Themes Surrounding COVID-19 and Its Infodemic: Qualitative Analysis of the COVID-19 Discussion on the Multidisciplinary Healthcare Information for All Health Forum

"Ultimately, the right message at the right time from the right messenger through the right medium can save lives..."

In rapidly evolving situations such as the COVID-19 pandemic, researchers, policymakers, journalists, and ordinary citizens may struggle to keep up with the extensive and evolving corpus of new information that spreads rapidly. It is in this context that online forums conducted by Healthcare Information for All (HIFA) saw active and lively discussion regarding the lack of information about COVID-19, the proliferation of misinformation, and the pandemic's impact on different communities. This analysis aims to contribute to the global effort to track, understand, and respond to the infodemic surrounding the COVID-19 pandemic by identifying themes and perspectives shared on English-language HIFA forums in 2020.

HIFA is a multidisciplinary global campaign consisting of more than 20,000 members worldwide committed to improving the availability and use of healthcare information in low- and middle-income countries (LMICs). The first post about COVID-19 on HIFA was published on January 24 2020. (Indeed, the thread continues to this day and stood at 1,464 messages as of May 29 2022, surpassing the number of posts made about any other topic previously on the forums.) For the study, 865 posts between January 24 and October 31 2020 from 246 unique study participants were included and analysed in an attempt to illuminate the information needs that surround the COVID-19 pandemic, particularly in LMICs, and what may be contributing to the infodemic.

The geographical distribution of study participants involved in the discussion spanned 46 different countries on every continent except Antarctica. Study participants' professions included public health workers, healthcare providers, and researchers, among others. Study participants' affiliation included non-government organisations (NGOs), commercial organisations, academic institutions, United Nations (UN) entities including the World Health Organization (WHO), and others.

Six major themes were identified and are illustrated in the article with excerpted posts:

1. Infodemic: This theme includes the following subthemes: distrust in authority and experts, inconsistent public health messaging, information overload, the role of social media, translation needs, and false health claims. Overall, a common consensus emerged around the importance of making verified healthcare information accessible to all to prevent infodemics. Further, members noted that information that is filtered, simplified, and succinct must be provided through multiple mediums, as access to technology can be a barrier. They suggested implementation of a universal and dynamic access point with the latest research, evidence, and guidance (e.g., an international website) to coordinate the influx of information from all sources. Throughout the English HIFA thread on COVID-19, there were multiple requests for the rapid translation of current guidelines and resources to other languages and dialects. In addition, members pointed out that misinformation is also prevalent in lesser known languages and dialects and is not being addressed.
2. Health system: This theme includes discussion about handwashing and personal protective equipment (PPE), the role of community health workers (CHWs), the ability to conduct surveillance for COVID-19, and the impact on healthcare workers and other health services. Among the communication threads: CHWs can educate the local communities they are part of, address any misinformation, and help conduct surveillance of cases. The importance of addressing the SEISMIC (Skills, Equipment, Information, Systems support, Medicines, Incentives, Communication) needs of healthcare workers was also raised.
3. Digital health literacy: Discussion included access to technology/internet services and dissemination of information through alternative and innovative media. The lack of access to adequate internet services, especially in conflict-prone places with internet shutdowns and slow connectivity, presented barriers to the COVID-19 response. Members iterated that unequal access to adequate healthcare information and COVID-19 guidelines online posed a gap that could potentially be fulfilled by the utilisation of radio, posters, and television broadcasts.
4. Economic consequences: Members deliberated about the economic sustainability of a lockdown in LMICs, the inability to meet basic needs leading to increased poverty-related deaths, and the importance of government relief and stimulus.
5. Marginalised peoples: Discussion focused on the impact of COVID-19 on slums in India and Nigeria, the favelas in Brazil, people experiencing homelessness, immigrants, refugees, and those at risk for severe manifestations of the disease.
6. Mental health: Topics covered centred around the mental health of vulnerable populations and addressing fear, anxiety, and psychological stress stemming directly or indirectly from COVID-19.

A timeline analysis highlights how HIFA discussions evolved during the course of the study period as the pandemic proceeded and when the various themes came to the fore.

In analysing the findings, the researchers assert that: "A fresh and important perspective was brought by the participants in this discussion, namely the central importance of facilitating access to reliable health care information as a vital aspect of protecting people from misinformation. Increasing people's access to the internet alone will not help and may make things worse. The key is to help people differentiate between reliable and unreliable health care information. One approach is to increase health literacy, but...even WHO staff are vulnerable to misinformation. Although health literacy is important, new approaches are needed to help people differentiate reliable from unreliable information....[I]nterventions that aim to improve critical thinking and trust in science may be a promising avenue for future research with regard to addressing infodemics and their downstream consequences."

In conclusion, this study reveals how HIFA members shared common concerns and frustrations regarding the COVID-19 infodemic, "with the consensus being that all public health organizations and institutions must effectively anticipate and address infodemics in the future to achieve maximal public adherence to guidelines and mitigate danger. Multiple approaches must be used, including holding influential figures and mass media accountable, deploying rapid knowledge and language translation efforts, using multiple channels of communication to disseminate information, and, most importantly, making verified health care information accessible."