Infodemic in Public health a reemerging public health threat: a scoping review

Introduction

Social media plays a pivotal role in dissemination of information. This information is always not credible, as it is believed to spread misinformation and disinformation. The spread of misinformation is not a new phenomenon but the magnitude of its spread was a concern during the COVID-19 pandemic.

The portmanteau word Infodemic is a neologism of ‘information’ and ‘epidemic’ coined in the year 2003.¹ An infodemic means an excessive amount of information of which some are accurate and some inaccurate, usually occurring during a pandemic/epidemic. Similar to the pattern of spread of a pandemic, an infodemic spreads in the same mode, but through digital or/physical information systems, making it more complex for people to isolate a solid and reliable source of information.^2,3

Infodemics have been one of the most virulent phenomena known to humankind, capable of transiting the world instantly. In every possible aspect they mimic a disease, with an epidemiology of its own, symptoms similar to a disease. Sadly it is one of the most highly neglected and underestimated problems.⁴

The spread of COVID-19 correlated to the spread of misinformation, in terms of circulating conspiracy theories, often dispersed through social media platforms. This constituted a risk to the public and presented a major global health hazard. Delivering a vital source of evidence-based information to the general public during an outbreak of a pandemic aids in quick act of managing the disaster.⁵

Evidence synthesis is a technique to appraise the literature which enables the extent of research activity in a specific area to be discovered. Systematic reviews usually detail a specific clinical question and seek to answer the question. Evidence mapping on the other hand provides a brief summary of the range, distribution and scope of evidence in a field of interest broadly.⁶ Evidence synthesis are formulated on an explicit research question concerning the field of interest, which are not in depth analysis of a question but rather a systematic accumulation of topics of interest.^5,7 The evidence synthesis initiates search, and collation of, suitable evidence making use of clear and replicable methods at every step. The synthesis includes clear definition of components, evolution of a detailed and reproducible search strategy, development of clear exclusion and inclusion criteria, and clear conclusions about the level of evidence to be obtained from individual study.

For the present evidence synthesis an open access online tool CADIMA was used for management of evidence that was established by Julius Kühn-Institut (JKI) during a EU-funded project called GMO Risk Assessment and Communication of Evidence (GRACE). CADIMA is a free web tool guiding the conduct and furnishing the documentation of systematic reviews, systematic maps and further literature reviews.⁸ CADIMA is outlined to offer substantial evidence to users in the structure of prompts, that majorly differentiates between a meticulous systematic review and a quality literature review, this feature substantially reduces the difficulty in assimilation of evidence for new research.

The main objective of this evidence synthesis presents the outcomes of an evidence map that was directed to know the extent of infodemics and its effects on public health during the ongoing pandemic and attempts to explore the nature of evidence present in literature. The process assures a procedure of ‘stocktaking’ of the evidence as vital gateway in providing a sketch of the extensiveness of research activities in the field of infodemics. After consulting experts in Public Health (community medicine), Public Health Dentistry and also the nodal Covid officers of COVID 19, a relevant question was framed and the scope and frame of the was chalked out. The process disclosed two domains, mainly the causes of Infodemics and the effects of infodemics on public health, as the first question was the primary focus of the evidence synthesis two secondary questions were included to widen the scope of this evidence. The objectives of the present review were to screen for good-quality evidence on the effects of infodemics on public health during the Covid-19 pandemic and to know the impact of infodemics and various strategies to manage infodemics in public health during the Covid-19 pandemic.

Methods

Inclusion and exclusion criteria

The reviewers deliberated all studies, regardless of design, as eligible for inclusion. A population and outcome (PO) search strategy that was wide enough to cover all topics was developed for categorizing potentially significant studies in any topic area. We excluded review articles that did not have any systematic search strategies but scrutinized the bibliography for identifying other potentially appropriate evidence. There were no restrictions for year of publication but the articles published in English or with an English translation were included.

