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SUMMARY
OBJECTIVE: The aim of this study was to evaluate the search for health information on the Internet and to determine the frequency
and main means of spreading fake health news.
METHODS: A descriptive cross-sectional study was conducted through the virtual distribution of questionnaires on social media platforms
in 2019 by using the snowball technique. The questionnaire collected information regarding sociodemographics, means used to clarify
doubts about health, implementation of information obtained through the Internet, receipt of fake news, and means of transmission of
fake news. Quantitative variables are described as means and standard deviations, and categorical variables are described as frequencies
and percentages. The chi-square and Fisher’s exact tests were used.
RESULTS: Out of 1,195 respondents, 53% had followed Internet guidance without consulting a health professional, especially young
people and individuals with low education levels (p<0.05). The resources most used to answer questions about health were a physician
(78%) and Google (51%), and searches using the latter were more predominant among younger age groups (p<0.05). A large part of
the sample (89.4%) had received fake news, and the main means of receipt were Facebook and WhatsApp.
CONCLUSIONS: The Internet was the second most commonly used means to search for health information. A signicant portion of
the population adopts actions based on this information. The frequency of broadcasting fake news through this digital medium is high.
KEYWORDS: Internet. Social media. Online access to information. Misinformation.
Fake news: the impact of the
internet on population health
Emanuelle Thais Zanatta1, Giulia Puppi de Macedo Wanderley1, Isabel Kuchpil Branco1* ,
Daiane Pereira1, Letícia Hanae Kato1, Eliane Mara Cesário Pereira Maluf2
ORIGINAL ARTICLE
https://doi.org/10.1590/1806-9282.20201151
INTRODUCTION
The Internet has democratized access to health informa-
tion, increasing the autonomy of patients in their relation-
ship with healthcare professionals. Known by some as the
“Dr. Google” phenomenon, the online search for symp-
toms, diagnoses, and treatments by patients has caused
fear due to the various misinformation that accompanies
such searches1.
In this scenario, fake news is a cause for concern. Fake news
is dened as intentionally false information that is similar to
credible news but with the intent to manipulate the recipient
and draw attention to its content2,3 by misinforming and/or
obtaining advantages over certain populations3.
Fake news usually has a wide reach, especially when propa-
gated over the Internet. People usually give in to the emotional
or political appeals coming from negative news2. Negative news
arouses greater interest than does optimistic news, and therefore,
such news stories are shared quickly4. To induce greater credibility,
these stories usually involve health professionals or institutions5.
According to PSafe (2018), a cybersecurity company, in
its fth Digital Security Report, health was the second most
frequent target of fake news, accounting for 41.6% of all fake
1Universidade Positivo – Curitiba (PR), Brazil.
2Universidade Federal do Paraná, Curitiba (PR), Brazil.
*Corresponding author: isabelkbranco@gmail.com
Conicts of interest: the authors declare there are no conicts of interest. Funding: none.
Received on May 07, 2021. Accepted on May 09, 2021.
Zanatta, E. T. et al.
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news2. Currently, there is an epidemic of fake news in Brazil,
directly impacting public health, and this epidemic has moti-
vated actions to combat disinformation. e Brazilian Ministry
of Health has dedicated an exclusive page to this topic, Saúde
sem Fake News (saude.gov.br/fakenews), which encourages peo-
ple to send images or texts they have received via WhatsApp so
that the information can be checked. Subsequently, the news
is classied as true or false and posted on the page.
Given this scenario, the aim of this study was to evaluate
the search for health information on the Internet by the popu-
lation and to determine the frequency of receiving fake health
news and main means by which fake news is propagated.
METHODS
This was a descriptive cross-sectional observational study.
isstudy was approved by the Research Ethics Committee
of the Universidade Positivo in 2019 (Opinion 3,496,815).
e data collection was performed in 2019 through the
virtual distribution of questionnaires (Google Forms) on social
media platforms. Brazilians who were older than 18 years and
who agreed to participate in the study were included. eques-
tionnaire collected information about sociodemographics, means
to clarify doubts about health, implementation of informa-
tion obtained through the Internet, receipt of fake news, and
means of fake news transmission. Duplicate questionnaires were
excluded. To reduce the risk of incomplete electronic forms,
all elds were marked as “mandatory questions.” e partici-
pants were informed that the data would be kept condential.
