Pedagogy and Propaganda in the Post-Truth Era: Examining Effective Approaches to Teaching About Mis/DisInformation

Abstract

The rapid dissemination of information through various media platforms has significantly transformed the landscape of health communication and public health. The COVID-19 pandemic underscored how health faculty and practitioners face an increasing challenge in navigating the complex terrain of mis/disinformation that permeates the online world. The proliferation of false or misleading health information poses a significant threat to public health, eroding trust in evidence-based practices and potentially leading to adverse health outcomes. In this post-truth era, it is crucial to equip students and those working in health occupations with the knowledge and skills that enhance their media literacy and ability to discern credible from suspect information. However, we must go further to help students critically examine mis/disinformation from an ecological perspective to understand the historical and socio-political factors that lead to its spread and their vulnerability to it. In this paper, we offer a rationale for focusing on pedagogy to prevent and to mitigate the spread of mis/disinformation in health promotion, and we provide examples of evidence-based approaches for doing so. Additionally, we offer resources to support teaching and learning in this area and identify opportunities for future research.

Keywords

misinformation disinformation pedagogy health media literacy

Introduction

As a society, our capacity to access health information is unprecedented. Digital technologies have expanded the reach of such information exponentially, producing “infodemics” that are characterized by an overabundance of (both factual and false) information (Borges Do Nascimento et al., 2022). This makes addressing health problems much more difficult. Eysenbach (2009) introduced the term infodemiology, which is ‘the science of studying the distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy” (Eysenbach, 2009, p. 1). Since then, however, and especially in the era of COVID- 19, public health professionals have had to contend with not only misinformation (false information spread erroneously), but disinformation (falsehoods spread with malicious intent) (Starbird, 2019).

The transmission of false health information, some of which may not have malintent, can lead to adverse effects, such as increased vaccine hesitancy and poor health decision-making in groups at increased vulnerability (Clark-Ginsberg & Petrun Sayers, 2020; Southwell et al., 2023; Swire-Thompson & Lazer, 2020). Recent studies indicate that COVID-19 information rooted in inaccurate or incomplete information or non-credible sources resulted in number of negative outcomes, including: increased public rejection of accepted public health measures to reduce infectious disease spread, increased anti- Asian bias and violence, heightened use of potentially dangerous and unproven treatment methods, and decreased use of COVID-19 vaccines (Chou & Budenz, 2020; Gover et al., 2020; Love et al., 2020; Miller, 2020). The COVID-19 pandemic fueled mis/disinformation during a time when trust in valid science-based information sources was already eroding (Latkin et al., 2020).

Both mis/disinformation are perpetuated by complex interdependent social and political factors. Yet, despite its web of causation, some argue that the way in which mis/disinformation is explained in mass media as well as popular and scientific literature can be incomplete and simplistic, giving rise to what Bratich (2020) calls a “moral panic,” and what others describe as a “trust nothing or no one mentality” (Paris et al., 2022). This challenge presents an opportunity for faculty and those in health occupations to adopt more of an ecological and critical approach to pedagogy and praxis. Students need more opportunities for critical examination and discussion of the historic, economic, political, social, and structural factors that lead to infodemics as a foundation to the design and dissemination of effective and ethical health communication (Paris et al., 2022).

In this paper, we offer a rationale for focusing on pedagogy in health promotion to help strengthen public understanding and response to mis/disinformation. We begin with the need to first develop a consistent lexicon, and we follow with a rationale for developing and testing pedagogical approaches. Additionally, we offer cross-disciplinary examples of promising, evidence-based strategies from the growing body of research on this topic, resources to support teaching and learning in this area, and recommendations for future research.

The Lexicon of Infodemiology

Misinformation studies is a growing research domain across disciplines such as public health, computer science, data science, communication, and digital humanities, yet definitions for commonly used terms vary widely. Many terms are used interchangeably, although they are not synonymous. Greater precision and consistency of terms is warranted (Wuyckens et al., 2021). Therefore, in our discussion, we operationalize common terms and provide definitions on the basis of their use in the literature, thoroughness, timeliness, and source.

While we have defined mis/disinformation previously, as well as in Table 1 (below), it’s worth highlighting the distinction between the two terms. Misinformation is characterized by falsehoods that might be spread unintentionally without malintent (Starbird, 2019), while disinformation is misleading or erroneous information that is spread to purposefully cause harm (Starbird, 2019). Disinformation is often mixed with some facts to intentionally cause confusion, sway public opinion, or obscure the science (Wineburg & Mcgrew, 2017).

Table 1.

Common Terminology Relating to Mis/Disinformation.

