Best Practices for Designing and Testing Behavioral and Health Communication Interventions for Delivery in Private Facebook Groups: Tutorial.

Facebook, the most popular social media platform in the United States, is used by 239 million US adults, which represents 71% of the population. Not only do most US adults use Facebook but they also spend an average of 40 minutes per day on the platform. Due to Facebook's reach and ease of use, it is increasingly being used as a modality for delivering behavioral and health communication interventions. Typically, a Facebook-delivered intervention involves creating a private group to deliver intervention content for participants to engage with asynchronously. In many interventions, a counselor is present to facilitate discussions and provide feedback and support. Studies of Facebook-delivered interventions have been conducted on a variety of topics, and they vary widely in terms of the intervention content used in the group, use of human counselors, group size, engagement, and other characteristics. In addition, results vary widely and may depend on how well the intervention was executed and the degree to which it elicited engagement among participants. Best practices for designing and delivering behavioral intervention content for asynchronous delivery in Facebook groups are lacking, as are best practices for engaging participants via this modality. In this tutorial, we propose best practices for the use of private Facebook groups for delivery and testing the efficacy of behavioral or health communication interventions, including converting traditional intervention content into Facebook posts; creating protocols for onboarding, counseling, engagement, and data management; designing and branding intervention content; and using engagement data to optimize engagement and outcomes.

A Comprehensive Analysis of COVID-19 Misinformation, Public Health Impacts, and Communication Strategies: Scoping Review.

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.

Harnessing the power of mobile and messaging apps for risk communication and intervention during the COVID-19 pandemic: lessons from the Western Pacific.

Problem: The spread of mis- and disinformation on mobile and messaging apps during the COVID-19 pandemic not only fuelled anxieties and mistrust in health authorities but also undermined the effectiveness of the overall public health response. Context: Mobile and messaging apps help users stay informed and connected to their families, friends, colleagues and communities. However, during the COVID-19 pandemic, these apps were also one of the primary channels where mis- and disinformation were circulated. Action: Recognizing the importance of including mobile and messaging apps in risk communication and emergency response strategies, the World Health Organization (WHO) and some countries in the WHO Western Pacific Region independently piloted initiatives to reach messaging app users, meet their evolving information needs, and streamline health ministry communication. Outcome: The enhanced use of mobile and messaging apps enabled consistent and timely communication and improved coordination during the COVID-19 pandemic. Leveraging their features also helped identify and potentially fill crucial information gaps, mitigating the harms of mis- and disinformation and fostering stronger trust in health authorities. Discussion: The findings from the work carried out by WHO and countries in the Western Pacific Region identified some promising innovative communication interventions using mobile and messaging apps. While these interventions should be further explored and evaluated, they have demonstrated that interventions need to be proactive, flexible, and able to adapt to changes in mis- and disinformation content being shared through messaging apps.

Animations to communicate public health prevention messages: a realist review protocol.

INTRODUCTION: With digital and social media advances, animated health communications (health animations) are highly prevalent globally, yet the evidence base underpinning them remains unclear and limited. While individual studies have attempted to explore the effectiveness, acceptability and usability of specific features of health animations, there is substantial heterogeneity in study design, comparators and the animation design and content. Consequently, there is a need to synthesise evidence of health animations using an approach that recognises this contextual complexity, which may affect their impact. METHODS AND ANALYSIS: This project aims to understand why, how, for whom, to what extent and in which contexts health animations are expected to promote preventive health behaviours. We will conduct a realist review following Pawson's five iterative stages to (1) define the review scope and locate existing theories; (2) search for evidence; (3) select and appraise evidence; (4) extract data and (5) synthesise data and refine theory. Engagement with stakeholders involved in developing, testing, implementing or commissioning health communications, including animations, will allow the initial programme theory to be tested and refined. The findings will be reported in accordance with Realist and Meta-narrative Evidence Syntheses: Evolving Standards. ETHICS AND DISSEMINATION: Ethical approval for the public stakeholder work was provided by the Northumbria University Research Ethics Committee. We will disseminate the findings widely through outputs tailored to target specific professional, public and patient audiences. Dissemination will occur through stakeholder engagement as part of the research, a peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42023447127.

