Trust in information sources as a moderator of the impact of COVID … – BMC Psychology
                            November 8, 2023
                                The emergence of infectious diseases has historically caused    serious problems for both global stability and public health.    In 2002, the world grappled with the severe acute respiratory    syndrome (SARS) outbreak, which, by 2003, had spread to 29    countries, resulting in 774 deaths, and affecting over 8,000    individuals [1]. In a striking    parallel, the novel coronavirus (COVID-19) surfaced in December    2019 in Wuhan, China, and has since evolved into a global    concern of unprecedented proportions.  
    The World Health Organization observed over 659million    confirmed COVID-19 cases as of January 10, 2023, with more than    6.7million fatalities and more than 13million    vaccination doses given globally [2]. The World Health    Organization classified the pandemic as a global health    disaster of substantial concern because of its enormous scope,    which caused severe suffering and fatalities across the globe    [3].  
    Beyond the direct impacts of the illness, the COVID-19 pandemic    has still sparked widespread fear and hysteria, with    far-reaching implications that are frequently unrelated to the    viruss actual medical effects [4, 5]. Addressing the    psychological effects of COVID-19 has become a pressing concern    in the twenty-first century[6].  
    Numerous research have examined the COVID-19 pandemics    psychological effects and found a variety of negative effects    on mental health and wellbeing. Sleep issues, increased    alertness, feelings of helplessness, alterations in mood,    health-related concerns, depression, and irritation are among    these effects[7,8,9,10,11,12]. In addition, the    epidemic has sparked an alarming rise in conspiracy views and    false information, despite intense efforts by governments and    groups to stop the viruss spread [13].  
    Conspiracy thinking, a well-documented phenomenon during    societal crises and health pandemics, has been shown to fuel    reluctance to engage in health-related behaviors and foster    misunderstandings about the underlying issues [14, 15]. Throughout the    COVID-19 pandemic, subjects such as the viruss origin,    severity, and containment have become focal points for    conspiracy theories [16] The study of    conspiracy thinking has emerged as a burgeoning field, seeking    to uncover the factors that influence individuals acceptance    of such beliefs [17, 18].  
    Different studies highlighted that conspiracy beliefs led to    anxiety and threat [7, 17, 19]. Douglas, Uscinski    [20] found that people who    believe in conspiracies tend to be more anxious. Additionally,    those who experience high levels of anxiety are more    susceptible to such beliefs. Misinformation beliefs during    covid-19 brought about feelings of anxiety [21]. Within the    perspective of continued influence theories, misinformation not    only cause poor judgements and decision-making, but it also has    a long-lasting effect on peoples reasoning after correction    [22]. In their model of    false beliefs drivers, Ecker, Lewandowsky [22] posited that    misinformation beliefs might come from cognitive drivers    (intuitive thinking, cognitive failure, and illusory truth),    and socio-affective drivers (source cues, emotion, world view).    Verma et al., (2022) found that anxiety level doubled or    tripled among twitter users who shared COVID-19 misinformation    compared to other users who refused to share misinformation. As    such, conspiracy thinking decreases trust in traditional media    and increase reliance on social media which transmit    misinformation [23, 24]. In other studies,    anxiety was not strongly associated with conspiracy theories    and misinformation beliefs [24]. We hypothesize that    COVID-19 anxiety and sources of information drive individuals    to believe in conspiracy theories and misinformation beliefs.  
    The COVID-19 pandemic has significantly impacted Oman, with    399,154 confirmed cases and 4,628 deaths as of January 10,    2023. While the country has made progress in vaccination    efforts, with 63.79% of the population having received at least    one dose, misinformation remains a significant issue that has    not been adequately addressed. In Western cultures, research    has shown the importance of conspiratorial and misinformation    beliefs in the proliferation of COVID-19 anxiety and    Coronaphobia, [25,26,27,28,29,30,31,32] leading to negative    effects such as vaccine hesitancy [33]. However, little to no    research has been conducted in the Arab Gulf region,    specifically in Oman, on the relationship between    misinformation beliefs, conspiracy theories, and COVID-19    anxiety.  
