Abstract
As the situation regarding COVID-19 evolves, information needs and behaviour regarding pandemics is more relevant than ever. We are living through the first social media infodemic and society’s internet reliance is directly affecting the current crisis. Consequently, it is important to be aware of prior pandemics and health crisis situations to better understand how information was disseminated to the public and its outcome. This literature review explores these topics within a library context at the intersection of media, government, and official health organization information. This knowledge could potentially be of use to national and international organizations, local public communication departments, hospitals, charity, and relief organizations, information professionals, and other public service agencies that would be involved in the prevention, preparation, and implementation of strategies regarding future public health crises. It is also clear that librarians and information professionals need to continue using evidence based practices to disseminate information and develop better strategies to inform the public and institutions of the dangers of misinformation.
Introduction
With increased urbanization and globalization, modern society is more at risk for disease outbreaks to rapidly become pandemics. Creating public awareness is imperative to avoid this. For this to be possible, a better understanding of information needs and behaviours is needed, as well as the role of information professionals. During a public health crises of this magnitude, it is crucial to efficiently disseminate accurate information and constructive advice to the public to prevent panic and further outbreak. (6) As seen throughout history, a failure to do so can put already vulnerable infrastructures and daily life at increased risk.(8) Due to COVID-19, not only are we currently living through a global pandemic, but also an “infodemic”. This is when there is an excess of information, making it difficult to discern between information and misinformation. It is therefore imperative for information professionals to develop strategies to combat this. (19, 20)
Methodology
In this literature review, I am looking at a broad perspective of public information regarding pandemics and epidemics including the numerous ways traditional libraries function, as well as various online platforms. I chose scholarly publications found within LISA: Library and Information Science Abstracts, written from the AIDS crisis of the 1980s to the most recent literature on COVID-19. Most of the literature found had both qualitative and quantitative data and also provided some historical and political contexts. My initial search strategy was “pandemics” OR “epidemics” AND “public information”. There was not an immense amount of literature on the topic so I also searched for literature written on specific pandemics that have occured in recent history including SARS, H1N1 (swine flu), Zika virus, and COVID-19 (coronavirus). Finally, I looked through the latest publications within several journals for the current research occurring on COVID-19.
Information behaviour
Consistent research on information-seeking behaviour has shown that people are most likely to begin information searches by seeking informal sources, such as friends and family. With regard to health information, the first formal source sought out is physicians. (2) As they are one of the most trusted sources, they are extremely valuable when using a more individualized approach. However, physicians have also indicated that this strategy would involve liability risks, workload concerns, and lack of reimbursement as likely challenges. A possible solution could involve public health officials distributing relevant information for physicians to view and forward to patients with minimal time and effort. (7) Online information is increasingly a resource, yet for some there are still obstacles regarding accessibility. (2) In the case of online information, some websites are more trusted than others. For example, health websites are seen as more reliable than online news sources. (6)
Despite this, a study on information during the 2009 H1N1 pandemic, found that the preferred information resources at the time were television, newspapers, and radio. For this reason, official health organizations should take more advantage of mass media platforms for disseminating emergency alerts, awareness, and advisories to encourage cooperation that will ultimately prevent further outbreak. The study also showed that participants were unhappy when receiving repetitive information. Too many organizations involved in public health information can cause information overload, anxiety, and confusion. Therefore they should also act strategically when providing health information to different parts of society and perhaps even collaborate. (13)
Public libraries
When a disease has no cure, educational campaigns become the only way to reduce transmission and outbreaks. This can be seen in the North American gay community, an at-risk population during the AIDS pandemic. In 1987, educational programs and libraries began promoting safer sex in San Fransisco. Thus causing the rates of infection to drop amongst gay and bisexual men. Unfortunately, educational campaigns are not always successful. It is suspected to be because young people do not always trust their teachers or parents and instead prefer information from friends, experts, or specialists. For this reason, the role of libraries can be quite important during public health emergencies. (1)
Specifically, collaboration between libraries and anti-AIDS organizations could be mutually beneficial. Particularly within more vulnerable communities such as rural infrastructures where very little information services exist, or even prisons which often have high rates of substance abuse and HIV. Librarians should be encouraged to make varied literature available that would include both preventative information to those most vulnerable, as well as to those less vulnerable who wish to better understand the disease. Methods for educational programming would include promoting workshops and reading clubs, showing films and documentaries, inviting healthcare workers or individuals affected by the disease to speak, and further consider these issues when developing the library’s collection. (1)
Undoubtedly, education can save lives. However, it should also be noted that education can also fight against other ignorance and social consequences that disease can cause. Relating to the AIDS pandemic, an escalation of already existing homophobic and xenophobic attitudes in society occured. Consequently, increasing discrimination and violence towards the primary risk groups occurred. For this reason, libraries should be aware that when disseminating information, there may be opposition by some social groups, a lack of content, as well as sensitivity in the communication of these issues. (1)