Testing a persuasive health communication intervention (PHCI) for emergency department patients who declined rapid HIV/HCV screening: a randomised controlled trial study protocol.

INTRODUCTION: Previous studies have shown that substantial percentages of emergency department (ED) patients in the USA recommended for HIV or hepatitis C (HCV) decline testing. Evidence-based and cost-effective interventions to improve HIV/HCV testing uptake are needed, particularly for people who inject drugs (PWIDs) (currently or formerly), who comprise a group at higher risk for these infections. We developed a brief persuasive health communication intervention (PHCI) designed to convince ED patients who had declined HIV/HCV testing to agree to be tested. In this investigation, we will determine if the PHCI is more efficacious in convincing ED patients to be tested for HIV/HCV when delivered by a video or in person, and whether efficacy is similar among individuals who currently, previously or never injected drugs. METHODS AND ANALYSIS: We will conduct a multisite, randomised controlled trial comparing PHCIs delivered by video versus in person by a health educator to determine which delivery method convinces more ED patients who had declined HIV/HCV testing instead to be tested. We will stratify randomisation by PWID status (current, former or never/non-PWID) to permit analyses comparing the PHCI delivery method by injection-drug use history. We will also perform a cost-effectiveness analysis of the interventions compared with current practice, examining the incremental cost-effectiveness ratio between the two interventions for the ED population overall and within individual strata of PWID. As an exploratory analysis, we will assess if a PHCI video with captions confers increased or decreased acceptance of HIV/HCV testing, as compared with a PHCI video without captions. ETHICS AND DISSEMINATION: The study protocol has been approved by the institutional review board of the Icahn School of Medicine. The results will be disseminated at international conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT05968573.

Using wiki surveys to rapidly test messages promoting COVID-19 vaccination boosters and child vaccination among Philadelphia residents.

Formative research is an important component of health communication campaign development. Rapid message testing approaches are useful for testing new messaging quickly and efficiently during public health emergencies, such as COVID-19, when guidance and recommendations are rapidly changing. Wiki surveys simultaneously collect quantitative message testing data and qualitative feedback on potential social media campaign messages. Philly CEAL used wiki surveys to test messages about COVID-19 vaccinations for dissemination on social media. A cross-sectional survey of Philadelphia residents (N = 199) was conducted between January and March 2023. Wiki surveys were used to assess the perceived effectiveness of messages promoting the updated COVID-19 booster and child vaccination. In each wiki survey, participants were presented with two messages and asked to select the one that they perceived as most effective. Participants could alternatively select "can't decide" or submit their own message. A score estimating the probability of selection was calculated for each message. Participant-generated messages were routinely reviewed and incorporated into the message pool. Participants cast a total of 32,281 votes on messages seeded by the research team (n = 20) and participants (n = 43). The highest scoring messages were those that were generated by participants and spoke to getting your child vaccinated to protect them against serious illness and getting the booster to protect your health and that of your community. These messages were incorporated into social media posts disseminated by Philly CEAL's social media accounts. Wiki surveys are a feasible and efficient method of rapid message testing for social media campaigns.

Exploring perceived learning effectiveness in virtual reality health communication through the lens of construal level theory.

BACKGROUND: Virtual reality is increasingly being used for health communication. This study aimed to propose and test an integrated model of the determinants of perceived learning effectiveness in virtual reality (VR) within health communication. It proposes that psychological distance negatively affects immersion, flow, and presence, positively affecting perceived learning effectiveness. METHODS: The Fuzzy Decision Making Trial and Evaluation Laboratory Method (F-DEMATEL) and structural equation modeling (SEM) were used to test the proposed model. Data for the F-DEMATEL study were collected from 20 participants, whereas data for the SEM study were collected from 1104 participants, with 775 included in the final analysis. RESULTS: The results of the F-DEMATEL study revealed that the three dimensions of psychological distance, emotional distance, spatial distance, and social distance are causal factors. In contrast, temporal, technical, and hypothetical distance are effect factors. The SEM results confirmed the negative effects of psychological distance on flow and presence and the positive effects of immersion and presence on perceived learning effectiveness. In addition, the mediating role of presence was confirmed. CONCLUSIONS: The results suggest that interrelationships among the factors can enhance the perceived learning effectiveness of health communication from VR. The crucial role of ensuring low psychological distance and high engagement in VR communication is also confirmed, providing crucial implications for VR communication practitioners.

