One Size Fits None: Why Public Health Messaging Must Be Tailored

During the pandemic, people around the world experienced simultaneous panic. While many were stockpiling masks and hand sanitizer, others were reading up on and sharing on social media the conspiracy theory that 5G technology caused COVID-19, a rumor that spread faster than any other during the pandemic.

We currently have abundant options when it comes to choosing a source to consume news and information from – the government press, traditional media outlets, online public figures, or even community members. Yet, this freedom to choose correlates with the freedom to create and share information, irrespective of whether it is factual or fictitious. The pandemic showed the challenges regarding how people get their information and the protective behaviors they adopt in response.

The media impacts virtually everything in daily life, but it also shapes how we access scientific information and respond to health crises. As many rely on social media platforms and their most prominent, far-reaching voices to “stay informed,” this type of media coverage of scientific information can enhance or diminish risk judgments, increase risk perception, and encourage protective behaviors from simple handwashing to more complex choices like vaccination.

 In “Ubiquitous News Coverage and its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Evidence from a National Longitudinal Survey,” Shaila Miranda (University of Arkansas, ISYS), Anqi Shao (University of Wisconsin), Kaiping Chen (University of Wisconsin), Branden Johnson (Decision Research), and Qidi Xing (Northern Kentucky University) explore how different media platforms, from national newspapers to social media, shape public discourse on preventive measures to infectious diseases, and how media exposure influences individuals’ intentions to adopt these behaviors.

It’s become a given that we no longer have a “one size fits all" media landscape where everyone is tuning into the same news channels and reading the same papers, which makes understanding how communication dynamics function across a variety of platforms important. It’s even more important in outbreaks and other situations where preventative behaviors may be necessary, yet where individual and community benefits may not always align.

Media and Public Health

While nationwide health messages are crucial for successfully building healthier collective behavior during infectious disease outbreaks, the overall preference for digital media changes overall access to health information, and not always for the better. For instance, the CDC issued guidelines in early 2020 for behaviors like handwashing and mask-wearing to help combat the coronavirus, which were communicated from authorities to the public. These top-down messages were also coexisting with bottom-up messages. For example, people were debating vaccinations before they were even available, with these messages spreading from social media users to legacy media.

When people access their health information primarily through social and legacy media forms, they are at risk for heightened anxiety, stress, and misplaced protective behaviors. Influences like social norms and perceived threats also burden behaviors, sometimes by causing overprotectiveness due to anxiety, negative emotional reactions, and mental health problems. These influences tend to be more prominent among less educated individuals, who rely more on non-authoritative claims.

“Communication during the COVID-19 pandemic has faced a concern of an ‘infodemic’ with wicked challenges like misinformation, resistance, and fear,” the researchers said. “Exposure to this infodemic might further elicit individuals’ worries about the uncertainty and information-seeking behavior.” Ultimately, health information that is clear, consistent, and comes from reliable and non-political sources is much more trustworthy and effective.

News sources also affect other news sources, which is why the researchers examined how economic and local social factors influence news sources, which then influence other news sources by transferring content.

For example, take the concept of vaccines. Both Twitter (now X) and newspapers contributed to public discussion and shaped public perception, with Twitter initiating or enhancing emotionally charged narratives that were picked up by newspapers, which then responded with expert-driven content that clarified or countered points raised online. Likewise, when newspapers published stories about vaccine topics, Twitter responded with increased discussion and commentary. Both platforms shaped the discussion, although in different ways, and influenced each other in real time. While this elevated vaccines to a central public issue, it also complicated the messaging landscape as different framing of information and credibility levels of information were swimming in the same sea.

To discover how traditional news and social media influence each other in shaping the public agenda around COVID-19 protective behaviors, the researchers examined the social media platform Twitter; legacy media, including national newspapers like the New York Times, the Wall Street Journal, and USA Today; and behaviors like mask-wearing, handwashing, vaccinations, quarantining, and avoiding public gatherings and traveling.

Information or Misinformation? 

Clear, consistent messages that come from reliable non-political sources work much more effectively at fostering healthier collective behavior. Miranda and her coauthors found this phenomenon to be even more true when the messages include descriptions of protective behaviors and recommendations for establishing them. Legacy and social media outlets used the term “protective behavior” too often and broadly during the pandemic, covering both simple (handwashing) and complex actions (getting vaccinated).

Making matters worse, much of the information was overwhelmingly unclear, ambiguous, and inaccurate. This lack of clarity meant that “agenda flow,” which refers to the way different media platforms influence one another and shape public discourse, often remained inconsistent, which then contributed to muddled or inconsistent public perceptions on the value of protective behaviors during the pandemic.  

Media organizations thus found it difficult to effectively address questions and concerns about protective actions, especially in a single message or information campaign. Granted, public health communication had a tough job, as it had to both engage diverse communities and combat stigmatization, misinformation, and propaganda. The result was information (and misinformation) overload, as well as heightened health-related anxiety amongst the public.

Their research suggests that individuals who read news articles about protective behaviors will assess their usefulness, consider available resources, check pandemic updates, and finally decide if they will adopt a behavior or not. However, perceived barriers like resource limitations can hinder their intentions and actions. For example, let’s say someone reads an article about how a certain type of mask will do wonders in protecting her, leading to increased awareness and a positive attitude towards wearing this type of mask. However, she does not consistently wear one, as they are either constantly sold out or the one store across town that has them in stock is always closed before she can get there after work. The media exposure (and the article’s authors) succeeded in their goal to shape positive perceptions, but the consumer’s ability to transform intention into action is hindered by a lack of access.

Furthermore, Miranda finds that newspapers and Twitter lacked agenda influence on each other for the adoption of avoiding public gatherings and travel, handwashing, and mask-wearing behaviors – likely because of some of the barriers exemplified above. That same agenda flow inconsistency mentioned can be found in who influenced (or failed to influence) whom. For instance, Twitter exposure decreased the benefit perceptions of handwashing and quarantine, but it increased perceptions of mask-wearing, avoiding public gatherings and travel, and vaccination. Increased exposure to newspaper coverage, however, could negatively influence perceptions of some of these same behaviors.

When it came to agenda setting, though, Twitter unpredictably oftentimes set the agenda for self-quarantine behavior, influencing newspaper coverage.

Effective Health Communication

These findings illustrate that social media platforms like Twitter can set agendas for some legacy media, which was shown through the selected newspaper outlets, revealing subtle differences in protective behavior patterns in the U.S. during the pandemic. However, it is crucial to remember that other countries have varying public risk perceptions and protective behaviors, as socio-cultural factors like individualistic or prosocial values, authoritative trust, and personal virus experience play influential roles.

For public health communication, there is an overwhelming need for tailored communication strategies for different media platforms. This means raising awareness and emphasizing protective behavior steps, paying attention to ongoing conversations, addressing barriers – emotional strain and practical challenges – providing clear and actionable information, and addressing misinformation. By doing so, communicators can offer support and solutions, as well as enhance the effectiveness of such.

Simply increasing the exposure of protective behavior messaging in the media won’t help online audiences and their perceptions. That said, these perceptions do not exist in a vacuum: communicators and practitioners must stay up to date on trending conversations about health behaviors on social media platforms. As social media and legacy media can both help and hinder public health efforts, we must understand the way they work and their influence on coverage, agendas, and public health behaviors.