key: cord-0693605-smxiwbr9 authors: Ritter, Ashley Z.; Aronowitz, Shoshana; Leininger, Lindsey; Jones, Malia; Dowd, Jennifer Beam; Albrecht, Sandra; Buttenheim, Alison M.; Simanek, Amanda M.; Hale, Lauren; Kumar, Aparna title: Dear Pandemic: Nurses as key partners in fighting the COVID‐19 infodemic date: 2021-04-20 journal: Public Health Nurs DOI: 10.1111/phn.12903 sha: 648414be5ef95eeebe1dab0e61e7eb4344ec364e doc_id: 693605 cord_uid: smxiwbr9 The COVID‐19 pandemic and subsequent proliferation of misinformation have created parallel public health crises. Social media offers a novel platform to amplify evidence‐based communication to broader audiences. This paper describes the application of science communication engagement on social media platforms by an interdisciplinary team of female scientists in a campaign called Dear Pandemic. Nurses are trusted professionals trained in therapeutic communication and are central to this effort. The Dear Pandemic campaign now has more than 97,000 followers with international and multilingual impact. Public health strategies to combat misinformation and guide individual behavior via social media show promise, and require further investment to support this novel dissemination of science communication. health-related information, primarily spread through social media and web-based news sources (Aharan, Ruban, Dubovi, 2020) Recent examples of COVID-19 misinformation contributing to the infodemic include widely-shared social media posts about the dangers of wearing masks, the use of supplements and untested treatments to cure COVID-19, and even conspiracy theories claiming that COVID-19 is a "hoax" (Bagherpour & Nouri, 2020) . While traditional means of health communication and education in nursing have centered on nurse-individual interactions, nurses are also well prepared to educate groups, communities, and populations through broader venues including news media outlets, public health departments, and social media. As part of its prevention strategies, the World Health Organization suggests managing misinformation through the scientific discipline of "infodemiology". Infodemiology includes examination of trends in web-based health information to actively counter misinformation by integrating evidence and disseminating accessible, applicable recommendations to individuals and communities in order to modify health knowledge, attitudes, practices, and behaviors (World Health Organization, 2020) . Essential to the discipline of infodemiology is the critical study of managing misinformation to instill behavior change and mitigate the pandemic's effects (World Health Organization, 2020) . A well-known example of infodemiology in practice is the analysis of Google search trends about symptoms to predict influenza outbreaks (Mavragani, 2020) . During the COVID-19 pandemic, misinformation is rampant, spreads quickly, and is easily accepted by users seeking health guidance-especially on social media (Baum et al., 2020) . A key to fighting misinformation is accelerating the spread of good information, including evidence-based public health messages. While the vital role of nurses as front-line clinicians during this pandemic is amplified, the role of nurses as educators and publicfacing experts receives less attention. When compared to other professionals, nurses rank as the most ethical and honest by public perception (Reinhart, 2020) . Nurses are ideally suited to influence the actions of individuals, to improve the health of the public through therapeutic communication, and to conduct public outreach. Information about disease outbreaks often aim to effectively communicate risks so that individuals and groups can make wellinformed choices in line with public health messaging (World Health Organization, 2017) . The voices of trusted, well-informed nurses via social media outlets, in concert with other highly trained professionals, amplifies the dissemination of effective public health messaging in alignment with public health departments, local, state and federal government, and larger organizations such as the Centers for Disease Control (CDC) and the World Health Organization (WHO). One strategy that equips nurses to successfully practice infodemiology is the development of the therapeutic relationship. The practice of developing the therapeutic relationship entails meeting individuals where they are, physically and psychologically, to navigate health and wellness comprehension and action (Peplau, 1995) . It requires nurses to focus on relationship building and communication of evidence-based recommendations to promote health and safety through the phases of orientation (establishing trust), working (identifying a problem), and resolution (resolving a problem), through which the client/patient drives the content and process (Forchuk & Dorsay, 1995) . This is central to the nurse-patient relationship, patient education, and to combating misinformation among both individuals and communities (Forchuk & Dorsay, 1995) . The trustworthiness of nursing professionals increases their ability to amplify good information and deliver it on a larger scale. Social media can serve as a platform for establishing the therapeutic relationship and ultimately provide content and education driven by the user--analogous to the patient-centered education derived from the traditional one-onone therapeutic relationship. Can't I just give my nose a little break while I'm wearing my mask? Social media can play a key role in the monumental task of informing the public about a novel disease and influencing personal actions. Americans increasingly report seeking news from social media platforms and less often from print news sources (Shearer, 2018) . In a study examining the source of news information pertaining to the COVID-19 vaccine, 1 in 5 reported getting vaccine information from Facebook (Hamel et al., 2021) . In another study, 80% of people report social media sites as a regular source of news (Pew Research Center, 2021) . However, patterns of use are not homogenous. For example, people under 30 are most likely to get news from social media outlets but may use Instagram more often than