Evaluation of a Template for Countering Misinformation - Real-world Autism Treatment Myth Debunking

"Given the significant public health impact of misinformation, development of effective debunking strategies is as vital as promoting effective evidence-based interventions."

Misinformation-based decisions carry risk of direct harm or opportunity costs. For example, misinformation-based rejection of vaccinations, especially in the wake of the vaccine-autism myth surrounding the mumps-measles-rubella (MMR) vaccine, has contributed to the resurgence of vaccine-preventable diseases. People tend to continue to rely on corrected misinformation in their reasoning even if they understand, believe, and later remember the correction. Thus, strategies have been developed to more effectively combat misinformation. The aim of this study was to test these strategies in a real-world setting, targeting misinformation about autism interventions.

As the researchers explain, a correction ideally emphasises detailing facts and evidence support of them. If a person falsely believes in an autism epidemic brought about by vaccinations, for example, it is crucial to refute the misinformation and to concurrently provide alternative information - e.g., that the observed rise in autism rates is mostly due to broadened diagnostic criteria and heightened awareness of the condition. Moreover, it is important to design refutations that use simple language to facilitate understanding and an empathetic, non-confrontational tone.

The study combined this basic refutational approach with 6 additional elements thought to boost the effectiveness of a correction:

1. Source credibility: Corrections are more effective if they come from a person or institution that is high in perceived trustworthiness.
2. Self-affirmation: Affirming a person's values makes them more open to worldview-inconsistent information.
3. Social norming: If either an injunctive or a descriptive norm is presented in support of a correction, it should facilitate acceptance of corrective information due to people's fear of social exclusion.
4. Warning people before exposing them to misinformation may prevent them from initially believing the misinformation upon exposure and may boost strategic monitoring and recollection processes that can avert reliance on misinformation.
5. Graphical representations can boost corrective impact by attracting attention, facilitating information processing and retention, and quantifying or clarifying the corrective evidence.
6. Salience of the core corrective message can enhance its effectiveness.

Debunking materials were designed along these guidelines for use in a real-world setting. Specifically, the researchers aimed to educate participants regarding the lack of evidence for 3 non-empirically-supported treatments (non-ESTs) for autism - facilitated communication, auditory integration training, and special diets - and prevent them from using and promoting these ineffective treatments. Participants (n=86) were recruited from 4 Autism Specific Early Learning and Care Centres (ASELCC) in 4 states of Australia. The study engaged early-intervention professionals because misinformation is especially problematic when disseminated by professionals who are a valued and trusted source of information for both families and other professionals. The researchers presented the "optimized-debunking" materials as part of a professional development intervention, contrasting the materials' efficacy with the impact of control training materials (freely available, commonly used training materials - e.g., information from the Raising Children Network and Positive Partnerships).

To prepare participants for the core non-EST debunkings, researchers highlighted how the apparent evidence for ineffective practices is often flawed because it relies on anecdotal experience and an associated illusion of causality. The core debunking of each non-EST followed a specific structure, which involved clarifying that a given treatment is ineffective, why it is ineffective, why people might want to falsely believe it to be effective, and what an alternative treatment might be. This general approach was supplemented by incorporating the 6 factors reviewed above:

1. Source credibility: The debunking materials emphasised that the intervention's motivation was a deep-rooted care for clients and a desire to assist professionals in their decision making, not vested interests. Also included was a portrait image of the lead researcher that was pre-rated in a pilot test as high in trustworthiness.
2. Self-affirmation: Participants were thanked and made aware that their participation demonstrated professional values and a commitment to high-quality care.
3. Social norming: The researchers emphasised the strong agreement amongst healthcare providers that intervention recommendations should be based on the best available evidence. This was later reinforced by providing an injunctive norm: that recommending only the treatments that work is the right thing to do.
4. Before exposing participants to specific misinformation regarding a non-EST, they received a statement that they were about to receive information about a treatment that research has shown to be ineffective. The label "Myth:" preceded introduction of non-EST misinformation.
5. Intuitive, colour-coded pie charts were used to illustrate the evidence against non-ESTs.
6. The salience of the core messages was enhanced by presenting the statements in bold black font or in coloured boxes in a larger, white font.

Having randomly assigned participants to the "optimized-debunking" or "treatment-as-usual" training condition, the researchers compared support for non-ESTs before, after, and 6 weeks following completion of online training. Results demonstrated greater benefits of optimised debunking immediately after training; thus, the implemented strategies can serve as a general and flexible debunking template, according to the researchers. However, the effect was not sustained at follow-up, highlighting the need for further research into strategies for sustained change. This may be particularly important in the field of autism, where endorsement of fad treatments by media, celebrities, and even professionals is common, and the myths may be frequently encountered.

The study also explored the potential association between attitudes and post-debunking support changes. The relationships were all non-significant, but there was a tendency for openness toward new interventions to be negatively linked to reductions in non-EST support. "Speculatively, openness may make a practitioner more vulnerable to the promotion of non-ESTs through misinformation, and thus effectively more resistant to science-based corrections. This notion requires further investigation and highlights the need to promote healthy skepticism."