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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 140-144

The modern e-word-of-mouth and its public health impact - A qualitative study


1 Pulbic Health Specialist, Jalandhar Cantt, New Delhi, India
2 Public Health Specialist, Firozepur Cantt, New Delhi, India
3 Senior Resident, Physiology, Lady Hardinge Medical College, New Delhi, India

Date of Submission26-Feb-2020
Date of Decision16-Apr-2020
Date of Acceptance13-Jul-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
R Vishnuprasad
No. 22, Muthu Nagar, Muthirayarpalayam, Puducherry - 605 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrsm.jcrsm_7_20

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  Abstract 


Background: The most important drawbacks of health information on social media are lack of quality and reliability, unreferenced, incomplete, or informal and hidden conflicts of interest. The present study was carried out with an aim to study the responses of the mass to various false information shared in a social networking site.
Materials and Methods: The present study was carried out as a qualitative study of word-of-mouth messages being floated in Facebook during the period of June 2018–December 2018. Regionally active 10 social media pages were followed regularly. Materials posted in these pages which were of relevance to public health were randomly selected for the study purpose. These posts were followed regularly by the authors, whereby all messages and responses by different individuals in the form of comments were collected and collated during the study period.
Results: Three posts relevant to public health of different domains were selected randomly for the study purpose. It was also observed that these posts in social media platforms were related to news in media or a health campaign during the time of data collection. Irrespective of age and educational qualification, people tend to believe raw information available on social networking sites and respond in the same line, without verifying the credibility of the information.
Conclusion: All messages or information available through social media platforms may not be evidence or facts, and people tend to believe these messages and respond without actually verifying the credibility of the information.

Keywords: Misleading information, perceptions, social media


How to cite this article:
Pasricha SK, Vishnuprasad R, Santhanalaskshmi D, Singh G. The modern e-word-of-mouth and its public health impact - A qualitative study. J Curr Res Sci Med 2020;6:140-4

How to cite this URL:
Pasricha SK, Vishnuprasad R, Santhanalaskshmi D, Singh G. The modern e-word-of-mouth and its public health impact - A qualitative study. J Curr Res Sci Med [serial online] 2020 [cited 2021 Apr 23];6:140-4. Available from: https://www.jcrsmed.org/text.asp?2020/6/2/140/304209




  Introduction Top


Consumers frequently talk to other consumers about their consumption experiences, a phenomenon called word-of-mouth (WOM) communication.[1] For most consumers, WOM might be the only chance to also learn something about the negative aspects of a purchase (Singh, 1990). The strategic importance of WOM for organizations could be proved by a variety of studies.[2] Due to increasing competition and new forms of online communication, the WOM concept will continue to gain importance, which includes players in the health-care sector.[2],[3] Health-care information might be obtained by WOM and frequently allows patients to gain somewhat authentic information provided by other consumers who have already dealt with the health-care provider and medical treatment in question (Swan and Oliver, 1989). WOM seems to influence patients' consumption of health services and therefore enormously impacts health-care providers and payers. The information from news media, the general public, as well as political leaders are limited to a number of issues, which they are able to recognize as important. The individual issues often vary in their perceived importance.[4] The results of the previous studies clearly reveal that WOM is used to distribute health-related information among large groups of individuals.[5],[6],[7],[8] Internet plays an important role for the distribution of WOM-related health-care information, because it offers both anonymity and the possibility to overcome geographical barriers.[9] In this way, also, highly sensitive health-related information might be exchanged. Significant sources of WOM-related health information and advice are family, friends, and acquaintances.[6],[8] The use of this information source decreases with increasing age.[10] The authors define online firestorms as a “sudden discharge of large quantities of messages containing negative WOM and complaint behavior against a person, company, or group in social media networks. In these messages, intense indignation is often expressed, without pointing to an actual specific criticism.” The most important drawbacks of health information on social media are lack of quality and reliability,[11] unreferenced, incomplete, or informal and hidden conflicts of interest.[12] Social media networks simplify the faster spread of false information[13] and subsequently may provoke panic in large scale. The present study was carried out with an aim to study the responses of the mass, in the form of WOM, to various false information shared in a social networking site.


