Five Ways Penn Nursing Is Tackling Health Misinformation and Disinformation

A commitment to science-based evidence centers Penn Nursing alumni, faculty, and students as champions of truth in a world of health rumors and fake news.

Medical myths have existed and persisted for centuries, often despite scientific advances. But modern-day health misinformation is skyrocketing at alarming rates. Baseless ideas about effective vaccines, treatments, and vital health screenings go viral on social media. Sifting the vast Internet to find trustworthy, factual sources grows trickier. Even well-intentioned friends and family pass along inaccuracies. Understandably, many patients who want to make appropriate health care decisions get confused. The U.S. Surgeon General Vivek H. Murthy has warned that health misinformation is a “serious threat to public health.” Add profit and politics into the mix, and you get health disinformation. Purveyors intentionally deceive to make money or score political points. Anti-vaccine influencers earn ad revenue on their social media channels. Unethical online peddlers sell ineffective (even harmful) “remedies.” There is hope: Nurses, as highly trusted professionals working at bedsides and in communities, are well-positioned to address false claims and guide people to accurate sources. Penn Nursing supports efforts to tackle health mis/disinformation around the world and in our own backyard. Read on to see how faculty, students, and alumni are confronting these twin foes and advancing health literacy.

1. National Leadership

“For patients to make informed decisions, they need information that is accurate, complete, and understandable. Nurses have an ethical responsibility to make sure they get it,” says Professor and Margaret Bond Simon Dean of Nursing Antonia M. Villarruel, PhD, RN, FAAN, GNu’82.

That professional mandate is one reason Dean Villarruel signed on to advise a National Academy of Medicine (NAM) assessment of credible health information. Initially, the advisors aimed to help social media platforms in their efforts to filter out mis/ disinformation. Ultimately, they developed helpful flowcharts that anyone can use to identify quality sources, whether that’s a federal agency, a private company, or a nonprofit. With information coming from every direction, every day, the evaluation criteria “has been helpful to many people in terms of discerning where they get the information and how they use it,” Dean Villarruel says. Their work informed Google’s method of elevating credible medical information. (YouTube was a funder.)

Since the paper’s publication, Dean Villarruel has shared the findings with a variety of audiences, from the American Nurses Association to the ABIM Foundation’s annual forum. For the American Journal of Nursing, she wrote “Preventing the Spread of Misinformation—A Role for All Nurses,” with former nursing liaison librarian Richard James, to frame the NAM papers for practitioners.

Mindful of the pandemic’s prevailing uncertainty and the fact that medicine and practice both change over time—a healthful nightly glass of wine, anyone?—Dean Villarruel suggests that nurses present information as “the best advice we know with all the evidence we have at this time.” Also, ask patients where they are getting their information and don’t assume they will follow medical advice. “It is a partnership and we just need to engage like it is.”

2. Partnerships

The School is collaborating with people across Penn and its neighbors throughout Philadelphia to ensure evidence-based information is accessible to all and that the public has the tools they need to make appropriate health care decisions. Penn Nursing’s longtime community health work often makes it a natural partner in projects that aim to share trustworthy resources.

“We need not just trusted information but trusted messengers. Sometimes that is not a health care provider.”

Together with Philly Counts, the city’s vaccine outreach program, Penn Nursing has led the Philly Community Alliance Against COVID-19 (Philly CEAL). As part of this local effort, which is connected to a larger, national NIH initiative, Principal Investigator José A. Bauermeister, PhD, MPH, FSBM, Chair of the Department of Family and Community Health, and Dean Villarruel spearheaded a research team starting in 2021. Their aim: Use data and community input to mitigate disparities in testing, vaccine uptake, and treatment across the city.

Philly CEAL university partners include Penn Medicine and the Annenberg School for Communication. According to Dean Villarruel, Penn Libraries’ participation has been crucial for addressing health mis/disinformation. After all, librarians are experts in quality public information. Penn nurses have volunteered at CEAL vaccination events. And CEAL has created community-informed campaigns about vaccinating children and pregnant women.

Others that have signed on include the Caribbean Community in Philadelphia, the Korean-American Association of Greater Philadelphia, and Children’s Hospital of Philadelphia.

“We need not just trusted information, but also trusted messengers,” Dean Villarruel says. “Sometimes that is not a health care provider. As we’re thinking about information and science in general, figuring out ways to incorporate a diverse lived experience is important.”

“A coordinated response among health care providers is essential to convey accurate information to patients and prevent the spread of false information.”