To distribute the questionnaires, nonprobabilistic sampling
(snowball technique) was used, a methodology that consists of
the individuals selected by the researchers to propagate theques-
tionnaire to their acquaintances, gradually increasingthe sam-
ple size. To ensure sample diversity, the questionnaires were
sent to people of dierent ages and with dierent professions.
eseparticipants were invited to spread the questionnaire
among their groups with people of a similar prole, and so on,
forming reference chains for the data collection.
e quantitative variables are presented as means and stan-
dard deviations, and the categorical variables are presented as
frequencies and percentages. Statistical analyses were performed
using the Statistical Package for the Social Sciences version
20.0® (SPSS Inc., Chicago, IL, USA) using the chi-square test
and Fisher’s exact test. e signicance level was set at p<0.05.
RESULTS
A total of 1,195 questionnaires were answered, of which
815 (68.2%) were answered by women. e median age of
the respondents was 35 years (minimum 18 and maximum
83years). e young adult population was predominant, that
is, 706 (59.1%) individuals; 370 (30.9%) were between the ages
of 40 and 60 years, and 119 (10%) were older than 60years.
Regarding origin, 935 (78.2%) respondents were from Paraná,
and 260 (21.8%) were from other states.
Regarding education, 282 (23.6%) respondents had com-
plete or incomplete elementary or high school education, and
913 (76.4%) had complete or incomplete higher education.
Ofthe total, 235 (19.7%) respondents were students, 176
(14.7%) were health professionals, and 750 (62.8%) were pro-
fessionals from other areas.
e majority, 929 (77.7%), stated that they go to the
physician to clarify doubts about health, 609 (51%) stated
that they consult Google, 219 (18.3%) stated that they resort
to friends, 167 (14%) stated that they seek information in
Basic Health Units, and 104 (8.7%) stated that they look
for information on government websites. It was possible to
include more than one source of information in the responses.
eyounger the age group, the greater was the use of Google.
In turn, physicians were more sought after by older individ-
uals (p<0.05) (Figure 1).
To answer health questions, women sought the opin-
ion of physicians more than did men (79.8 versus 73.4%,
p=0.017), while men used Google more than women (56.8
versus 48.2%, p=0.006). People with higher education levels
sought the opinion of physicians more (p<0.001). ere was
no positive association between education level and seeking
health information on social networks and Google (p=0.734
and p=0.454, respectively).
*With the increase in age, there was an increasing trend in the use of
physicians (p<0.001).
**With the increase in age, there was a decreasing trend in the utilization
of these sources (p<0.001).
Figure 1. Distribution of health information search sources
by age group (n=1,195).
Fake news: the impact on health
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Of the total participants, 638 (53.4%) had followed health
guidance from social networks without consulting a professional
in the eld, and 190 (15.9%) had not followed any medical
guidance because of the social network content. Regarding
health-related behaviors, young people were more inuenced
by news found on the Internet (Figure 2).
Individuals with an education that did not exceed the high
school level followed information obtained on the Internet
without consulting a professional more often than did indi-
viduals with higher education (p=0.029).
e majority of the respondents, 888 (74.3%), claimed
to verify the sources of health news received. Health profes-
sionals claimed to verify these sources more than did other
professionals (83.1 versus 72.9%, p<0.001), and people
with higher education claimed to verify these sources more
than did those with a lower level of education (77.7 versus
63.5%, p<0.001).
Most of the respondents, 1,069 (89.4%), received some
fake news about health. e main routes of receipt are shown
in Figure 3. Facebook was the main source for younger respon-
dents (p=0.015), and WhatsApp was the main source for older
respondents (p=0.005).
Only 9 (0.7%) respondents had never heard about “fake
news,” while 1,081 (90.5%) were unaware of the Saúde sem
Fake News tool. Health professionals showed greater knowl-
edge of this resource than did other professionals (16.4 versus
8.1%, p=0.0017).
DISCUSSION
Physicians were the source most consulted among the respon-
dents to answer questions about health. Women reported con-
tacting a physician to answer their questions more frequently
than did men, a nding that is consistent with the Brazilian
reality, where health services are more commonly used by
women. is is due, among other factors, to the various socio-
cultural and institutional barriers that hinder men from seek-
ing health services6.