  Materials and Methods Top


The present study was carried out as a qualitative study analysis, WOM messages being floated in Facebook. The study was carried out during the period of June 2018–December 2018. Regionally active social media pages were followed regularly by the authors SD and VR during the data collection period (June–July 2018). Ten social media pages with at least 0.5 million followers were included for the study. Materials posted in these pages were of various different subjects and issues. Posted materials which were of relevance to public health or those which tend to impact health-care management were randomly selected for the study purpose, using nonprobability sampling technique. These posts were followed regularly by the authors, whereby all messages and responses by different individuals in the form of comments were collected and collated during the study period. The messages/comments posted were in local vernacular language as well as in English. All the messages were translated and retranslated for validation by the authors VR and SD. Subsequently, thematic analysis of the collected data was carried out by the authors who were earlier trained for the same. The details of the individuals responding to these materials posted in social media were checked from the profile when available for access by the authors. Dummy numbers were allotted for each individual after noting their personal information, thereby restricting the disclosure of identity of these individuals. Personal identity of these individuals was not recorded during any part of the study. The study involved only passive collection of information from social media platforms which are openly available for all public; however, ethical committee approval was obtained for undertaking the study. Collection of information with respect to a specific post was stopped once when there are no new comments for the posted material or when a saturation level was reached.


  Results Top


Three posts relevant to public health of different domains were selected randomly for the study purpose. It was also observed that these posts in social media platforms were related to news in media or a health campaign during the time of data collection.

Cesarean deliveries

A post in Facebook page as an image quoted that “In last 5 years, 67% of deliveries conducted by surgery (LSCS). After 5 years, wherever normal deliveries are going to happen, people will talk about it as a surprise matter. For earning money, normal deliveries are converted into LSCS.” A young male student doing his graduation commented in response to the above post that “Our great grandparents had never gone to hospitals, even they delivered at homes only. Everything is created only for money.” The post sparked immediate response in the form of comments by the users. A middle-aged woman voiced her concern that “In government hospitals, all the deliveries are cesarean only” in response to which another middle-aged woman stated that “Women chose cesarean to avoid painful procedure during normal delivery.” Furthermore, “No women will agree for cesarean, they made them to agree stating that delivery is a very complicated and risky for both mother and fetus” expressed a young female. A middle-aged graduate male accused that “Doctors are responsible for all these, they are changing the reports and we became afraid thinking that nothing should happen to our baby and hence we are saying ok for everything.” A male graduate commented that “There is no “Maruthuvachi” (Dhais/traditional healer) in modern days, this is the problem for everything. Government has banned this old traditional ways of treatment. Only very few are still left in some villages.” These comments by the users were even highlighted upon by other users/peers, who were, in most occasions, adults and had graduate level education.



Vaccination

A misguiding image posted in Facebook with text, as follows: “Vaccine once given can prevents or cures the disease, then what is the use of giving vaccine again to children born from that sperm? If vaccine cures the disease means, in last 10 years we could have cured or removed so many diseases, but it is not the scenario, every year there is a new disease. Why is it happening so?” The above image was uploaded onto the social media platform during implementations of a mass supplementary vaccination campaign in the study region. A graduate male reacted to the above post by commenting as “Then why chicken pox, jaundice are recurring again even after getting vaccinated for it?” Another user registered his thoughts as “We cannot change the gene with the help of medicines and injections. All these medicines and injections are formed for acting on one's own body and its cells.” In addition, peer pressure was quoted as reason for vaccinating their children by a homemaker female, who said “When everyone are vaccinating their kids, if we are not doing so, then it distresses. Because of this reason only we are also vaccinating our kids.” Anonymous claims were also put forth by an user who texted in the page that “100% bad, one scientist told that all the diseases are due to vaccines, the very next day he was shot dead by some unknown persons.”

