Public health pedagogy and digital misinformation: Health professional influencers and the politics of expertise

On 27 August 2021, general practitioner Dr Michael Mrozinski posted a short video to his Instagram account in which he declared: ‘It's about time that we really start pushing back against misinformation regarding the COVID vaccines.’ Mrozinski went on to debunk untruths told by ‘conspiracy theorists and anti-vaxxers’, including allegations that three children had been killed that week by vaccines. Mrozinski concluded his video by insisting that viewers ‘challenge people’ who spread these lies.

That video offers one example of how social media influencers have leveraged platforms to provide health advice and challenge false and misleading content. Those influencers have included health professionals. This article asks first: ‘To what extent can health professional influencers function as health pedagogues, educating their audiences and protecting public health in an era of digital misinformation?’ In answering that question, the article suggests that it is useful to conceptualise those influencers as providing ‘public health pedagogy’ (PHP)- pedagogy that is designed to promote fact-based, health-related knowledge outside traditional educational settings, with a view to educating followers to protect the health of themselves and others. PHP is steeped in public health principles, particularly an emphasis on health promotion. The article describes techniques adopted by health professional influencers, and the challenges they face in their work. These challenges include the hostility that they face from misinformation actors, such as anti-vaccination activists. Mrozinski has been chosen as a case study because of his public profile in Australia, where he regularly provides health-related media commentary.

The article moves on to deploy Content Analysis and Framing Analysis to a selection of TikTok and Instagram posts in which Mrozinski does one or more of the following: explains medical information relating to COVID; describes the benefits of vaccine for protecting oneself against the virus; and dispels COVID-related misinformation. Following this, the article asks a second question: ‘How exactly does Mrozinski respond to misinformation actors and to what extent does this diminish the effectiveness of his PHP?’ In pursuing that question, the article investigates whether and how he reinforces negative stereotypes about health professionals as elitist and uncaring. Those stereotypes can (further) erode communication and understanding between health professionals and misinformation actors, and thus undermine efforts by health professionals to educate the public about protecting their health. This study's findings have ramifications for the designing of educational online content pertaining to health and wellness, and for PHP undertaken by health professionals.

Social media influencers and public health pedagogy

Social media influencers (SMIs) are individuals ‘who accumulate a following on blogs and social media through textual and visual narrations of their personal, everyday lives, upon which advertorials for products and services are premised’ (Abidin, 2016, p. 86). The SMI's online performance of self has several key features; this article focuses on five of these. The first is authenticity: in their content, the influencer should seem genuinely invested (emotionally as well as financially) in the messages they purvey. The second is interactivity; for instance, the SMI poses a question in a YouTube video and encourages audiences to respond in the below-the-line comments section. This interactivity helps to strengthen the parasocial relationship between SMI and viewer, and therefore increase the power of the SMI's message (Jun & Yi, 2020). The third feature is the use of multiple modalities (text, imagery, videos, memes, GIFs, music, sometimes a combination of these) to engage with and influence their audiences.

The fourth key feature of the SMI's online performance of self is visuality. Media scholar Crystal Abidin describes the work undertaken by SMIs as ‘visibility labour’, which is ‘the work individuals do when they self-posture and curate their self- presentations so as to be noticeable and positively prominent among prospective employers … clients … the press … or followers and fans’ (2016, p. 90). Visuality is ‘intimately linked to trust. This is presumably why people wish to see each other even if there is no real advantage in securing veracity’ (Miller & Synanan, 2014, p. 174). Photos and videos of influencers living their (onscreen) lives while simultaneously promoting products/services imbues them and their product endorsement with a trustworthiness that may be more difficult to perceive in, say, a voice recording (where the SMI's corporeality is absent). This is even despite the clearly staged nature of their performances.

The fifth feature is the strategic deployment of emotions. A 2021 study states: ‘Influencers convey their emotion through videos with nonverbal cues (e.g., facial expressions, varied tones, rich body language) and verbal expressions (e.g., words and phrases such as “we are excited …”)’ (Lee & Theokary, 2021, p. 864). They can also do so via use of music and imagery; Mrozinski's videos exemplify this. The 2021 study points out that ‘when exposed to influencers who express certain emotions, viewers can have a corresponding change in their own emotional state’ (Lee & Theokary, 2021, p. 864). This ability to change a viewer's emotional state is crucial to an SMI's ability to influence their publics.