Misinformation	False information which may be spread unintentionally or without the intent to cause harm (Starbird, 2019).
Disinformation	False or misleading information spread with malicious intent (Starbird, 2019). Disinformation often layers truth with falsehoods or statements that are not supported with scientific evidence (Fridman et al., 2023).
Infodemic	An overabundance of information (some accurate and some not) that makes it hard for people to find trustworthy sources and reliable guidance when they need it (World Health Organization [WHO], 2020).
Information literacy	A set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information (American Library Association, 2000).
Digital literacy	The way in which we use digital technology to communicate as well as to navigate an increasingly online world (Wuyckens et al., 2021).
Confirmation bias	The tendency to interpret or seek out information that confirms one’s existing beliefs or opinions, while disregarding contradictory evidence (Nickerson, 1998).
Fake news	Newspaper articles, television news shows, or other information disseminated through broadcast or social media that are intentionally based on falsehoods or that intentionally use misleading framing to offer a distorted narrative (Kavanagh & Rich, 2018).
Media literacy	A person’s ability to access, analyze, evaluate, create, and act using all forms of communication (National Association for Media Literacy Education, n.d.).
eHealth literacy	One’s ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem (Norman & Skinner, 2006).
Health literacy	The degree to which individuals can obtain, process, and understand the basic health information and services they need to make appropriate health decisions. (Health Resources and Services Administration [HRSA], 2022). Monkman et al. (2017) adds that health literacy is distinct from eHealth literacy because it includes all information formats including electronic.
“Post-truth” era	Relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief” (Oxford Languages, 2016). A time when people are more likely to accept and promote an argument based on their emotions and beliefs rather than facts. (Heinrich, 2020).
Propaganda	False or misleading information spread intentionally, usually to achieve some political or economic objective, to influence public attitudes, or to hide the truth. This is a synonym for disinformation (Kavanagh & Rich, 2018).
Truth Decay	The diminishing role of facts and analysis in American public life. “This phenomenon has taken hold over the last two decades, eroding civil discourse, causing political paralysis, and leading to general uncertainty around what’s true and what is not” (Kavanagh & Rich, 2018).

The term “media literacy” is also a term that we will use throughout this paper, and it’s often used interchangeably with terms like “information literacy,” “health literacy,” or “ehealth literacy.” While these terms all are relative to mis/disinformation, there are differences in meaning. Information literacy, media literacy, and digital literacy are similar in that they all have to do with the way in which people interact with and use information. The American Library Association defines information literacy as “a set of abilities requiring individuals to recognize when information is needed and have the ability to locate, evaluate, and use effectively the needed information” (ALA, p. 2). Media literacy is the ability to evaluate, analyze, and understand messages in all forms with a critical eye (National Association for Media Literacy Education, n.d.), whereas digital literacy refers to the way in which we use digital technology to communicate as well as navigate an increasingly online world (Wuyckens et al., 2021 The extent to which one can use digital (electronic) tools and sources to identify, understand, appraise, and apply health-related information is referred to as “ehealth literacy” (Early et al., 2022; Norman & Skinner, 2006). Additional definitions and distinctions are further provided in Table 1.

The Power of Pedagogy to Counter Mis/Disinformation

Pedagogy in health promotion plays an important role in preventing and mitigating the spread of mis/disinformation. While it is unlikely that we can slow the speed and amount of information generated in our hyper-connected world, our pedagogy can help influence what people do (or don’t do) with the information they encounter and their consciousness about the factors and systems that shape the quality of that information (Bratich, 2020; Breakstone et al., 2018; Buckingham, 2019; Caufield, 2017a, 2017b; Paris et al., 2022). Effective pedagogies can equip individuals with the skills to investigate and to verify trustworthy sources and to decipher credible information from misleading or false content (Brodsky et al., 2021; Buckingham, 2019; Caufield, 2017a, 2017b; Paris et al., 2022; Wineburg & Mcgrew, 2017). Learners can also apply this learning outside the classroom, sharing it within their families and social networks.

Additionally, there is still much to learn about the use of artificial intelligence (AI), both as a contributor to the swift spread of mis/disinformation (e.g., think bots and the spread of politically-motivated misinformation in the 2017 and 2020 presidential elections), and as a tool to combat it (e.g., fact checking and false account verification). Those creating health education and health communication will need to understand how to harness the best of AI, as well as its limitations. With the speed and spread of mis/disinformation, AI will likely play an instrumental role in content surveillance and fact-checking, as there simply won’t be the resources in public health or healthcare to supply staffing dedicated to monitoring it (Villasenor, 2020).

Further, by promoting ethical standards and emphasizing the potential consequences of spreading false information, effective pedagogy can encourage individuals to prioritize truthfulness, integrity, and responsible information sharing (Kavanagh & Rich, 2018; Paris et al., 2022). Pedagogy can also help prepare an engaged citizenry to better resist manipulation and propaganda and to enhance people’s ability to make more informed choices about the information they share (Early et al., 2022; Kavanagh & Rich, 2018; Paris et al., 2022).

Teaching about mis/disinformation can also promote civic engagement and social dialog (Kavanagh & Rich, 2018; Paris et al., 2022). History has demonstrated that mis/disinformation can contribute to social divisions, political polarization, and conflict (Bratich, 2020; Latkin et al., 2020). People need to be well-informed to better identify propaganda and to hold institutions accountable. Effective pedagogy can strengthen media literacy skills, promote diverse perspectives, increase understanding and empathy, and strengthen one’s ability to engage in productive conversations even amidst disagreement (Kavanagh & Rich, 2018; Miller, 2020).

