Mixed Media Messages
Do Conflicts in Health Communication Shake Your Confidence?
Should I eat fish for better heart health or worry more about the mercury it contains? How about alcoholic beverages—is a glass of red wine good for me or not? When should I start having regular mammograms—at age 40, 45, 50? And should I go annually or every 2 years?
No doubt most of us have confronted health headlines that presented us with conflicting options. What, if any, effect did the conflict have on your confidence in science or medicine? How did media reports factor into your decision?
To offer insights on how the public receives and processes such mixed messages, NIH grantee Dr. Rebekah Nagler presented “Conflicting and Controversial Health Information in the Media: Content, Exposure and Effects,” the final installment in the Office of Dietary Supplements 2019-2020 Seminar Series.
Media frequently broadcast health information that, to Joe and Jane Public, seems at odds, Nagler said, describing the examples above. “In our experience, the conflict and controversy often co-occur, but they don’t always,” she said. “It’s possible to have information that is in conflict, but where there is not necessarily heated dispute or disagreements.”
An associate professor in the Hubbard School of Journalism and Mass Communication at the University of Minnesota, Nagler has conducted research on public health messaging for more than a decade. Her work has been supported by NCI as well as the Office of Research on Women’s Health via its Building Interdisciplinary Research Careers in Women’s Health program.
“Researchers, clinicians, we’re pretty well-equipped to negotiate this...My concern has always been about the public and the public’s ability to reconcile seemingly conflicting information,” she explained.
She defined conflicts in health information in a few ways, including “messages that are providing information about the same behavior, resulting in two distinct outcomes.”
Several factors can account for the disputes, Nagler explained. Distinct study design or variations in measurement are two examples. “Early cohort studies pointed to potential benefits of antioxidants and certain individual vitamins, but in the later, randomized control trials, results “didn’t hold up. That’s another place where there could seem to be a shift in findings…
“This is just the very nature of scientific discovery,” she said, “and we’re seeing that play out in the covid context right now. As research—as knowledge—advances, there is going to be that sort of two-steps-forward/one-step-back approach. And we can wind up with situations where there are legitimately opposing effects.”
Generally, she noted, public understanding of scientific research is limited, a fact that the National Science Foundation has been documenting for years. A large percentage of Americans don’t know what scientific study is.
“We’re seeing a lot of these gaps play out now with Covid-19, with limited research literacy among the public and variations in people’s understanding of risk,” Nagler said.
In addition, she noted, “news coverage historically has omitted a lot of the methodological and contextual information that people would need to make sense of these findings and understand why there could be shifts and seemingly inconsistent results.”
So the media sends mixed messages and the public might be confused. Would people’s behavior reflect this?
Over the years, “there were a lot of assumptions of adverse media effects—this belief that the media was disseminating all of this conflicting information and it was having all sorts of deleterious effects,” said Nagler, who took issue with the assumptions, mainly because she couldn’t find any empirical evidence linking media exposure to the reported outcomes. She and colleagues set out to provide data on how people are exposed to messages and whether behavior changes as a result.
One key finding: Conflicting nutrition messages delivered by television were perceived differently than messages in print media. TV was associated with greater confusion and, in turn, more distrust in dietary recommendations. Researchers also saw some evidence of reduced health behaviors linked to the confusion people felt, with markedly lower levels of fruit and vegetable consumption, for example.
Nagler’s group also looked at messages involving e-cigarettes, the HPV vaccine as well as guidelines for mammography and screening for prostate cancer. The researchers considered accuracy of the media reports as well. Many 2009 broadcasts of mammography guidelines, for instance, contained mistakes or erroneous reporting.
Timing of the research could prove significant too, Nagler found. Debates surrounding the Affordable Care Act coincided with media events about shifts in cancer screening recommendations from major professional organizations.
“So what we did—through systematically analyzing media content—was ask to what extent did discourse around the controversy evolve?” Nagler explained. “How much explicit mention of conflict and controversy is there? How much attention was paid to risks and benefits, on balance?”
Researchers were able to connect some subsequent actions to respondents’ exposure to warring medical messages, particularly in a study about mammography screening.
But, specific behavior changes aside, why does it matter whether people take note of a couple of conflicting health stories? What’s the real harm?
Nagler worries about what she termed the “carryover or spillover” result. She described a worst case “cumulative, across-topic, across-source meta effect” on someone exposed to volumes of conflicting or controversial media content over time.
“It could ultimately systematically undermine their trust in science at large, but specifically in public health recommendations,” she said.
As an example, she referred to a 2014 study in which people who were exposed to conflicting reports about wine, fish and coffee were shown to be less inclined to eat fruits and vegetables, which have never been in dispute as healthy.
In the Q&A period, an attendee asked about the potential impact of health messages delivered via Twitter, Facebook and other social media platforms.
“What’s unique about social media, of course, is the ability to share and disseminate,” Nagler responded. “And a lot of the concern is about misinformation…How quickly and easily we could share information is super problematic right now.”
What about getting messages directly from the horse’s mouth, so to speak? Would surveying scientists with health-related questions and sharing results with the public help solve some of the contradictions presented by media?
“I don’t know if it would necessarily solve the problem, but it might at least help get an upstream factor where you know who is doing the actual message creation and development,” Nagler concluded. “To what extent do scientists feel that it is their responsibility to help communicate their results? I think the move towards open communication and public engagement in the last couple years is really positive. Journalists often struggle to get researchers to call them back to serve as sources and help talk things through for the public. I would like to think that could be a potential solution or part of a solution.”