The selection of the retrieved articles involved the authors (MP and AS) independently and solved disagreements by consensus or consultation with a third reviewer (SY) Each time the title or abstract reported a keyword of relevance appearing to be eligible for the inclusion, the full article was obtained. All references were retained post the initial screening and later assessed for the inclusion and exclusion criteria the following information was extracted: (i) title, (ii) author, (iii) journal, (v) publication year, (vi) location of key words, (vii) type of article/study and (viii) comments based upon the full texts. all the articles were charted in a standard Excel format. The data extraction sheet can be found under Underlying data.²⁵

The present review drives past the scope of only ‘evidence mapping’ if a systematic review was obtainable than that was inserted into the mapping process and can be considered as an umbrella review and evidence mapping and a brief qualitative explanation of the key results have been considered and each theme is described below (Figure 1).

Figure 1. Flow diagram.

Results

The authors identified 55 records through database searching, after screening for duplicates, 53 records were screened at title/abstract level of which, 16 incomplete or non-English articles were removed and 37 were eligible for full text screening. 37 full-text articles were then assessed for eligibility and only 22 articles were included as per the inclusion criteria with an interrater Outcome Kappa value: 0.91. The strength of agreement was considered to be: ‘excellent’.

The majority of the studies focused on the first domain impact of infodemic followed by effect of infodemic and management in infodemic during the covid-19 pandemic. The studies explicitly mentioned the psychological impacts on infodemics, the health care burden, low digital health literacy, economic burden, financial losses, and desensitization of the public towards infodemics.

Discussion

We conducted a synthesis of 55 records from the databases, of which 22 articles were retrieved satisfying the inclusion criteria as predetermined. This amalgamation included 4 phases of systematic data synthesis - Phase 1 focused on the 3 domains, one - the impact of infodemic on public health, two - its effects on public health and, three – Management of infodemic. Our evidence synthesis revealed that the most effective way to overcome an infodemic phenomenon was to increase digital health literacy by educating the masses and the future research to be directed with an accurate methodological process that is supported by strong evidence.

A review by Choukou et al.¹⁹ categorised the needs for digital health into five parts. They are 1) knowledge of the disease to be increased by digital health literacy, 2) to manage and cope with new practices and changes from the routine, 3) to overcome anxiety and fear regarding the disease (COVID 19), 4) to overcome the barriers to health literacy and 5) increase the acceptance to technology.¹⁹ A study by Li X²⁰ revealed that during the COVID-19 pandemic the main barrier for cohorts with HIV/AIDS to understand their individual health, illness and treatment was considered to be poor health literacy.

Social media as a preventive approach could help in circulating the authentic news and information on diseases. This could help the public in adopting the necessary measures for control of the disease. Lack of digital equipment in vulnerable groups is the basis for poor digital health literacy in population, and resolving this situation through health care organisations reaching out to such groups and enabling access to an electronic source for information and health care of these groups should remain a priority.²⁰

A systematic review conducted to assess the media sources of information and knowledge levels about COVID-19 revealed that 40% of the population depended on social media as their primary source of information regarding the disease.²¹ The increased circulation of misinformation in social media platforms during the accelerated health emergency has led to a cataclysmal infodemic.

Researchers have the advantage and the right medium to hold back this tide of infodemic and any paucity in conducting the research process could lead to either insufficient information or could be interpreted insufficiently. The rapid spread in false medical cures or false remedies was noticed during the pandemic in large populations. The examples for such false remedies include smelling spices and inhalation of steam with salt could kill COVID 19 before it reached the lower respiratory system.²² Implementing artificial intelligence to tackle this will help publish evidence based and systematically conducted research and filter out the biased publications during a pandemic.²² The quality of research published should be evaluated critically for any misinformation. Hence researchers have to comply with publishing and reporting strong scientific evidence.²³

This review has exposed certain definite evidence gaps in the field of infodemics and the ways to manage infodemics during a pandemic. In this unprecedented world with many unexpected situations, infodemics will be a common phenomenon, hence studies on health literacy, and identification of cohorts at high risk of this phenomenon will be a way forward.

Conclusion

This synthesis focused mostly on the gaps in the field of infodemics and public health. The two main gaps identified were lack of systematically conducted research and poor digital health literacy. As infodemics are a new phenomenon with respect to the COVID-19 pandemic, it was an eye opener at different levels of public health, furthermore this evidence map highlights the need for further research on the impact of infodemics and prevention of their spread. Hence further studies are required to strengthen public health infrastructure and prevent this digital virus.

It has been recommended that the application of Artificial intelligence (AI) in assisting to screen the data available for accurate translation, summarization, simplification and content filtering should be the immediate approach to address this catastrophe.