The School also joined a university partnership that brings together nurses, physicians, media experts, computer scientists, and more to strengthen health literacy. Launched in 2022, Penn Medical Communication Research Institute (PMCRI) is a multidisciplinary effort with the Perelman School of Medicine, the Annenberg School for Communication, and Penn Engineering.

“A coordinated response among health care providers is essential to convey accurate information to patients and prevent the spread of false information,” says Anne R. Cappola, MD, ScM, M’94, PMCRI, Director and Professor of Medicine, Perelman School of Medicine. “Penn Nursing has a wealth of expertise in highquality care and communications research, and their faculty have been valuable and engaged partners in PMCRI’s mission to advance medical and health communication.”

Two Penn Nursing faculty have collaborated on projects supported by PMCRI’s $50,000 pilot grants. Alison Buttenheim, PhD, MBA, Patricia Bleznak Silverstein, and Howard A. Silverstein Term Endowed Professorship in Global Women’s Health, has studied how to communicate with parents and caregivers about vaccinating children against COVID-19. Assistant Professor of Nursing Melanie L. Kornides, ScD, RN, FNP-BC, has worked on two pilots. One examined how to increase vaccination rates in lower-income communities. For another, Kornides and a team are promoting pediatric flu shots in marginalized communities of color in West Philadelphia. This fall, customers at some CVS stores will see their Penndesigned, community-informed campaign. Shoppers who point their smartphones at QR codes on educational posters will get information about the flu vaccine.

“We want to make sure that every message we put out there is something that will actually resonate within that community,” Kornides says of the approach she and colleagues took. They met with West Philadelphia parents and adolescents, health care providers, and community stakeholders to craft the messaging. The researchers are set up to analyze whether the QR code attracts clicks and increases flu shots at the store.

Kornides says multidisciplinary projects like PMCRI’s are the “gold standard.”

“You can bring a diversity of perspectives. We can bring in people from Annenberg who use health communication science. We can bring people in on design and creativity aspects. It really makes your project so much better, to have all these people with their experience working together to create an intervention,” she says.

Other PMCRI pilots have taken aim at reducing medical bias and improving the diversity of participants in pediatric trials.

For an annual symposium, PMCRI also draws on Penn Nursing faculty. This October, Terri Lipman, PhD, CRNP, FAAN, GNu’83, GRN’91, until recently the Assistant Dean for Community Engagement, is set to speak at the 2023 Symposium on Social Media & Effective Medical Communication.

3. Research

Penn Nursing faculty have won federal grants and been awarded university funding to study health mis/ disinformation—and find methods to address its ill effects or, even better, to prevent harmful myths from taking root. “A lot of really smart people are working in this space now. It’s definitely been easier to get funding for research projects,” Kornides says.

She has been studying parents who are hesitant to have their children vaccinated against HPV since 2016. “We haven’t reached the levels that we’d like to reach as far as uptake goes,” she acknowledges. An NIH grant has afforded the opportunity to test an “inoculation approach.”

“We’re trying to get ahead of misinformation” spread on social media, she says. Over the course of a year, they’ll test messages designed to look like posts on platforms such as Instagram with a group of parents of children younger than 11 or 12 (the typical age the shot is administered). “Hopefully in our trial, that will translate into actual higher vaccination rates,” she says, adding that scientists still have a lot to learn about the long-term efficacy of inoculation theory. “How much inoculation do you need? How many messages are sufficient?”

Of course, baseless beliefs about vaccines don’t just ripple across social media. With a PMCRI pilot grant, Buttenheim and a team studied another source of misinformation in fall 2021. The FDA was considering emergency use authorization to vaccinate children ages 5 to 11 and invited public comment via the regulations. gov website. Some calls for input only garnered a handful of comments, but this one was popular. Buttenheim says about 130,000 comments were posted—with the vast majority opposed to the authorization. Using natural language processing models, the team identified prevalent themes among the commenters to gain insight into misinformation claims and other mindsets shaping anti-vaccine attitudes. From there, they developed and tested messaging for pediatric providers to use during office visits.

“There’s not going to be one magic bullet that cures belief in misinformation,”

“Most of the evidence provided in these public comments is factually not correct. But it’s really helpful to see how arguments against the vaccine are constructed and communicated,” Buttenheim says. “It helps if clinicians are prepared for those conversations and know what sorts of objections are going to come in the door.”

Effective strategic messaging is also key to Kornides’ research into COVID vaccine uptake. “There’s not going to be one magic bullet that cures belief in misinformation,” Kornides says. “It’s really going to be a more tailored approach to specific demographics and to specific audiences.”

