new media %D 2025 %7 20.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. Objective: This study aims to characterize and contextualize e-cigarette–related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. Methods: We conducted a qualitative analysis of COVID-19–related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. Results: e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette–related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Conclusions: Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions. %M 40112286 %R 10.2196/66010 %U https://www.jmir.org/2025/1/e66010 %U https://doi.org/10.2196/66010 %U http://www.ncbi.nlm.nih.gov/pubmed/40112286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59687 %T COVID-19 Public Health Communication on X (Formerly Twitter): Cross-Sectional Study of Message Type, Sentiment, and Source %A Parveen,Sana %A Pereira,Agustin Garcia %A Garzon-Orjuela,Nathaly %A McHugh,Patricia %A Surendran,Aswathi %A Vornhagen,Heike %A Vellinga,Akke %K public health communication %K surveillance %K COVID-19 %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pulmonary %K pandemic %K public health messaging %K healthcare information %K social media %K tweets %K text mining %K data mining %K social marketing %K infoveillance %K intervention planning %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Social media can be used to quickly disseminate focused public health messages, increasing message reach and interaction with the public. Social media can also be an indicator of people’s emotions and concerns. Social media data text mining can be used for disease forecasting and understanding public awareness of health-related concerns. Limited studies explore the impact of type, sentiment and source of tweets on engagement. Thus, it is crucial to research how the general public reacts to various kinds of messages from different sources. Objective: The objective of this paper was to determine the association between message type, user (source) and sentiment of tweets and public engagement during the COVID-19 pandemic. Methods: For this study, 867,485 tweets were extracted from January 1, 2020 to March 31, 2022 from Ireland and the United Kingdom. A 4-step analytical process was undertaken, encompassing sentiment analysis, bio-classification (user), message classification and statistical analysis. A combination of manual content analysis with abductive coding and machine learning models were used to categorize sentiment, user category and message type for every tweet. A zero-inflated negative binomial model was applied to explore the most engaging content mix. Results: Our analysis resulted in 12 user categories, 6 message categories, and 3 sentiment classes. Personal stories and positive messages have the most engagement, even though not for every user group; known persons and influencers have the most engagement with humorous tweets. Health professionals receive more engagement with advocacy, personal stories/statements and humor-based tweets. Health institutes observe higher engagement with advocacy, personal stories/statements, and tweets with a positive sentiment. Personal stories/statements are not the most often tweeted category (22%) but have the highest engagement (27%). Messages centered on shock/disgust/fear-based (32%) have a 21% engagement. The frequency of informative/educational communications is high (33%) and their engagement is 16%. Advocacy message (8%) receive 9% engagement. Humor and opportunistic messages have engagements of 4% and 0.5% and low frequenciesof 5% and 1%, respectively. This study suggests the optimum mix of message type and sentiment that each user category should use to get more engagement. Conclusions: This study provides comprehensive insight into Twitter (rebranded as X in 2023) users’ responses toward various message type and sources. Our study shows that audience engages with personal stories and positive messages the most. Our findings provide valuable guidance for social media-based public health campaigns in developing messages for maximum engagement. %R 10.2196/59687 %U https://formative.jmir.org/2025/1/e59687 %U https://doi.org/10.2196/59687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63824 %T Understanding Citizens’ Response to Social Activities on Twitter in US Metropolises During the COVID-19 Recovery Phase Using a Fine-Tuned Large Language Model: Application of AI %A Saito,Ryuichi %A Tsugawa,Sho %+ , Institute of Systems and Information Engineering, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8577, Japan, 81 08055751714, saito.ryuichi.tkb_gw@u.tsukuba.ac.jp %K COVID-19 %K restriction %K United States %K X %K Twitter %K sentiment analysis %K large language model %K LLM %K GPT-3.5 %K fine-tuning %D 2025 %7 11.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to hold an important place in the collective memory as of 2024. As of March 2024, >676 million cases, 6 million deaths, and 13 billion vaccine doses have been reported. It is crucial to evaluate sociopsychological impacts as well as public health indicators such as these to understand the effects of the COVID-19 pandemic. Objective: This study aimed to explore the sentiments of residents of major US cities toward restrictions on social activities in 2022 during the transitional phase of the COVID-19 pandemic, from the peak of the pandemic to its gradual decline. By illuminating people’s susceptibility to COVID-19, we provide insights into the general sentiment trends during the recovery phase of the pandemic. Methods: To analyze these trends, we collected posts (N=119,437) on the social media platform Twitter (now X) created by people living in New York City, Los Angeles, and Chicago from December 2021 to December 2022, which were impacted by the COVID-19 pandemic in similar ways. A total of 47,111 unique users authored these posts. In addition, for privacy considerations, any identifiable information, such as author IDs and usernames, was excluded, retaining only the text for analysis. Then, we developed a sentiment estimation model by fine-tuning a large language model on the collected data and used it to analyze how citizens’ sentiments evolved throughout the pandemic. Results: In the evaluation of models, GPT-3.5 Turbo with fine-tuning outperformed GPT-3.5 Turbo without fine-tuning and Robustly Optimized Bidirectional Encoder Representations from Transformers Pretraining Approach (RoBERTa)–large with fine-tuning, demonstrating significant accuracy (0.80), recall (0.79), precision (0.79), and F1-score (0.79). The findings using GPT-3.5 Turbo with fine-tuning reveal a significant relationship between sentiment levels and actual cases in all 3 cities. Specifically, the correlation coefficient for New York City is 0.89 (95% CI 0.81-0.93), for Los Angeles is 0.39 (95% CI 0.14-0.60), and for Chicago is 0.65 (95% CI 0.47-0.78). Furthermore, feature words analysis showed that COVID-19–related keywords were replaced with non–COVID-19-related keywords in New York City and Los Angeles from January 2022 onward and Chicago from March 2022 onward. Conclusions: The results show a gradual decline in sentiment and interest in restrictions across all 3 cities as the pandemic approached its conclusion. These results are also ensured by a sentiment estimation model fine-tuned on actual Twitter posts. This study represents the first attempt from a macro perspective to depict sentiment using a classification model created with actual data from the period when COVID-19 was prevalent. This approach can be applied to the spread of other infectious diseases by adjusting search keywords for observational data. %M 39932775 %R 10.2196/63824 %U https://www.jmir.org/2025/1/e63824 %U https://doi.org/10.2196/63824 %U http://www.ncbi.nlm.nih.gov/pubmed/39932775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63910 %T Public Health Messaging on Twitter During the COVID-19 Pandemic: Observational Study %A Rao,Ashwin %A Sabri,Nazanin %A Guo,Siyi %A Raschid,Louiqa %A Lerman,Kristina %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way STE 1001, Marina del Rey, CA, 90292, United States, 1 2135050363, mohanrao@usc.edu %K public health %K public health messaging %K COVID-19 %K Twitter %K emotions %K moral foundations %K polarization %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is crucial during health crises, and social media has become a prominent platform for public health experts (PHEs) to share information and engage with the public. At the same time, social media also provides a platform for pseudoexperts who may spread contrarian views. Despite the importance of social media, key elements of communication, such as the use of moral or emotional language and messaging strategy, particularly during the emergency phase of the COVID-19 pandemic, have not been explored. Objective: This study aimed to analyze how PHEs and pseudoexperts communicated with the public during the emergency phase of the COVID-19 pandemic. We focused on the emotional and moral language used in their messages on various COVID-19 pandemic–related topics. We also analyzed their interactions with political elites and the public’s engagement with PHEs to gain a deeper understanding of their influence on public discourse. Methods: For this observational study, we gathered a dataset of >539,000 original posts or reposts from 489 PHEs and 356 pseudoexperts on Twitter (subsequently rebranded X) from January 2020 to January 2021, along with the replies to the original posts from the PHEs. We identified the key issues that PHEs and pseudoexperts prioritized. We also determined the emotional and moral language in both the original posts and the replies. This allows us to characterize priorities for PHEs and pseudoexperts as well as differences in messaging strategy between these 2 groups. We also evaluated the influence of PHEs’ language and strategy on the public response. Results: Our analyses revealed that PHEs focused more on masking, health care, education, and vaccines, whereas pseudoexperts discussed therapeutics and lockdowns more frequently (P<.001). PHEs typically used positive emotional language across all issues (P<.001), expressing optimism and joy. Pseudoexperts often used negative emotions of pessimism and disgust, while limiting positive emotional language to origins and therapeutics (P<.001). Along the dimensions of moral language, PHEs and pseudoexperts differed on care versus harm and authority versus subversion across different issues. Negative emotional and moral language tends to boost engagement in COVID-19 discussions across all issues. However, the use of positive language by PHEs increases the use of positive language in the public responses. PHEs act as liberal partisans: they express more positive affect in their posts directed at liberals and more negative affect in their posts directed at conservative elites. In contrast, pseudoexperts act as conservative partisans. These results provide nuanced insights into the elements that have polarized the COVID-19 discourse. Conclusions: Understanding the nature of the public response to PHEs’ messages on social media is essential for refining communication strategies during health crises. Our findings underscore the importance of using moral-emotional language strategically to reduce polarization and build trust. %M 39908546 %R 10.2196/63910 %U https://www.jmir.org/2025/1/e63910 %U https://doi.org/10.2196/63910 %U http://www.ncbi.nlm.nih.gov/pubmed/39908546 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e55642 %T When Infodemic Meets Epidemic: Systematic Literature Review %A Asaad,Chaimae %A Khaouja,Imane %A Ghogho,Mounir %A Baïna,Karim %+ TICLab, College of Engineering and Architecture, International University of Rabat, Shore Rocade, Rocade S, Rabat, Salé, 11103, Morocco, 212 (5)30112063, chaimae.asaad@uir.ac.ma %K epidemics %K social media %K epidemic surveillance %K misinformation %K mental health %D 2025 %7 3.2.2025 %9 Review %J JMIR Public Health Surveill %G English %X Background: Epidemics and outbreaks present arduous challenges, requiring both individual and communal efforts. The significant medical, emotional, and financial burden associated with epidemics creates feelings of distrust, fear, and loss of control, making vulnerable populations prone to exploitation and manipulation through misinformation, rumors, and conspiracies. The use of social media sites has increased in the last decade. As a result, significant amounts of public data can be leveraged for biosurveillance. Social media sites can also provide a platform to quickly and efficiently reach a sizable percentage of the population; therefore, they have a potential role in various aspects of epidemic mitigation. Objective: This systematic literature review aimed to provide a methodical overview of the integration of social media in 3 epidemic-related contexts: epidemic monitoring, misinformation detection, and the relationship with mental health. The aim is to understand how social media has been used efficiently in these contexts, and which gaps need further research efforts. Methods: Three research questions, related to epidemic monitoring, misinformation, and mental health, were conceptualized for this review. In the first PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) stage, 13,522 publications were collected from several digital libraries (PubMed, IEEE Xplore, ScienceDirect, SpringerLink, MDPI, ACM, and ACL) and gray literature sources (arXiv and ProQuest), spanning from 2010 to 2022. A total of 242 (1.79%) papers were selected for inclusion and were synthesized to identify themes, methods, epidemics studied, and social media sites used. Results: Five main themes were identified in the literature, as follows: epidemic forecasting and surveillance, public opinion understanding, fake news identification and characterization, mental health assessment, and association of social media use with psychological outcomes. Social media data were found to be an efficient tool to gauge public response, monitor discourse, identify misleading and fake news, and estimate the mental health toll of epidemics. Findings uncovered a need for more robust applications of lessons learned from epidemic “postmortem documentation.” A vast gap exists between retrospective analysis of epidemic management and result integration in prospective studies. Conclusions: Harnessing the full potential of social media in epidemic-related tasks requires streamlining the results of epidemic forecasting, public opinion understanding, and misinformation detection, all while keeping abreast of potential mental health implications. Proactive prevention has thus become vital for epidemic curtailment and containment. %R 10.2196/55642 %U https://publichealth.jmir.org/2025/1/e55642 %U https://doi.org/10.2196/55642 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 5 %N %P e50021 %T Unraveling the Use of Disinformation Hashtags by Social Bots During the COVID-19 Pandemic: Social Networks Analysis %A Suarez-Lledo,Victor %A Ortega-Martin,Esther %A Carretero-Bravo,Jesus %A Ramos-Fiol,Begoña %A Alvarez-Galvez,Javier %+ Computational Social Science DataLab, University Institute of Research for Sustainable Social Development (INDESS), University of Cadiz, Avda. de la Universidad, 4, Jerez de la Frontera, 11406, Spain, 34 956167216, victor.sanz@uca.es %K social media %K misinformation %K COVID-19 %K bot %K hashtags %K disinformation %K network analysis %K community detection %K dissemination %K decision-making %K social bot %K infodemics %K tweets %K social media network %D 2025 %7 9.1.2025 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, social media platforms have been a venue for the exchange of messages, including those related to fake news. There are also accounts programmed to disseminate and amplify specific messages, which can affect individual decision-making and present new challenges for public health. Objective: This study aimed to analyze how social bots use hashtags compared to human users on topics related to misinformation during the outbreak of the COVID-19 pandemic. Methods: We selected posts on specific topics related to infodemics such as vaccines, hydroxychloroquine, military, conspiracy, laboratory, Bill Gates, 5G, and UV. We built a network based on the co-occurrence of hashtags and classified the posts based on their source. Using network analysis and community detection algorithms, we identified hashtags that tend to appear together in messages. For each topic, we extracted the most relevant subtopic communities, which are groups of interconnected hashtags. Results: The distribution of bots and nonbots in each of these communities was uneven, with some sets of hashtags being more common among accounts classified as bots or nonbots. Hashtags related to the Trump and QAnon social movements were common among bots, and specific hashtags with anti-Asian sentiments were also identified. In the subcommunities most populated by bots in the case of vaccines, the group of hashtags including #billgates, #pandemic, and #china was among the most common. Conclusions: The use of certain hashtags varies depending on the source, and some hashtags are used for different purposes. Understanding these patterns may help address the spread of health misinformation on social media networks. %M 39786891 %R 10.2196/50021 %U https://infodemiology.jmir.org/2025/1/e50021 %U https://doi.org/10.2196/50021 %U http://www.ncbi.nlm.nih.gov/pubmed/39786891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56651 %T Wellness Influencer Responses to COVID-19 Vaccines on Social Media: A Longitudinal Observational Study %A O'Brien,Gabrielle %A Ganjigunta,Ronith %A Dhillon,Paramveer S %+ School of Information, University of Michigan, 105 S. State Street, Ann Arbor, MI, 48103, United States, 1 (734) 764 1555, elleobri@umich.edu %K social media, COVID-19, vaccination %K personal brands %K public health %K wellness %K global health %K pandemic %K Twitter %K tweets %K vaccine %K longitudinal design %K wellness influencers %K hand-annotation %K anti-vaccination %K infodemiology %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Online wellness influencers (individuals dispensing unregulated health and wellness advice over social media) may have incentives to oppose traditional medical authorities. Their messaging may decrease the overall effectiveness of public health campaigns during global health crises like the COVID-19 pandemic. Objective: This study aimed to probe how wellness influencers respond to a public health campaign; we examined how a sample of wellness influencers on Twitter (rebranded as X in 2023) identified before the COVID-19 pandemic on Twitter took stances on the COVID-19 vaccine during 2020-2022. We evaluated the prevalence of provaccination messaging among wellness influencers compared with a control group, as well as the rhetorical strategies these influencers used when supporting or opposing vaccination. Methods: Following a longitudinal design, wellness influencer accounts were identified on Twitter from a random sample of tweets posted in 2019. Accounts were identified using a combination of topic modeling and hand-annotation for adherence to influencer criteria. Their tweets from 2020-2022 containing vaccine keywords were collected and labeled as pro- or antivaccination stances using a language model. We compared their stances to a control group of noninfluencer accounts that discussed similar health topics before the pandemic using a generalized linear model with mixed effects and a nearest-neighbors classifier. We also used topic modeling to locate key themes in influencer’s pro- and antivaccine messages. Results: Wellness influencers (n=161) had lower rates of provaccination stances in their on-topic tweets (20%, 614/3045) compared with controls (n=242 accounts, with 42% or 3201/7584 provaccination tweets). Using a generalized linear model of tweet stance with mixed effects to model tweets from the same account, the main effect of the group was significant (β1=–2.2668, SE=0.2940; P<.001). Covariate analysis suggests an association between antivaccination tweets and accounts representing individuals (β=–0.9591, SE=0.2917; P=.001) but not social network position. A complementary modeling exercise of stance within user accounts showed a significant difference in the proportion of antivaccination users by group (χ21[N=321]=36.1, P<.001). While nearly half of the influencer accounts were labeled by a K-nearest neighbor classifier as predominantly antivaccination (48%, 58/120), only 16% of control accounts were labeled this way (33/201). Topic modeling of influencer tweets showed that the most prevalent antivaccination themes were protecting children, guarding against government overreach, and the corruption of the pharmaceutical industry. Provaccination messaging tended to encourage followers to take action or emphasize the efficacy of the vaccine. Conclusions: Wellness influencers showed higher rates of vaccine opposition compared with other accounts that participated in health discourse before the pandemic. This pattern supports the theory that unregulated wellness influencers have incentives to resist messaging from establishment authorities such as public health agencies. %M 39602782 %R 10.2196/56651 %U https://www.jmir.org/2024/1/e56651 %U https://doi.org/10.2196/56651 %U http://www.ncbi.nlm.nih.gov/pubmed/39602782 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e56675 %T Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study %A Helgeson,Scott A %A Mudgalkar,Rohan M %A Jacobs,Keith A %A Lee,Augustine S %A Sanghavi,Devang %A Moreno Franco,Pablo %A Brooks,Ian S %A , %+ Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, United States, 1 9049532000, helgeson.scott@mayo.edu %K social media %K infodemic %K COVID-19 %K healthcare utilization %K misinformation %K disinformation %K Twitter %K hydroxychloroquine %K X %K drugs %K pharmacy %K pharmacology %K pharmacotherapy %K pharmaceuticals %K medication %K prescription %K sentiment %K SARS-CoV-2 %K pandemic %K respiratory %K infectious %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information. Objective: We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting. Methods: In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter’s data, and focused on mentions of “hydroxychloroquine” and “Plaquenil.” Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch’s sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression. Results: A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study’s period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates. Conclusions: During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms. %M 39556417 %R 10.2196/56675 %U https://infodemiology.jmir.org/2024/1/e56675 %U https://doi.org/10.2196/56675 %U http://www.ncbi.nlm.nih.gov/pubmed/39556417 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58378 %T Evaluation of Drug and Herbal Medicinal Promotions on Social Media During the COVID-19 Pandemic in Relation to World Health Organization Ethical Criteria and South African Health Products Regulatory Authority Guidelines in South Africa: Cross-Sectional Content Analysis %A Chimukuche,Rujeko Samanthia %A Ndlazi,Julia %A Mtolo,Lucky Thembani %A Bird,Kristien %A Seeley,Janet %+ Social Sciences Core, Africa Health Research Institute, Nelson R Mandela School of Medicine, 3rd Floor, K-RITH Tower Building, 719 Umbilo Road, Durban, 4013, South Africa, 27 31 521 0038, rujeko.chidawanyika@ahri.org %K drug advertising %K internet %K social media %K ethical guidelines %K traditional medicine %K COVID-19 %D 2024 %7 18.9.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Consideration of ethics in the promotion of medications is essential to safeguard the health of consumers, particularly during health crises. The World Health Organization (WHO) and the South African Health Products Regulatory Authority (SAHPRA) have established stringent standards to ensure the integrity of pharmaceutical promotions and safeguard public health, including advertisements on the internet and social media platforms. However, the dynamic nature of online advertising poses challenges for monitoring and enforcing ethical standards. Objective: The study aimed (1) to examine the COVID-19 drug and medicinal promotions across online platforms and social media from 2020 to 2022 in South Africa and (2) to ensure that drug promotions adhere to ethical guidelines outlined by the WHO and SAPHRA. Methods: A cross-sectional content analysis was conducted to assess drug and medicinal advertisements across various internet and social media platforms. A systematic approach was used to identify and analyze promotional content, focusing on adherence to ethical guidelines outlined by WHO and SAPHRA. Data were collected and analyzed to determine the extent of compliance and identify any potential violations or areas for improvement. Results: A total of 14 online drug advertisements were included in this analysis. Our findings show that most of the drugs advertised did not meet the regulations and guidelines provided by WHO and SAHPRA. There were omissions about active ingredients, proprietary names, adverse drug responses, precautions, and overdosage and adverse drug reactions. Traditional medicines were not fully consistent with the approved WHO ethical criteria data sheet. Conclusions: Our analysis highlights the critical importance of ensuring compliance with ethical guidelines in drug promotions on the internet and social media platforms. There is a need for continued vigilance and enforcement efforts to uphold ethical standards and protect the health of the public. Ongoing monitoring and collaboration between national drug regulatory agencies, pharmaceutical companies, and online platforms will be essential for promoting responsible advertising. In addition, safety monitoring and pharmacovigilance systems for herbal medicinal products are yet to be established. %M 39293046 %R 10.2196/58378 %U https://ojphi.jmir.org/2024/1/e58378 %U https://doi.org/10.2196/58378 %U http://www.ncbi.nlm.nih.gov/pubmed/39293046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56931 %T A Comprehensive Analysis of COVID-19 Misinformation, Public Health Impacts, and Communication Strategies: Scoping Review %A Kisa,Sezer %A Kisa,Adnan %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass, Oslo, 0130, Norway, 47 92501403, sezerkisa@hotmail.com %K communication strategies %K COVID-19 %K infodemic %K misinformation %K public health %D 2024 %7 21.8.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic was marked by an infodemic, characterized by the rapid spread of both accurate and false information, which significantly affected public health. This infodemic led to confusion, mistrust in health authorities, noncompliance with health guidelines, and engagement in risky health behaviors. Understanding the dynamics of misinformation during the pandemic is crucial for developing effective public health communication strategies. Objective: This comprehensive analysis aimed to examine the complexities of COVID-19 misinformation. Specifically, it sought to identify the sources and themes of misinformation, the target audiences most affected, and the effectiveness of various public health communication strategies in mitigating misinformation. Methods: This scoping review used the MEDLINE (PubMed), Embase, and Scopus databases to identify relevant studies. An established, methodical framework for scoping reviews was used to review literature published between December 2019 and September 2023. The inclusion criteria focused on peer-reviewed studies published in English that address COVID-19 misinformation and its sources, themes, and target audiences, as well as the effectiveness of public health communication strategies. Results: The scoping review identified that misinformation significantly impacted mental health, vaccine hesitancy, and health care decision-making. Social media and traditional media were major conduits for spreading misinformation. Key misinformation themes included the origins of the virus, ineffective treatments, and misunderstandings about public health measures. Misinformation sources ranged from social media platforms to traditional media outlets and informal networks. The impact of misinformation was found to vary across different regions and demographic groups, with vulnerable populations being disproportionately affected. Effective strategies to counter misinformation included enhancing health literacy; using digital technology; promoting clear, authoritative communication; and implementing fact-checking mechanisms. In addition, community engagement and targeted health campaigns played a crucial role in addressing misinformation. Conclusions: The review emphasizes the critical need for accurate and consistent messaging to combat misinformation. Cooperative efforts among policy makers, health professionals, and communication experts are essential for developing effective interventions. Addressing the infodemic is vital for building a well-informed, health-literate society capable of handling misinformation in future global health crises. The study provides valuable insights into the dynamics of misinformation and highlights the importance of robust public health communication strategies. These findings can guide future efforts to mitigate the impact of misinformation during health emergencies. %M 39167790 %R 10.2196/56931 %U https://www.jmir.org/2024/1/e56931 %U https://doi.org/10.2196/56931 %U http://www.ncbi.nlm.nih.gov/pubmed/39167790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49422 %T Retrospecting Digital Media Use, Negative Emotions, and Trust Gaps During the COVID-19 Pandemic in China: Cross-Sectional Web-Based Survey %A Wei,Lu %A Huang,Qing %+ International Communication Institute, College of Media and International Culture, Zhejiang University, 866 Yuhangtang Road, Zijingang Campus, Hangzhou, 310058, China, 86 0571 87075102, qing_huang@zju.edu.cn %K digital media use %K negative emotions %K family members–strangers trust gap %K family members–acquaintances trust gap %K mediation effect %K COVID-19 %D 2024 %7 10.