There is a growing corpus of scholarship on health and wellness SMIs. These SMIs seek not only to influence the thoughts and behaviours of their audience, but also to educate them, and provide them with the critical tools necessary to protect the health of themselves and others. This work has been described as ‘influencer pedagogy’ (Hendry et al., 2021). There are studies of individual influencers (e.g. Ashy Bines; see Hendry et al., 2021); and of how organisations have deployed SMIs in health campaigns (Lutkenhaus et al., 2019; McCosker, 2018). Researchers have investigated how influencers have sought to combat COVID-19 misinformation (Abidin et al., 2021, p. 123).

This article classifies the work being undertaken by the SMIs as ‘public health pedagogy’. PHP is more specific than ‘influencer pedagogy’; in particular, it describes educational activities that are undertaken in the service of public health (see Evans et al., 2011; Mansfield & Rich, 2013). ‘Public health’ deserves a brief examination here, given its significance to the analysis. This term encompasses ‘a wide array of services, policies, and practices within an equally wide range of institutional and governmental entities’ (Green et al., 2022, p. 1). These are ‘concerned with promoting the conditions that give everyone a chance to have a healthy life’ (Parvanta et al., 2017, n.p.). Public health places a considerable emphasis on health promotion as a way to promote good health in the broader community. Health promotion is an endeavour that ‘requires looking at the underlying causes of ill health and then tackling these on a community-wide basis’ (Baum, 2008, p. 41).

One aim of health promotion, and of public health initiatives in general, has been empowering members of the public to protect their own health. Empowerment ‘can operate at the individual, organisational or community level’ (Baum, 2008, p. 484). Empowerment can take the form of developing health literacy skills ‘through identification and evaluation of information relevant to health and well-being’ (Rowlands, 2012, p. 24). Health promotion has sought also to debunk misinformation. This debunking involves ‘enabling people to appropriately update their health belief model’ and avoid subscribing to baseless, harmful beliefs, practices and procedures (Helfers & Ebersbach, 2022, p. 1). In his social media posts, Mrozinski provides his audience with tools which they can use to determine which information pertaining to COVID-19 and vaccines is valid and helpful, and which is misleading and potentially harmful. In doing this, he debunks a number of COVID and vaccine-related falsehoods.

Also, the term ‘PHP’ owes an intellectual debt to ‘public pedagogy’, which encompasses education that takes place outside of traditional educational settings (e.g. schools, universities). This is ‘an oppositional practice and active process of learning [and] is central to any viable notion of critical citizenship, inclusive democracy, and the democratic demands of a broader global public sphere’ (Giroux, 2004, p. 500). That ‘broader global public sphere’ is not restricted to videos or social networking services (SNS); Mrozinski's television and newspaper commentary exemplify this. SNS are important inasmuch as they are where ‘networked publics’ (boyd, 2011) are formed. These networked publics are ‘(1) the space[s] constructed through networked technologies and (2) the imagined collective[s] that emerges as a result of the intersection of people, technology, and practice’ (boyd, 2011, p. 39). Networked publics can be international in scope, their ‘members’ united – even if only in a virtual sense – through their use of a particular site.

Public pedagogy is similar to public health inasmuch as both entail ‘border crossing’ and ‘work across artificial institutional boundaries’ (Mansfield & Rich, 2013, p. 357). Public pedagogy and public health both involve educating diverse publics in spheres that are not restricted to the lecture theatre, the laboratory, the clinic. Both seek to equip members of these publics with the skills and knowledge to assess the validity of information (health-related and otherwise) they encounter and to make decisions that benefit themselves and others (Giroux, 2010, p. 193).

This article argues that PHP should be an inherently ethical endeavour. PHP should enable audiences to weigh up the potential benefits and risks of medical procedures, medicines and so forth (Leask et al., 2021, p. 10). PHP should involve providing information that is accurate as possible; errors and oversights should be acknowledged by the pedagogue once these become known to them. PHP should debunk misinformation. Finally, PHP should seek to minimise the likelihood of harm (physical, emotional, psychological) to oneself and others. These others include audiences, as well as those promoting misinformation. Mrozinski's PHP fulfils succeeds only partly in fulfilling these aims, and this is one reason why his PHP serves as a useful case study for this article. His ethical breaches, for example, suggest why it is important for PHP to be as ethical as possible.