In response, only one medical professional, doctor, reverted to the content positively by explaining as “After 40 years, Diptheria again started killing many lives. Longtime ago this diphtheria has killed many lives, because of immunization it came under control. In 2008, Tamilnadu health welfare association have announced that this state is diphtheria free and continued with immunization programme. But in 2018, again this diphtheria has come back, this is because some people stopped giving the vaccine.” Comfortingly, only one individual from nonmedical background condemned the false information and responded that “Vaccines will make you immune to particular disease, even if you are getting the disease, vaccine induced immune system will attack the disease causing agent and fight against it. In your page you are posting some unnecessary things without having a proper knowledge, this will misguide others, better do some research to gain a knowledge about the topic and post your comment.”

Iodization of common salt

Another page questioned the fortification of common salt with iodine with an image quoting as “People involved in Salt manufacturing are not mixing iodine in salt, they are not having iodine deficiency also. Then who is adding iodine to salt? Tell us the answer…?” An young male responded to the above post as “They are advertising the poor quality salt mixed with some chemicals as iodised salt and selling it” while another male replied as “For business they add iodine” A young male expressed his displeasure over fortification of food with vitamins and its supplementation via national health programs instead of natural sources. He said Government has started vitamin A drops to all the children who aged from 6 months to 5 years. Today it is vitamin A and tomorrow it is going to be Vitamin B, C, D etc. We all will stand in a que and use it. Whether they are going to give the nutrients which are already adequately available in Mother's milk, vegetables and fruits? Today the Government will introduce and start this scheme for free and may be in next year, all the hospitals will convert these plans or schemes into business.” It is also noted that information posted which are in relevance to existing political situation in the study setting provoked extensive response from users as compared to those which are not in limelight.


  Discussion Top


There exist no studies which systematically compile and analyze the current WOM research in the health-care sector. Still, as WOM strongly influences health care behaviour[14] and therefore enormously impact health care providers and payers, access to such compilation of WOM literature appears to be essential for both scholars and practitioners. The potential harmful results due to spreading false information are numerous. A deeper understanding of WOM-related factors might, for example, reduce the multiple and unnecessary change of physicians (doctor shopping), the retaking of several medical tests, and consequently reduces costs.[15] In a highly competitive market such as the health-care sector, stakeholder management might even gain importance.[15] As one important group of stakeholders, patients are increasingly demanding to be integrated into both the choice of a health-care provider and the treatment.[16],[17] Even though patients are nowadays better educated and have improved access to various online information than a decade ago, seeking health information is still a complex process and congeniality bias complicates the process even more.[15],[18] More precisely, WOM directly impacts the selection of a health-care provider as well as treatment and is seen as a significant measure of patient satisfaction.[15],[19] WOM is such a determinant, because it strongly impacts health-care utilization[14] and therefore might offer potential to reduce costs. Individuals tend to seek additional information actively when one is unclear about the information they possess. The present study results revealed that, irrespective of age and educational qualification, people tend to believe raw information available on social networking sites and respond in the same line, with verifying the credibility of the information. In a YouTube-based study on anorexia, it was noticed that though pro-anorexia-related videos were less common than informative videos, they were highly preferred and rated by users. Furthermore, these misleading videos were more popular.[20] A systematic review on the subject also reported that the probability of misleading information on health care being disseminated to the users is high and can leave disastrous impact to health care.[21] Consolingly, a study reported that significantly higher intention was noted among young individuals to read postings related to health information by medical/health professionals, as compared to broadcasting media and friends.[22] Health-care professionals could potentially exploit this in responding to false information and providing the users with appropriate and credible information. Some of the possible limitations of the present study are that it involved only Facebook.

[TAG:2]Conclusion[TAG:2]

All messages or information available through social media platforms may not be evidence or facts; people tend to believe these messages and respond without actually verifying the credibility of the information. Social media users should actively involve themselves in accuracy oriented information seeking and fact-check the validity of such information received through social media rather than inertly retorting to the rumors and spread. Involvement of health-care managers with multisectoral co-ordination and specific interventions in curbing spread of false rumors/false information that affect health care of the mass is required.

Acknowledgment

The authors would like to extend their gratitude to Dr. Atul Kotwal and Dr. Madhumitta for their valuable inputs in preparing the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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