Exploring New Pedagogies in the Post-Truth Era

Despite increased public attention on the topic of mis/disinformation, student media literacy skills and faculty pedagogical tactics are still lagging behind. For example, in a large, national study that included a diverse sample of 3,446 high school students from 14 states, Breakstone et al. (2021) found that most students struggled to distinguish between trustworthy and suspect information online (Breakstone et al., 2021). Only about 3% of the students involved in the study realized that a website purporting to deliver legitimate information about climate change was run by the fossil fuel industry. More than half believed a misleading video (from Russia) suggesting ballot mishandling in a U.S. presidential election. Researchers found that students tended to use ineffective methods for deciding whether to trust an internet source. They put a great deal of trust in “.org” web addresses, for example, and took “About Us” pages at face value. Less than 10% cross-checked a source’s credentials with a simple web search (Breakstone et al., 2021).

Additionally, research in higher education indicates that large proportion of faculty do not teach about mis/disinformation. Saunders (2022) reported results of a descriptive study of U.S. faculty opinions and behaviors relating to mis/disinformation. The sample (n = 724) was comprised of faculty from 429 public and private nonprofit colleges and universities in the U.S. and represented multiple disciplines. The majority of faculty surveyed (80%) agreed or strongly agreed that teaching about the spread of mis/disinformation was important. However, a significant proportion (67%) reported that they had not addressed issues of mis/disinformation in their classrooms over the past year. When asked about teaching about it in their discipline, answers varied; the highest percentage of respondents (48%) indicated they do not teach mis/disinformation in their classes because they perceive the concepts are not relevant to their field/discipline. An open-ended question that followed allowed for elaboration on why mis/disinformation was not taught in their classroom and yielded a common theme of lack of expertise and the need for faculty to receive more focused training on pedagogy (Saunders, 2022).

Recently, an interdisciplinary throng of media literacy experts, researchers, data scientists, librarians, and educators highlighted the need for new pedagogies for this post-truth era (Paris et al., 2022). The current media and information landscape is “characterized by viral misinformation, echo chambers, algorithmic bias, and the manipulation of information for various purposes” (Törnberg, 2018, p. 2). The ways in which people are finding and consuming media have changed; therefore, our pedagogy and praxis must evolve to adjust for them.

Researchers argue that pedagogical strategies should focus on how people search for this information and include fact-checking and media verification techniques (Brodsky et al., 2021; Caufield, 2017a, 2017b; Wineburg & Mcgrew, 2017). Others emphasize pedagogies that consider the role of emotions and cognitive biases in shaping individuals’ responses to information (Milner & Phillips, 2020). Approaches that incorporate emotional intelligence and cognitive strategies can help learners recognize and manage their biases, enabling them to critically engage with information without succumbing to confirmation bias or emotional manipulation (Brodsky et al., 2021; Caufield, 2017a, 2017b; Wineburg & Mcgrew, 2017).

Additionally, the ever-evolving media landscape requires individuals to be active participants and creators of media content. Pedagogies that promote media production, digital storytelling, design thinking, and collaborative projects can empower individuals to engage critically with media and counter misinformation through their own content creation (Early et al., 2022; Paris et al., 2022).

Also, the interdisciplinary nature of mis/disinformation calls for novel pedagogies that draw from various disciplines, including: health sciences, psychology, sociology, communication studies, gender studies, cultural studies, political sciences, and information science. By integrating insights from different fields, new pedagogical models can provide a more holistic understanding of the complex factors that contribute to the spread and impact of mis/disinformation (Paris et al., 2022). And finally, discussing the etiology of how mis/disinformation occurs is paramount. Fact-checking skills alone miss the mark in terms of helping people to understand why mis/disinformation spreads in the first place. Using an ecological framework to inform pedagogy can help individuals understand the problem of mis/disinformation as multifaceted and multi-layered (Paris et al., 2022). An ecological approach acknowledges that the interconnected factors that drive mis/disinformation cannot be simply countered with “facts,” but that society must consider the multi-dimensional nature of the problem and use multiple strategies across these dimensions to address the issue more holistically and effectively (Milner & Phillips, 2020). For example, the early years of the HIV/AIDS pandemic serve as a case study of why examining the politics of the time is important to understanding the factors that influenced the way in which information was shared, what was shared, and how it was framed for the public (France, 2012). The most recent COVID-19 pandemic and mis/disinformation about vaccines serves as another example (Wang et al., 2022).

Promising Approaches

What evidence of promising pedagogy can we find in the peer-reviewed literature or the wider landscape of K-12 and higher education? We offer some evidence-based ideas and approaches below:

Teaching Students to Think Like Fact Checkers

Teaching students how to combat the perpetual onslaught of mis/disinformation requires more skill-building than having them use a checklist or inventory (Brodsky et al., 2021; Caufield, 2017a, 2017b; Wineburg & Mcgrew, 2017). There is compelling evidence that helping students think like professional fact checkers, to leave an online article or story to see if anyone online has already fact-checked it (e.g., “lateral reading”), is an effective pedagogical strategy (Breakstone et al., 2018; Brodsky et al., 2021; Wineburg & Mcgrew, 2017). For example, in a study by Brodsky et al. (2021) researchers taught two 75-minute sessions on evaluating the credibility of online information to an experimental group (n = 136) of randomly chosen sections of a public university’s general education course in critical thinking and writing and compared scores to those in a control group (n = 94). Those in the experimental group received instruction on how to apply lateral reading and skills used by fact checkers. Results showed that students in the experimental group performed better on the post-session test, which was given a month after the instruction was delivered. Those results were statistically significant, but still left room for improvement.