(Anti-)expertise and information disorder

In 2019, media theorist Mark Davis critiqued an anti-expertise animus that permeates the anti-vaccination movement. This animus is evident in public attacks on the supposedly ‘politicised’ agendas of health professionals and the deployment of ‘we versus they’ rhetoric – with the ‘we’ being non-health professionals, and ‘they’ being the doctors and scientists promoting supposedly harmful vaccines (Davis, 2019, p. 362). An assumption underlying this rhetoric is that the ‘we’ can and should adopt the mantle of ‘expertise’ – the assumption being that ‘we’ are untainted by ideology or bias. As Davis acknowledges, the self-appointment of expertise has been enabled by internet affordances and SNS.

This anti-expertise – and, in particular, anti-medical expertise – animus can take a number of forms. They include conspiracy theories based on the premise that medical scientists belong to a transnational cabal that is using COVID as a ruse through which to subjugate individuals globally and achieve global political power. These theories have been promoted via memes, GIFs and videos that can be easily located via a quick Google search. Anti-medical expertise encompasses acts of violence perpetrated against health professionals. Anti-medical expertise is also evident in governments that disregard the advice of the World Health Organization, such as Indonesia early in the pandemic (Chairil, 2021).

The anti-expertise animus described has proliferated during the same historical moment as, and indeed is evident within, what Wardle (2017) calls an ‘information disorder’. Wardle uses that term to describe the widespread distribution of false and misleading information in online spaces. This proliferation stems from the open, non-hierarchical nature of the contemporary internet, as British journalist Richard Fisher elucidates in a paper on science journalism:

The top-down vertical model, where communicators at the top of an information hierarchy feed their work down to hypothetical audience-members at the base, no longer operates. The media ecosystem is now far more horizontal: traditional institutions, legacy publishers and platforms share territory with social media, online video and all the other eye-catching digital attractions in the fairground of the Internet. The means of publishing are now in everybody's hands. (Fisher, 2022, p. 275; emphasis in original)

And, the means of spreading misinformation is in everybody's hands – or at least of those with an internet connection. Social media platforms and email enable that information to be spread at a speed and scope that would have been unimaginable in an era of heritage media.

This article focuses on the specific expertise demonstrated by SMIs such as Mrozinski. Briefly describing that expertise is necessary for contextualising the analysis that follows. Mrozinski's social media work fits the ‘linear model of expertise’, whereby ‘science assum[es] the role of arbiter of preferences and meanings and prescriber of policy, on the assumption that expertise reduces uncertainties and more expertise leads to better policies’ (Durant, 2016, p. 17). Put simply, the words of experts must shape public discourse and help bring about positive policy change. This model has limitations. For instance, policy changes are not simply enacted because of what a scientist or general practitioner might say about an issue. Also, there remains an ‘information asymmetry between experts and non-experts. Democratic civility is compromised by experts persuading non-experts while non-experts have less capacity and/or success persuading experts’ (Durant, 2019, p. 43). While theoretically any internet user can perform the role of ‘expert’, some experts will always have more prominent and credible public profiles than others.

This article acknowledges those limitations, but also suggests that substituting expertise with public deliberation is neither possible nor desirable; the two can and should coexist. Individuals without health qualifications can and should deliberate publicly (e.g., on SNS) about health and wellbeing. Equally, the ‘specialist knowledge’ of health professionals can and should shape public understandings of health and wellness; PHP initiatives can help achieve this, providing as they do the opportunity for the health professional to educate members of the public via the likes of social media. Yet health professionals do not always know best; they are capable of promoting incorrect information and of treating poorly the audience they are meant to be educating.

With that last point in mind, this article poses a second research question: ‘How exactly does Mrozinski respond to misinformation actors and to what extent does this diminish the effectiveness of his PHP?’ Mrozinski has been chosen as a case study because of his prominence in Australia, where this article's author is based. This prominence is suggested in the numbers following him on his TikTok and Instagram accounts, both of which are titled ‘Dr Michael Says’; as of 9 July 2022, the TikTok account has 281.2k followers, while the Instagram account has 9,926 followers. Mrozinski routinely provides media commentary on health issues and has been profiled on numerous occasions in the Australian media (see Baath, 2021; Farmilo, 2022; Green, 2022; Waters, 2020).

Mrozinski is, of course, not the only health professional who uses social media to debunk health misinformation. Others include Australian pharmacist Mustafa Dhahir, US epidemiologist Katrine Wallace and British physician Idrees Mughal. Future studies could compare and contrast the techniques and rhetoric deployed by these health practitioners.

