Written by Dr Lauren Bussey, Lecturer in Psychology at Teesside University, Centre for Applied Psychological Science, Cognition and Decision-Making theme. Email: firstname.lastname@example.org
At some point we have all consulted with ‘Dr Google’ to search for health information regarding a new symptom, prescribed medication, or perhaps to feel better informed before attending a GP appointment. Whatever the reason for searching, online health information can play an important role in the decisions we make about our health (Bussey & Sillence, 2019).
As you may expect, over the past year much of the world’s health information searching has revolved around the COVID-19 pandemic, and following the news of approved COVID-19 vaccines, internet searches have shifted to focus on vaccine information (Ahamad et al., 2021). Whilst uptake of the vaccine is recommended by health professionals, the decision to do so is a personal choice, which means that many of us have turned to the internet for information to help inform our decision.
Online health information can take many forms but can be broadly categorised as factual or narrative. The former tends to comprise a summary of quantitative data to communicate important information such as risk (Allen & Preiss, 1997), whilst the latter is usually written by patients who describe their experience of making (and living with) a certain health decision (Kopfman et al., 1998). Consideration of both types of information might seem the most appropriate to informing decisions such as vaccination uptake, however this may be more complicated than you think as psychological research suggests narrative information may be more persuasive than factual/risk information. For example, De Wit et al. (2008) found that narrative information provided by a member of the participants peer group was more effective than statistical evidence (objective facts) in persuading the participant of their risk in relation to Hepatitis B and increasing their intentions to vaccinate for prevention.
So, what makes narrative information so persuasive and influential to our decision making?
Patient narratives contain social and emotional information that is not captured in factual resources but can successfully immerse the reader in the story and make the narrative more likely to be remembered (Newman, 2004). In addition, because there is so much information to consider in our decisions, we often subconsciously use mental shortcuts to help us make a choice more efficiently. These shortcuts are referred to as heuristics in cognitive decision-making literature. For example, if we rely on the availability heuristic, this means that we focus on the most easily recalled, readily available, piece of information to inform our decision (Tversky & Kahneman, 1973). Given that narrative information contains contextual details that makes it easier to remember than statistical (risk) data, it is likely that our use of mental shortcuts will bias our decisions toward narrative information, when making a decision.
If our information processing is biased toward patient narratives, which have shown to influence vaccination intentions, it is important to acknowledge that the credibility and validity of the information source is often unknown, so there are concerns that vaccination decisions may be made on the basis of misinformation. Indeed, I have witnessed spikes in COVID-19 vaccine discussions following news headlines that report on vaccine safety concerns around use in pregnancy and in the development of blood clots. Such discussions attract passionate debates that are often punctuated with misinformation or personal thoughts presented as facts by anti-vaxxers or those with vaccine hesitancy. Therefore, these discussions could dissuade some from taking the vaccine, based on misinformation, and limited knowledge of the author’s credentials.
Trust and message valence
In addition to the type of message (factual or narrative), psychological research has also established that the message source (author) and message valence (positive or negative) can also influence both our acceptance of the information and our decisions.
As mentioned earlier, De Wit et al. (2008) found that vaccination intentions increased when vaccine information was delivered by a member of the person’s peer group. This finding could be attributed to another information processing bias called Perceived Homophily, which is the level of perceived similarity the receiver ascribes to a message source (Wang et al., 2008). This means that health messages are more persuasive when the information comes from someone who we can identify with, and this greater degree of similarity is associated with information engagement (Sillence et al., 2014) and increased likelihood to act on advice (Wang et al., 2008).
As we are more likely to trust and act upon information from message sources who we identify with, we should be equally aware that the content of their messages can also persuade our decisions. For example, the tone of narratives can range from extremely positive to extremely negative (known as valence) and can influence decisions by inducing different information processing routes (see Shaffer & Zikmund-Fisher, 2012), or effect mood which can affect judgements of message credibility and persuasiveness (Clore & Huntsinger, 2007; Skalski et al., 2009). Indeed, in a hypothetical decision-making task, Ubel et al. (2001) found message valence to affect surgery choice, despite the messages being paired with the same statistical information about the treatment success. If we apply this concept of message valence to discussions about COVID-19 vaccine safety and side effects on social media, then it is conceivable that negative, impassioned narratives produced by anti-vaxxers or those with vaccine hesitancy may persuade people to align with those views, by affecting their mood or by providing enough contextual detail that would facilitate information recall by the availability heuristic.