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Retrospecting the trust gaps and their dynamics during the pandemic is crucial for understanding the root causes of postpandemic challenges and offers valuable insights into preparing for future public health emergencies. The COVID-19 pandemic eroded people’s trust in strangers and acquaintances, while their trust in family members remained relatively stable. This resulted in 2 trust gaps, namely, the family members–strangers trust gap and the family members–acquaintances trust gap. Widening trust gaps impede social integration and undermine the effective management of public health crises. However, little is known about how digital media use shaped trust gaps during a pandemic. Objective: This study aims to investigate the relationships between digital media use, negative emotions, the family members–strangers trust gap, and the family members–acquaintances trust gap during the COVID-19 pandemic in China. We test the mediating role of negative emotions between digital media use and 2 trust gaps and compare the indirect effect of digital media use on 2 trust gaps through negative emotions. Methods: A cross-sectional web-based survey was conducted in China between January 31, 2020, and February 9, 2020. A total of 1568 adults participated in the survey. Questions related to digital media use, negative emotions, trust in family members, trust in acquaintances, and trust in strangers during the pandemic were asked. Regression analyses were performed to test the associations between the examined variables. We used a 95% bootstrap CI approach to estimate the mediation effects. Results: Digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), which in turn were positively associated with the family members–strangers trust gap (B=0.15, SE 0.03; P<.001). Likewise, digital media use was positively associated with negative emotions (B=0.17, SE 0.03; P<.001), while negative emotions were positively associated with the family members–acquaintances trust gap (B=0.08, SE 0.03; P=.01). Moreover, the indirect effect of digital media use on the family members–strangers trust gap (B=0.03, SE 0.01; 95% CI 0.01-0.04) was stronger than that on the family members–acquaintances trust gap (B=0.01, SE 0.01; 95% CI 0.003-0.027). Conclusions: The results demonstrate that negative emotions resulting from the frequent use of digital media are a key factor that accounts for the widening trust gaps. Considering the increasing reliance on digital media, the findings indicate that the appropriate use of digital media can prevent the overamplification of negative emotions and curb the enlargement of trust gaps. This may help restore social trust and prepare for future public health crises in the postpandemic era. %M 38986127 %R 10.2196/49422 %U https://www.jmir.org/2024/1/e49422 %U https://doi.org/10.2196/49422 %U http://www.ncbi.nlm.nih.gov/pubmed/38986127 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e45546 %T A Serious Game (“Fight With Virus”) for Preventing COVID-19 Health Rumors: Development and Experimental Study %A Xiong,Shuo %A Zuo,Long %A Chen,Qiwei %A Zeliang,Zhang %A Nor Akmal Khalid,Mohd %+ Philosophy and Social Sciences Laboratory of Big Data and National Communication Strategy, Huazhong University of Science and Technology, Building 6, No 1037, Luoyu Road, Wuhan, 430074, China, 86 15927188806, xiongshuo@hust.edu.cn %K serious game %K COVID-19 %K health rumor %K game communication %K game TCP model %K Transmission Control Protocol %K gaming %K misinformation %K disinformation %K rumor %K health communication %K false information %K elder %K older adult %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors. Objective: This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders. Methods: This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named “Fight With Virus” as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved. Results: We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games. Conclusions: Compared to traditional media, serious games can effectively improve midelders’/elders’ cognitive abilities while they face a health rumor. The gameplay effect is related to the individual’s age and educational background, while income and gender have no impact. %M 38407954 %R 10.2196/45546 %U https://games.jmir.org/2024/1/e45546 %U https://doi.org/10.2196/45546 %U http://www.ncbi.nlm.nih.gov/pubmed/38407954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38323 %T Ontarians’ Perceptions of Public Health Communications and Misinformation During the COVID-19 Pandemic: Survey Study %A Fahim,Christine %A Cooper,Jeanette %A Theivendrampillai,Suvabna %A Pham,Ba' %A Straus,Sharon %+ Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada, 1 416 360 4000 ext 77300, christine.fahim@unityhealth.to %K misinformation %K information seeking %K COVID-19 %K trust %K dissemination %K health communication %K risk %K communication %K policy maker %K transmission %K health emergency %K age %K gender %K survey %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clear, accurate, and transparent risk communication is critical to providing policy makers and the public with directions to effectively implement public health strategies during a health emergency. Objective: We aimed to explore the public’s preferred sources of obtaining COVID-19 information, perceptions on the prevalence and drivers of misinformation during the pandemic, and suggestions to optimize health communications during future public health emergencies. Methods: We administered a web-based survey that included Likert scale, multiple choice and open-ended response questions to residents of Ontario, Canada. We aimed to recruit a sample that reflected population diversity with respect to age and gender. Data were collected between June 10, 2020, and December 31, 2020, and were analyzed using descriptive statistics; open-ended data were analyzed using content analysis. Subgroup analyses to explore perceptions by age and gender were conducted using ordinal regression. Results: A total of 1823 individuals participated in the survey (n=990, 54% women; n=703, 39% men; n=982, 54% aged 18-40 years; n=518, 28% aged 41-60 years; and n=215, 12% aged ≥61 years). Participants most commonly obtained COVID-19 information from local television news (n=1118, 61%) followed by social media (n=938, 51%), national or international television news (n=888, 49%), and friends and family (n=835, 46%). Approximately 55% (n=1010) of the participants believed they had encountered COVID-19–related misinformation; 70% (n=1284) of the participants reported high levels of trust in health authority websites and health care providers; 66% (n=1211) reported high levels of trust in health ministers or public health organizations. Sources perceived to be less trustworthy included friends and family, talk radio, social media, as well as blogs and opinion websites. Men were more likely to report encountering misinformation and to trust friends or family (odds ratio [OR] 1.49, 95% CI 1.24-1.79) and blogs or opinion websites (OR 1.24, 95% CI 1.03-1.50), compared to women. Compared to those aged 18-40 years, participants aged ≥41years were more likely to trust all assessed information sources, with the exception of web-based media sources, and less likely to report encountering misinformation. Of those surveyed, 58% (n=1053) had challenges identifying or appraising COVID-19 information. Conclusions: Over half of our participants perceived that they had encountered COVID-19 misinformation, and 58% had challenges identifying or appraising COVID-19 information. Gender and age differences in perceptions of misinformation and trust in information sources were observed. Future research to confirm the validity of these perceptions and to explore information-seeking patterns by population subgroups may provide useful insights on how to optimize health communication during public health emergencies. %M 37159394 %R 10.2196/38323 %U https://formative.jmir.org/2023/1/e38323 %U https://doi.org/10.2196/38323 %U http://www.ncbi.nlm.nih.gov/pubmed/37159394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38430 %T A Personalized Avatar-Based Web Application to Help People Understand How Social Distancing Can Reduce the Spread of COVID-19: Cross-sectional, Observational, Pre-Post Study %A Etienne,Doriane %A Archambault,Patrick %A Aziaka,Donovan %A Chipenda-Dansokho,Selma %A Dubé,Eve %A Fallon,Catherine S %A Hakim,Hina %A Kindrachuk,Jason %A Krecoum,Dan %A MacDonald,Shannon E %A Ndjaboue,Ruth %A Noubi,Magniol %A Paquette,Jean-Sébastien %A Parent,Elizabeth %A Witteman,Holly O %+ VITAM – Centre de recherche en santé durable, Université Laval, 2480, Chemin de la Canardière, Québec, QC, G1J 2G1, Canada, 1 418 663 5313 ext 12286, doriane.etienne.1@ulaval.ca %K social distancing %K COVID-19 %K SARS-CoV-2 %K pandemic %K personalized risk communication %K public health %K digital health intervention %K web application %K visualization %K personalized avatar %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: To reduce the transmission of SARS-CoV-2 and the associated spread of COVID-19, many jurisdictions around the world imposed mandatory or recommended social or physical distancing. As a result, at the beginning of the pandemic, various communication materials appeared online to promote distancing. Explanations of the science underlying these mandates or recommendations were either highly technical or highly simplified. Objective: This study aimed to understand the effects of a dynamic visualization on distancing. Our overall aim was to help people understand the dynamics of the spread of COVID-19 in their community and the implications of their own behavior for themselves, those around them, the health care system, and society. Methods: Using Scrum, which is an agile framework; JavaScript (Vue.js framework); and code already developed for risk communication in another context of infectious disease transmission, we rapidly developed a new personalized web application. In our application, people make avatars that represent themselves and the people around them. These avatars are integrated into a 3-minute animation illustrating an epidemiological model for COVID-19 transmission, showing the differences in transmission with and without distancing. During the animation, the narration explains the science of how distancing reduces the transmission of COVID-19 in plain language in English or French. The application offers full captions to complement the narration and a descriptive transcript for people using screen readers. We used Google Analytics to collect standard usage statistics. A brief, anonymous, optional survey also collected self-reported distancing behaviors and intentions in the previous and coming weeks, respectively. We launched and disseminated the application on Twitter and Facebook on April 8, 2020, and April 9, 2020. Results: After 26 days, the application received 3588 unique hits from 82 countries. The optional survey at the end of the application collected 182 responses. Among this small subsample of users, survey respondents were nearly (170/177, 96%) already practicing distancing and indicated that they intended to practice distancing in the coming week (172/177, 97.2%). Among the small minority of people (n=7) who indicated that they had not been previously practicing distancing, 2 (29%) reported that they would practice distancing in the week to come. Conclusions: We developed a web application to help people understand the relationship between individual-level behavior and population-level effects in the context of an infectious disease spread. This study also demonstrates how agile development can be used to quickly create personalized risk messages for public health issues like a pandemic. The nonrandomized design of this rapid study prevents us from concluding the application’s effectiveness; however, results thus far suggest that avatar-based visualizations may help people understand their role in infectious disease transmission. %M 36961787 %R 10.2196/38430 %U https://formative.jmir.org/2023/1/e38430 %U https://doi.org/10.2196/38430 %U http://www.ncbi.nlm.nih.gov/pubmed/36961787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38404 %T Understanding the Public’s Attitudes Toward COVID-19 Vaccines in Nottinghamshire, United Kingdom: Qualitative Social Media Analysis %A Jones,Leah Ffion %A Bonfield,Stefanie %A Farrell,Jade %A Weston,Dale %+ UK Health Security Agency, Manor Farm Road, Porton Down, Salisbury, SP4 0JG, United Kingdom, 44 2084953256, leah.jones@bupa.com %K COVID-19 %K vaccine %K social media %K qualitative %K vaccine hesitancy %K infodemic %K misinformation %K infodemiology %K online health information %K content analysis %K Facebook %K Twitter %K transmission %D 2023 %7 29.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines remain central to the UK government’s plan for tackling the COVID-19 pandemic. Average uptake of 3 doses in the United Kingdom stood at 66.7% as of March 2022; however, this rate varies across localities. Understanding the views of groups who have low vaccine uptake is crucial to guide efforts to improve vaccine uptake. Objective: This study aims to understand the public’s attitudes toward COVID-19 vaccines in Nottinghamshire, United Kingdom. Methods: A qualitative thematic analysis of social media posts from Nottinghamshire-based profiles and data sources was conducted. A manual search strategy was used to search the Nottingham Post website and local Facebook and Twitter accounts from September 2021 to October 2021. Only comments in the public domain and in English were included in the analysis. Results: A total of 3508 comments from 1238 users on COVID-19 vaccine posts by 10 different local organizations were analyzed, and 6 overarching themes were identified: trust in the vaccines, often characterized by a lack of trust in vaccine information, information sources including the media, and the government; beliefs about safety including doubts about the speed of development and approval process, the severity of side effects, and belief that the ingredients are harmful; belief that the vaccines are not effective as people can still become infected and spread the virus and that the vaccines may increase transmission through shedding; belief that the vaccines are not necessary due to low perceived risk of death and severe outcomes and use of other protective measures such as natural immunity, ventilation, testing, face coverings, and self-isolation; individual rights and freedoms to be able to choose to be vaccinated or not without judgement or discrimination; and barriers to physical access. Conclusions: The findings revealed a wide range of beliefs and attitudes toward COVID-19 vaccination. Implications for the vaccine program in Nottinghamshire include communication strategies delivered by trusted sources to address the gaps in knowledge identified while acknowledging some negatives such as side effects alongside emphasizing the benefits. These strategies should avoid perpetuating myths and avoid using scare tactics when addressing risk perceptions. Accessibility should also be considered with a review of current vaccination site locations, opening hours, and transport links. Additional research may benefit from using qualitative interviews or focus groups to further probe on the themes identified and explore the acceptability of the recommended interventions. %M 36812390 %R 10.2196/38404 %U https://www.jmir.org/2023/1/e38404 %U https://doi.org/10.2196/38404 %U http://www.ncbi.nlm.nih.gov/pubmed/36812390 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e38390 %T Detecting Tweets Containing Cannabidiol-Related COVID-19 Misinformation Using Transformer Language Models and Warning Letters From Food and Drug Administration: Content Analysis and Identification %A Turner,Jason %A Kantardzic,Mehmed %A Vickers-Smith,Rachel %A Brown,Andrew G %+ Data Mining Lab, Department