Methodology

The data that forms the basis of the case study analysis comprises 94 of Mrozinski's posts that were published between March 2020 and December 2021, the first two years of the COVID-19 pandemic; the first COVID-related post was published on 15 March 2020. Many of these posts were first published on Mrozinski's TikTok account; that account appears to be his best-known social media presence, with one journalist dubbing him ‘Dr TikTok’ (Livingstone, 2022). The author of this study encountered Mrozinski's posts on, and collected them from, Mrozinski's Instagram account. The author has followed that account since early 2020, due to a personal interest in health and wellbeing and a professional/academic interest in combating misinformation. This introduces an ethnographic component to the study (which is not a conventional ethnography as such); the researcher developed an awareness of a content creator and their work through becoming familiar with this work and the techniques (stylistic and otherwise) the creator uses to promote their messages (Airoldi, 2018, p. 665). This knowledge was particularly useful in designing the coding criteria described below.

Mrozinski's posts certainly demonstrate an awareness of the affordances and trends specific to TikTok and Instagram, and especially the former. TikTok hosts short (maximum 3-minute) videos, which make use of affordances such as music and filters (Vizcaino-Verdu & Abidin, 2022). That platform has been enthusiastically deployed by health professionals wanting to spread information about health, as hashtags such as #doctorsoftiktok and #nursesoftiktok testify (Southerton, 2021, p. 3250). Instagram showcases visual materials – videos, but also photos, images, GIFs, memes – with comments sections in which the account holder and other Instagram users can post comments about that content. Instagram also uses hashtags, which can be ‘a way of increasing the communicative reach of a social media text by attracting a greater audience who might “engage” (to use social media marketing parlance) with a post’ (Zappavigna, 2018, p. 8). Mrozinski's use of hashtags and multiple platforms is likely to increase the reach – and therefore the publics – for his PHP.

The criteria for inclusion in this study was thus: the post had to refer in some way to COVID-19 or to vaccines generally. This includes posts that:

debunk COVID misinformation;

provide factual information on COVID and vaccines;

refer in any general way either to COVID or to vaccines, e.g., in the form of words, graphics, videos.

The article does not pretend that 94 Instagram posts is an exhaustive perspective of the PHP being undertaken by all health and wellness SMIs, or even Mrozinski himself. The posts are useful for the analysis because they demonstrate some of the techniques being adopted by health professional SMIs to educate their audiences about COVID-19 and vaccine-related issues. There are posts published during the above period that have not been included; these include summaries of medical conditions, remarks about nutrition, and footage of Mrozinski lifting weights. Those latter posts are nonetheless important insofar as they contribute to Mrozinski's online performance of someone who is concerned with health and wellbeing on a professional and personal level.

Each post was coded using the following criteria:

Date posted

Format (e.g., video, meme, GIF)

Short summary of content

Accompanying text

Hashtags used – Yes/No?

If ‘yes’, which hashtags were used?

Tone of post

Provides facts about COVID-19 – Yes/No?

If ‘Yes’, then how?

Debunks COVID-related disinformation – Yes/No?

If ‘Yes’, then how?

Mentions disinformation proponents – Yes/No?

If ‘Yes’, then what does Mrozinski say about them?

Mrozinski mentions his profession – Yes/No?

If ‘Yes’, then how does Mrozinski mention his profession?

The researcher deployed two theoretical frameworks to analyse the data. The first is Content Analysis, which involves determining the prevalence of a certain attribute (e.g., a hashtag) in a work or collection of works. Through doing this, the researcher can ‘singl[e] out the key features [they] think are important and to which [they] want to pay attention’ (Shoemaker & Reese, 1996, p. 31; cited in Macnamara, 2005, p. 3).

The second is Framing Analysis, which explores the ‘aspects of perceived reality’ that are made ‘salient’ in a particular text (Entman, 1993, p. 52). The frames within which a piece of content is captured can play an integral role in determining how audiences respond to that information (Entman, 1993, p. 55). Within social media content, framing can be achieved via the use of imagery, text, hashtags, emojis, tone, use of music.

The analysis that follows is qualitative in nature. Qualitative research is inherently subjective, depending as it does on the researcher's interpretations and thoughts about the data collected. This is evident in the coding criteria above and in the article's readings of Mrozinski's posts. For example, the ‘Work It’ video described below clearly seeks to be humorous through its use of music, imagery and body language; it is difficult to read this post as neutral (the sexual politics of the post are problematic, as will be elucidated).