Facebook (Pew Research Center, 2021) . In this context, the use of social media to spread public health information offers great opportunity as well as challenges. Facebook can also present a significant public health threat. For example, in the aftermath of the Boston marathon bombing, factual information took nearly six times as long to reach 1,500 people compared to misinformation (Fox, 2018) . Similarly, in an analysis of tweets of popular news headlines, false news stories were approximately 70% more likely to be retweeted than true stories (Fox, 2018 engage with a broad audience, and also allow Dear Pandemic followers to easily share content within their own personal network of family and friends. This is critical, as 40% of people across demographic and age groups cite friends and family as their source of COVID-19 information. (Hamel, et al.2021) . The combination of vetted scientific information, conversational language, and the ability to share posts within trusted networks results in significant engagement with Dear Pandemic content and downstream impact. An example of a Dear Pandemic Instagram post can be found in Figure 1 with companion text available on Facebook (Dear Pandemic, 2020). A taxonomy of Dear Pandemic topics is included in Table 2 . Dear Pandemic's strategy of daily messaging in bite-size chunks via social media platforms has yielded wide reach and impact in the last 9 months. On Facebook alone, Dear Pandemic now has over 80,000 followers. Across the four platforms, the project has over 100,000 followers. Since November of 2020, the content reaches more than one million people monthly. The average monthly reach across all the platforms is summarized in Table 3 . Table 4 Pandemic scientific team is currently conducting an impact evaluation using a developmental evaluation framework, which is informative for an innovative public health project that emerges rapidly and has no formal control group. Outcomes will be measured at the levels of information environment, readers (and their networks), and systems. Platforms such as Dear Pandemic will not singlehandedly solve the deep divides present in our society, but can offer fresh and engaging June 3, 2020 COVID-19 Safety precautions during the Black Lives Matter protests Dear Pandemic advice was critical to us when we were deciding then preparing to go to the march this weekend. Love that page! June 28, 2020 Follower Recommendation Dear friends: I have generally made few comments about the pandemic but as the world and your life and our social circles open up, I cannot recommend the following FB/Instagram/Twitter site enough: "Dear Pandemic." I have individually told several friends about the page but want to make a blanket recommendation to look at this site for all of your COVID-19 questions and answers. They are vetting a ton of academic research in plain English, giving recommendations on the risk of activities (often within the context of disease spread in communities), and pointing out good and bad science. They even do Q and As -online and in person! … They are stellar scientists and are giving very good info without scare tactics or sugar coating lack of risk. When recs change, they are also explaining why. Check them out-for your sanity and for the sanity of those around you! July 21, 2020 Face Shields This is a very nice COVID-science site/team of superheroes sorting through the data to give clear answers to what we should and shouldn't do. Masks, everyone. And follow this page or scan it for answers. Good science is good preparedness and practice. August 13, 2020 Daycare I've been getting posts from Dear Pandemic for a while now-It's a project of Nerdy Girls. Their information is factual, the science is explained very well, and everything presented is sourced. This one might be helpful if you are getting information to parents about the safety of childcare. Great page to follow for trustworthy information and myth-busting regarding COVID-19! October 9, 2020 Testing Once again, Dear Pandemic proves to be a great resource. This is another very timely explainer for one of the concepts that seems to be eluding many: the limits of testing for mitigation and the need to combine it with other measures. You can be contagious both before you have symptoms and before you test positive. October 20, 2020 Safety of activities As an ER doc in an area that has seen many patients with COVID-all ages, all different risk groups, some with no risks at all, all different symptoms…. the medical community has been consistent with our message from day one. It's quite exhausting but we will continue to show up! Don't listen to the noise. Listen to the healthcare professionals. Stay safe! Luv this example. I will incorporate it into my discussions! Thank you! November 16, 2020 Curfews Your content on this page is so helpful! I often find myself in situations where I need to quickly support and defend COVID safety measures, and your Q/A posts have been a great reference for me. This work was funded in part by a Robert Wood Johnson Foundation Alumni Network Activation Grant. Ashley Z. Ritter @AshleyZRitter Knowledge and information credibility evaluation strategies regarding COVID-19: A cross-sectional study COVID misinformation is killing people The state of the nation: A 50-State COVID-19 survey report 314: Misinformation and vaccine acceptance Misinformation of COVID-19 on the internet: Infodemiology study What is an mRNA vaccine Those Nerdy Girls. Dear Pandemic Hildegard Peplau meets family systems nursing: Innovation in theory-based practice Fake news: Lies spread faster on social media than truth does Fresh Air KFF COVID-19 Vaccine Monitor Infodemiology and infoveillance: A scoping review Information overload helps fake news spread, and Social Media Knows It Peplau's Theory of Interpersonal News use across social media platforms in 2020 Nurses continue to rate high in honesty Social media outpaces print newspapers in the U.S. as a news source Communicating risk in public health emergencies: A WHO Guideline for emergency risk communication (ERC) policy and practice Dear Pandemic: Nurses as key partners in fighting the COVID-19 infodemic