With PMCRI funding, she and a team tested three different messaging strategies to address COVID vaccine myths known to be circulating in low-income communities. First, they presented a piece of misinformation together with actual facts that expose the falsehood. Second, they conveyed the truth, then the rumor, and then the truth again (commonly called the “sandwich method”). Third, they stuck with just the facts and didn’t call out any specific misinformation. Their recently finished data analysis revealed the third option was most effective in decreasing belief in the misinformation and increasing the likelihood of willingness to get a shot.

Skepticism toward COVID shots is a fresh reminder that vaccine hesitancy has been around as long as vaccines have. Buttenheim hopes to get out in front of such doubts regarding HIV prevention.

There isn’t yet a vaccine that prevents HIV, but she is leading a study that could help with demand for the vaccine once it is available. With a five-year NIH grant, the team is focusing on young women in South Africa, a group with high rates of new HIV cases. Their inoculation approach seeks to “pre-bunk” myths before misinformation runs rampant on social media.

Starting this fall, they’ll identify myths that could arise. For example, Buttenheim says, they already know that many adolescent girls take pre-exposure prophylaxis (known as PrEP) to reduce their chances of contracting HIV. That may make them doubt whether they need a vaccine at all. They’ll then test evidence-based inoculation messages in a randomized trial of about 1,000 adolescent girls and young women to identify effective ways to “build resistance to misinformation.” Eventually, the researchers also hope to learn whether people who gain that resistance apply it beyond the HIV vaccine and strengthen their ability to recognize other untruths more readily.

They’re not the only Penn Nursing researchers working in the vaccine acceptance space, especially around HIV—and the research projects complement one another. A team of researchers led Dolores Albarracín, PhD, the Alexandra Heyman Nash Penn Integrates Knowledge University Professor in Penn Nursing’s Department of Family and Community Health and in the Annenberg School for Communication, has received a $4 million, five-year grant from the National Institutes of Health to identify ways to increase vaccination rates, studying how health and social policies and norms affect acceptance of vaccines, in general, and a future HIV vaccine, in particular. This project will investigate how to increase the usage of any approved vaccination.

“Although a common theory attributes the reluctance to vaccinate to misinformation, vaccines are created and rolled out within a complex social context that includes intertwined norms, public communications, and public health policies,” Albarracín notes. “Understanding the causal pathways to vaccination requires the kind of cross-disciplinary effort this grant will facilitate.”

4. Policy

Governments, businesses, and institutions can help to spread quality medical information and counter mis/ disinformation. Many faculty and alumni are involved in projects to give more organizations guidance on adopting effective policies toward that goal.

Mary Naylor, PhD, RN, FAAN, GNu’73, GRN’82, is a driving force behind the Coalition for Trust in Health & Science. More than 70 organizations and companies have joined since the launch in early 2023. Naylor says the Coalition intentionally includes a broad array of health ecosystem players. The American Nurses Association and American Medical Association have joined up, along with consulting giant KPMG and health care tech firm Real Chemistry.

Even though some members have competing agendas, each has pledged to work individually and collectively to “help the public to be positioned to make appropriate health choices, based on truth.” Those who sign on get access to a curated collection of effective strategies for correcting misinformation and educational sessions on topics like emerging disinformation.

“The easiest thing to do in a policy debate is to scare people. Our goal is to shed light based on the actual conditions.”

“These are big organizations who have signed on because they all play a part. And they are all very concerned, as we all should be, about the truth decay that is happening,” says Naylor, who is Director of the NewCourtland Center for Transitions and Health.

She has recruited Penn Nursing faculty, students, and alumni to further the Coalition’s mission. “I know it’s something that nurses need to be at the forefront in contributing to,” she says.

Many are dedicating time to creating the Coalition’s “Compendium.” This “living library” will be a continually updated resource members can reference for help with promoting trust in evidence-based health information.

Assistant Professor Michael Stawnychy, PhD, CRNP, GRN’23, says he volunteered to help create the Compendium for several reasons. As a nurse practitioner, Stawnychy noticed patients bringing up issues of trust in health care and research frequently. Also, with an awareness that there are historical reasons that some patients mistrust medicine, he has a growing interest in finding ways to promote trust, not just in one-on-one interactions, but in a large-scale way.