In collecting and analysing posts, the researcher bore in mind several ethical concerns pertaining to internet research. Those concerns are necessary to mitigate the possibility of injury to oneself and others, including readers and those who feature in the content being analysed. The first concern relates to privacy; as the Association of Internet Researcher's Ethical Guidelines 3.0 state: ‘Special care should be taken when collecting data from social media sites in order to ensure the privacy and dignity of the subjects’ (Franzke et al., 2020, p. 12). The posts under discussion have been taken from public accounts; they appear to have been posted with the aim of being widely seen and generating discussion. The researcher has decided not to name or provide identifying material on the misinformation actors that Mrozinski critiques – even as this information is sometimes evident in his posts. Exceptions to this are podcaster Joe Rogan (who has interviewed anti-vaccine proponents), ex-physician Andrew Wakefield (who famously drew a since-discredited link between vaccines and autism) and rapper Nicki Minaj (who alleged that a family member had a swollen testicle as a reaction to a vaccine). All three have either articulated or (in Rogan's case) platformed misleading COVID-related views. Their high profiles, and the corresponding global reach of their views, are undoubtedly reasons why Mrozinski has critiqued them, and why there is no valid reason not to name them here.

The second, and related, ethical concern involves minimising the amplification of misinformation. Giving any attention to this misinformation can mean giving it the publicity its proponents seek (Phillips, 2018). ¹ The misinformation discussed in Mrozinski's videos is cited here in order to demonstrate how Mrozinski debunks false and misleading information. There is no suggestion that this information contains any factual veracity.

Results

The text published by Mrozinski to accompany his Instagram posts is relatively neutral. This may reflect an adherence to the Australian Health Practitioner Regulatory Authority's (AHPRA) guidelines for health practitioners using social media, namely the instruction not to post ‘overly personal and familiar or includes suggestive comments’ (AHPRA, 2019). Though, as will be discussed later, Mrozinski does elsewhere stray from those guidelines.

All of the posts contained hashtags; the majority of these were medical in nature, such as #doctor, #healthcare. Ninety percent (or 85) of the posts contained videos. There were two photos, four screenshots, and one trio of visual images about how to respond if one tests positive for the novel coronavirus.

Eighty-eight posts (94%) contained text that (usually) provided a short description of that content. For example, in a video published on 8 September 2021, Mrozinski responds to a question from an unnamed viewer about the relationship between vaccines and miscarriage. This video is accompanied by text that reads: ‘Miscarriage and COVID vaccines?’ That text is followed by two ‘shrug’ emojis. In a video dated 27 September 2021, Mrozinski discusses Ivermectin, the tranquilliser drug commonly used on animals that was erroneously touted by Joe Rogan as suitable for treating COVID. This video is accompanied by the text that reads ‘Vaccinated people in hospital?’ and a ‘shocked’ emoji.

In terms of tone, 62 posts (66%) were ‘informative’, that is, they entailed Mrozinski explaining/talking through a particular issue; 4 posts (4%) were humorous; 25 posts (27%) were informative and humorous; one post was promotional, that is, it promoted a media appearance by Mrozinski; 1 post was humorous and promotional; 1 post was informative and promotional (promotes a television appearance from Mrozinski and alerts viewers that he debunks COVID misinformation); and 1 post could most accurately be described as ‘matter of fact’. That latter post (dated 23 December 2021) is a video of Mrozinski receiving his booster shot.

49 posts (52%) provided facts that related specifically to COVID-19. These included whether it was safe to receive a vaccine shot one month after a COVID infection; and the rareness of developing heart conditions after receiving a vaccine injection.

52 posts (55%) sought to debunk misinformation relating to COVID and/or vaccines. These include allegations that the Pfizer vaccine is not recommended for pregnant women (Mrozinski says this is untrue) and that three vaccine doses is abnormal (Mrozinski explains that a number of vaccines require three doses, not just those used to protect against COVID).

35 posts (37%) mentioned misinformation actors, though few of these were actually named. The ones who were named tended to be the high-profile figures cited above. Mrozinski mostly speaks of misinformation actors in general terms, as ‘conspiracy theorists’, ‘anti-vaxxers’ or ‘influencers’.

87 posts (93%) mentioned, or at least acknowledged, Mrozinski's health professional status. These mentions were sometimes explicit; for example, in one video, Mrozinski discusses his work ‘in clinic’. On other occasions, this acknowledgement is made visually, through the use of hashtags such as #doctor and #healthcareworker; and through Mrozinski wearing medical scrubs.