In a follow up study by Brodsky et al. (2021), college students (n = 221) in an online general education civics course were taught through asynchronous assignments how to use lateral reading strategies to fact-check online information about COVID-19. Students improved from pretest to posttest in the use of lateral reading to fact-check information, and students also reported increased confidence in their ability to fact- check COVID-19 news. Findings supported the effectiveness of an online curriculum to improve fact-checking among college students.

Pennycook et al. (2021) studied content sharing behaviors within a large sample (n = 1,002) of social media users and found that by shifting people’s focus to accuracy, people are less likely to share inaccurate or misleading content. Their findings upended the notion that people value partisanship over accuracy and provide evidence and justification for developing scalable interventions that focus on accuracy for content- sharing to reduce the spread of misinformation online.

In short, there is ample evidence that teaching students to think like fact checkers can help them more accurately decipher mis/disinformation or at least refrain from sharing information they think may be misleading or suspect. More research is necessary to test the effects over time and to create performance-based information verification skills since students tend to overestimate the time they engage in lateral reading (Pennycook et al., 2021). It’s also important to remember that fact-checking as a sole strategy is not sufficient. As we argue throughout this paper, helping students first understand the why behind the proliferation of mis/disinformation is an important pre or corequisite to this approach (Paris et al., 2022).

Teaching Triangulation: Unpacking Confirmation Bias and Selecting Search Results

In addition to helping students think more like fact checkers, researchers and pedagogues from the Stanford History Education Group (2017) suggest teaching students about confirmation bias, which is when people seek out information that confirms their existing beliefs (Nickerson, 1998). McGrew et al. (2017) assert that teaching strategies should address this bias as well as the role of emotional appeal and people’s own hubris in thinking they are not vulnerable to misinformation (McGrew et al., 2017). Additionally, students need help identifying credible information from search results. For example, knowing that sites listed do not appear in rank order by quality, but can appear first because of paid search optimization, might help people take more time to scroll down, explore, and to scrutinize multiple sites instead of clicking on the first one that appears. Further, McGrew et al. (2017) emphasize the need for source triangulation, encouraging students to compare multiple sources, even referring them to Wikipedia to identify primary sources. As a learning exercise, McGrew et al. (2017) recommend having students explore what’s written about a particular topic in Wikipedia and comparing it to what is written about the topic in other sources listed on the Wikipedia page’s references or other sources, like Encyclopedia Britannica or peer-reviewed journals.

Applying the SIFT Method

Michael Caulfield, a research scientist at the University of Washington’s Center for an Informed Public, is an expert on the topic of mis/disinformation and pedagogical strategies to address it. His work examines mis/disinformation and its role in fostering and perpetuating conspiracy theories and political polarization. Caulfield’s pedagogical research expands on studies from the Stanford History Education Group (McGrew et al., 2017); he, too, emphasizes the importance of teaching people to verify information sources and to read laterally. “The Internet is a web,” Caufield argues, “and the way to establish authority and truth is to use its web-like properties” (Caufield, 2017a).

Caulfield suggests a few steps for navigating the vast ecosystem of online information effectively. The key term is “few,” as Caufield argues that requiring lengthy checklists for evaluation can lead to cognitive overload, poor decision making, and less likelihood that people will adopt intended behaviors long-term (Caufield, 2017a). Caufield’s suggestion is to teach students four moves, called SIFT (Figure 1 below), which include the following: (1) stop, (2) investigate the source, (3) find better coverage, and (4) trace claims, quotes, and media to the original source and context.

Figure 1.

The SIFT method for identifying mis/disinformation.

Caufield claims that people can learn the SIFT moves quickly (in less than a minute) which will help them develop small habits and skills that can dramatically reduce the misinformation they spread or believe. Faculty can include the SIFT method in health communication courses or throughout a program’s curriculum as one of many strategies to help students develop habits and critical thinking skills that speed their identification of suspicious or false information.

Applying Technology Tools That Strengthen Media Literacy

Several technologies and forms of AI often used in marketing and business, can be applied in education and public health education to help strengthen students’ ability to navigate, identify, and critically analyze media content. Here are just a few examples based on some of the most common technologies and strategies:

Fact-checking Platforms

Platforms such as Snopes.org, Politifact, or ClaimBuster (Table 2) can assist students in verifying the accuracy of information. These tools use algorithms to analyze claims, compare them with reputable sources, and provide real-time feedback on the credibility of the information. The use of AI tools such as Full Fact and Fact Check are becoming popular and show promise in terms of accuracy and speed, as well as giving people the ability to check and verify information in real-time (Google’s Digital News Innovation Fund, 2020). Students could use multiple fact-checking tools to compare and/or to verify results.

Table 2.

Resources for Teaching and Learning About Mis/Disinformation.

