An infodemic is an overflow of information across physical and digital environments during a public health emergency, which makes it difficult for people to find information to better protect themselves and their communities (Calleja et al., 2021). During an infodemic, timely and reliable communications from trustworthy sources can be undermined by a flood of low quality sources and misinformation, and challenges in discerning between conflicting information. This creates a challenge for public health responses to the emergency by creating confusion, misunderstanding of health information, or mistrust in health authorities. In the twenty years since infodemiology was defined as an area of research (Eysenbach, 2002), these public health challenges have been observed for vaccine-preventable diseases (Gu et al., 2014; Gillespie et al., 2016; Avery, 2017), the uptake of e-cigarettes among non-smokers (Amin et al., 2020; Wright et al., 2021) and the introduction of the human papillomavirus vaccine (Dunn et al., 2017; Dempsey et al., 2006; Rosenthal et al., 2008).
WHO has defined an infodemic as an overabundance of information, including mis and disinformation, which occurs during a health emergency. While low quality health information is always in circulation, the context of health emergencies is of special interest to the WHO, because people search for, process, react to and use health information differently during crises. Harmonised measures of how people encounter and engage with health information would help us understand how the information environment affects health behaviours at population levels, and how that might be different during and outside of a public health emergency. Other differences may be topic-specific—consider the use of face masks, immunization, drinking alcohol, smoking, taking unproven treatments or diagnostics, and others. Other differences may exist in different community contexts—a pandemic or an epidemic, an immunization campaign in a community of focus, health promotion in a vulnerable group, communities where adverse events during an immunization campaign are widely publicized.
Since the beginning of the COVID-19 pandemic, the World Health Organization (WHO) has considered an expanded definition of infodemiology to study not only information that is produced and consumed online, but also that circulating in offline environments and communities. For research to be actionable in how it informs health emergency preparedness and response, it requires harmonised measures and cohesive interventions that can only be achieved through transdisciplinary approaches (Calleja et al., 2021). Measures of impact and the interventions they inform must consider online and offline sources of information and account for the complex ways in which information exposure and trust relate to non-protective behaviours and poor health outcomes (Briand et al., 2021; Tangcharoensathien et al., 2020).
Social media analysis is a common study design in infodemiology (Wang et al., 2019), but very few are designed to link measures of individual information exposure to risks of harmful or non-protective behaviours or health outcomes, or observe or measure trust as a modifying factor. Most social media analyses only measure the incidence of relevant information online and can only speculate on impact (Dunn et al., 2021). This skewed focus in infodemiology research affects our ability to assess the burden of disease associated with information exposure, and limits the potential to use infodemiology research to inform public health actions aimed at reducing the impact of exposure to low-quality or harmful information on health outcomes (Dunn et al., 2018).
Another challenge comes from inconsistency in how information exposure is measured. Most data-driven infodemiology studies are restricted to individual social media platforms (T.K et al., 2021; Tsao et al., 2021). Where information access, exposure, and engagement are measured, they are measured inconsistently across studies due to differences in sampling and inclusion criteria. Beyond social media, other—potentially more important—sources and conduits of information that might influence behaviour are typically not measured, including targeted advertising, consultations with health professionals, and online and offline conversations between friends and family. To the best of our knowledge, no studies have been conducted to determine whether data from individual social media platforms can be used as a proxy for broader information exposure in the context of identifying risk factors for harmful or non-protective behaviours.
Prior to the rapid growth of social media platforms and data-driven infodemiology studies, measures of information exposure came from surveys. Simple questionnaires would ask participants questions about which information sources they access and trust, and media use diaries could be used to collect more detailed information about some of the sources of information people engaged with by time of day (Christner et al., 2021). An advantage of these approaches was that they captured information sources people recall, which means they represent more salient information. Disadvantages included intrusiveness in the sense that they required effort from participants, and that they relied on participants remembering what they have seen, heard, or read days or weeks later.
Recognising this as an issue in infodemiology, the WHO developed research priorities related to measuring the burden of infodemics on population health. The first WHO infodemiology conference discussed these issues and developed research priorities related to measuring the infodemic burden (Calleja et al., 2021). In a follow-up WHO infodemiology conference, a panel of experts developed recommendations on specific actions that needed to be taken to improve the availability and quality of data required to measure infodemic burden (World Health Organization, 2022).
Recognising the need for new tools in the area, our aim here was to describe one possible solution for measuring associations between information exposure and health behaviours, with a focus on making the tools available and easy to use in low-resource settings.