Discussion

The neutrality of Mrozinski's Instagram prose is beneficial inasmuch as it helps him avoid dictating what his audience should and should do – a move that would surely lend credence to the stereotype (commonly endorsed by misinformation actors) of the health professional as elitist and ultimately unconcerned with the health and wellbeing of others. Rather, he is providing his audience with the knowledge that they can use to make good decisions for their health.

Mrozinski's acknowledgement of being a #doctor and #healthcareworker may be a conscious ethical move; one study actually recommends that health professionals ‘properly identify their credentials on [social media]’ (Bressler et al., 2021, p. 7). By reminding social media followers of his health professional status, Mrozinski can distinguish himself from individuals without medical qualifications who are promoting misinformation. This distinction is made overt in a video dated 20 December 2021. The video contains two screens. The first features an unnamed woman reciting her qualifications – qualifications that include being ‘a freedom-loving American’ – presumably to support an anti-vaccination or anti-lockdown argument (the specific setting in which she is speaking – for example, a rally, a lecture theatre – is unclear). The second, larger screen depicts Mrozinski listening to the woman and looking unconvinced. These screens are accompanied by a caption within the video that reads: ‘What's your qualifications to give out advice on social media?’ On Instagram, Mrozinski has published the following text in the video's comments section: ‘medical experts everywhere #medical #expert #internet #healthcare’. In another video, this one published on 21 March 2020, Mrozinski is speaking to a ‘patient’ who remarks: ‘I Googled Corona virus [sic], so I know all about it.’ Mrozinski points to certificates on wall; an in-video caption reads: ‘My Qualifications [sic] beat your Google search!’

Further, Mrozinski's qualifications (which are provided in his TikTok and Instagram bios) and his work as a general practitioner serve as reasons for his audience to trust him. In recent years, researchers have noted global decline in trust – in health professionals, politicians, media outlets. The pandemic has exacerbated this decline:

On one hand, the public has been bombarded with pandemic-related information and updates, but on the other, an information vacuum has emerged as individuals have been forced to re-assess whose interpretation of the crisis and consequent advice to trust. Some of the traditionally most trusted and relied on sources of information, such as governments, health authorities, and even the World Health Organization (WHO), have been challenged and questioned… Simultaneously, highprofile individuals like the US President Donald Trump have publicly endorsed controversial virus treatments like the injection of bleach … which have immediately been challenged by health professionals.… As a result, large groups of people have ignored critical health advice, as they came to doubtsic the veracity of information or fell prey to the large volumes of mis- and disinformation that quickly filled any vacuum. (Archer et al., 2021, p. 108)

One result of this lack of trust is that audiences turn to information from non-traditional sources, including SMIs. Mrozinski is an SMI and a health professional; he can thus frame his content as being especially trustworthy. This trustworthiness is reinforced in a video dated 17 December 2021, in which Mrozinski denies being remunerated for his posts. This denial signals to viewers that his pronouncements are not driven by financial incentives; that they emerge from his expertise and concern for public health.

Additionally, posts such as the 17 December video frame Mrozinski's self-performance as being authentic. SMIs ‘perform authenticity in myriad ways, including strategic transparency or sharing details from their personal lives that align with their personal brand’ (Wellman et al., 2020, p. 70). On ‘Dr Michael Says’, there are videos of Mrozinski working out in the gym, and of his lean, muscular physique. Such footage can routinely be encountered in health and wellness influencer content. Its inclusion in ‘Dr Michael Says’ suggests that Mrozinski's interest in health and wellness are deeply personal, lived out by the man himself; they are not strictly occupational concerns.

Another key aspect of Mrozinski's performance of trustworthiness and authenticity lies in his interactivity. Mrozinski encourages his viewers to interact with his content, rather than leaving them to simply watch on as the expert explains viruses and vaccines. For instance, in a video dated 3 October 2021, he declares: ‘Here's another conspiracy theory that we can debunk together.’ The tone here is conversational; Mrozinski is inviting his audience to participate in the debunking process. The theory being debunked is that pharmaceutical company Merck have rebranded Ivermectin as Molnupiravir. The latter has been shown to assist COVID patients; the former has been found to be unhelpful. Mrozinski debunks this theory by asking viewers to compare the chemical structure for Ivermectin and Molnupiravir. Whether or not the viewer has medical qualifications is a moot point; the two chemical structures are visibly different and the viewer should be able to recognise this.