of Computer Science and Engineering, Speed School of Engineering, University of Louisville, Louisville, KY, 40292, United States, 1 859 302 0189, jason.turner@louisville.edu %K transformer %K misinformation %K deep learning %K COVID-19 %K infodemic %K pandemic %K language model %K health information %K social media %K Twitter %K content analysis %K cannabidiol %K sentence vector %K infodemiology %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: COVID-19 has introduced yet another opportunity to web-based sellers of loosely regulated substances, such as cannabidiol (CBD), to promote sales under false pretenses of curing the disease. Therefore, it has become necessary to innovate ways to identify such instances of misinformation. Objective: We sought to identify COVID-19 misinformation as it relates to the sales or promotion of CBD and used transformer-based language models to identify tweets semantically similar to quotes taken from known instances of misinformation. In this case, the known misinformation was the publicly available Warning Letters from Food and Drug Administration (FDA). Methods: We collected tweets using CBD- and COVID-19–related terms. Using a previously trained model, we extracted the tweets indicating commercialization and sales of CBD and annotated those containing COVID-19 misinformation according to the FDA definitions. We encoded the collection of tweets and misinformation quotes into sentence vectors and then calculated the cosine similarity between each quote and each tweet. This allowed us to establish a threshold to identify tweets that were making false claims regarding CBD and COVID-19 while minimizing the instances of false positives. Results: We demonstrated that by using quotes taken from Warning Letters issued by FDA to perpetrators of similar misinformation, we can identify semantically similar tweets that also contain misinformation. This was accomplished by identifying a cosine distance threshold between the sentence vectors of the Warning Letters and tweets. Conclusions: This research shows that commercial CBD or COVID-19 misinformation can potentially be identified and curbed using transformer-based language models and known prior instances of misinformation. Our approach functions without the need for labeled data, potentially reducing the time at which misinformation can be identified. Our approach shows promise in that it is easily adapted to identify other forms of misinformation related to loosely regulated substances. %M 36844029 %R 10.2196/38390 %U https://infodemiology.jmir.org/2023/1/e38390 %U https://doi.org/10.2196/38390 %U http://www.ncbi.nlm.nih.gov/pubmed/36844029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38949 %T Empowering Health Care Workers on Social Media to Bolster Trust in Science and Vaccination During the Pandemic: Making IMPACT Using a Place-Based Approach %A Jain,Shikha %A Dhaon,Serena R %A Majmudar,Shivani %A Zimmermann,Laura J %A Mordell,Lisa %A Walker,Garth %A Wallia,Amisha %A Akbarnia,Halleh %A Khan,Ali %A Bloomgarden,Eve %A Arora,Vineet M %+ Department of Medicine, University of Illinois at Chicago, 1740 W Taylor St, Chicago, IL, 60612, United States, 1 773 960 2567, sjain03@gmail.com %K misinformation %K COVID-19 %K place-based %K infodemic %K infographic %K social media %K advocacy %K infodemiology %K vaccination %K health care worker %K policy maker %K health policy %K community health %D 2022 %7 17.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the widespread and concerted efforts to propagate health misinformation on social media, particularly centered around vaccination during the pandemic, many groups of clinicians and scientists were organized on social media to tackle misinformation and promote vaccination, using a national or international lens. Although documenting the impact of such social media efforts, particularly at the community level, can be challenging, a more hyperlocal or “place-based approach” for social media campaigns could be effective in tackling misinformation and improving public health outcomes at a community level. Objective: We aimed to describe and document the effectiveness of a place-based strategy for a coordinated group of Chicago health care workers on social media to tackle misinformation and improve vaccination rates in the communities they serve. Methods: The Illinois Medical Professionals Action Collaborative Team (IMPACT) was founded in March 2020 in response to the COVID-19 pandemic, with representatives from major academic teaching hospitals in Chicago (eg, University of Chicago, Northwestern University, University of Illinois, and Rush University) and community-based organizations. Through crowdsourcing on multiple social media platforms (eg, Facebook, Twitter, and Instagram) with a place-based approach, IMPACT engaged grassroots networks of thousands of Illinois health care workers and the public to identify gaps, needs, and viewpoints to improve local health care delivery during the pandemic. Results: To address vaccine misinformation, IMPACT created 8 “myth debunking” infographics and a “vaccine information series” of 14 infographics that have generated >340,000 impressions and informed the development of vaccine education for the Chicago Public Libraries. IMPACT delivered 13 policy letters focusing on different topics, such as health care worker personal protective equipment, universal masking, and vaccination, with >4000 health care workers signatures collected through social media and delivered to policy makers; it published over 50 op-eds on COVID-19 topics in high-impact news outlets and contributed to >200 local and national news features. Using the crowdsourcing approach on IMPACT social media channels, IMPACT mobilized health care and lay volunteers to staff >400 vaccine events for >120,000 individuals, many in Chicago’s hardest-hit neighborhoods. The group’s recommendations have influenced public health awareness campaigns and initiatives, as well as research, advocacy, and policy recommendations, and they have been recognized with local and national awards. Conclusions: A coordinated group of health care workers on social media, using a hyperlocal place-based approach, can not only work together to address misinformation but also collaborate to boost vaccination rates in their surrounding communities. %M 35917489 %R 10.2196/38949 %U https://www.jmir.org/2022/10/e38949 %U https://doi.org/10.2196/38949 %U http://www.ncbi.nlm.nih.gov/pubmed/35917489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37846 %T Public Health Information Seeking, Trust, and COVID-19 Prevention Behaviors: Cross-sectional Study %A Tetteh,Emmanuel Kwabena %A Combs,Todd %A Geng,Elvin Hsing %A McKay,Virginia Ruth %+ Center for Public Health Systems Science, Washington University in St Louis, One Brookings Drive, St Louis, MO, 63130, United States, 1 314 935 5740, virginia.mckay@wustl.edu %K COVID-19 %K public health %K health communication %K trust and mistrust %K disease prevention %K health measure %K health information %K cross-sectional study %K Health Belief Model %D 2022 %7 30.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Preventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People’s attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information. Objective: The aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States. Methods: We conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ≥18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19–related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources. Results: Of the 1650 eligible participants, the majority (n=1381, 83.7%) had sought or received COVID-19–related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1% increase in preventative behaviors for every 12% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors. Conclusions: Trust in COVID-19 information increases an individual’s likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks. %M 36084197 %R 10.2196/37846 %U https://www.jmir.org/2022/9/e37846 %U https://doi.org/10.2196/37846 %U http://www.ncbi.nlm.nih.gov/pubmed/36084197 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38070 %T Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration %A Maragh-Bass,Allysha %A Comello,Maria Leonora %A Tolley,Elizabeth Ellen %A Stevens Jr,Darrell %A Wilson,Jade %A Toval,Christina %A Budhwani,Henna %A Hightow-Weidman,Lisa %+ Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, 359 Blackwell Street #200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11966, AMaraghBass@fhi360.org %K young Black adults %K COVID-19 %K vaccine hesitancy %K digital storytelling %K community-based participatory research %K digital health intervention %D 2022 %7 26.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite high rates of novel COVID-19, acceptance of COVID-19 vaccination is low among Black adults. In response, we developed a digital health intervention (Tough Talks-COVID) that includes digital stories created in a workshop we held with young Black adults. Objective: Our formative research using digital storytelling workshops asked 3 research questions: (1) What issues did participants have in conceptualizing their stories, and what themes emerged from the stories they created? (2) What issues did participants have related to production techniques, and which techniques were utilized in stories? and (3) Overall, how did participants evaluate their workshop experience? Methods: Participants were workshop-eligible if they were vaccine-accepting based on a baseline survey fielded in late 2021. Final participants (N=11) completed a consent process, all 3 workshops, and a media release form for their digital story. The first 2 workshops provided background information and hands-on digital storytelling skills from pre- to postproduction. The third workshop served as a screening and feedback session for participants’ final videos. Qualitative and quantitative feedback elements were incorporated into all 3 sessions. Results: Digital stories addressed one or more of 4 broad themes: (1) COVID-19 vulnerability, (2) community connections, (3) addressing vaccine hesitancy, and (4) countering vaccine misinformation. Participants incorporated an array of technical approaches, including unique creative elements such as cartoon images and instant messaging tools to convey social interactions around COVID-19 decision-making. Most (9/11, 82%) strongly agreed the digital storytelling workshops were delivered as expected; 10 of 11 agreed (n=5) or strongly agreed (n=5) that they had some ideas about what story to tell by the end of the first workshop, and most (8/11, 73%) strongly agreed they had narrowed down their ideas by workshop two. Of the participants, 9 felt they would very likely (n=6) or likely (n=3) use digital storytelling techniques for personal use in the future, and even more were very likely (n=7) to use the techniques for professional use. Conclusions: Our study is one of the first to incorporate digital storytelling as a central component to a digital health intervention and the only one to do so with exclusive focus on young Black adults. Our emphasis on digital storytelling was shown to be highly acceptable. Similar approaches, including careful consideration of the ethical challenges of community-based participatory approaches, are applicable to other populations experiencing both COVID-19 inequities and marginalization, such as other age demographics and people of color. %M 36155984 %R 10.2196/38070 %U https://formative.jmir.org/2022/9/e38070 %U https://doi.org/10.2196/38070 %U http://www.ncbi.nlm.nih.gov/pubmed/36155984 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38359 %T Co-Development of a Web Application (COVID-19 Social Site) for Long-Term Care Workers (“Something for Us”): User-Centered Design and Participatory Research Study %A Saunders,Catherine H %A Sierpe,Ailyn %A Stevens,Gabrielle %A Elwyn,Glyn %A Cantrell,Matthew %A Engel,Jaclyn %A Gonzalez,Melissa %A Hayward,Martha %A Huebner,Joellen %A Johnson,Lisa %A Jimenez,Alejandro %A Little,Nancy Ruth %A McKenna,Corinne %A Onteeru,Manu %A Oo Khine,May %A Pogue,Jacqueline %A Salinas Vargas,José Luis %A Schmidt,Peter %A Thomeer,Rachael %A , %A Durand,Marie-Anne %+ The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, 1 Medical Center Dr, Lebanon, NH, 03766, United States, 1 (603) 653 0800, catherine.hylas.saunders@dartmouth.edu %K COVID-19 %K vaccine hesitancy %K long-term care %K social media %K web application %K website %K intervention development, information and communications technology %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving confidence in and uptake of COVID-19 vaccines and boosters among long-term care workers (LTCWs) is a crucial public health goal, given their role in the care of elderly people and people at risk. While difficult to reach with workplace communication interventions, most LTCWs regularly use social media and smartphones. Various social media interventions have improved attitudes and uptake for other vaccines and hold promise for the LTCW population. Objective: We aimed to develop a curated social web application (interactive website) to increase COVID-19 vaccine confidence (a 3-arm randomized trial is underway). Methods: Following user-centric design and participatory research approaches, we undertook the following 3 steps: (1) content identification, (2) platform development, and (3) community building. A LTCW and stakeholder advisory group provided iterative input. For content identification (step 1), we identified topics of concern about COVID-19 vaccines via desktop research (published literature, public opinion polls, and social media monitoring), refined by interviewing and polling LTCWs. We also conducted a national online panel survey. We curated and fact-checked posts from popular social media platforms that addressed the identified concerns. During platform development (step 2), we solicited preferences for design and functionality via interviews and user experience testing with LTCWs. We also identified best practices for online community building (step 3). Results: In the interviews (n=9), we identified 3 themes: (1) LTCWs are proud of their work but feel undervalued; (2) LTCWs have varying levels of trust in COVID-19–related information; and (3) LTCWs would welcome a curated COVID-19 resource that is easy to understand and use-"something for us". Through desktop research, LTCW interviews, and our national online panel survey (n=592) we found that participants are interested in information about COVID-19 in general, vaccine benefits, vaccine risks, and vaccine development. Content identification resulted in 434 posts addressing these topic areas, with 209 uploaded to the final web application. Our LTCW poll (n=8) revealed preferences for personal stories and video content. The platform we developed is an accessible WordPress-based social media web application, refined through formal (n=3) and informal user experience testing. Users can sort posts by topic or subtopic and react to or comment on posts. To build an online community, we recruited 3 LTCW “community ambassadors” and instructed them to encourage discussion, acknowledge concerns, and offer factual information on COVID-19 vaccines. We also set “community standards” for the web application. Conclusions: An iterative, user-centric, participatory approach led to the launch of an accessible social media web application with curated content for COVID-19 vaccines targeting LTCWs in the United States. Through our trial, we will determine if this approach successfully improves vaccine confidence. If so, a similar social media resource could be used to develop curated social media interventions in other populations and with other public health goals. %M 35926074 %R 10.2196/38359 %U https://www.jmir.org/2022/9/e38359 %U https://doi.org/10.2196/38359 %U http://www.ncbi.nlm.nih.gov/pubmed/35926074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38944 %T Social Media News Use and COVID-19 Misinformation Engagement: Survey Study %A Ahmed,Saifuddin %A Rasul,Muhammad Ehab %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, #03-43, Singapore, 637718, Singapore, 65 63168910, sahmed@ntu.edu.sg %K COVID-19 %K misinformation %K personality %K cognitive ability %K social media %K Singapore %D 2022 %7 20.