Sufficient knowledge, but sense of information overload evident early in pandemic

Residents of central Pennsylvania had the information they needed to slow the spread of COVID-19 early on in the pandemic, but were overwhelmed with worries about mixed messages and distrust of some sources, according to Penn State College of Medicine researchers. The researchers said the results from a late March 2020 survey may be useful for refining health messaging approaches during COVID-19 resurgences and in planning for future pandemics.

Dr. Robert Lennon, associate professor of family and community medicine at the College of Medicine and adjunct faculty at Penn State Law, and Dr. Lauren Van Scoy, professor of medicine, humanities and public health sciences, and co-director of the College of Medicine's Qualitative and Mixed Methods Core, studied survey responses collected early in the COVID-19 pandemic from nearly 6,000 people living in central Pennsylvania. Their goal was to determine if people had adequate knowledge about the coronavirus, where they received their information from, their willingness to comply with public health recommendations,and their level of trust in information sources.

"Effective communication is essential for successful pandemic management," Lennon said. "Failure to ensure key messages are received and trusted may result in overuse of health services, spread of fear and misconceptions and failure by the public to comply with public health recommendations."

The researchers developed a survey to assess participants' basic knowledge of COVID-19—including measures to slow its spread—from the Centers for Disease Control and Prevention (CDC). In addition to answering knowledge questions and providing demographic information, participants provided written responses to three questions on what may have prevented them from following CDC recommendations, what worried them most about the pandemic and how they felt about how information regarding COVID-19 had been delivered to them. A total of 5,948 participants completed the survey between March 25 and 31, 2020.

The team found that four out of five respondents were likely to have adequate knowledge about COVID-19 and that people with a bachelor's degree level of education had higher odds of responding to questions correctly. Despite most people having sufficient information, the researchers said many respondents felt they lacked a proper understanding of managing symptoms of COVID-19.

Their results were published in Annals of Family Medicine on May 13.

"Early in the pandemic, there was a real fear of the unknown and focus on severe cases," Lennon said. "But the knowledge most people needed, aside from prevention measures, was how and when to get tested for COVID-19 and how to manage their symptoms if they tested positive and were symptomatic."

Approximately 43% of respondents indicated government websites were their most trusted source of information, followed by 27% who said that news media was their most trusted source. Van Scoy said that although people seemed to have sufficient knowledge of COVID-19 early in the pandemic, there was a mistrust of messages from certain sources and concern about mixed messages.

"We found that some people had negative feelings about how the pandemic was portrayed in the news," Van Scoy said. "Others were concerned that people had politicized the pandemic response and expressed a distrust of information provided by the executive branch of the government."

In their open-ended responses, participants expressed three key worries as the pandemic began to unfold: fears that they or a family member would contract COVID-19; public health concerns like asymptomatic spread of the virus and community members not practicing social distancing; and worries about economic and social disruptions. Many participants also reported feeling a sense of information overload.

The researchers said one limit to their study was a lack of responses from racial and ethnic minorities. Survey data showed there were possible knowledge disparities in these groups, but they said that further research is needed. According to Lennon, consistent messaging from trusted sources that can reach all audiences will be needed to address COVID-19 resurgences and future pandemics.

"Panic and pandemic fatigue are real problems, especially when it comes to health communication," Lennon said. "An important question to ask is, when the time comes for key information to be communicated, will people be able to hear the messages public health officials and government leaders try to send amidst so many competing and conflicting messages?"