Name of resource	Brief description of the resource	Where to find
Public Health Communication Collaborative (PHCC)	Provides online tools and resources for public health communicators to create timely, clear, credible, and effective messages as well as to help people identify and counter mis/disinformation.	https://publichealthcollaborative.org/
Web Literacy for Fact Checkers (2017; updated resources in 2021).	A free, open e-book developed by misinformation expert Michael Caufield that presents practical fact-checking strategies particularly for social media and online sources. Caufield presents four strategies (SIFT) for evaluating information with a number of effective examples and activities	https://pressbooks.pub/webliteracy/
Check, Please: A Starter Course (2019)	A free, open-source online course developed by Michael Caufield. The course includes five lesson modules (approx. 30 minutes each) with interactive learning activities, videos, and instructor resources and notes.	https://pressbooks.pub/webliteracy/
Truth Decay: An initial Exploration of the Diminishing Role of Facts and Analysis in American Public Life (2019)	A report by Kavanagh and Rich that explores the causes and wide-ranging consequences of Truth Decay and proposes strategies for further action.	https://www.rand.org/pubs/research_reports/RR2314.html#download (online, PDF version is free)
Verification Handbook: An Ultimate Guide on Digital Age Sourcing for Emergency Coverage. (n.d.)	A free, digital handbook, edited by Craig Silverman, designed for journalists or other fact-checkers with steps and tools for verifying sources and information when time is of the essence. The skills, tools, and examples provided are helpful for everyone no matter discipline or background.	https://datajournalism.com/read/handbook/verification-1
The Critical Thinking about Sources Cookbook (2020).	Provides lesson plans, resources, ideas, and inspiration to empower librarians in helping students develop crucial critical thinking and information and media literacy skills. Written by Sarah Morris and published by the Association of College and Research Libraries.	https://www.alastore.ala.org/content/critical-thinking-about-sources-cookbook
Bad News (n.d.)	A free, interactive game (Artificial Intelligence Chatbot), where players take on the role of a fake newsmonger, designed to help them become an expert at identifying disinformation and fake news from the Cambridge Social-Decision Making Lab at Cambridge University.	https://getbadnews.com
The Euphorigen Investigation (2020; updated versions in 2023)	A game created by the Center for an Informed Public (CIP) at the University of Washington that uses storyline and an escape room strategy to mimic the psychological and emotional responses elicited by real-life interactions with digital misinformation. The game helps students better identify mis/disinformation and can be played online or in a classroom. New versions of the game are also available on the website.	https://www.lokisloop.org
First Draft News	An international consortium and network of partners that is now part of the Information Futures Lab at Brown University. It provides resources and training for the public on how to identify, verify, and debunk online information.	https://firstdraftnews.org
Media Wise	A project by the Poynter Institute that aims to improve digital literacy among young people. Media Wise provides a range of resources for educators, including lesson plans, videos, and fact-checking tools	https://www.poynter.org/mediawise/
Fact Check	A nonpartisan, nonprofit organization that provides resources for checking the accuracy of claims made by politicians, public figures, and organizations.	https://factcheck.org
Snopes	The oldest and largest fact-checking site online, widely used by journalists and readers as an invaluable research companion. Snopes investigates and fact-checks urban legends, rumors, and other forms of misinformation.	https://Snopes.com
Harvard’s Shorenstein Center	A research center dedicated to increasing understanding of how people access, create, and process information, particularly as it relates to news and societal issues. Their website offers a wealth of research and publications on media and politics, including studies on misinformation and disinformation.	https://shorensteincenter.org/
Stanford History Education Group (SHEG)	Provides free lesson plans and resources for teaching students how to critically evaluate online information.	https://cor.stanford.edu/
The Center for an Informed Public (CIP)	An interdisciplinary research center at the University of Washington studying how mis/disinformation starts and spreads, how it converts to personal beliefs and actions, and what legal and policy actions are available to address the spread of mis/disinformation.	https://www.cip.uw.edu/
Center for Countering Digital Hate (CCDH)	CCDH US is a nonprofit, non-governmental agency with headquarters in Washington DC and UK headquarters in London. The Center’s work stops the spread of online hate and disinformation through innovative research, public campaigns, and policy advocacy.	https://counterhate.com/our-work/
Gapminder	An independent Swedish foundation with a mission to “fight devastating ignorance with a fact-based worldview everyone can understand.” The website provides free teaching materials, games, fact-checking tools, data visualization tools, and resources for teachers and learners to improve their critical thinking about how data is displayed and interpreted and to enlarge their worldview.	http://gapminder.org
Allsides.com (n.d)	The site provides a Media Bias Chart that categorizes media news outlets by political leaning so that people can explore multiple perspectives on any topic to avoid echo chambers.	https://www.allsides.com
Dis/Information (2023)	A free, online, and open course by North Carolina State University that engages students in the ways that information is created, shared, and interpreted. It includes topics such as: infographics, cyber security, news, news bots, cookies and online tracking, and digital privacy.	https://oercommons.org/courseware/lesson/78295/student/?section=0
Navigating Digital Information (2020)	In 10 YouTube episodes, John Green teaches people how to navigate the internet and the information they read online. This resource was developed in partnership with Media Wise, The Poynter Institute, and the Stanford History Education Group.	https://www.youtube.com/playlist?list=PL8dPuuaLjXtN07XYqqWSKpPrtNDiCHTzU

Disrupting Echo Chambers and Recommendation Algorithms

Not long ago, news editors once decided which stories should receive the broadest reach. Today, recommender systems determine what content users encounter on online platforms—and what information enjoys mass distribution. As a result, recommender systems underlying these platforms—and the recommendation algorithms and trained AI they encompass—are of great importance (Peckham, 2023). They can contribute to echo chambers (when users see only information that confirms their beliefs or point of view) by hiding content that is irrelevant based on the algorithm (Peckham, 2023). This is content that a person might swipe past, doesn’t interact with or blocks on their feed. However, the content that users don’t see may help create a more balanced view of the world.