    To address this gap, this study investigates the relationship    between misinformation beliefs, conspiracy theories, and    COVID-19 anxiety among the Omani population. Research has shown    that people believe conspiracy theories when important    psychological needs are unmet, such as the desire to satisfy    curiosity, avoid uncertainty, and reduce COVID-19 anxiety. By    understanding the factors contributing to the spread of    misinformation and conspiratorial beliefs in the Omani context,    policymakers and health-care professionals can develop targeted    interventions to combat this issue.  
    In simple terms, any activity is conspiratorial if it is    undertaken in secret by a group of agents who intend some end    [34., p. 24]. Conspiracy theories    explain that some kind of conspiracy thinking interprets the    incidence of an event. The concept of conspiracy should satisfy    three main conditions to be classified as a conspiracy: (a) the    conspirators condition (plotters), (b) the secrecy condition,    and (c) the goal condition [34]. Considering these    three conditions, we can assume that they are inherent in most    conspiracy thoughts that accompanied the outbreak of COVID-19    pandemic.  
    Conspiracy theories significantly increased following the    outbreak of COVID-19. The main purpose of these theories is to    explain important events and situations as the malicious acts    of third parties [35]. For example, during    the pandemic, many people believed that COVID-19 was    manufactured in a Chinese laboratory, while others believed    that governments exaggerated the severity of the virus as part    of a plot to control citizens [28]. People who believe in    conspiracy theories tend to engage in irrational behaviors,    leading to severe or negative impacts on their health    [20]. Additionally,    conspiracy theories can harm trust in health institutions and    hinder efforts to combat the virus [36].  
    Scholars have begun to explore the impact of conspiracy    theories on individual and public health during the pandemic    [25, 37, 38]. For example, Romer    and Jamieson [39] examined the impact of    conspiracy theories on protective measures in the United    States. The results showed that these theories lead to    resistance to precautionary actions and vaccination. People    avoided wearing masks and getting vaccinated because they    believed the virus did not exist and that the vaccine was a    means of control. Previous studies have also confirmed the link    between conspiracy theories and individuals hesitancy to make    informed decisions [40, 41].  
    Uscinski, Enders [32] found that, while many    people recognized the seriousness of COVID-19, a significant    number of study participants agreed that the danger posed by    the virus had been exaggerated and that the virus was purposely    produced and spread by other parties. The study highlighted    that individuals beliefs in conspiracy theories may be driven    by denialism, conspiracy thinking, and biased or ideological    motivations.  
    It is difficult to identify a single mechanism that controls    the association between education and conspiracy thinking as    different psychological mechanisms underlie this relationship    e.g., [17]. Not surprisingly,    low-educated individuals and those dissatisfied with government    actions in response to the pandemic are particularly    susceptible to conspiracy theories [42]. Conversely, past    research has shown that high levels of education predict low    belief in conspiracy theories due to educations cognitive,    emotional, and social outcomes e.g., [17, 43, 44].  
    It is widely acknowledged in the literature that false beliefs    led to an underestimation of the threat and hindered    individuals efforts to get vaccinated [45]. Different conspiracy    theories spread during the pandemic, for example, the belief    that 5G technology was the direct cause of the outbreak of    COVID-19 [46] and that the virus was    manufactured in a Chinese laboratory [35]. As a result,    conspiracy theories describing COVID-19 as a hoax were    positively associated with less preparedness in containment    procedures [30] and predicted vaccine    hesitancy [47].  
    The spread of the virus worldwide was accompanied by thousands    of people, backed by pseudoscientific treatment ideas and    conspiracies [31, 48]. Misinformation has    increased on social media due to people believing in this type    of information and conspiracy theories, which made social media    outlets fertile to germinate a massive amount of misinformation    [49, 50].  
    In the last phases of the pandemic, most false claims were    about the vaccine, specifically its side-effect, which cause    fear and panic [51, 52]. Some examples of    these claims are:  
        Vaccines are not safe and cause health risks,      
        A way to reduce the population will alter human DNA and        causes infertility or death.      