In a sense, then, viewers are framed as being themselves experts on health and wellness. Their ability to make sense of medical information, and separate fact from fiction, is placed in the centre of the frame. This suggests a ‘democratisation of expertise’ in which the acquisition of knowledge can be undertaken by everyone, and not just a learned few (Durant, 2016, p. 24). Yet, Mrozinski never suggests that the expertise of audience members – or at least, the non-health professionals in the audience – will be equivalent to his. Recall his questioning of the unnamed woman about her ‘qualifications to give out advice on social media’. The ‘experts’ following ‘Dr Michael Says’ still require the expertise of the genuinely qualified (in terms of university degrees and clinical experience) expert. This is an expert who (viewers are reminded) is invited to provide health-related commentary to media outlets, an opportunity that is presumably not available to many of his audience members.

Mrozinski's skills as a public health pedagogue are further suggested by his use of humour. As one study argues: ‘Humour, and the complex and contradictory affects that it can engender, can be seen as one affective-discursive tool through which social norms are made visible, felt in the body and reinforced/re-negotiated’ (Graefer, 2014, p. 109). The humorous tone of Mrozinski's videos has the potential to generate emotions such as joy and feelings of empowerment – namely empowerment through being able to sort fact from fiction. In a video dated 11 September 2021, Mrozinski stares po-faced at the camera, alongside an in-video caption that reads: ‘Ivermectin cured my friend.’ The video cuts to footage of a horse. This video highlights the absurdity of humans using a drug that is not manufactured for humans. A video dated 15 September 2021 opens with Mrozinski uttering ‘paging Dr Minaj’ in a drily sarcastic voice. The ‘Minaj’ is, of course, Nicki; the attribution of ‘doctor’ underscores the fact that she is an entertainer, and as such is unqualified to make pronouncements about vaccine side effects. Mrozinski's humour could also make grim topics palatable and even engaging for viewers. Compare this with the deployment of more negative emotions in online conspiracy narratives. Those narratives typically invoke feelings of fear and distrust, exploiting widespread distrust of experts and elites by frightening their audience with allegations of the supposedly oppressive schemes being hatched by those figures (Kim & Chen, 2022, p. 5).

It is worth now addressing the second research question: ‘How exactly does Mrozinski respond to misinformation actors and to what extent does this impact on his PHP?’ Some of these responses have already been provided. In a video dated 29 August 2021, Mrozinski asks: ‘how do you know what to trust on social media?’ He suggests that ‘Instagram influencers’ are particularly untrustworthy. A video dated 20 November 2021 opens with an in-video caption that reads: ‘Medical professionals vs anti-vaxxers explaining immunology.’ The video cuts to a clip from the music video for Missy Elliott's ‘Work It’, alongside a caption that reads ‘medical professionals’. The video then cuts to footage of an overweight (white) woman singing that same song, tunelessly, alongside the caption ‘antivaxxers’. Mrozinski is shown laughing at that woman.

On one level, Mrozinski's framing of misinformation actors is understandable. Those actors are endorsing scientifically unverified and potentially dangerous information. Yet Mrozinski's demonising of misinformation actors also threatens the effectiveness of his posts in terms of educating misinformation actors, or at least encouraging them to question their views; and contravenes the AHPRA guidelines for social media use among health professionals. There seems little incentive for those actors to engage with Mrozinski's content when he represents them as irrational and laughable. Consider the ‘Work It’ video, which depicts a particularly visceral and gendered belittling. The humour is generated through the tune, which has been listed as one of the ‘popular songs on TikTok’, and which chronicles a sexual encounter in which Elliott plays a commanding role. These lyrics are contrasted with the amateur singer's weight and vocal discordance, as well as with the athletic, articulate and male Mrozinski – the latter of whom knows better than said singer.

The ‘Work It’ video is further significant in its breaches of public health protocol and ethics. For instance, there has been a push from health professionals and researchers to develop ‘non-stigmatising’ public health strategies for promoting healthy eating and physical activity (Rathbone et al., 2022, p. 1602). These strategies are necessary, not least because public health campaigns have contributed to the stigmatising of those individuals. Conversely, the humour in the ‘Work It’ video depends upon the existence of that stigma. The aforementioned AHPRA guidelines caution: ‘Comments in social media that reflect or promote personal views about social and clinical issues might impact on someone's sense of cultural safety or could lead to a patient/client feeling judged, intimidated or embarrassed’ (AHPRA, 2019). The ‘Work It’ video has the potential to diminish an obese patient's feeling of safety within the offline clinical settings in which Mrozinski works. The woman is easily identifiable, and this could pose a threat to her physical and emotional safety (e.g., through hostility expressed by those who have watched the video).