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is widely used as a source of news and information regarding COVID-19. However, the abundance of misinformation on social media platforms has raised concerns regarding the spreading infodemic. Accordingly, many have questioned the utility and impact of social media news use on users’ engagement with (mis)information. Objective: This study offers a conceptual framework for how social media news use influences COVID-19 misinformation engagement. More specifically, we examined how news consumption on social media leads to COVID-19 misinformation sharing by inducing belief in such misinformation. We further explored if the effects of social media news use on COVID-19 misinformation engagement depend on individual differences in cognition and personality traits. Methods: We used data from an online survey panel administered by a survey agency (Qualtrics) in Singapore. The survey was conducted in March 2022, and 500 respondents answered the survey. All participants were older than 21 years and provided consent before taking part in the study. We used linear regression, mediation, and moderated mediation analyses to explore the proposed relationships between social media news use, cognitive ability, personality traits, and COVID-19 misinformation belief and sharing intentions. Results: The results suggested that those who frequently used social media for news consumption were more likely to believe COVID-19 misinformation and share it on social media. Further probing the mechanism suggested that social media news use translated into sharing intent via the perceived accuracy of misinformation. Simply put, social media news users shared COVID-19 misinformation because they believed it to be accurate. We also found that those with high levels of extraversion than those with low levels were more likely to perceive the misinformation to be accurate and share it. Those with high levels of neuroticism and openness than those with low levels were also likely to perceive the misinformation to be accurate. Finally, it was observed that personality traits did not significantly influence misinformation sharing at higher levels of cognitive ability, but low cognitive users largely drove misinformation sharing across personality traits. Conclusions: The reliance on social media platforms for news consumption during the COVID-19 pandemic has amplified, with dire consequences for misinformation sharing. This study shows that increased social media news consumption is associated with believing and sharing COVID-19 misinformation, with low cognitive users being the most vulnerable. We offer recommendations to newsmakers, social media moderators, and policymakers toward efforts in limiting COVID-19 misinformation propagation and safeguarding citizens. %M 36067414 %R 10.2196/38944 %U https://www.jmir.org/2022/9/e38944 %U https://doi.org/10.2196/38944 %U http://www.ncbi.nlm.nih.gov/pubmed/36067414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36085 %T Assessing the Role of Social Bots During the COVID-19 Pandemic: Infodemic, Disagreement, and Criticism %A Suarez-Lledo,Victor %A Alvarez-Galvez,Javier %+ Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Av Ana de Viya, Cádiz, 11009, Spain, 34 956019080, victor.sanz@uca.es %K infodemics %K social media %K misinformation %K epidemics %K outbreaks %K COVID-19 %K infodemiology %K health promotion %K pandemic %K chatbot %K social media bot %K Twitter stream %K Botometer %K peer support %D 2022 %7 25.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has changed the way we live and communicate, as well as offering unprecedented opportunities to improve many aspects of our lives, including health promotion and disease prevention. However, there is also a darker side to social media that is not always as evident as its possible benefits. In fact, social media has also opened the door to new social and health risks that are linked to health misinformation. Objective: This study aimed to study the role of social media bots during the COVID-19 outbreak. Methods: The Twitter streaming API was used to collect tweets regarding COVID-19 during the early stages of the outbreak. The Botometer tool was then used to obtain the likelihood of whether each account is a bot or not. Bot classification and topic-modeling techniques were used to interpret the Twitter conversation. Finally, the sentiment associated with the tweets was compared depending on the source of the tweet. Results: Regarding the conversation topics, there were notable differences between the different accounts. The content of nonbot accounts was associated with the evolution of the pandemic, support, and advice. On the other hand, in the case of self-declared bots, the content consisted mainly of news, such as the existence of diagnostic tests, the evolution of the pandemic, and scientific findings. Finally, in the case of bots, the content was mostly political. Above all, there was a general overriding tone of criticism and disagreement. In relation to the sentiment analysis, the main differences were associated with the tone of the conversation. In the case of self-declared bots, this tended to be neutral, whereas the conversation of normal users scored positively. In contrast, bots tended to score negatively. Conclusions: By classifying the accounts according to their likelihood of being bots and performing topic modeling, we were able to segment the Twitter conversation regarding COVID-19. Bot accounts tended to criticize the measures imposed to curb the pandemic, express disagreement with politicians, or question the veracity of the information shared on social media. %M 35839385 %R 10.2196/36085 %U https://www.jmir.org/2022/8/e36085 %U https://doi.org/10.2196/36085 %U http://www.ncbi.nlm.nih.gov/pubmed/35839385 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37367 %T Misinformation About COVID-19 Vaccines on Social Media: Rapid Review %A Skafle,Ingjerd %A Nordahl-Hansen,Anders %A Quintana,Daniel S %A Wynn,Rolf %A Gabarron,Elia %+ Faculty of Health, Welfare, and Organisation, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 69 60 80 00, ingjerd.skafle@hiof.no %K social media %K misinformation %K COVID-19 vaccines %K vaccination hesitancy %K autism spectrum disorder %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: The development of COVID-19 vaccines has been crucial in fighting the pandemic. However, misinformation about the COVID-19 pandemic and vaccines is spread on social media platforms at a rate that has made the World Health Organization coin the phrase infodemic. False claims about adverse vaccine side effects, such as vaccines being the cause of autism, were already considered a threat to global health before the outbreak of COVID-19. Objective: We aimed to synthesize the existing research on misinformation about COVID-19 vaccines spread on social media platforms and its effects. The secondary aim was to gain insight and gather knowledge about whether misinformation about autism and COVID-19 vaccines is being spread on social media platforms. Methods: We performed a literature search on September 9, 2021, and searched PubMed, PsycINFO, ERIC, EMBASE, Cochrane Library, and the Cochrane COVID-19 Study Register. We included publications in peer-reviewed journals that fulfilled the following criteria: original empirical studies, studies that assessed social media and misinformation, and studies about COVID-19 vaccines. Thematic analysis was used to identify the patterns (themes) of misinformation. Narrative qualitative synthesis was undertaken with the guidance of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Statement and the Synthesis Without Meta-analysis reporting guideline. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Ratings of the certainty of evidence were based on recommendations from the Grading of Recommendations Assessment, Development and Evaluation Working Group. Results: The search yielded 757 records, with 45 articles selected for this review. We identified 3 main themes of misinformation: medical misinformation, vaccine development, and conspiracies. Twitter was the most studied social media platform, followed by Facebook, YouTube, and Instagram. A vast majority of studies were from industrialized Western countries. We identified 19 studies in which the effect of social media misinformation on vaccine hesitancy was measured or discussed. These studies implied that the misinformation spread on social media had a negative effect on vaccine hesitancy and uptake. Only 1 study contained misinformation about autism as a side effect of COVID-19 vaccines. Conclusions: To prevent these misconceptions from taking hold, health authorities should openly address and discuss these false claims with both cultural and religious awareness in mind. Our review showed that there is a need to examine the effect of social media misinformation on vaccine hesitancy with a more robust experimental design. Furthermore, this review also demonstrated that more studies are needed from the Global South and on social media platforms other than the major platforms such as Twitter and Facebook. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021277524; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021277524 International Registered Report Identifier (IRRID): RR2-10.31219/osf.io/tyevj %M 35816685 %R 10.2196/37367 %U https://www.jmir.org/2022/8/e37367 %U https://doi.org/10.2196/37367 %U http://www.ncbi.nlm.nih.gov/pubmed/35816685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38395 %T COVID-19 Misinformation and Social Network Crowdfunding: Cross-sectional Study of Alternative Treatments and Antivaccine Mandates %A Shaw,Nathan M %A Hakam,Nizar %A Lui,Jason %A Abbasi,Behzad %A Sudhakar,Architha %A Leapman,Michael S %A Breyer,Benjamin N %+ Department of Urology, University of California, San Francisco, 1001 Potrero Ave, Suite #3A26, San Francisco, CA, 94110, United States, 1 9252859854, shawlah88@gmail.com %K COVID-19 %K misinformation %K infodemic %K social media %K GoFundMe %K vaccine hesitancy %K vaccination %K infodemiology %K campaign %K treatment %K vaccine mandate %K health care %K online health information %D 2022 %7 27.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Crowdfunding is increasingly used to offset the financial burdens of illness and health care. In the era of the COVID-19 pandemic and associated infodemic, the role of crowdfunding to support controversial COVID-19 stances is unknown. Objective: We sought to examine COVID-19–related crowdfunding focusing on the funding of alternative treatments not endorsed by major medical entities, including campaigns with an explicit antivaccine, antimask, or antihealth care stances. Methods: We performed a cross-sectional analysis of GoFundMe campaigns for individuals requesting donations for COVID-19 relief. Campaigns were identified by key word and manual review to categorize campaigns into “Traditional treatments,” “Alternative treatments,” “Business-related,” “Mandate,” “First Response,” and “General.” For each campaign, we extracted basic narrative, engagement, and financial variables. Among those that were manually reviewed, the additional variables of “mandate type,” “mandate stance,” and presence of COVID-19 misinformation within the campaign narrative were also included. COVID-19 misinformation was defined as “false or misleading statements,” where cited evidence could be provided to refute the claim. Descriptive statistics were used to characterize the study cohort. Results: A total of 30,368 campaigns met the criteria for final analysis. After manual review, we identified 53 campaigns (0.17%) seeking funding for alternative medical treatment for COVID-19, including popularized treatments such as ivermectin (n=14, 26%), hydroxychloroquine (n=6, 11%), and vitamin D (n=4, 7.5%). Moreover, 23 (43%) of the 53 campaigns seeking support for alternative treatments contained COVID-19 misinformation. There were 80 campaigns that opposed mandating masks or vaccination, 48 (60%) of which contained COVID-19 misinformation. Alternative treatment campaigns had a lower median amount raised (US $1135) compared to traditional (US $2828) treatments (P<.001) and a lower median percentile of target achieved (11.9% vs 31.1%; P=.003). Campaigns for alternative treatments raised substantially lower amounts (US $115,000 vs US $52,715,000, respectively) and lower proportions of fundraising goals (2.1% vs 12.5%) for alternative versus conventional campaigns. The median goal for campaigns was significantly higher (US $25,000 vs US $10,000) for campaigns opposing mask or vaccine mandates relative to those in support of upholding mandates (P=.04). Campaigns seeking funding to lift mandates on health care workers reached US $622 (0.15%) out of a US $410,000 goal. Conclusions: A small minority of web-based crowdfunding campaigns for COVID-19 were directed at unproven COVID-19 treatments and support for campaigns aimed against masking or vaccine mandates. Approximately half (71/133, 53%) of these campaigns contained verifiably false or misleading information and had limited fundraising success. International Registered Report Identifier (IRRID): RR2-10.1001/jamainternmed.2019.3330 %M 35820053 %R 10.2196/38395 %U https://www.jmir.org/2022/7/e38395 %U https://doi.org/10.2196/38395 %U http://www.ncbi.nlm.nih.gov/pubmed/35820053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38324 %T Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic %A Royan,Regina %A Pendergrast,Tricia Rae %A Del Rios,Marina %A Rotolo,Shannon M %A Trueger,N Seth %A Bloomgarden,Eve %A Behrens,Deanna %A Jain,Shikha %A Arora,Vineet M %+ Department of Emergency Medicine, Northwestern University, 211 E Ontario St, Suite 200, Chicago, IL, 60611, United States, 1 312 694 7000, reginaroyan@me.com %K social media %K combating disinformation %K misinformation %K infodemic %K amplifier %K COVID-19 %K advocacy %K public health communication %K disinformation %K medical information %K health professional amplifier %K healthcare profession %K health care profession %K Twitter %K public communication %K health information %K health promotion %D 2022 %7 22.7.2022 %9 Viewpoint %J J Med Internet Res %G English %X Social media is an important tool for disseminating accurate medical information and combating misinformation (ie, the spreading of false or inaccurate information) and disinformation (ie, spreading misinformation with the intent to deceive). The prolific rise of inaccurate information during a global pandemic is a pressing public health concern. In response to this phenomenon, health professional amplifiers such as IMPACT (Illinois Medical Professional Action Collaborative Team) have been created as a coordinated response to enhance public communication and advocacy around the COVID-19 pandemic. %M 35839387 %R 10.2196/38324 %U https://www.jmir.org/2022/7/e38324 %U https://doi.org/10.2196/38324 %U http://www.ncbi.nlm.nih.gov/pubmed/35839387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38332 %T The Relationship Between Information Sources, Health Literacy, and COVID-19 Knowledge in the COVID-19 Infodemic: Cross-sectional Online Study in Japan %A Inoue,Mami %A Shimoura,Kanako %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-cho, Shogoin Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K COVID-19 infodemic %K information source %K health literacy %K COVID-19 knowledge %K social media %K cross-sectional study %K mass media %K digital media %D 2022 %7 22.