    In Oman, many refused to get the vaccine because of such rumors    [53, 54]. Smith, Ng    [55] argued that false    information about a cure for the Coronavirus had caused    widespread fear and distrust among the public. Vaccine    hesitancy was added to the World Health Organizations top ten    global health issues for 2019, according to the WHOs website.    This highlights the concern over the growing trend of    individuals refusing vaccines for themselves or their children.    The inclusion of vaccine hesitancy on this list predates the    COVID-19 pandemic [56]. The authors revealed    that misinformation and unfavorable attitudes are very    contagious and can lower vaccination rates. For example, during    the 2009 swine flu outbreak, the spread of skepticism and    unproven hypotheses about vaccine safety affected peoples    willingness to be vaccinated. Several studies have found that    exposure to anti-vaccination beliefs and misinformation on    Twitter has increased vaccine reluctance and refusal and a drop    in vaccination uptake [57,58,59]. Omani citizens and    Omani government made positive efforts to deal with    misinformation [21].  
    Health institutions and information systems were not    well-prepared to respond to the outflow of infected cases.    Although trust in health systems helped shape the public    response to the COVID-19 pandemic [60], Peoples belief in    misleading thoughts decreased their confidence in medical    procedures [36]. In his warning in    2020, the Director General of WHO declared the fighting against    infodemic which spreads faster and more easily than the virus    [30]. Misleading    information about COVID-19 negatively affected governmental    efforts in the struggle with the epidemic leading to unintended    deaths [61], and vice versa, the    awareness of preventive measures might weaken misinformation    beliefs also studies found that there was a strong association    between trust in science and belief in misinformation e.g.,    trusting science more are less likely to believe misinformation    [62] Those authors later    found that the same trust in science scale was associated with    COVID-19 vaccination intention [63]. No doubt that    misleading information has a negative impact on taking    preventative measures [28]. Conversely, Alper,    Bayrak [64] found no association    between misinformation beliefs and preventative measures.    According to Jovanevi and Milievi [65], optimistic people    have more preventative measures and less fear than pessimistic    people. Kim and Kim [66] claimed that people    who perceive danger accept fake news. In this context,    McCaffery, Dodd [67] concluded that health    knowledge and ways of thinking might have reduced efforts    against the pandemic spread in Australia.  
    The amount of misinformation spread through social networks    affected the response to the pandemic, as it had health,    psychological and social effects on individuals [25]. The inability to    distinguish between facts and misinformation might lead to    psychological, health and social distress and may even extend    to the economic and political aspects [22, 68]. Many researchers    claimed that misinformation increased the level of COVID-19    anxiety among individuals leading to unpredicted actions to    avoid infection with covid-19. In addition, it was found that    exposure to misinformation increased the level of depression    [69]. In order to alleviate    these feelings, individuals looked for more information that    might comfort them [70].  
    The COVID-19 outbreak has proved that responding to    misinformation is challenging for many reasons. Social,    emotional and cultural factors affect the absorption of    misinformation, hindering efforts to stop the negative impact    of this type of information [71]. In terms of health,    Joseph et al. (2022) indicated that spreading false information    about the virus through social networks leads to negative    results, including reluctance to follow recommendations related    to the virus to preserve public health and increasing levels of    COVID-19 anxiety and fear. The accumulation of this unfounded    information leads to abstaining from vaccinations, which    seriously affects public health [72]. Misinformation    regarding prevention and treatment measures is particularly    harmful because it may directly cause deaths [73]. Misinformation also    causes uninformed and rushed health decisions [74].  
    Psychologically, increased exposure to social media information    can negatively affect the community mental health (Hammad and    Alqarni [69]. Similarly, in the    Arab region, it was believed that the outbreak of the virus has    led to continued doubt and uncertainty about the nature of the    virus [75]. It has also been    proven that the spread of misinformation raises concern and    suspicion among the public from the advice given by public    health officials [76]. Shehata and Eldakar    [75] found that    misinformation affects individuals health decisions and mental    health, leading to increased fear and anxiety. On the other    hand, peoples disagreement about the reality of the virus and    their exchange of information led to personal and family    conflicts [77]. It can also adversely    affect health-care infrastructure and society [76].  