Importantly, the reasons why individuals subscribe to misinformation are largely unmentioned in ‘Dr Michael Says’, save for their promotion by public figures such as Nicki Minaj. For example, one recent study lists ‘feelings of anxiety, uncontrollability, and uncertainty’ as reasons (van Prooijen et al., 2022, p. 26); such feelings can be amplified in times of social upheaval. Those reasons are largely obscured by Mrozinski's framing of misinformation actors as irrational and dangerous. Further, that framing has the potential to deter misinformation actors (including conspiracists) from rethinking their beliefs and actions. A former QAnon ² follower makes this clear in a 2022 media interview:

They say ‘tinfoil hat brigade’. What has that got to do with a goddamn thing? You’re acting like these people are crazy, like they belong in a nuthouse. These people go to work. They have family. And they believe you are a part of a controlling cabal, and they will justify incredible misdeeds as a justification for righting wrongs. And that includes violence… There has to be some sort of pathway back to polite society for most of these people because most of them haven't done anything. If there isn't, then there's no incentive for them to come back. (cited in Dexter & Koob, 2022)

The point here is not that a single SMI can marginalise and (re-)radicalise misinformation actors, but rather that posts such as those described above at least contribute to an environment in which those actors are mocked and dehumanised. This could strengthen those actors’ hostility towards experts and elites. That is known as a ‘backfiring effect’, whereby ‘an unintended increase in misinformation belief result[s] from the exposure to a debunking intervention’ (Helfers & Ebersbach, 2022, p. 5). Further research needs to be undertaken on how this kind of content contributes to the stigmatising of misinformation actors, and the extent to which this stigma reinforces their beliefs.

Mrozinski seems mostly critical of those SMIs who promote misinformation, but his use of the term ‘Instagram influencers’ appears to encompass all SMIs, especially (though not exclusively) those who use Instagram. In fact, there are SMIs without medical qualifications who deploy social media and whose PHP does not set out to mislead. For example, a 2021 study investigates how wellness influencer Ashy Bines uses a range of platforms (including Instagram, Facebook and YouTube) to share ‘her “authentic” lifestyle choices without positioning herself as a formal expert, explaining that her recommendations are based on what “feels right” for her body rather than evidence-based facts’ (Hendry et al., 2021, p. 9). Bines’ absence of qualifications means that her ‘authority comes with minimal responsibility and accountability’ towards followers (Hendry et al., 2021, p. 10). This means, though, that she does not mislead followers into believing she possesses the kinds of knowledge and skills that, say, a general practitioner might.

The insights gleaned through an analysis of Mrozinski's social media content should provide useful information for marketers who wish to use health professionals in their campaigns, and health professionals who wish to undertake PHP, in terms of what to do and what to be mindful of. For example, it is important not to exacerbate the ‘information asymmetry between experts and non-experts’ (Durant, 2019, p. 43). Health professionals undertaking PHP must know the distinction between a (necessary) critique of misinformation actors and a belittling of those same actors. This belittling is ethically dubious and goes against public health principles. Finally, this article suggests that PHP can be undertaken without admonishing SMIs who are not health professionals but who may still be crucial in disseminating health information.

Conclusions

This article has argued that health professionals can play an important role as ‘public health pedagogues’ in using social media to debunk misinformation and education audiences about medical facts. This argument has been teased out via the case study of Michael Mrozinski. Via a Content Analysis and Framing Analysis of Mrozinski's COVID-related TikTok and Instagram content, the article has demonstrated some of the ways in which pedagogues such as Mrozinski can effectively harness platform affordances to educate followers about the facts and fallacies being distributed in online spaces regarding the novel coronavirus; and to encourage their audiences to protect the health of themselves and others. The article has also demonstrated the ethical and educational pitfalls of the public health pedagogue publicly belittling misinformation actors and portraying themselves as elitist experts. The article contains lessons for those content producers (SMIs, health professionals and others) who aim to debunk health-related misinformation, as well as marketers who want to use SMIs in health campaigns.