Therefore, it’s important to teach people about the power of the algorithm tied to their social media and how important it is to disrupt it in order to break free of echo-chambers. Algorithms in recommendation systems on websites like PolitiFact Health Check (politifact.com), or the Perspective (theperspective.com) can expose students to a diverse range of media sources and viewpoints. Another great site is Allsides.com (n.d) which provides a Media Bias Chart with popular political and news sources categorized by political leanings. Students can use this to explore how particular topics are covered by various media sources, gain a more comprehensive understanding on issues, and explore diverse perspectives.

Digital Analysis and Annotation Tools

Technologies, such as Hypothes.is (https://web.hypothes.is/) or Kami (https://www.kamiapp.com/) can enable students to critically analyze and individually and/or collectively annotate media content. These annotation tools can be used to help students review information carefully and note key elements of an image or video, such as objects, people, or locations, helping students to understand the context and potential biases.

Image Search and Verification Tools

Platforms and technologies like the Google reverse image search on Google Images or using the Google Lens app or other search apps like Tin Eye (tineye.com) can help students determine if the visual or image is original or falsified. There are also tutorials and teaching resources available to help people learn to better detect altered images and media, such as the “Which Face is Real?” (https://www.whichfaceisreal.com) game and accompanying tutorial developed by Drs. Jevon West and Carl Bergstrom from the University of Washington’s Center for an Informed Public (see Table 2).

It’s important to note that while these technologies can be valuable in strengthening students’ media literacy and digital skills, they are best used in conjunction with a more comprehensive approach and teaching critical thinking. In addition, many of these tools are not free or open; they require a trial period and subscription. Human guidance and context remain crucial in helping students develop a deep understanding of media literacy concepts and the ability to think critically about the information they encounter.

Using Gamification to Teach About Mis/Disinformation

Gamification has emerged as a powerful and effective approach for teaching about mis/disinformation, engaging learners through interactive game elements to enhance their media literacy skills. Gamified exercises include strategies such as: online or on- site scavenger hunts, story-based scenarios, puzzles, self-quizzes, and simulations.

Games can challenge students to evaluate the credibility of different sources, analyze media messages, and make informed judgments (Roozenbeek et al., 2020).

Bad News

Bad News is another example of an online game that teaches about mis/disinformation with promising results. The game was developed by the Cambridge Social Decision-Making Lab and puts players in the role of a person spreading disinformation to gain social media followers. Players are challenged to manipulate information and use various propaganda tactics to build their virtual “fake news” empire. Through this experience, players become more aware of the strategies used to spread disinformation and the potential consequences of consuming or sharing misleading content online. Roozenbeek et al. (2020) investigated the impact of playing Bad News on participants’ susceptibility to disinformation. The results showed that individuals who played the game were better equipped to recognize common tactics used in disinformation campaigns and were more resistant to being influenced by false information presented to them.

Escape Rooms

One emerging learning strategy gaining popularity is the escape game, also known as escape room (ER) or breakout. An ER is a game in which a team of players enter a physical or digital space where they work together to solve a mystery or problem, usually progressing from one or many rooms looking for clues and solving puzzles (Veldkamp et al., 2020). Like recreational escape rooms, escape rooms used for education combine hands-on and critical thinking activities to be achieved with a team in a limited time. In a classroom setting, teachers try to create authentic environments with meaningful activities and room for failure.

One example using escape rooms for mis/disinformation is The Euphorigen Investigation, developed by researchers and game developers at the University of Washington’s Center for an Informed Public (CIP), the GAMER Research Group, and Puzzle Break (the first escape room company in the U.S.). The aim for players is to work in teams of 4 to 6 to investigate claims about a new supplement, called “Euphorigen,” which is touted to increase brain activity and productivity in humans (Photo 1). Players are given the challenge to unlock and assess information that will help them determine if the government should allow Euphorigen to be added to the public water supply. Players work through a series of puzzles that require them to analyze the credibility of written claims and data visualizations, and decipher social media bots, deepfakes and other forms of deception (Coward, 2021). The game is available in two versions—online and on-site. The online version is played over video conferencing software (e.g., Teams, Zoom) and web browser. The on-site version is a kit that can be downloaded and printed for in-person play. In both versions a gamehost (e.g., teacher, librarian) facilitates the experience.

Photo 1.

Using an escape room approach to learning about mis/disinformation.