    People should obtain adequate and accurate information about    COVID-19 and vaccine from a trusted source. Public trust    building should be a priority through collaboration between    citizens and civic institutions in supporting health-care    providers [78]. Although Exposure    to traditional media regularly undertake efforts to debunk    conspiracy theories and misinformation"[24], spread of    misinformation about COVID-19 progressed at unprecedented speed    worldwide via social media networking sites [79]. Likewise, social    media are considered as the main reason behind conspiracy    theories as well Georgiou, Delfabbro [42]. Narratives of    conspiracy theories and misinformation beliefs were strongly    associated with exposure to digital media causing higher    feelings of depression [24]. Since COVID-19    preventive precautions were negatively associated with    conspiratorial and misinformation beliefs, researchers ought to    investigate the psychological, political, and health factors    underlying those fake thoughts [80].  
    A significant number of studies have explored the sources of    information adopted by individuals to obtain information about    COVID-19 [81,82,83]. These studies have    found a variance in the sources utilized by individuals to seek    information related to the virus. Interestingly, it was found    that social media outlets represented a significant source of    information as many used them for health information. However,    using social media outlets produced many problems, as much of    the information shared through them is false or misleading    [84,85,86].  
    Li, Pastukhova [87] and Andika, Kao    [88] explored the use of    YouTube as a source of information during the COVID-19    pandemic. Both studies revealed that many videos watched by a    huge number of viewers contained misleading information that    could negatively affect individuals exposed to this    information. The studies recommended that health authorities    need to collaborate with Youtubers in producing videos that    contain reliable health information as the reach of these    videos is higher than traditional communication channels.  
    A study by Mansour, Shehata [89] explored the sources    of information utilized by Egyptian physicians working in    isolation hospitals. Results indicated that participants prefer    to use traditional information sources when dealing with    COVID-19 cases, such as research papers and trusted medical    databases, with a little emphasis on non-traditional sources,    such as social media. Similarly, Tran, Dang [90] focused on Vietnams    health and community workers. The results outlined that the    Internet, online newspapers, and social networks were the most    popular channels used by health workers in Vietnam, revealing a    lack of proper information literacy practices and a need for    tailored programs for information literacy skills. In Taiwan,    Wang, Lu [82] found that while many    participants, including health-care workers, are using the    Internet and social media to obtain health information related    to COVID-19, the use of such channels was associated with the    participants confidence in their ability to obtain reliable    information.  
    Studies also found that individuals utilize other sources of    information for health information, including COVID-19    information. A study by Shehata [91] revealed that in    addition to social media as a source of health information,    personal contacts (family and friends) were among the top    sources of information. Other sources, such as authorities    webpages, newspapers, and magazines, were confirmed to be used    by the participants. Notably, many studies confirmed that    social outlets such as WhatsApp, Telegram, Instagram, and    Facebook were among the highly used sources of health    information on the Internet rather than being a source of    rumors and misinformation [92,93,94].  
    Social networks have facilitated the dissemination of    information worldwide; however, with the infodemic that    accompanied the COVID-19 pandemic, individuals could not trust    the information they find through social outlets    [95]. During the pandemic,    COVID-19 misinformation evolved continuously, contributing to    the digital destruction of the mental model [96]. Therefore, many    studies aimed to explore the factors that affect individuals    trust in the information they read on the Internet. On an    individual level, Shehata and Alnadabi [97] investigated the    factors that lead undergraduates to trust and share information    online using the theory of reasoned action. The results    revealed that age, gender, self-efficacy, personal beliefs, and    subjective norms play a key role in determining trust in    information. Moreover, using digital platforms was associated    with lack of basic ethical competencies [98].  
    Pan, Liu [99] confirmed the previous    results, as the study showed that pre-existing beliefs lead to    acceptance of misinformation and trust in online information    sources. On the other hand, the study claimed that education    level and age are not associated with the acceptance of    misinformation or trust in online information. Similarly,    Shehata [91] explored the health    information behavior of undergraduates and revealed that    personal beliefs affect individuals trust of information,    confirming Pan, Liu [99] results. Individuals    tend to trust information that is consistent with their beliefs    to avoid dissonance in behavior.  
