Surprisingly, the Swedish researchers found no harm in addressing misinformation head on.
Doctors can effectively debunk health myths using simple – and sometimes counterintuitive – steps.
A Swedish randomised controlled trial found that people were most likely to change their beliefs when doctors both directly addressed the existence of misinformation, and provided the individual with correct information. The three most effective techniques for getting through to people were: using a trusted voice, understanding recipients’ world view and repetition.
To find the most effective way of combating health myths, researcher Maike Winters, from the Karolinska Institute, and colleagues compared several methods to debunk widespread beliefs in Sierra Leone about typhoid.
One belief was that mosquitos could cause typhoid, and another that the two diseases occurred together.
Around 750 participants from the West African nation’s capital were split into three groups; one group was sent four audio dramas via WhatsApp in which local actors played doctors and nurses who explicitly raised and challenged misinformation and countered it with correct information, the second group was sent four dramas with only the accurate information and the control group was sent two unrelated dramas about breastfeeding.
WhatsApp is a popular messaging service there that many use to share video and audio, and audio dramas are a common way to disseminate information.
Before the intervention, 51% of study participants said typhoid was caused by mosquitos, and 59% that typhoid and malaria always occurred together.
But those who watched “doctors” and “nurses” address the misinformation, as well as give the correct alternative explanations, reported significantly fewer false beliefs about typhoid and mosquitos. People who heard only the correct information, with no reference to the myths, were less likely to wrongly believe that malaria and typhoid always co-occurred and had better knowledge of typhoid and malaria prevention strategies.
On all measures, the group who heard the myths tackled explicitly were better informed afterwards.
Surprisingly, bringing up misinformation to challenge it did not counterproductively “seed” it, as previously believed. In fact, raising misinformation upfront appeared to be responsible for the intervention’s success.
“In other studies, you have to start with the facts, and then maybe mention the missing information and then debunk it and highlight the facts again, but we also saw that we can start with the misinformation, mention it and then debunk it, and that worked pretty well in our study,” Ms Winters told The Medical Republic.
While elements of this trial were specific to Sierra Leone, Ms Winters was confident that the findings had broader relevance. “It is the building blocks in the drama that are important, that can be translated to other countries,” she said.
The first of those building blocks was to use trusted sources.
“The actors in the audio dramas played doctors and nurses, who are highly trusted in Sierra Leone. And they were also well-known actors in Sierra Leone, who identified themselves and that they were working with researchers at the start of the drama,” she explained.
“In different settings, maybe you don’t use audio dramas, but you use influencers on Instagram, for instance, that you see have an impact on groups that you want to target,” Ms Winters said.
But delivering the message in person, in a clinical setting, was even more effective, she added.
“Clinicians are trusted sources of information. If you see people face-to-face, that really is an opportunity to understand why they think the way they do and to listen to them, and not push beliefs onto them.”
Ms Winters also emphasised that understanding and acknowledging the person’s world view was an essential building block in the process.
“We put a lot of thought and effort into producing these dramas, because we had to do it in a way that was not just a white woman like me saying, ‘Hey, you’re wrong. There’s no such thing as typhoid-malaria’.
“We were really careful to make sure that it’s really how people interact normally with typhoid and malaria in that setting. So you have to do a lot of background research to make sure that it’s really culturally appropriate,” Ms Winters explained.
Finally, people needed to be repeatedly exposed to the message.
“It’s not just one ad somewhere or one billboard; it’s making sure that people constantly see the right information and constantly hear the debunking,” she said.
Ms Winters said these building blocks could be used in the more politically charged context of the “infodemic” around covid.
“I think you have to try. And you have to really make an effort to understand where these beliefs come from, not to simply think people are crazy and they believe in crazy conspiracy stories. Why do people believe in it? Where does it come from? And how can you reach them? If we try to reach and not judge, I think we have a chance.”
