What is “digital health literacy” to prevent being swayed by wrong information on the Internet?

“Infodemic” caused serious health problems

Communication capacity during the COVID-19 pandemic was estimated to be about 1.5 million times higher than that during the time of the Spanish flu outbreak (1918–1920), and 68 times as much as that during the time of the SARS outbreak (2003). The main medium for that was the Internet, having interactivity with Web 2.0, and social media by which we can easily share information.

Mass media such as TV remain one of the major sources of health information. However, it is reported that currently more than 3.6 billion people are using social media worldwide, and they are spending on average 144 minutes per day on social media and messaging apps. The weight of the Internet as an information source is becoming significantly larger.

The immediacy of social media provides opportunities to spread lots of information to both experts and the general public instantly, and plays an important role in building and responding to the effective risk communication strategy. On the other hand, there is a possibility that the correct information which people should encounter will be lost owing to excessive amounts of information.

Especially, misinformation that is also shared among well-intentioned people, and disinformation that is created with an intended attack and damage obstructed health-related communication by governments, administrative agencies, health authorities, and each country’s public health measures and vaccination, and complicated their responses to the pandemic, bringing serious health damage and negative impacts on social health.

For example, it is reported that owing to the wrong information saying “consumption of highly concentrated alcohol would disinfect the inside of the body and kill the virus,” by taking in methanol, approximately 800 people died, 5,876 people were hospitalized, and 60 people developed complete blindness in different parts of the world. Moreover, social media amplified prejudice against healthcare workers and people of Asian descent and led to violent attacks within and outside the Internet.

With the current Internet, anyone can be the sender of information as well as the receiver of information. Moreover, health information, such as healthcare and public health, is directly connected to social health in addition to people’s lives and QOL.

Therefore, in order for people to utilize health information properly and maintain social health, not only the skill to search and obtain information online, but also the skill to judge whether the information can be shared and sent, in addition to the skill to evaluate and utilize the contents, will be required.

I think that the improvement of this skill, known as digital heath literacy (DHL), will be a measure against infodemic and will lead to people’s appropriate preventive behavior and the prevention of misinformation and disinformation being spread around.

Developing a Japanese version of the Digital Health Literacy Instrument

It has already been pointed out that in order to effectively make use of health information from the Internet, eHealth Literacy (eHL), which corresponds to the skill to search and collect health information appropriately (= Health 1.0), is necessary. Also during the pandemic, it was demonstrated that eHL has a positive correlation with knowledge and preventive behavior related to COVID-19 and a negative correlation with belief in conspiracies.

In addition to this eHL, the Digital Health Literacy Instrument (DHLI) was developed making use of Dutch and English as a standard for evaluation, including the skill to send and share information by oneself (= Health 2.0), corresponding to the Internet with interactivity based on Web 2.0.

In our research, we developed a Japanese version of this DHLI and examined its validity and reliability. After conducting an Internet-based survey covering 2,000 men and women aged 20–64, who were registered as survey participants for a social survey company, we found out some interesting facts.

DHLI evaluates 21 items in total, consisting of 3 items each for 7 skills including “operational skills,” “information searching,” “evaluating reliability,” “determining relevance,” “navigation skills,” “adding content,” and “protecting privacy.”

First of all, it was observed that “operational skills” and “navigation skills” were highly-scored in general, and the ceiling effect (the data distribution was deflected towards the full score) was also observed. Since this survey is based on an Internet survey, we can expect that the surveyed participants were equipped with a certain level of digital literacy. However, it indicates that now that some time has passed since widespread use of the Internet was reached, making use of the Internet per se is not a problem for many people.

On the other hand, it was observed that “evaluating reliability” concerning the evaluation of authenticity of information, etc., and “determining relevance” to consider whether the information applies to oneself or can be utilized, scored relatively low. Additionally, “adding content,” which is required from the perspective of interactivity, also scored low. This suggests that some guidance is needed for assessing and conveying information when one becomes the sender in social media.