    Notably, Latkin, Dayton [100] reported a decline in    trust in formal information sources in the USA. The study    revealed that the state health department and the White House    were among the samples top untrusted sources of information    due to their doubt that politics are playing a part in the    spread of COVID-19. Figueiras, Ghorayeb [101] rated health    information sources in terms of trust in these sources in UAE.    The study argued that trust is influenced by sociodemographic    (culture, age, gender) factors. The most trusted sources were    physicians, health-care workers, and formal government    channels. The results revealed that the use of sources and    levels of trust varied based on age, gender, and education. The    study also noted that adopting protective behavior affected the    level of trust among the sample.  
    De Coninck, Frissen [24] investigated the    relationship between exposure to information sources and    conspiracy, and misinformation beliefs; and tested the    moderating role of trust in information sources as well as the    mediating role of depression and anxiety in eight European,    Asian, and American countries during the pandemic. Results    indicated that greater exposure to politicians and digital    media and personal contacts was associated with higher rate of    belief in conspiracy and misinformation, while exposure to    traditional media was associated with lower conspiracy and    misinformation beliefs. The difference between our study and    that of De Coninck et al. is that their study was    cross-national comparative research, yet ours is a    within-nation comparative study. They used cross-cultural and    overseas samples to collect data from USA, UK, New Zealand,    Canada, Philippines, Hong Kong, Switzerland, but we recruited    only participants from Omani citizens. It is worth noting that    we adopted the same instruments.  
    Overall, studies have shown that the use of information    resources varies. The type of information resources used in one    region is not necessarily the same in the other as many    variables shape the individuals behavior and acceptance of    information resources. However, it can be said that personal    beliefs, self-efficacy, culture, age, gender, and education    were the most visible factors in all studies [95, 102, 103].  
    Gender has been found to impact the belief in conspiracy    theories. Despite the limited research on gender differences in    conspiracy thinking, it has been generally observed that men    tend to be more inclined to endorse COVID-19 conspiracy    theories than females [16] and are more affected    by false beliefs [79]. Conversely, Pan, Liu    [99] research indicates    that females tend to be more accepting of online misinformation    than males.  
    Different studies indicated that people with high level of    education are less inclined than those with low level of    education to believe in conspiracy theories [17, 43, 44]. To interpret this,    Gerosa, Gui [104] argued that people    with higher levels of education display higher levels of    knowledge. On the other hand, level of education did not have a    significant role in believing misinformation. With regard to    age, studies in this area are still nascent but some studies,    e.g., Douglas, Sutton [105] concluded that young    people in middle adolescence are keen on accepting conspiracy    theories. Jolley, Douglas [106] believed that    conspiracy theories beliefs change across lifespan, and it is    not easy to examine conspiracy theories across the lifespan.    Concerning employment, countries with high levels of    unemployment offer fertile ground for the conspiracy theories    [107].  
    In this study, our primary aims were to elucidate the intricate    interplay between conspiracy theories, misinformation beliefs,    and COVID-19 anxiety. Specifically, we sought to examine the    moderating effect of trust and the mediating effect of COVID-19    anxiety in shaping the relationship between exposure to    information sources and individuals tendencies towards    conspiracy theories and misinformation beliefs. Additionally,    we endeavored to explore how these relationships may vary    across demographic factors, including age group, educational    level, gender, and place of residence (governorate).  
    In line with this literature, we formulated the following    hypotheses  
        H1. Exposure to digital media will be associated with        greater conspiracy and misinformation beliefs.      
        H2. Exposure to traditional media is expected to be        associated with lower conspiracy and misinformation        beliefs.      
        H3. The impact of COVID-19 anxiety and exposure to        information sources on conspiracy theories and        misinformation beliefs is moderated by trust in these        sources.      
        H4. COVID-19 anxiety is positively associated with        conspiracy and misinformation beliefs.      
        H5. The rate of conspiracy and misinformation beliefs is        similar across all governorates.      
        H6. Conspiracy theories, misinformation beliefs, and        COVID-19 would differ significantly according to gender,        education level, employment, place of residence, and age.      
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Trust in information sources as a moderator of the impact of COVID ... - BMC Psychology