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused not only a disease epidemic but also an infodemic. Due to the increased use of the internet and social media, along with the development of communication technology, information has spread faster and farther during the COVID-19 infodemic. Moreover, the increased choice of information sources has made it more difficult to make sound decisions regarding information. Although social media is the most common source of misinformation, other forms of media can also spread misinformation. However, the media sources used by people with high health literacy and COVID-19 knowledge to obtain information are unclear. Furthermore, the association between the use of multiple information sources and health literacy or COVID-19 knowledge is ill-defined. Objective: This study aims to examine the following 3 aspects regarding the COVID-19 infodemic: (1) the relationship between health literacy, COVID-19 knowledge, and the number of information sources used; (2) the impact of media use on health literacy; and (3) the impact of media use on COVID-19 knowledge. Methods: An online cross-sectional study was conducted in November 2021. Participants were 477 individuals aged 20-69 years. After obtaining consent to participate in the study, participants were asked about sociodemographic indicators, sources of health-related information, health literacy, and COVID-19 knowledge. Sources of health-related information were categorized into 4 types: mass media, digital media, social media, and face-to-face communication. The Spearman rank correlation test was conducted to determine the relationship between health literacy, the number of correct answers to COVID-19 knowledge, and the number of information sources used. Multiple regression analysis was conducted with health literacy and the number of correct answers as dependent variables, the 4 media types as independent variables, and age and sex as adjustment variables. Results: Mass media was the most frequently used source of information, followed by digital media, face-to-face communication, and social media. Social media use was significantly higher among individuals aged 20-29 years than among other age groups. Significant positive correlations were found between health literacy, the number of positive responses to COVID-19 knowledge, and the number of information sources used. Multiple linear regression analysis showed that health literacy is associated with access to information from digital media and face-to-face communication. Additionally, COVID-19 knowledge was associated with access to information from mass media, digital media, and face-to-face communication. Conclusions: Health literacy and COVID-19 knowledge could be improved using diverse information sources, especially by providing opportunities to use digital media and face-to-face communication. Furthermore, it may be important to improve health literacy and provide accurate knowledge about COVID-19 to young adults. %M 35839380 %R 10.2196/38332 %U https://www.jmir.org/2022/7/e38332 %U https://doi.org/10.2196/38332 %U http://www.ncbi.nlm.nih.gov/pubmed/35839380 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37142 %T Exploring COVID-19–Related Stressors: Topic Modeling Study %A Leung,Yue Tong %A Khalvati,Farzad %+ Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada, 1 416 813 7910, Farzad.Khalvati@utoronto.ca %K COVID-19 %K natural language processing %K public health informatics %K topic modeling %D 2022 %7 13.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has affected the lives of people globally for over 2 years. Changes in lifestyles due to the pandemic may cause psychosocial stressors for individuals and could lead to mental health problems. To provide high-quality mental health support, health care organizations need to identify COVID-19–specific stressors and monitor the trends in the prevalence of those stressors. Objective: This study aims to apply natural language processing (NLP) techniques to social media data to identify the psychosocial stressors during the COVID-19 pandemic and to analyze the trend in the prevalence of these stressors at different stages of the pandemic. Methods: We obtained a data set of 9266 Reddit posts from the subreddit \rCOVID19_support, from February 14, 2020, to July 19, 2021. We used the latent Dirichlet allocation (LDA) topic model to identify the topics that were mentioned on the subreddit and analyzed the trends in the prevalence of the topics. Lexicons were created for each of the topics and were used to identify the topics of each post. The prevalences of topics identified by the LDA and lexicon approaches were compared. Results: The LDA model identified 6 topics from the data set: (1) “fear of coronavirus,” (2) “problems related to social relationships,” (3) “mental health symptoms,” (4) “family problems,” (5) “educational and occupational problems,” and (6) “uncertainty on the development of pandemic.” According to the results, there was a significant decline in the number of posts about the “fear of coronavirus” after vaccine distribution started. This suggests that the distribution of vaccines may have reduced the perceived risks of coronavirus. The prevalence of discussions on the uncertainty about the pandemic did not decline with the increase in the vaccinated population. In April 2021, when the Delta variant became prevalent in the United States, there was a significant increase in the number of posts about the uncertainty of pandemic development but no obvious effects on the topic of fear of the coronavirus. Conclusions: We created a dashboard to visualize the trend in the prevalence of topics about COVID-19–related stressors being discussed on a social media platform (Reddit). Our results provide insights into the prevalence of pandemic-related stressors during different stages of the COVID-19 pandemic. The NLP techniques leveraged in this study could also be applied to analyze event-specific stressors in the future. %M 35731966 %R 10.2196/37142 %U https://www.jmir.org/2022/7/e37142 %U https://doi.org/10.2196/37142 %U http://www.ncbi.nlm.nih.gov/pubmed/35731966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38523 %T Health Misinformation Across Multiple Digital Ecologies: Qualitative Study of Data From Interviews With International Students %A Bahl,Rashika %A Chang,Shanton %A McKay,Dana %A Buchanan,George %+ School of Computing and Information Systems, University of Melbourne, Grattan Street, Parkville, 3053, Australia, 61 83441583, rashikabahl@gmail.com %K international students %K social media %K COVID-19 %K misinformation %K infodemic %K digital ecology %K health information %K information seeking %K web-based health information %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Transient migrants such as international students have received limited support from host country governments throughout the COVID-19 pandemic. An increase in misinformation, resulting in poor health outcomes for individuals, may impact an already vulnerable group. Objective: Existing research examines the spread of misinformation. Similarly, there is extensive literature on the health information behavior of international students. However, there is a gap in the literature focusing on international students’ interaction with health misinformation. This exploratory research aims to address this gap by examining international students’ interaction with health misinformation during the COVID-19 pandemic. Methods: A total of 11 participants took part in semistructured interviews and a health misinformation-identification exercise via Zoom. The data collected were subjected to qualitative thematic analysis. Multiple rounds of coding, checked by other coders, revealed 2 themes and 6 subthemes. Results: The 2 main themes that emerged were (1) approaches to dealing with health misinformation and (2) how international students navigate across multiple digital ecologies. Results show that international students who draw on multiple digital ecologies for information reliably identify misinformation, suggesting that the use of multiple digital ecologies may have a protective effect against health misinformation. Conclusions: Findings show that international students encounter health misinformation across multiple digital ecologies, and they also compare information across multiple ecologies. This comparison may support them in identifying health misinformation. Thus, the findings of this study combat narratives of international students’ susceptibility to misinformation. %M 35727960 %R 10.2196/38523 %U https://www.jmir.org/2022/7/e38523 %U https://doi.org/10.2196/38523 %U http://www.ncbi.nlm.nih.gov/pubmed/35727960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38418 %T Chatbot-Delivered COVID-19 Vaccine Communication Message Preferences of Young Adults and Public Health Workers in Urban American Communities: Qualitative Study %A Weeks,Rose %A Cooper,Lyra %A Sangha,Pooja %A Sedoc,João %A White,Sydney %A Toledo,Assaf %A Gretz,Shai %A Lahav,Dan %A Martin,Nina %A Michel,Alexandra %A Lee,Jae Hyoung %A Slonim,Noam %A Bar-Zeev,Naor %+ International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N Washington Street 5th Floor, Baltimore, MD, 21231, United States, 1 3478046526, rweeks@jhu.edu %K vaccine hesitancy %K COVID-19 %K chatbots %K AI %K artificial intelligence %K natural language processing %K social media %K vaccine communication %K digital health %K misinformation %K infodemic %K infodemiology %K conversational agent %K public health %K user need %K vaccination %K health communication %K online health information %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated conversational agents, or chatbots, have a role in reinforcing evidence-based guidance delivered through other media and offer an accessible, individually tailored channel for public engagement. In early-to-mid 2021, young adults and minority populations disproportionately affected by COVID-19 in the United States were more likely to be hesitant toward COVID-19 vaccines, citing concerns regarding vaccine safety and effectiveness. Successful chatbot communication requires purposive understanding of user needs. Objective: We aimed to review the acceptability of messages to be delivered by a chatbot named VIRA from Johns Hopkins University. The study investigated which message styles were preferred by young, urban-dwelling Americans as well as public health workers, since we anticipated that the chatbot would be used by the latter as a job aid. Methods: We conducted 4 web-based focus groups with 20 racially and ethnically diverse young adults aged 18-28 years and public health workers aged 25-61 years living in or near eastern-US cities. We tested 6 message styles, asking participants to select a preferred response style for a chatbot answering common questions about COVID-19 vaccines. We transcribed, coded, and categorized emerging themes within the discussions of message content, style, and framing. Results: Participants preferred messages that began with an empathetic reflection of a user concern and concluded with a straightforward, fact-supported response. Most participants disapproved of moralistic or reasoning-based appeals to get vaccinated, although public health workers felt that such strong statements appealing to communal responsibility were warranted. Responses tested with humor and testimonials did not appeal to the participants. Conclusions: To foster credibility, chatbots targeting young people with vaccine-related messaging should aim to build rapport with users by deploying empathic, reflective statements, followed by direct and comprehensive responses to user queries. Further studies are needed to inform the appropriate use of user-customized testimonials and humor in the context of chatbot communication. %M 35737898 %R 10.2196/38418 %U https://www.jmir.org/2022/7/e38418 %U https://doi.org/10.2196/38418 %U http://www.ncbi.nlm.nih.gov/pubmed/35737898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37806 %T Impact of COVID-19 Vaccine Misinformation on Social Media Virality: Content Analysis of Message Themes and Writing Strategies %A Ngai,Cindy Sing Bik %A Singh,Rita Gill %A Yao,Le %+ Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University, AG520b, Kowloon, Hong Kong, 852 27667465, cindy.sb.ngai@polyu.edu.hk %K antivaccine misinformation %K content themes %K writing strategies %K COVID-19 %K virality %K social media %K content analysis %D 2022 %7 6.