Moreover, current people in their twenties, who are called digital natives, scored higher in “evaluating reliability” and “determining relevance” than people aged 50–64, and higher in “adding content” than people aged 40–64. Nevertheless, these skills scored relatively lower than other skills within the same age group. We tend to think that youngsters use social media more often and have a strong command of using it. However, when it comes to evaluating, judging, and sharing information, their skills may not necessarily be sufficient.

Furthermore, I personally would like to note that people who responded that their health status is “fair” or “poor” scored lower in every item than people who responded “excellent” or “very good.”

Does low DHL lead to bad health conditions, or do bad health conditions cause difficulty in collecting and judging information? Surely, from this survey we cannot determine the causal correlation. However, at least, there seems to be a relation between DHL and health conditions.

Low DHL has the possibility of causing a health information gap, and that requires appropriate measures. I think the Japanese version of DHLI is useful to consider specific supporting measures, because we can identify people who need improvement in DHL, or skills which need to be strengthened, and it can also be used as an indicator to evaluate interference.

Key to detecting wrong health information from the Internet

So, what kind of measures are effective in order for people to see through misinformation and disinformation in a situation like infodemic, and not let it spread easily?

Of course we hope that the administrative agencies and municipalities will work on educational activities widely. However, it is important that first and foremost they send correct information in such a way that it reaches people. For example, in Singapore, it is reported that during the 2016 Zika outbreak, the health authorities rapidly disseminated the risk factors, the mechanism, symptoms, case reports, and the status such as government measures via social media, and this controlled the general public’s panicking and contributed to their preventive behavior.

In Japan, compared to Europe and the U.S., we have the impression that highly-specialized official institutions are less active in using social media. Concerning health information, it is effective as measures against misinformation and disinformation, for official institutions, medical doctors, and experts in public health, etc., to create messages in advance of the general public, and deliver links to reliable information sources (such as official institutions, medical institutions, and experts).

A measure that can be implemented personally is to be always conscious about distinguishing information by using a checklist. This is something we cannot start suddenly during a pandemic or a massive disaster when we encounter conflicting information. Thus, it is good to remember this as a tip on a routine basis. I wrote down below a list of items presupposing the case of a website article, also using the guideline by WHO.

– Do not make a judgement only based on the headline of the article. Catchy titles often do not directly match the content. Especially, as website articles often gain advertisement revenue by page views, headlines tend to be sensational.

– Not only who is sharing the article, but the reliability should be examined by checking the source and the evidence (scientific ground) of the article. This information source does not only mean the name of the medium, but also includes the source of information which is the ground for the article (whether it is announced by a public institution, an insider leak, or whether scientific data are presented, etc.).

– Check the date and time when the article was delivered. The information you see is not necessarily always the latest. Especially with so-called flow-based SNS (real-time social media platforms) such as X (formerly Twitter), we tend to overlook the date and time. Thus, we need to be careful.

– Be aware that you have a bias yourself. We cannot avoid reflecting our personal habits or values in our point of view. Moreover, with the Internet, because we proactively search for information that we want, similar opinions as ourselves seem to stand out. We need to keep in mind that this echo-chamber phenomenon will occur.

– Stop and think once before you share the article. People try to share with others the information that they felt was useful out of good intention, and during an emergency, they do not scrutinize the content because they want to do that as soon as possible. However, not conveying misinformation and disinformation can protect others far more than sharing it quickly.

As previously mentioned, the infodemic of COVID-19 confronted us with how difficult it is to face a copious amount of information via the interactive Internet. Since correct information sometimes requires scientific verification and procedures, the initial response can be later than misinformation and disinformation. Therefore, it is all the more important to increase our digital health literacy on a routine basis.

* The information contained herein is current as of June 2024.
* The contents of articles on Meiji.net are based on the personal ideas and opinions of the author and do not indicate the official opinion of Meiji University.
* I work to achieve SDGs related to the educational and research themes that I am currently engaged in.

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