Researchers in Vaccine share their design of a training programme intended to enhance the skills and confidence of healthcare workers in “recognising and effectively responding” to misinformation. Through evidence-based misinformation strategies, learner engagement strategies, and authentic scenarios, the curriculum was developed for administration in 2023 in 8 countries. The authors place a “key emphasis” on a learner-driven approach that enables real-world application, and hope that their work can be used as a resource for practitioners.
Vaccine misinformation
The researchers recall WHO Director-General Dr Tedros Adhanom Ghebreyesus’ warning of a dangerous “infodemic” in parallel with the COVID-19 pandemic.
“An ‘infodemic’ describes the proliferation of information spanning a spectrum from credible to misleading to intentionally deceptive, inundating our everyday communication and making it difficult to discern accurate, reliable knowledge.”
This spectrum includes misinformation, which is false information shared “without intention of causing harm”, and disinformation, which is false information shared with an “intent to deceive” or serve an “agenda or political goal”. The implications of misinformation on public health, particularly attitudes to vaccination, are not new.
The role of healthcare workers
“Healthcare workers play an incredibly important role in combatting and responding to misinformation for vaccine communication; they routinely emerge as a trusted messenger for vaccine information for community members including in communities with lower levels of trust toward the government broadly, and the health care system specifically.”
They are often the primary point of contact for guidance and advice, but this responsibility is often unsupported with a “lack” of formal training on best practices. Furthermore, there are concerns that healthcare workers are also “being swayed by health misinformation” and feel insufficiently prepared to address it.
“There is a felt need amongst healthcare workers for support and trainings to be able to confidently respond to questions and growing concerns about vaccines, including responding to vaccine misinformation.”
Equipping healthcare workers
To support healthcare workers, the researchers developed training to provide evidence-based strategies to identify and reject misinformation. It uses participatory, problem-based learning. The goal was to provide healthcare workers with “concise, evidence-based practices” to respond to patients and support community members in addressing misinformation through “prebunking, debunking, and interpersonal communication strategies”.
Once the programme was developed, training took place in 2023 with 287 participants in eight countries: Cameroon, Guyana, Kenya, India, Mozambique, Nigeria, Philippines, and the US. It was translated from English into three other languages: French, Spanish, and Portuguese.
The curriculum
The training used findings from a pilot study and incorporated systematic reviews of social media, misinformation, and vaccine acceptance. A “robust” theory for mitigating misinformation is phycological inoculation theory, which finds that pre-exposing individuals to “weakened” versions of an argument can build “resistance” towards real-world examples of the argument. Thus, in the training, the authors presented learners with “weakened” formats of common misinformation, accompanied by refutations, to “build their cognitive resistance and enhance their ability to effectively identify and counteract false health information”.
Another strategy that they used is “prebunking”, or pre-emptive debunking. This “promising, scalable intervention” trains individuals to recognise common manipulative strategies used to spread misinformation. This puts the focus on a “generalisable skillset” for identifying misinformation across topics, providing a “general ‘immunity’ effect”. The researchers also used a debunking strategy, the process of correctly noting and refuting false information. The training allowed healthcare workers to refute false claims in simulated conversations.
The training reflected feedback from the initial pilot, which identified the importance of using intervention strategies that build trust and empathy in patient-provider interactions. Therefore, it included modules on best practices for evidence-based communication approaches.
Lessons and recommendations
The authors state that the principles of problem-based learning were “well-received” but that trainings could be more effective with contextualisation. However, they note an “inherent tension” between the benefits associated with tailored content and the “additional resources” required for customisation. Thus, a “middle ground” could use a “core” curriculum in a modular format with the possibility to tailor examples for specific cohorts.
“The results of our training add to the body of evidence that participatory, problem-based learning is effective and important.”
The paper is concluded with the hope that it can be used as a resource for practitioners and researchers who seek to implement similar, contextualised training.
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