Ultimately, when using online health information to inform our health decisions, we should be guided by both factual and narrative information, whilst remaining aware of the information source credibility and acknowledging the ‘active ingredients’ of the message which might impact our decisions, such as the message source and valence.
If you have any concerns or questions about the COVID-19 vaccine, contact your GP.
Vaccine information resources:
World Health Organization https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/explainers
Ahamad, M. G., Ahmed, M. U., & Uden, D. R. (2021). Public Search Interests related to COVID-19: Insights from Google Search Trends in Bangladesh. medRxiv, 2020-12. DOI: https://doi.org/10.1080/08824099709388654.
Allen, M., & Preiss, R. W. (1997). Comparing the persuasiveness of narrative and statistical evidence using meta‐analysis. Communication Research Reports, 14(2), 125-131. DOI: https://doi.org/10.1080/08824099709388654.
British Islamic Medical Association. (2021, April). Position Statement on the Oxford/ AstraZeneca Covid-19 Vaccine. https://britishima.org/covid19-vaccine-az/.
Bussey, L. G., & Sillence, E. (2019). The role of internet resources in health decision-making: A qualitative study. Digital health, 5. DOI: https://doi.org/10.1177/2055207619888073
Clore, G. L., & Huntsinger, J. R. (2007). How emotions inform judgment and regulate thought. Trends in cognitive sciences, 11(9), 393-399. https://doi.org/10.1016/j.tics.2007.08.005
De Wit, J. B., Das, E., & Vet, R. (2008). What works best: objective statistics or a personal testimonial? An assessment of the persuasive effects of different types of message evidence on risk perception. Health Psychology, 27(1), 110. DOI: 10.1037/0278-6188.8.131.52.
Dickerson, J., Lockyer, B., Moss, R. H., Endacott, C., Kelly, B., Bridges, S., … & McEachan, R. R. (2021). COVID-19 vaccine hesitancy in an ethnically diverse community: Descriptive findings from the Born in Bradford study [version 1; peer review: awaiting peer review]. Wellcome Open Research, 6(23), 23. DOI: https://doi.org/10.12688/wellcomeopenres.16576.1
iNews. (2021, April). Religious leaders must ‘dispel fears’ of Covid-19 vaccine among ethnic minorities, say senior medics. https://inews.co.uk/news/health/religious-leaders-dispel-fears-covid-vaccine-ethnic-minorities-medics-863216.
Kopfman, J. E., Smith, S. W., Ah Yun, J. K., & Hodges, A. (1998). Affective and cognitive reactions to narrative versus statistical evidence organ donation messages. Journal of Applied Communication Research, 26(3), 279-300. DOI https://doi.org/10.1080/00909889809365508
Newman, T. B. (2004). The power of stories over statistics: Lessons from neonatal jaundice and infant airplane safety. Narrative research in health and illness, 257-276.
Royal Society of Public Health. (2021, April) New poll finds BAME groups less likely to want COVID vaccine. 2020. https://www.rsph.org.uk/about-us/news/new-poll-finds-bame-groups-less-likely-to-want-covid-vaccine.html. Accessed December 19 2020
Shaffer, V. A., & Zikmund-Fisher, B. J. (2012). All Stories Are Not Alike A Purpose-, Content-, and Valence-Based Taxonomy of Patient Narratives in Decision Aids. Medical Decision Making, 33(1), 4-13. https://doi.org/10.1177/0272989X12463266
Sillence, E., Hardy, C., Harris, P. R., & Briggs, P. (2014). Modeling patient engagement in peer-to-peer healthcare. Paper presented at the Proceedings of the companion publication of the 23rd international conference on World wide web companion.
Skalski, P., Tamborini, R., Glazer, E., & Smith, S. (2009). Effects of humor on presence and recall of persuasive messages. Communication Quarterly, 57(2), 136-153. https://doi.org/10.1080/01463370902881619
Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for judging frequency and probability. Cognitive psychology, 5(2), 207-232.
Ubel, P. A., Jepson, C., & Baron, J. (2001). The inclusion of patient testimonials in decision aids effects on treatment choices. Medical Decision Making, 21(1), 60-68.
Wang, Z., Walther, J. B., Pingree, S., & Hawkins, R. P. (2008). Health information, credibility, homophily, and influence via the Internet: Web sites versus discussion groups. Health communication, 23(4), 358-368. https://doi.org/10.1080/10410230802229738