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines serve an integral role in containing pandemics, yet vaccine hesitancy is prevalent globally. One key reason for this hesitancy is the pervasiveness of misinformation on social media. Although considerable research attention has been drawn to how exposure to misinformation is closely associated with vaccine hesitancy, little scholarly attention has been given to the investigation or robust theorizing of the various content themes pertaining to antivaccine misinformation about COVID-19 and the writing strategies in which these content themes are manifested. Virality of such content on social media exhibited in the form of comments, shares, and reactions has practical implications for COVID-19 vaccine hesitancy. Objective: We investigated whether there were differences in the content themes and writing strategies used to disseminate antivaccine misinformation about COVID-19 and their impact on virality on social media. Methods: We constructed an antivaccine misinformation database from major social media platforms during September 2019-August 2021 to examine how misinformation exhibited in the form of content themes and how these themes manifested in writing were associated with virality in terms of likes, comments, and shares. Antivaccine misinformation was retrieved from two globally leading and widely cited fake news databases, COVID Global Misinformation Dashboard and International Fact-Checking Network Corona Virus Facts Alliance Database, which aim to track and debunk COVID-19 misinformation. We primarily focused on 140 Facebook posts, since most antivaccine misinformation posts on COVID-19 were found on Facebook. We then employed quantitative content analysis to examine the content themes (ie, safety concerns, conspiracy theories, efficacy concerns) and manifestation strategies of misinformation (ie, mimicking of news and scientific reports in terms of the format and language features, use of a conversational style, use of amplification) in these posts and their association with virality of misinformation in the form of likes, comments, and shares. Results: Our study revealed that safety concern was the most prominent content theme and a negative predictor of likes and shares. Regarding the writing strategies manifested in content themes, a conversational style and mimicking of news and scientific reports via the format and language features were frequently employed in COVID-19 antivaccine misinformation, with the latter being a positive predictor of likes. Conclusions: This study contributes to a richer research-informed understanding of which concerns about content theme and manifestation strategy need to be countered on antivaccine misinformation circulating on social media so that accurate information on COVID-19 vaccines can be disseminated to the public, ultimately reducing vaccine hesitancy. The liking of COVID-19 antivaccine posts that employ language features to mimic news or scientific reports is perturbing since a large audience can be reached on social media, potentially exacerbating the spread of misinformation and hampering global efforts to combat the virus. %M 35731969 %R 10.2196/37806 %U https://www.jmir.org/2022/7/e37806 %U https://doi.org/10.2196/37806 %U http://www.ncbi.nlm.nih.gov/pubmed/35731969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38423 %T COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study %A Xue,Haoning %A Gong,Xuanjun %A Stevens,Hannah %+ Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA, 95616, United States, 1 5303048532, hnxue@ucdavis.edu %K COVID-19 vaccine %K fact checking %K misinformation correction %K sentiment analysis %K social media %K COVID-19 %K vaccination %K misinformation %K health information %K online information %K infodemic %K public sentiment %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy. Objective: This work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem. Methods: We collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem. Results: The percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=–0.92, df=21, t=–10.94, 95% CI –0.97 to –0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=–0.62, df=25, t=–3.94, 95% CI –0.81 to –0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95% CI 0.00-0.12, t=2.03, P=.04). Conclusions: The percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media. %M 35671409 %R 10.2196/38423 %U https://www.jmir.org/2022/6/e38423 %U https://doi.org/10.2196/38423 %U http://www.ncbi.nlm.nih.gov/pubmed/35671409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37623 %T Understanding How and by Whom COVID-19 Misinformation is Spread on Social Media: Coding and Network Analyses %A Zhao,Yuehua %A Zhu,Sicheng %A Wan,Qiang %A Li,Tianyi %A Zou,Chun %A Wang,Hao %A Deng,Sanhong %+ School of Information Management, Nanjing University, 163 Xianlin Road, Qixia District, Nanjing, 210023, China, 86 2589685996, sanhong@nju.edu.cn %K health misinformation %K COVID-19 %K social media %K misinformation spread %K infodemiology %K global health crisis %K misinformation %K theoretical model %K medical information %K epidemic %K pandemic %D 2022 %7 20.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During global health crises such as the COVID-19 pandemic, rapid spread of misinformation on social media has occurred. The misinformation associated with COVID-19 has been analyzed, but little attention has been paid to developing a comprehensive analytical framework to study its spread on social media. Objective: We propose an elaboration likelihood model–based theoretical model to understand the persuasion process of COVID-19–related misinformation on social media. Methods: The proposed model incorporates the central route feature (content feature) and peripheral features (including creator authority, social proof, and emotion). The central-level COVID-19–related misinformation feature includes five topics: medical information, social issues and people’s livelihoods, government response, epidemic spread, and international issues. First, we created a data set of COVID-19 pandemic–related misinformation based on fact-checking sources and a data set of posts that contained this misinformation on real-world social media. Based on the collected posts, we analyzed the dissemination patterns. Results: Our data set included 11,450 misinformation posts, with medical misinformation as the largest category (n=5359, 46.80%). Moreover, the results suggest that both the least (4660/11,301, 41.24%) and most (2320/11,301, 20.53%) active users are prone to sharing misinformation. Further, posts related to international topics that have the greatest chance of producing a profound and lasting impact on social media exhibited the highest distribution depth (maximum depth=14) and width (maximum width=2355). Additionally, 97.00% (2364/2437) of the spread was characterized by radiation dissemination. Conclusions: Our proposed model and findings could help to combat the spread of misinformation by detecting suspicious users and identifying propagation characteristics. %M 35671411 %R 10.2196/37623 %U https://www.jmir.org/2022/6/e37623 %U https://doi.org/10.2196/37623 %U http://www.ncbi.nlm.nih.gov/pubmed/35671411 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38269 %T Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet %A Stokes-Parish,Jessica %+ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, 4227, Australia, 61 755951468, jstokesp@bond.edu.au %K science communication %K critical appraisal %K social media %K health literacy %K digital literacy %K misinformation %K COVID-19 %K online health %K infodemic %K infodemiology %D 2022 %7 17.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic. %M 35649183 %R 10.2196/38269 %U https://www.jmir.org/2022/6/e38269 %U https://doi.org/10.2196/38269 %U http://www.ncbi.nlm.nih.gov/pubmed/35649183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37466 %T The Effect of Fear of Infection and Sufficient Vaccine Reservation Information on Rapid COVID-19 Vaccination in Japan: Evidence From a Retrospective Twitter Analysis %A Niu,Qian %A Liu,Junyu %A Kato,Masaya %A Nagai-Tanima,Momoko %A Aoyama,Tomoki %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan, 81 075 751 3964, tanima.momoko.8s@kyoto-u.ac.jp %K COVID-19 %K vaccine hesitancy %K Japan %K social media %K text mining %D 2022 %7 9.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global public health and socioeconomic impacts of the COVID-19 pandemic have been substantial, rendering herd immunity by COVID-19 vaccination an important factor for protecting people and retrieving the economy. Among all the countries, Japan became one of the countries with the highest COVID-19 vaccination rates in several months, although vaccine confidence in Japan is the lowest worldwide. Objective: We attempted to find the reasons for rapid COVID-19 vaccination in Japan given its lowest vaccine confidence levels worldwide, through Twitter analysis.  Methods: We downloaded COVID-19–related Japanese tweets from a large-scale public COVID-19 Twitter chatter data set within the timeline of February 1 and September 30, 2021. The daily number of vaccination cases was collected from the official website of the Prime Minister’s Office of Japan. After preprocessing, we applied unigram and bigram token analysis and then calculated the cross-correlation and Pearson correlation coefficient (r) between the term frequency and daily vaccination cases. We then identified vaccine sentiments and emotions of tweets and used the topic modeling to look deeper into the dominant emotions.  Results: We selected 190,697 vaccine-related tweets after filtering. Through n-gram token analysis, we discovered the top unigrams and bigrams over the whole period. In all the combinations of the top 6 unigrams, tweets with both keywords “reserve” and “venue” showed the largest correlation with daily vaccination cases (r=0.912; P<.001). On sentiment analysis, negative sentiment overwhelmed positive sentiment, and fear was the dominant emotion across the period. For the latent Dirichlet allocation model on tweets with fear emotion, the two topics were identified as “infect” and “vaccine confidence.” The expectation of the number of tweets generated from topic “infect” was larger than that generated from topic “vaccine confidence.” Conclusions: Our work indicates that awareness of the danger of COVID-19 might increase the willingness to get vaccinated. With a sufficient vaccine supply, effective delivery of vaccine reservation information may be an important factor for people to get vaccinated. We did not find evidence for increased vaccine confidence in Japan during the period of our study. We recommend policy makers to share accurate and prompt information about the infectious diseases and vaccination and to make efforts on smoother delivery of vaccine reservation information. %M 35649182 %R 10.2196/37466 %U https://www.jmir.org/2022/6/e37466 %U https://doi.org/10.2196/37466 %U http://www.ncbi.nlm.nih.gov/pubmed/35649182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36830 %T The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media %A Chen,Yen-Pin %A Chen,Yi-Ying %A Yang,Kai-Chou %A Lai,Feipei %A Huang,Chien-Hua %A Chen,Yun-Nung %A Tu,Yi-Chin %+ Department of Computer Science and Information Engineering, National Taiwan University, No 1, Sec 4, Roosevelt Rd, Taipei, 106, Taiwan, 886 2 3366 3366, yvchen@csie.ntu.edu.tw %K misinformation %K vaccine hesitancy %K vaccination %K infodemic %K infodemiology %K COVID-19 %K public immunity %K social media %K fake news %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is an important intervention to prevent the incidence and spread of serious diseases. Many factors including information obtained from the internet influence individuals’ decisions to vaccinate. Misinformation is a critical issue and can be hard to detect, although it can change people's minds, opinions, and decisions. The impact of misinformation on public health and vaccination hesitancy is well documented, but little research has been conducted on the relationship between the size of the population reached by misinformation and the vaccination decisions made by that population. A number of fact-checking services are available on the web, including the Islander news analysis system, a free web service that provides individuals with real-time judgment on web news. In this study, we used such services to estimate the amount of fake news available and used Google Trends levels to model the spread of fake news. We quantified this relationship using official public data on COVID-19 vaccination in Taiwan. Objective: In this study, we aimed to quantify the impact of the magnitude of the propagation of fake news on vaccination decisions. Methods: We collected public data about COVID-19 infections and vaccination from Taiwan's official website and estimated the popularity of searches using Google Trends. We indirectly collected news from 26 digital media sources, using the news database of the Islander system. This system crawls the internet in real time, analyzes the news, and stores it. The incitement and suspicion scores of the Islander system were used to objectively judge news, and a fake news percentage variable was produced. We used multivariable linear regression, chi-square tests, and the Johnson-Neyman procedure to analyze this relationship, using weekly data. Results: A total of 791,183 news items were obtained over 43 weeks in 2021. There was a significant increase in the proportion of fake news in 11 of the 26 media sources during the public vaccination stage. The regression model revealed a positive adjusted coefficient (β=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient (β=–3.21, P=.04) of the interaction term on the fake news percentage with the Google Trends level. The Johnson-Neiman plot of the adjusted effect for the interaction term showed that the Google Trends level had a significant negative adjustment effect on vaccination doses for the following week when the proportion of fake news exceeded 39.3%. Conclusions: There was a significant relationship between the amount of fake news to which the population was exposed and the number of vaccination doses administered. Reducing the amount of fake news and increasing public immunity to misinformation will be critical to maintain public health in the internet age. %M 35380546 %R 10.2196/36830 %U https://www.jmir.org/2022/4/e36830 %U https://doi.org/10.2196/36830 %U http://www.ncbi.nlm.nih.gov/pubmed/35380546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33680 %T The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review %A Gunasekeran,Dinesh Visva %A Chew,Alton %A Chandrasekar,Eeshwar K %A Rajendram,Priyanka %A Kandarpa,Vasundhara %A Rajendram,Mallika %A Chia,Audrey %A Smith,Helen %A Leong,Choon Kit %+ National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 67723737, dineshvg@hotmail.sg %K digital health %K social media %K big data %K population health %K blockchain %K COVID-19 %K review %K benefit %K challenge %K public health %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background:  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods:  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results:  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions:  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health. %M 35129456 %R 10.2196/33680 %U https://www.jmir.org/2022/4/e33680 %U https://doi.org/10.2196/33680 %U http://www.ncbi.nlm.nih.gov/pubmed/35129456 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35786 %T Digital Visual Communication for Public Health: Design Proposal for a Vaccinated Emoji %A Boender,Tamara Sonia %A Louis-Ferdinand,Noah %A Duschek,Gideon %+ Surveillance Unit, Department of Infectious Disease Epidemiology, Robert Koch Institute, Seestrasse 10, Berlin, 13353, Germany, 49 3018754, BoenderS@rki.de %K vaccination %K emoji %K design %K science communication %K infodemic management %K vaccine confidence %K digital communication %D 2022 %7 7.4.2022 %9 Viewpoint %J J Med Internet Res %G English %X In the 21st century, the internet and particularly social media have become essential platforms for the spread of health information (including misinformation and disinformation). One of the distinguishing features of communication on these platforms is the widespread use of emojis. Though seemingly trivial emojis are now used by many if not most public health figures and organizations alongside important health updates. Much of that information has had to do with vaccination. Vaccines are a critical public health tool but one surrounded by falsehoods, phobias, and misinformation fueling vaccine hesitancy. Part of that has to do with their lack of positive representation on social media (eg, the syringe emoji is a plain needle, which for many people is an uncomfortable image). We thus argue that vaccination deserves an entirely new emoji to communicate vaccine confidence and discuss a design proposal for a vaccinated emoji that has gained traction in the global public health community. %M 35389363 %R 10.2196/35786 %U https://www.jmir.org/2022/4/e35786 %U https://doi.org/10.2196/35786 %U http://www.ncbi.nlm.nih.gov/pubmed/35389363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34831 %T The Challenge of Debunking Health Misinformation in Dynamic Social Media Conversations: Online Randomized Study of Public Masking During COVID-19 %A Mourali,Mehdi %A Drake,Carly %+ Haskayne School of Business, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 6684, mehdi.mourali@haskayne.ucalgary.ca %K misinformation %K debunking %K correction %K social media %K truth objectivity %K COVID-19 %K infodemiology %K health information %K digital health %K public health %K health professional %D 2022 %7 2.