Stawnychy is conducting an umbrella review for the Compendium. (Also pitching in: NewCourtland predoctoral fellow Claire Regan DNP CRNP, AGPCNP; Adele Crouch, PhD, RN, AGCNS, who was previously a NewCourtland postdoctoral fellow; and Research Professor Karen Hirschman, PhD, MSW, GRN’01, MSW’96, who works with Naylor at NewCourtland.)

So far, Stawnychy has turned up research on everything from strategies for building community trust to improving recruitment of underrepresented groups in research. Intervention types include debunking and pre-bunking. Modality ranges from social media messaging to in-person conversation. The end goal: Generate a practicable resource for Coalition members, he says, “so they could present the problem they are trying to solve, and then figure out the best intervention.”

The Coalition may be in its early days, but the School has a longtime resource for government and health care system policymakers, too. Founded in 1989 , the Center for Health Outcomes and Policy Research stands ready to analyze what works and what doesn’t. Based on current evidence, faculty forecast potential impacts of public health legislation—and their work often serves to debunk the misinformation that’s a reality in modern politics.

“The easiest thing to do in a policy debate is to scare people,” says current CHOPR Director Matthew D. McHugh, PhD, JD, MPH, RN, CRNP, FAAN, GNu’98, GRN’04. “Our goal is to shed light based on the actual conditions. There are some reasonable concerns about unintended consequences, and we can use our research to help legislators understand what aspects seem to be more successful in terms of policy design or seem to be feasible.”

5. Innovation

As effective communicators, nurses are leading the way in the innovative use of storytelling and media to help the public sort fact from fiction. On podcasts, Facebook posts, and more, they clarify what disinformation purveyors seek to cloud.

One such source of illumination is the School’s Amplify Nursing podcast. Hosts Marion Leary, PhD, MPH, RN, GNu’13, GR’14, GRN’23, and Angelarosa DiDonato, DNP, CRNA, GNu’11, see each episode as an opportunity for listeners to hear the proof behind why nursing is the most trusted of professions. Their guests are not just “talking heads,” says DiDonato. They are providers with the “research to back up what they’re saying. It’s a nice contrast to a lot of the nonsense that’s out there.”

The podcast also offers plenty of helpful tips for nurses who want to use their own platforms to address mis/ disinformation and share facts with the public. Barbara Glickstein, who has a nursing degree and a background in journalism and now prepares nurses for media appearances, appeared on Amplify Nursing to talk about how nurses can make their voices heard. In one episode, Beth Toner, Director of Program Communications at the Robert Wood Johnson Foundation, recommended that all nurses take an improv course to sharpen listening and adaptive response skills. Prolific blogger and RN Patrick McMurray shared tips for posting health care stories while protecting patient privacy.

“There are so many ways to get factual information out there.”

“Nurses are expert health communicators and experts in their respective areas, and we want to promote them as such on the podcast,” says Leary, who adds that she is a “huge proponent of nurses using their voices on social media” or through other forms of communications like op-eds, blogs, and live storytelling such as the School’s annual Nursing Story Slam event. “There are so many ways to get factual information out there.”

Early in the COVID pandemic, Amplify Nursing aired a special series to bring the latest science-backed information to listeners. “We were so fortunate to be able to have experts within the School come on and talk about what was happening and what we knew,” DiDonato says.

Those experts included researchers and clinicians from Dear Pandemic, which started in the early days of the pandemic as a way to educate people about the spread of the virus with humanity and a dose of humor. Many of the founders are Penn Nursing faculty and alumni. Ashley Ritter, PhD, APRN, Nu’07, GNu’10, GR’18, is currently chief executive officer of the project, which is now called Those Nerdy Girls. The name change, in late 2022, reflects the group’s expansion well beyond their original focus. Today, they publish evidence-based information on everything from supplements (“Will taking magnesium help with my mental health?”) to over-thecounter birth control pills. Their website has nearly 200 posts filed under the category of “Uncertainty and Misinformation,” where they break down the facts about health screenings, science literacy, identifying legitimate news sources, and more.

Dean Villarruel highlighted Dear Pandemic in “Preventing the Spread of Misinformation—A Role for All Nurses,” as an example of how to effectively share accurate health information with the public. And in that same article, she and her co-author urged action. Their words echo the School’s dedication to countering health mis/disinformation through faculty, alumni, and students.

“Nurses have access to a wealth of tools, principles, and approaches for ensuring that patients and communities receive evidence-based, up-to-date, and credible health information,” they wrote. “The COVID-19 pandemic and related infodemic are calling us all to act in our professional and personal lives. How will you answer the call?

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