Holiday Tweets: A Qualitative Analysis of How Major Health Organizations Addressed Culture During the COVID-19 Pandemic.

This study examines COVID-19-related messages disseminated by major health and government organizations on Twitter during the overlapping holidays of Easter and Ramadan in 2022. Recognizing the importance of tailored health communication, the research focuses on the textual and visual content of tweets to understand how messages attend to diverse cultural, religious, and ethnic groups. Qualitative analysis of 382 Tweets revealed 3 Major Themes related to COVID-19 and Easter and 4 Major Themes associated with Ramadan. Easter-related tweets emphasized celebrating safely and the importance of vaccinations using science-based messaging, slang, and playful imagery. Ramadan-related tweets prioritized safety during religious practices, incorporating traditional symbols and religious references; countering vaccine-related myths; and social responsibility. The findings highlight culturally relevant health communication and tailoring messages to specific cultural contexts. The study contributes insights for public health organizations aiming to improve communication strategies during pandemics, fostering engagement, and addressing the unique needs of diverse populations.

mRNA Vaccine Hesitancy: Spreading Misinformation Through Online Narratives.

This research examined the themes that emerge from online discussions of the COVID-19 vaccines to assist health communicators and officials in combating misinformation in health-related discussions. Using framing theory and the diffusion of innovation framework, this study presents findings from a semantic network analysis of 3842 tweets collected during the first week of February 2022. The authors calculated betweenness and page rank centrality scores for Twitter users participating in the online dialogue and identified 36 semantic themes. Findings revealed that the most influential dialogue participants were retired health and medical professionals, data analysts, journalists, online advocates, and politicians. The frames identified in the study contained several misinformation narratives about the COVID-19 vaccines. The authors discuss the implications of these findings for health officials and communicators as well as the theoretical implications of the diffusion of misinformation and framing as a tool to reiterate untruths.

Social Media Users' Engagement with Fear Appeal Elements in Government's Health Crisis Communication via State-Owned Media.

Government health messaging is significant to the containment of public health crises. Such communication may benefit from using fear appeal, a message strategy for promoting health and preventing diseases. Yet little scholarly attention has been paid to how fear appeal is employed in government messaging to promote social media engagement through online actions including likes, shares, and comments. These actions play a meaningful role in addressing communication exigencies within the context of health crises. In this study, quantitative content analysis and corpus linguistics methods were employed to analyze fear appeal-related elements in COVID-19 messages sent by a state-owned media outlet on social media. The results show that when compared to messages without threat, messages conveying threat elicited significantly more comments, in which emotions and perceptions to threat and efficacy were exhibited, while messages containing both threat and efficacy generated more engagement in comparison to messages with threat alone. Moreover, while subdimensions under efficacy were positive predictors of engagement, those under threat were primarily found to have exerted negative effects. The findings provide insights into how fear appeal elements can be employed in government health crisis communication to engage the public.

Cancer linguistics and the politics of decolonizing health communication in Coastal Tanzania: Reflections from an anthropological investigation.