Researchers on the Euphorigen project team conducted a series of beta testing of the Euphorigen escape room with five public libraries in Washington State to get formative feedback and to refine the game. In 2022, they launched a national study, implementing the game with 10 libraries across the U.S. Overall, the game generated largely positive outcomes and reviews, and demonstrated effectiveness in achieving the learning goals (Coward, 2021). Subsequently, the team was awarded a grant from the Institute of Museum and Library Services (IMLS) to make Euphorigen available for educational use, to create additional escape rooms, and to develop a design kit for others to use to make their own escape rooms. Details on where to find Euphorigen for download or use in electronic format can be found in Table 2.

Using an Ecological and Interdisciplinary Approach

Some scholars argue that teaching about “fake news” and fact-checking without helping learners understand the broader, systemic factors that perpetuate mis/disinformation may lead to increased doubt, mistrust, and cynicism about public health and healthcare rather than discernment and understanding (Boyd, 2018; Paris et al., 2022). Pedagogy that uses an ecological and interdisciplinary approach offers a comprehensive and multi-layered way for students to examine the problem of mis/disinformation and strategize solutions. Providing insights from various disciplines, including sociology, political science, mathematics, information science, engineering, management science, economics, health, education, and law, can help students to understand the inter-related historical, sociological, and political forces that perpetuate “truth decay” (Kavanagh & Rich, 2018; Paris et al., 2022). There are power structures and agents at play that perpetuate the spread of mis/disinformation and require “ecological literacy” to foster not only critical analysis but individual and collective agency (Milner & Phillips, 2020; Paris et al., 2022). An ecological approach introduces a pathway for raising social consciousness and strengthening the response to mis/disinformation (Kavanagh & Rich, 2018; Paris et al., 2022).

A promising approach to curriculum development using an ecological framework is the “Disinformation Detox” course, designed by Paris et al. (2022), that helps early undergraduate students examine mis/disinformation from technical, social, cultural, political, and economic angles. The course draws on critical informatics perspectives on mis/disinformation and draws from black feminist social epistemology, cultural studies, and neo-Marxist critical theory to “focus squarely on systems and practices of power and oppression in information systems” (Paris et al., 2022, p. 8). The 15-week syllabus, situated as part of a general education course for undergraduate students, includes interdisciplinary readings and weekly activities to encourage self- reflection and a systematic critique of the myriad structures involved in mis/disinformation. In the first part of the course, students are introduced to mis/disinformation, real-life scenarios, and systems that contribute to power imbalances, political polarization, mistrust, and conspiracies. In the second part of the course students are introduced to theoretical and analytical tools that help students better understand and analyze mis/disinformation through an intersectional lens (Paris et al., 2022). In the third part of the course, students discuss how things could change for the better; identify real-world scenarios and offer examples of more ecological responses to addressing mis/disinformation that go beyond just individual tactics (Paris et al., 2022).

Paris et al. (2022) did not include course outcomes or other empirical results in their discussion. However, they presented a detailed outline of a syllabus, complete with course readings and assignments, that could be an effective, holistic introduction to this topic for students in any academic discipline. Courses like Disinformation Detox provide short, introductory assignment ideas to address concerns about mis/disinformation raised by most higher education faculty, who acknowledge this is a problem for students but do not know how to incorporate this topic into their courses (Saunders, 2022).

Involving Librarians as Allies

Teaching or co-teaching about mis/disinformation with librarians is another promising strategy. Recent studies have demonstrated the effectiveness of working with librarians to help strengthen students’ media literacy and skills of discernment (Apuke & Gever, 2023; Saunders, 2022). Apuke and Gever (2023) explored the impact of librarian intervention in combating mis/disinformation in academic settings. The researchers observed that students who engaged in workshops designed and delivered by librarians developed a higher level of media literacy skills. They became more proficient at fact-checking, assessing the reliability of online resources, and recognizing biased sources. Moreover, these students demonstrated increased skepticism toward viral information without proper verification. The findings indicate that working collaboratively with librarians to deliver targeted information literacy sessions equips students with the tools to navigate the digital landscape more critically and responsibly.

While research points to the positive benefits of involving librarians in pedagogical strategy to combat and to mitigate mis/disinformation, a descriptive study by Saunders (2022) found that most faculty are not doing so. Among the national, random sample of 4-year institutions surveyed (n = 429) 79% of the 724 faculty who responded to the survey reported that they had not worked with a librarian to help teach about media literacy or mis/disinformation in their courses. This finding underscores the need to promote librarian and faculty partnerships as an effective pedagogical tactic and countermeasure to mis/disinformation and as an area for further research. Faculty could integrate a workshop or modules on media literacy authored and/or facilitated by a librarian in a course or throughout an entire academic program.

Combining Strategies

Bak-Coleman et al. (2022) explored the efficacy of common strategies such as fact-checking, nudging (e.g., using labels on misleading or inaccurate content), and social media account banning for those repeatedly sharing violent or false information to slow the spread of mis/disinformation. Their sample included a large dataset of over 23 million Twitter (now known as X) posts and 10.8 million unique user accounts during the 2020 U.S. presidential election. Their findings showed that while each method demonstrated some level of efficacy to slow the spread of mis/disinformation online, using a combined approach can achieve a more substantial reduction in the prevalence of misinformation online.

