Results from a field experiment found that prevalent misinformation about health can be more effectively debunked using a direct approach. These findings were published in BMJ Global Health.
The Contagious Misinformation Trial (CMT) was a prospective, 3-arm, superiority randomized controlled trial conducted in Freetown, Sierra Leone in 2019. In this trial, researchers aimed to assess 2 pieces of health misinformation: typhoid is caused by mosquitos and that typhoid only co-occurs with malaria.
A total of 21 administrative sections in Freetown were selected for this study. Participants were randomly assigned in a 1:1:1 fashion into 3 groups to receive 1 of 3 different audio dramas delivered via WhatsApp. Of the 3 audio dramas, the first explicitly discussed misinformation and provided a detailed counterargument (group A; n=246), the second did not directly discuss misinformation and focused on only providing correct information (group B; n=245), and the third discussed breast-feeding (controls; n=245). Baseline and follow-up assessment of participants’ beliefs about typhoid were captured via self-reported questionnaires.
To be eligible for inclusion in the study, participants (N=736) had to be aged 18 years and older, live in Freetown, be fluent in Krio, be in possession of a phone with WhatsApp, and have no hearing impairments. No significant baseline group differences were observed between the 3 groups. In addition, participants were well-balanced in terms the number of men vs women in each group, most (54%) had completed secondary education, most (60%) practiced Islam, and most (66%) earned fewer than 300,000 leones ($30) per month.
At baseline, 66% of participants indicated a past diagnosis of typhoid, 51% believed typhoid was caused by mosquitoes, and 59% believed typhoid only co-occurs with malaria.
Compared with the controls, the belief that typhoid is caused by mosquitoes was significantly decreased among participants in group A (adjusted odds ratio [aOR], 0.29; 95% CI, 0.18-0.47) but not among those in group B (aOR, 0.61; 95% CI, 0.39-0.95). The belief that typhoid only co-occurs with malaria was significantly decreased among participants in both groups A (aOR, 0.29; 95% CI, 0.19-0.45) and B (aOR, 0.55; 95% CI, 0.36-0.83).
In comparing participants in intervention groups A and B, the researchers found that those in group A were less likely to believe that typhoid was caused by mosquitoes (aOR, 0.46; 95% CI, 0.28-0.76; P =.002) or that typhoid only co-occurs with malaria (aOR, 0.51; 95% CI, 0.33-0.81; P =.004).
The researchers found that knowledge about typhoid prevention strategies was most increased among participants in group A (67%), followed by those in group B (66%), and those in the control group (51%). Of note, most participants in groups A (aOR, 2.78; 95% CI, 1.67-4.64) and B (aOR, 1.77; 95% CI, 1.08-2.91) reported drinking treated water to prevent typhoid.
Although the researchers observed a decrease in the belief mosquitoes cause typhoid as the number of audio drama episodes increased among participants in groups A vs B, a similar effect was not observed for the belief that typhoid only co-occurs with malaria.
Limitations of this study included that 30% of participants did not receive or listen to any of the audio drama episodes.
According to the researchers, “the results of this field experiment provide some grounds for optimism that even as [health] misinformation becomes more prevalent, there are effective tools at hand to count its impact and its spread.”
Winters M, Oppenheim B, Sengeh P, et al. Debunking highly prevalent health misinformation using audio dramas delivered by WhatsApp: evidence from a randomised controlled trial in Sierra Leone. BMJ Glob Health. 2021;6(11):e006954. doi:10.1136/bmjgh-2021-006954