The role of language in maintaining asymmetries of power in global public health and biomedicine has become a central part of the broader movement to "decolonize Global Health." While considering how language engenders inequalities in Global Health, hinders interventions, and inhibits medical care, this article contends that colonially derived theorizations of what language is undergirding top-down health communication efforts labeled as "decolonial" can thwart efforts to make biomedical care and public health clearer in postcolonies. We do this through outlining predicaments found in a linguistic anthropological exploration of cancer terminology in Coastal Tanzania. In the small town of Bagamoyo, saratani-the official translation for cancer in Tanzania created by the government in the 1980s as part of a larger effort of decolonial state-building-is dominantly understood as a different or unequivocal disease than kansa-the English-adapted name. As the dissemination of the term saratani into a linguistic arena where colonially derived word kansa is dominantly registered as the biological disease "cancer," this linguistic disjuncture between saratani and kansa has not only created a plethora of problems for oncological care in Bagamoyo, but also illuminates the perils of creating more just health communication in an unequal global political economy. Through showing how binary conceptualizations of language as "colonial" and "local" can reproduce incommunicability-the rendering of racialized subjects as fundamentally unintelligible in hegemonic regimes-we contend that the afterlives of this past effort to decolonize medical language has important lessons for the present of "decolonizing Global Health." Moving beyond static conceptualizations of language, we argue for a fluid "translanguaging" perspective of medical linguistics that facilitates the dismantlement of incommunicability and the global ordering that creates it.

The Role of Culturally Appropriate Mediated Communication Strategies to Reduce Hepatitis B and Liver Cancer Disparities.

Asian, Pacific Islander, African, and Caribbean communities in the U.S. are heavily impacted by chronic hepatitis B (HBV) and hepatocellular carcinoma (HCC). Educating these groups about the link between the two diseases is imperative to improve screening rates and health outcomes. This study aims to identify and incorporate preferred mediated communication methods into community-specific educational campaigns which emphasize the connection between the conditions, to promote uptake of prevention and management behaviors for HBV and HCC. Fifteen focus groups and two key informant interviews were conducted with Micronesian, Chinese, Hmong, Nigerian, Ghanaian, Vietnamese, Korean, Somali, Ethiopian, Filipino, Haitian, and Francophone West African communities. Data were analyzed using thematic coding and analysis. Findings demonstrate that all communities preferred materials be offered in both English and native languages and requested that materials highlight the connection between HBV and HCC. Delivery channel preferences and messaging themes varied by group. This study provides insight into community-specific preferences for learning about HBV and HCC. The findings can be used to design culturally and linguistically tailored, multi-platform, health education campaigns to facilitate improved HBV screening and vaccination rates and increase knowledge about HCC risk among highly impacted communities in the U.S.

Deciphering Discord: How Conflicting Information and Political Ideology Shape Public Attitude Toward PFAS Regulation.

Per- and polyfluorinated substances (PFAS) contamination is an emerging environmental and health risk facing the world. This study examines the impact of conflicting information on Americans' attitude toward PFAS regulation and intention to engage in mitigation behaviors through a one-way, between-subjects experiment. Participants were 1,062 U.S. adults recruited from CloudResearch. Results showed that compared to participants exposed to consistent information, those exposed to conflicting information displayed less favorable attitude toward existing regulation, which led to lower intention to support related policies and to engage in mitigation behaviors. Political ideology moderated these relationships, with stronger experimental effects among conservatives. These findings underscore the importance of conveying consistent risk messages, especially when multiple stakeholders are involved.

Coping with Non-COVID-19 Health Problems Through Communicative Action in Cyberspace.

This study investigated how the online health information behaviors of U.S. adults with illnesses unrelated to COVID-19 virus infection affected their coping with health problems and concerns during the COVID-19 pandemic. Guided by the cybercoping model (Kim & Lee, 2014), the study examined associations between these patients' online information behaviors (information seeking and information forwarding) and coping outcomes (health problems and affective states). The study further explored the mediating roles of health coping processes (problem-and emotion-focused) in the associations between these information behaviors and coping outcomes. Survey data from 687 participants were analyzed using structural equation modeling. The results highlighted the significance of information forwarding in enhancing both coping processes and outcomes, while information seeking enhanced problem-focused coping and health-problem coping outcomes alone. These associations were more pronounced among U.S. adults without chronic conditions than among those with chronic illnesses. These findings' implications, the study's limitations, and suggestions for future research were also addressed.

The role of mental well-being in the effects of persuasive health messages: A scoping review.