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The spread of false and misleading health information on social media can cause individual and social harm. Research on debunking has shown that properly designed corrections can mitigate the impact of misinformation, but little is known about the impact of correction in the context of prolonged social media debates. For example, when a social media user takes to Facebook to make a false claim about a health-related practice and a health expert subsequently refutes the claim, the conversation rarely ends there. Often, the social media user proceeds by rebuking the critic and doubling down on the claim. Objective: The aim of this study was to examine the impact of such extended back and forth between false claims and debunking attempts on observers’ dispositions toward behavior that science favors. We tested competing predictions about the effect of extended exposure on people’s attitudes and intentions toward masking in public during the early days of the COVID-19 pandemic and explored several psychological processes potentially underlying this effect. Methods: A total of 500 US residents took part in an online experiment in October 2020. They reported on their attitudes and intentions toward wearing masks in public. They were then randomly assigned to one of four social media exposure conditions (misinformation only vs misinformation+correction vs misinformation+correction+rebuke vs misinformation+correction+rebuke+second correction), and reported their attitudes and intentions for a second time. They also indicated whether they would consider sharing the thread if they were to see it on social media and answered questions on potential mediators and covariates. Results: Exposure to misinformation had a negative impact on attitudes and intentions toward masking (β=–.35, 95% CI –.42 to –.29; P<.001). Moreover, initial debunking of a false claim generally improved attitudes and intentions toward masking (β=.35, 95% CI .16 to .54; P<.001). However, this improvement was washed out by further exposure to false claims and debunking attempts (β=–.53, 95% CI –.72 to –.34; P<.001). The latter result is partially explained by a decrease in the perceived objectivity of truth. That is, extended exposure to false claims and debunking attempts appear to weaken the belief that there is an objectively correct answer to how people ought to behave in this situation, which in turn leads to less positive reactions toward masking as the prescribed behavior. Conclusions: Health professionals and science advocates face an underappreciated challenge in attempting to debunk misinformation on social media. Although engaging in extended debates with science deniers and other purveyors of bunk appears necessary, more research is needed to address the unintended consequences of such engagement. %M 35156933 %R 10.2196/34831 %U https://www.jmir.org/2022/3/e34831 %U https://doi.org/10.2196/34831 %U http://www.ncbi.nlm.nih.gov/pubmed/35156933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e35707 %T A Stanford Conference on Social Media, Ethics, and COVID-19 Misinformation (INFODEMIC): Qualitative Thematic Analysis %A Gisondi,Michael A %A Chambers,Daniel %A La,Tatum Minh %A Ryan,Alexa %A Shankar,Adyant %A Xue,Athena %A Barber,Rachel Anne %+ Department of Emergency Medicine, Stanford School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 650 721 4023, mgisondi@stanford.edu %K COVID-19 %K infodemic %K misinformation %K disinformation %K vaccine %K social media %K thematic analysis %K qualitative %D 2022 %7 15.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to challenge the world’s population, with approximately 266 million cases and 5 million deaths to date. COVID-19 misinformation and disinformation led to vaccine hesitancy among the public, particularly in vulnerable communities, which persists today. Social media companies are attempting to curb the ongoing spread of an overwhelming amount of COVID-19 misinformation on their platforms. In response to this problem, the authors hosted INFODEMIC: A Stanford Conference on Social Media and COVID-19 Misinformation (INFODEMIC) to develop best practices for social media companies to mitigate online misinformation and disinformation. Objective: The primary aim of this study was to develop recommendations for social media companies to address the COVID-19 infodemic. We report the methods used to execute the INFODEMIC conference, conference attendee engagement and analytics, and a qualitative thematic analysis of the conference presentations. The primary study outcomes were the identified themes and corresponding recommendations. Methods: Using a constructivist paradigm, we conducted a thematic analysis of the 6-hour conference transcript to develop best practice recommendations. The INFODEMIC conference was the study intervention, the conference speakers were the study participants, and transcripts of their presentations were the data for this study. We followed the 6-step framework for thematic analysis described by Braun and Clarke. We also used descriptive statistics to report measures of conference engagement including registrations, viewership, post-conference asynchronous participation, and conference evaluations. Results: A total of 26 participants spoke at the virtual conference and represented a wide array of occupations, expertise, and countries of origin. From their remarks, we identified 18 response categories and 4 themes: trust, equity, social media practices, and interorganizational partnerships. From these, a total of 16 best practice recommendations were formulated for social media companies, health care organizations, and the general public. These recommendations focused on rebuilding trust in science and medicine among certain communities, redesigning social media platforms and algorithms to reduce the spread of misinformation, improving partnerships between key stakeholders, and educating the public to critically analyze online information. Of the 1090 conference registrants, 587 (53.9%) attended the live conference, and another 9996 individuals viewed or listened to the conference recordings asynchronously. Conference evaluations averaged 8.9 (best=10). Conclusions: Social media companies play a significant role in the COVID-19 infodemic and should adopt evidence-based measures to mitigate misinformation on their platforms. %M 35030089 %R 10.2196/35707 %U https://www.jmir.org/2022/2/e35707 %U https://doi.org/10.2196/35707 %U http://www.ncbi.nlm.nih.gov/pubmed/35030089 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29246 %T Constituents’ Inferences of Local Governments’ Goals and the Relationship Between Political Party and Belief in COVID-19 Misinformation: Cross-sectional Survey of Twitter Followers of State Public Health Departments %A Stevens,Hannah %A Palomares,Nicholas A %+ Department of Communication, College of Letters and Science, University of California, Davis, One Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K outbreak %K mass communication %K Twitter %K goal inferences %K political agendas %K misinformation %K infodemic %K partisanship %K health information %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Amid the COVID-19 pandemic, social media have influenced the circulation of health information. Public health agencies often use Twitter to disseminate and amplify the propagation of such information. Still, exposure to local government–endorsed COVID-19 public health information does not make one immune to believing misinformation. Moreover, not all health information on Twitter is accurate, and some users may believe misinformation and disinformation just as much as those who endorse more accurate information. This situation is complicated, given that elected officials may pursue a political agenda of re-election by downplaying the need for COVID-19 restrictions. The politically polarized nature of information and misinformation on social media in the United States has fueled a COVID-19 infodemic. Because pre-existing political beliefs can both facilitate and hinder persuasion, Twitter users’ belief in COVID-19 misinformation is likely a function of their goal inferences about their local government agencies’ motives for addressing the COVID-19 pandemic. Objective: We shed light on the cognitive processes of goal understanding that underlie the relationship between partisanship and belief in health misinformation. We investigate how the valence of Twitter users’ goal inferences of local governments’ COVID-19 efforts predicts their belief in COVID-19 misinformation as a function of their political party affiliation. Methods: We conducted a web-based cross-sectional survey of US Twitter users who followed their state’s official Department of Public Health Twitter account (n=258) between August 10 and December 23, 2020. Inferences about local governments’ goals, demographics, and belief in COVID-19 misinformation were measured. State political affiliation was controlled. Results: Participants from all 50 states were included in the sample. An interaction emerged between political party affiliation and goal inference valence for belief in COVID-19 misinformation (∆R2=0.04; F8,249=4.78; P<.001); positive goal inference valence predicted increased belief in COVID-19 misinformation among Republicans (β=.47; t249=2.59; P=.01) but not among Democrats (β=.07; t249=0.84; P=.40). Conclusions: Our results reveal that favorable inferences about local governments’ COVID-19 efforts can accelerate belief in misinformation among Republican-identifying constituents. In other words, accurate COVID-19 transmission knowledge is a function of constituents' sentiment toward politicians rather than science, which has significant implications on public health efforts for minimizing the spread of the disease, as convincing misinformed constituents to practice safety measures might be a political issue just as much as it is a health one. Our work suggests that goal understanding processes matter for misinformation about COVID-19 among Republicans. Those responsible for future COVID-19 public health messaging aimed at increasing belief in valid information about COVID-19 should recognize the need to test persuasive appeals that address partisans’ pre-existing political views in order to prevent individuals’ goal inferences from interfering with public health messaging. %M 37113808 %R 10.2196/29246 %U https://infodemiology.jmir.org/2022/1/e29246 %U https://doi.org/10.2196/29246 %U http://www.ncbi.nlm.nih.gov/pubmed/37113808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31726 %T COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment–Based Topic Modeling %A Huangfu,Luwen %A Mo,Yiwen %A Zhang,Peijie %A Zeng,Daniel Dajun %A He,Saike %+ The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China, 86 (010)82544537, saike.he@ia.ac.cn %K COVID-19 %K COVID-19 vaccine %K sentiment evolution %K topic modeling %K social media %K text mining %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public’s conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public’s vaccine awareness through sentiment–based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson & Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter’s application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment–based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51%) were positive, 204,084 (23.81%) were negative, 245,976 (28.70%) were neutral, 6899 (0.80%) were highly positive, and 1508 (0.18%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13%), getting vaccination (76,029/405,560, 18.75%), and vaccine information and knowledge (21,127/405,560, 5.21%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04%), extreme side effects of the vaccines (19,690/205,592, 9.58%), and vaccine supply and rollout (17,154/205,592, 8.34%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment–based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. %M 34783665 %R 10.2196/31726 %U https://www.jmir.org/2022/2/e31726 %U https://doi.org/10.2196/31726 %U http://www.ncbi.nlm.nih.gov/pubmed/34783665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e35552 %T A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation %A Gisondi,Michael A %A Barber,Rachel %A Faust,Jemery Samuel %A Raja,Ali %A Strehlow,Matthew C %A Westafer,Lauren M %A Gottlieb,Michael %+ The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA, 94304, United States, 1 650 721 4023, mgisondi@stanford.edu %K COVID-19 %K social media %K misinformation %K disinformation %K infodemic %K ethics %K vaccination %K vaccine hesitancy %K infoveillance %K vaccine %D 2022 %7 1.2.2022 %9 Editorial %J J Med Internet Res %G English %X COVID-19 is currently the third leading cause of death in the United States, and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online COVID-19 infodemic has deadly consequences. In this editorial, the authors examine the roles that social media companies play in the COVID-19 infodemic and their obligations to end it. They describe how fake news about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate the COVID-19 infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide the next steps for all readers to consider. This guest editorial accompanies the Journal of Medical Internet Research special theme issue, “Social Media, Ethics, and COVID-19 Misinformation.” %M 35007204 %R 10.2196/35552 %U https://www.jmir.org/2022/2/e35552 %U https://doi.org/10.2196/35552 %U http://www.ncbi.nlm.nih.gov/pubmed/35007204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34218 %T Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study %A Tan,Edina YQ %A Wee,Russell RE %A Saw,Young Ern %A Heng,Kylie JQ %A Chin,Joseph WE %A Tong,Eddie MW %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Ave West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K social media %K WhatsApp %K infodemiology %K misinformation %K COVID-19 %K tracking %K surveillance %K app %K longitudinal %K Singapore %K characteristic %K usage %K pattern %K well-being %K communication %K risk %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC). Objective: In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns. Methods: We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants. Results: During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19–related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19–related thoughts throughout the day. Conclusions: Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic. Trial Registration: ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363 %M 34881720 %R 10.2196/34218 %U https://www.jmir.org/2021/12/e34218 %U https://doi.org/10.2196/34218 %U http://www.ncbi.nlm.nih.gov/pubmed/34881720