Public health emergencies like pandemics will often call for quarantine and social distancing, causing the closure of public services, such as libraries. (3) Ironically, this is when public health information is most important. Health science librarians have the resources and specialized knowledge, however public librarians tend to be the first contacted by the public when seeking health information. This was seen in 2003 in Ontario, Canada, when the SARS crisis was occuring. Early in the crisis, most public libraries in the province were inadequately prepared for reference questions and few provided resources on their websites regarding the disease. At the time, librarians commonly claimed that the topic of SARS was too recent and that patrons should instead turn to the internet. The largest library system in the province, Toronto Public Library, did offer consumer health information services that included print and digital materials, as well as referrals to other agencies and organizations. However, the program was only staffed by one librarian for four hours a day, five days a week. While investigating reference services during crisis situations may be an unfair representation of this infrastructure, it can also be disputed that these moments are the best times to emphasize the value of public libraries and reference services. (2)
Health science libraries
When libraries are forced to close during a public health crisis, health sciences libraries should continuously try to provide services regardless of if librarians can no longer physically be in their places of work. During the H1N1 pandemic, health administrators were imperative in the dissemination of pandemic information and librarians’ skills at evaluating and selecting credible information to support administrators’ decision making was crucial. As part of disaster planning, health science librarians should be encouraged to become familiar with information sources from local health authorities, provincial and state-level management groups, and international organizations. For example, the Medical Library Association developed the Disaster Information Specialization Program, which supports librarians to provide pandemic information services. (3)
There should also be more public recognition of the skills and potential that librarians can offer in order to integrate them in formalized pandemic planning. Pandemic information needs are very case-specific, however health science librarians should prepare to use their skills during future infectious outbreaks and anticipate library services to assist in future pandemic response efforts. (4) An example of this can be seen in the development of the National Emergency Preparedness & Response Plan by the National Network of Libraries of Medicine. With this plan, they encouraged its members to establish partnerships with other organizations to provide specific services, as well as a back-up library in case of disaster. For something like this to be successful, it is crucial that there are good working relationships between inter-library loan departments, cooperation between the information technology departments, and flexibility and adaptability in policies and procedures. (3)
Health science websites
It is important that every industry adopts modern media and technology. Failure to do so will cause information professionals to neglect useful information and resources produced online. Increasingly, the internet has become the main resource in seeking health information with infectious disease information being one of the more popular searches. The internet becomes even more crucial when quarantines take place, as this becomes the quickest and most accessible source for information. Therefore, it is imperative to adequately disseminate information in order to reduce chances of outbreak and relieve the public’s anxiety. (6)
There is an immense amount of information online, often with questionable credibility. Though, as with traditional sources, it is still possible to establish quality control guidelines. This was seen by multiple organizations during the H1N1 pandemic. The Center for Disease Control, the World Health Organization, and databases like PubMed and MedlinePlus provided numerous resources. Some of these included links, announcements, reports, advisories, clinical and public health documents, response guidelines, pandemic history, and more. Information was also commonly disseminated via social media, podcasts, email, mobile text messages, RSS feeds, videos, and widgets featuring content for display on webpages. Databases and Journal Publishers that were normally fee-based also provided free access to their public health content. (5) Similar practices were also seen in 2015 during the Zika virus epidemic by the The World Health Organization, the Pan American Health Organization, the European Centre for Disease Prevention and Control, and the Center for Disease Control. (8)
In 2001, bioterrorism became a public health concern when anthrax spores were spread via the U.S. postal system. During this time, many people were turning to the internet to clarify information received from mass media campaigns. The information people received made them more likely to follow safety procedures, proving the ability for the internet in managing a public health crisis. Unfortunately, the internet still has limitations on accessibility. It was reported that those who sought out information on bioterrorism and/or anthrax were more often caucasian, educated, and had higher incomes. While other populations reported to have less computer and internet access. Despite the internet enabling society to be more connected than ever, it is still susceptible to racial and economic inequality. (7)
Social media
With the rise of social media, online discussion forums involving both physicians and the masses have become another resource for health information seekers. It is known that discussion can enable better consumption of information, but it is also likely that users will be consuming misinformation. While peer-to-peer health information found in online discussion forums such as Reddit could offer possibilities that warrant further research, they should not be seen as credible sources. (9,11)