Emerging evidence in health communication and psychology suggests that a) exposure to specific persuasive health messages can have unintended effects on the mental well-being of recipients and b) recipients' mental well-being before exposure can influence message processing. Available evidence regarding the relationship between mental well-being and exposure to specific health messages lacks consistency and is scattered across different fields. This scoping review of 24 publications summarizes what is known about mental health effects in health communication and provides a research agenda for future work. Among others, key findings suggest that particularly negative emotional appeals may have broad, negative effects on indicators of hedonic well-being. Further, humor and gain appeals may positively impact mental well-being, although positive message features are strongly understudied in this space. Lower mental well-being prior to message exposure may impact message processing, but not necessarily message effectiveness. We find that potential well-being effects of health communication have been largely ignored, especially outside the realm of mental health research. Yet, initial evidence does underline the importance of such inquiry. This review summarizes initial evidence of systematic, unintended effects of health messaging on mental well-being and highlights fruitful avenues for future work in this space.

The Need to Focus More on Climate Change Communication and Incorporate More Systems Approaches.

Society is at an inflection point-both in terms of climate change and the amount of data and computational resources currently available. Climate change has been a catastrophe in slow motion with relationships between human activity, climate change, and the resulting effects forming a complex system. However, to date, there has been a general lack of urgent responses from leaders and the general public, despite urgent warnings from the scientific community about the consequences of climate change and what can be done to mitigate it. Further, misinformation and disinformation about climate change abound. A major problem is that there has not been enough focus on communication in the climate change field. Since communication itself involves complex systems (e.g. information users, information itself, communications channels), there is a need for more systems approaches to communication about climate change. Utilizing systems approaches to really understand and anticipate how information may be distributed and received before communication has even occurred and adjust accordingly can lead to more proactive precision climate change communication. The time has come to identify and develop more effective, tailored, and precise communication for climate change.

Assessing ChatGPT's Potential in HIV Prevention Communication: A Comprehensive Evaluation of Accuracy, Completeness, and Inclusivity.

With the advancement of artificial intelligence(AI), platforms like ChatGPT have gained traction in different fields, including Medicine. This study aims to evaluate the potential of ChatGPT in addressing questions related to HIV prevention and to assess its accuracy, completeness, and inclusivity. A team consisting of 15 physicians, six members from HIV communities, and three experts in gender and queer studies designed an assessment of ChatGPT. Queries were categorized into five thematic groups: general HIV information, behaviors increasing HIV acquisition risk, HIV and pregnancy, HIV testing, and the prophylaxis use. A team of medical doctors was in charge of developing questions to be submitted to ChatGPT. The other members critically assessed the generated responses regarding level of expertise, accuracy, completeness, and inclusivity. The median accuracy score was 5.5 out of 6, with 88.4% of responses achieving a score ≥ 5. Completeness had a median of 3 out of 3, while the median for inclusivity was 2 out of 3. Some thematic groups, like behaviors associated with HIV transmission and prophylaxis, exhibited higher accuracy, indicating variable performance across different topics. Issues of inclusivity were identified, notably the use of outdated terms and a lack of representation for some communities. ChatGPT demonstrates significant potential in providing accurate information on HIV-related topics. However, while responses were often scientifically accurate, they sometimes lacked the socio-political context and inclusivity essential for effective health communication. This underlines the importance of aligning AI-driven platforms with contemporary health communication strategies and ensuring the balance of accuracy and inclusivity.

Health Controversies: Long-Term Disagreement Management Challenges.

Health controversies involve complex exchanges of disagreements over health and medicine. They unfold differently in different parts of the world, and they often extend over long periods of time. In contemporary argumentation theory, proposals have recently been emerging for "disagreement management at large scale" and for an explicit focus on design of disagreement management methods. Lewinski and Aakhus characterize large-scale disagreement as polylogic: formed of complex networks of players holding contrasting positions that are attacked and defended in multiple places. Large-scale disagreements such as health controversies are important sites for emergence of new disagreement management methods, including new ways of arriving at conclusions about questions of fact (affecting positions) and new formats for coming to decisions about questions of policy (affecting places). The controversy over myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), spanning a period of very rapid change in reasoning about health, has been deeply entangled with the design of new institutional places for managing disagreements about health. It serves well to illustrate both the large, multi-scale structure of health controversies and the importance of long-term disagreement management strategies.