Gayle Thomas, MD, is concerned. She has learned that many of her patients, whom she serves as the medical director of the North Carolina Farmworker Health Program, believe that if they go to the hospital with COVID-19, they will not come out. They resist transfer to their local hospital even with a severe COVID-19 infection. This type of concern has spread across the country. Health care workers, health departments, and other community organizations witness how health misinformation, which is being spread on social media and through other outlets, is influencing the lives of their patients, and the safety of their communities. However, there are tactics, solutions, and messaging that can reduce the spread of misinformation and help patients access accurate information. 

As can be anticipated, the spontaneity of misinformation surrounding health causes a range of reactions. During a recent Migrant Clinicians Network webinar, Dr. Thomas joined two fellow clinicians and a media expert to discuss health misinformation and how to counter it. Heather Kathrens, LCSW-C, a licensed clinical social worker working as a refugee mental health coordinator in the Maryland Department for Health’s Center for Global Migration and Immigrant Health, reported a wide range of reactions from refugees to misinformation. Noting the COVID-19 crisis specifically, Kathrens has found that some of the Afghan refugee families, rather than displaying a disbelief in the severity of COVID-19 or a distrust of the health care system, are being “too safe.”

“We can’t go for a walk in the park,” they tell her. “We can’t leave our house to go grocery shopping.” Yet their extreme sense of safety results in detriments to their overall health, causing them to miss health appointments or preventing them from getting fresh air and exercise.

Sources of misinformation vary. “We see a lot of things that are sometimes perpetuated by social media, and sometimes word of mouth,” Kathrens noted. Dr. Thomas believes death rates in the hospitals of some immigrants’ native countries might spur the distrust of US hospitals that some community members have. She has also heard conspiracy theories that spur from distrust for pharmaceutical companies, creating “kind of a disbelief in the severity of the illness and in the need for a vaccine.”  Habacuc Petion, a local volunteer with Wicomico County and Salisbury Maryland’s COVID-19 Vulnerable Populations Task Force, and a local advocate for immigrant workers, pinpointed the spread of misinformation in his community as coming from social media platforms such as WhatsApp, Facebook, and Instagram. Regardless of the source, clinicians are seeing the negative health effects misinformation and its remarkable spread have on their patients. 

The Driving Forces Behind Misinformation

It is difficult to understand what is driving some of the health misinformation we are seeing throughout the US without looking at the larger picture. Federico Subervi-Vélez, PhD, media and communications expert and Honorary Associate/Fellow of Latin America, Caribbean and Iberian Studies at the University of Wisconsin-Madison, fears that the lack of consistent messaging from political and health authorities at the federal level causes misinformation to spread more easily. Additionally, if inaccurate information is presented from the top tiers of leadership, it takes away media attention from scientific conversations. Dr. Subervi-Vélez believes federal effort, leadership, and support of the voices of organizations such as the Centers for Disease Control and Prevention (CDC) and health departments are crucial for creating a supportive political environment for health safety and improvement which in turn could counteract misinformation. 

Another piece that helps explain what spurs misinformation is perceptions of health topics that are culturally influenced. Petion explained that in his community, drinking aloe is perceived as a solution to and preventative measure against COVID-19. The importance of aloe in many communities stems from its historic cultural use for many health ailments in Haiti. This strong trust of aloe, Petion said, creates misinformation about the importance of other preventative measures, or the need for health care if a community member is severely ill. “Sometimes it comes from the homeland, ideas of what does and what doesn’t work,” Petion said.

Unsure of exactly which platform is used to spread misinformation, Dr. Gayle contemplated Facebook as a possible culprit. Petion stressed the use of WhatsApp as a transmitter of misinformation in his community; Kathrens noted WhatsApp in her refugee community is seen as a trusted source of health information. “We have refugees coming from refugee camps in the Congo, and they have been there for 20 years, and they have been using WhatsApp for 20 years,” Kathrens explained. While clinicians can incessantly suggest going to reputable sources, Kathrens said that accurate health information is far from readily accessible unless that health information is translated into the community member’s language of origin. Yet even for those who speak English as their primary language, social media has been proven to be just as dangerous of a tool for the spread of misinformation.

Community Solutions to Preventing and Deflating Misinformation

Misinformation, like the COVID-19 health crisis, is easier to combat if you focus on preventing new occurrences. However, there are barriers to misinformation prevention, especially in many vulnerable population communities. Language barriers pose one of the greatest hurdles community organizations need to get used to moving, rather than jumping. Kathrens is happy with the Maryland Health Department’s efforts to translate critical health information into multiple languages, which they offer on their website. In some cases, making your information accessible to various populations means creating new partnerships.

Dr. Subervi-Vélez suggested reaching out to key “influencers” like pastors and priests, business owners, and local radio stations and newspapers, to create relationships focused around COVID-19 message dissemination. Petion seconded the idea, noting that his community radio station offers spots for the local Latinx and Haitian influencers to share trusted health information.  MCN’s public service announcements in Spanish cover the COVID-19 crisis and are available for free download. COVID-19 has also brought increased partnership with farm owners and other agricultural employers, as well as farmer associations, many of whom traditionally have not been as readily available for partnership.

Another example of partnership creation is the Covid-19 Vulnerable Populations Task Force on which Habacuc Petion serves. The task force, started in June 2020, is a grassroots coalition of over 30 private and public organizations on the Eastern Shore of Maryland that are interested in meeting the needs of vulnerable populations in their community. Among frequent contactless outreach events that provide food, health care, information, masks, and other services, the task force has created a language group that organizes the translation of informational materials as well as the availability of interpreters at their community events.  

However, sometimes translating information into someone’s language and making it more accessible is not enough to combat daunting barriers. Kathrens described how her health department contacts patients one-on-one via WhatsApp – the community’s preferred communication platform -- to build personal relationships: “We give them education and we email them translated information, but I think a part of those one-on-one help calls is to ask, ‘do you have any questions?’”

Directing people back to a reputable source, making that source legible in their language of origin, and building bridges between health experts and the target community, help to prevent misinformation and to distribute accurate information in communities. Seeking misinformation by specifically asking for it, lets your community know they are being heard, and provides organizations with a chance to deflate misinformation in a culturally sensitive way.

New Tools to Debunk False Messaging and Get Out Good Information

While best practices for COVID-19 messaging focused on combating misinformation are still growing, there is an abundance of ideas and tools to help clinicians ‘unlock’ misinformation and tactfully help their community members create a clearer strategy for critically assessing the information they connect with. MCN’s new interactive tool offers best practices for deconstructing health messages. Spurring from "Five Key Questions”, developed by the Center for Media Literacy, the tool guides a user through critically assessing the trustworthiness of messages they may encounter, as we as links to more resources. 

Whatever method you choose to use, Dr. Thomas highlights the importance of using research-backed approaches. Noting research on myth debunking, Dr. Thomas said, “the more you are trying to bust a myth by talking about it, the more you reinforce it… that is kind of counter-intuitive and it means we have to be careful about how we go about trying to bust myths and that we need to say it all in a very positive way and not restate the myth.” Especially when it comes to vulnerable populations, Petion added that mutual respect and reaching out to meet your community “where they are” are essential for fighting misinformation. “A lot of organizations wait for people to come to them, which in a lot of situations is hard,” he said.  “For a lot of undocumented people, they are afraid to come to you, so you need to meet them halfway.”

Editor's Note: The webinar discussed in this blog is part of MCN's partnership with the National Resource Center for Refugees, Immigrants and Migrants. More information can be found here: https://nrcrim.org/

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