In a Twitter analysis during the H1N1 pandemic, many users believed that pigs and pork hosted and/or spread the virus. There was also a debate regarding the name of the virus, as Israel had renamed it “Mexican Flu”, contributing to the already existing stigma towards Mexico. As well, Hollywood film narratives around infectious disease outbreaks contributed to users’ perception and understanding. It should be noted though that Twitter data does not accurately reflect populations offline, as certain age groups (younger generations) and geographical locations (the U.S.) tend to be overrepresented, with views often being exaggerated. However, social media analysis could be a potential tool for libraries who lack the resources to conduct surveys and/or interviews regarding information behaviour. Libraries should also consider social media a possibility when disseminating reliable information. With an awareness of a platform’s users, campaigns could be used to eliminate fear and misinformation. (10)
COVID-19
We are now not only facing a global pandemic, but also an “infodemic”. (18,19) As the situation continues to evolve, we are only beginning to see scholarly literature written about the information behaviour of the COVID-19 pandemic. Due to social distancing and quarantine mandates, it is clear that the internet and social media are playing a large role in the situation. Particularly when we see the dangers of misinformation at play. Library and information professionals must always be conscious of this and now it is more pertinent than ever. On March 12, 2020 the Canadian Health Library Association released links to information from reputable sources and a statement reminding us of the roles of health information professionals:
With the advent of COVID-19, we are once again reminded of the power of information and its ability to help—or hinder—the public response to a public health crisis. Canadian Health Libraries Association/Association des bibliothèques de la santé du Canada, representing over 300 library and information professionals working in health sciences libraries and information services, reiterates the importance of evidence-based information to health decision making, as well as the value of health information professionals in disseminating this information. With constantly updating information and public concern, there is a need to focus on evidence-based information to guide our response and responsibly inform the public. Health information professionals are well-trained in the searching and critical appraisal of evidence, and instrumental to ensuring appropriate information is available to decision makers, clinicians, policy makers, and the public. We urge everyone to continue to make use of evidence-based information to respond to the current situation, and to seek the guidance of health information professionals when information is needed. (13)
Libraries
Though many public and academic libraries must remain closed due to the virus, they continue to provide access to information, either relating to COVID-19 or continuing with virtual programming. (14) When relating to the pandemic, some are hosting seminars, doing Q&As on social media, or developing websites for their communities. (15) It is the responsibility of all librarians to use an evidence based practice while disseminating the latest public health information and counter any misconceptions. Other roles can also include supporting researchers, academics, and medical staff. (17) Like during the 2015 Zika epidemic and the 2009 H1N1 pandemic, we are seeing many usually fee-based databases and publishers providing free access to articles to provide aid in the crisis and assist information professionals in these supporting roles. (8,12,16)
Governments and organizations
Government institutions and health organizations, both national and international, are actively working towards educating the public on the safest procedures and practices via numerous online platforms. We can see this being done by the Pakistani government with their efforts in creating a website with this exact purpose in mind (http://www.covid.gov.pk/). The World Health Organization has also created a WhatsApp where users can directly receive the latest health information and global updates (https://www.who.int/news-room/feature-stories/detail/who-health-alert-brings-covid-19-facts-to-billions-via-whatsapp). This has become an especially good resource for librarians to share in order to dispel misinformation. (16)
Social media
As seen during the AIDs crisis (1) and the H1N1 pandemic (10), COVID-19 has also created a similar stigma towards a specific demographic of people. Consequently, there has been a rise in calling the virus “Chinese flu” or “Chinese virus”, propagating more misinformation. (18) Despite a massive amount of misinformation circulating social media, it is how many people receive news and information today. For this reason, governments and health departments are trying to further understand these digital environments to better communicate with the public. Misinformation is not the only concern, as there is also too much information being disseminated at once. This can be further harmful as it can make it difficult for the public to find reliable information and guidance. (18)
Infodemic
The World Health Organization has officially declared that while there is an ongoing battle against a global pandemic, there is also a social media infodemic occurring. Undeniably, with so much information and misinformation, more fear and panic is being propagated globally. (19) While infodemiology has been studied on the internet for at least 18 years, the COVID-19 pandemic has caused the first social media infodemic. Not only is the public unable to differentiate which information is true or false on social media, but this has been shown to have a negative effect on mental health and psychological well-being. This can primarily be seen within younger generations as they are more likely to get information via social media. Thus, showing that there is a need to better educate the public through these platforms. (20) More awareness should also be made amongst both non-health personnel and the scientific community about the quality of information that they consume and produce. (21) Finally, it is necessary to urge and promote the use of the websites of official public health organizations so that the public can better obtain credible information. (22)
Conclusion
The accuracy, efficiency, and accessibility in disseminating information during public health crises such as pandemics can have dramatic results in preventing further outbreaks and societal turmoil. National and international organizations seem to be doing so adequately through a variety of channels. While public and even medical librarians often lack support and resources in the preparation for these events, online information seems to have far too many resources resulting in misinformation and information overload. Further research still needs to be conducted, but the internet has been shown to be a potentially powerful tool in these situations. Unfortunately, this could be equally dangerous. For these reasons, it is essential that both librarians and information professionals continue collaborating and being involved in this process.
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