Teaching Resources

Faculty often look for pedagogical resources that are easily adaptable in their course assignments or activities. The interdisciplinary resources in Table 2 represent a mixture of articles, professional organizations tackling mis/disinformation, fact-checking websites, open online courses and open educational resources, syllabi and lesson plans, reports, games, videos, podcasts, and simulations. These resources provide clear definitions and strategies in a variety of formats to improve engagement; offer assessment steps and questions for reliable source and information evaluation; and encourage students to check information through story-based scenarios. Many of these resources are freely accessible.

Discussion and Recommendations

Despite an abundance of research on teaching about media literacy and health literacy, empirical studies in the health professions relating to promising pedagogies and interventions addressing mis/disinformation are lacking. Cross-disciplinary publications often emphasize cognitive strategies and digital literacy skills, rather than socio- emotional and ecological aspects of mis/disinformation (Miller, 2020; Milner & Phillips, 2020; Paris et al., 2022; Roozenbeek et al., 2020). Recent studies demonstrate the importance of addressing emotional reactions to misinformation, suggesting that incorporating emotional regulation and empathy-building strategies into pedagogical approaches can enhance students’ resilience against misleading information (Buckingham, 2019; Clark-Ginsberg & Petrun Sayers, 2020; Kavanagh & Rich, 2018; Miller, 2020; Paris et al., 2022). Another notable gap is the scarcity of studies focusing on the long-term impact of such educational interventions. While many studies may demonstrate short-term improvements in students’ abilities to identify and critically assess misinformation, there is a dearth of research examining whether these skills are retained and effectively applied in real-world contexts over time.

Furthermore, faculty and health practitioners need opportunities and institutional support to develop their pedagogy and praxis relating to mis/information (Saunders, 2022). Schools and institutions can organize professional development workshops, learning communities, and cross-disciplinary seminars about mis/disinformation challenges and pedagogies to counter it. Also, new technologies to track, monitor, detect, check and verify are critical, but in addition to these tools, faculty will need to help students think more critically about the information they consume as well as the tools they use to evaluate it. Experts advise that innovation is necessary to keep pace with mis/disinformation propagation. In a recent interview for Wired magazine, Dr. Kate Starbird, an associate professor and director of the Center for an Informed Public at the University of Washington, discussed how generative AI is helping to produce disinformation content that is more sophisticated, tailored for specific audiences, and harder to detect (Benson, 2023). Raising people’s consciousness about it will be an ongoing effort.

Health scholars and practitioners must also recognize the relationship between mis/disinformation and health inequities and the power of pedagogy in shaping advocacy and legislation that can create change at the systems level. Evidence from a recent systematic review published in the Bulletin of the World Health Organization (Borges Do Nascimento et al., 2022) underscored the correlation between mis/disinformation and negative health outcomes pertaining to mental health, delay in medical treatment, misallocation of health resources, vaccine hesitancy, and stress and anxiety caused by increased political division and civil unrest (Borges Do Nascimento et al., 2022). This research also supports knowledge gap theory which posits that as mass media information and new technologies increase, so will information disparity for those with less power, education, and income (Hindman, 2012).

Monolithic approaches are not sufficient to address intersectional differences in how people access, interpret, use, and/or share health information (Lee et al., 2023). Consequently, faculty and health practitioners will need to gain a deeper understanding of factors that threaten trust in public health, government, and health- promoting organizations and create tailored interventions as well as grassroots and systems level strategies that can lead to positive change. All of these examples provide a strong rationale for conducting more empirical studies that can identify and enrich effective pedagogies and praxis.

Conclusion

While complete containment of mis/disinformation is not realistic, concerted efforts such as those presented in this article can significantly mitigate its impact. Teaching to strengthen individuals’ critical thinking skills, media literacy, and information verification techniques can help emerging health professionals be better equipped to evaluate the credibility and reliability of the information they encounter. By gaining an ecological understanding of the techniques and motivations behind the creation and dissemination of false information, individuals can become more cautious and conscientious about the information they read, create, and disseminate. They can also develop a heightened awareness of the ethical implications of sharing and endorsing unverified information, leading to a more informed and responsible public, and preventing potential harm caused by conspiracy theories and propaganda.

Furthermore, by using a multi-level approach, combining effective pedagogy with strategies from the micro (individual) to macro (policy) levels, those working in the health professions can help to create a society that is more resistant to the harmful effects of mis/disinformation. Collaboration at the policy level, for example, can involve developing and supporting legislation that holds online platforms accountable for their content, promotes transparency in algorithms, and facilitates information-sharing initiatives and campaigns to counter mis/disinformation collectively. Leveraging AI and machine learning algorithms to detect and to flag false information, improving content moderation systems, and developing tools that facilitate the verification of information sources are also important. However, no matter how platforms are moderated, education will remain essential. Therefore, continuous adaptation and improvement of pedagogies will be necessary to stay ahead of evolving tactics used by those spreading false information. More empirical and longitudinal research is needed to test and to report on the efficacy of such strategies. With a comprehensive and sustained effort, we can collectively strive toward minimizing harm and fostering a healthier, more informed society.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Jody O. Early

Ronica N. Rooks

LaHoma Smith Romocki

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