However, the Internet is an important vehicle for health
information and has been increasingly used. In this study, there
was a worrying trend among young people regarding a reduc-
tion in the use of physicians as sources of health information
and a signicant increase in Google searches. is could be
explained by the higher occurrence of chronic diseases in the
elderly population and consequently more frequent medical
follow-ups. In addition, this portion of the population has
greater diculty nding this information on the Internet7.
ebehavior of young people, in turn, is probably due to
greater contact with technology, leading to greater condence
in using online tools. is nding suggests that with the aging
of this population, the search for information on the Internet
will tend to increase and will become frequent even among
future elderly individuals.
e data show that the greater the use of the Internet, the
lower is the inclination to seek a physician and the higher are
self-medication levels7. is is consistent with what was found
in this study, as among those who reported having followed
Internet guidance without consulting a health professional, the
majority were young people.
People with a lower level of education also more frequently
followed guidance obtained on the Internet without consulting
health professionals. is can be explained by the lower access
to health services by this portion of the population8.
If reliable sources are used, the search for health informa-
tion on the Internet may have benets, such as a greater under-
standing by the patient about the treatment and prevention
*There was a decreasing trend in the rst and second behaviors as age
increased (p<0.001 and p=0.002, respectively).
Figure 2. Actions taken by the population regarding health
information obtained through the Internet by age group
(n=1,195).
Figure 3. Percentage distribution of the source of fake news
by social media platform (n=1,069).
Zanatta, E. T. et al.
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of diseases9. However, it can lead to increased self-diagno-
ses, leading to erroneous conclusions and impairment in the
physician–patient relationship10. It can also cause anxiety,
increased medicalization, instrumentalization, and overdi-
agnosis among patients10. Also concerning is the increase in
self-medication, its various side eects, and its interference
with prescribed treatments9.
e percentage of respondents who had received proven
fake health news was high (89.4%). In Brazil, the impact
offake news can be observed in the low adherence to vacci-
nation campaigns, as occurred from 2016 to 2018 with the
yellow fever and measles vaccines, which lead to new out-
breaks of these diseases5, and during the COVID-19 pan-
demic in 2020/21, when several ineective treatments were
disseminated3. In addition, fears caused by false information
can lead to reduced adherence to treatment and scientically
proven diagnostic methods11.
PSafe (2018) reported that the three main platforms for the
dissemination of fake news are WhatsApp, Internet browsers,
and Facebook. In agreement with these data, the most frequent
means of the dissemination of fake health news found in this
study were Facebook and WhatsApp; these platforms are easy
to access and facilitate the creation and sharing of content,
in addition to being the most currently accessed media plat-
forms2,11. e lack of monitoring of what is posted and lim-
ited media education among users also facilitates the dissem-
ination of fake news11.
Given that the Internet has become one of the main resources
for searching health information and that fake news is increas-
ingly present on the Internet, it is essential to develop strate-
gies for the safe use of these technologies. Coordinated actions
among health professionals, governments, fact-checkers, and
social media platforms are necessary12.
e Ministry of Health adopted an important action in the
ght against fake news by creating Saúde sem Fake News in 2018.
However, our study showed that only 9.5% of participants and
only 16.4% of health professionals knew about this channel.
Investment in media education and awareness campaigns
about fake news is extremely important. Another suggestion
is to reduce the priority of sites that are sources of fake news
by search engines, leading to less views of these publications13.
As fake news feeds on the distrust of people regarding medicine
and science, it is important to strengthen the physician–patient rela-
tionship. For this, professionals must use language accessible to the
population, be open to clarify doubts, and provide their patients with
reliable sources to search for health information on the Internet5,9.
One of the limitations of this study is that the sample was
not completely representative of the Brazilian population.
ere was a predominance of respondents with higher educa-
tion. Due to this, it is possible that this study underestimated
the inuence of the Internet on the health of the population
because people with less education were those who most fol-
lowed information from the Internet.
CONCLUSIONS
Young people mostly used the Internet to learn about health.
A large proportion of the population implements advice found
on the Internet without consulting a physician (53.4%), espe-
cially people with low education levels and young people, and
this behavior can have harmful consequences on health.
e percentage of people who had received fake health
news, mainly through Facebook and WhatsApp, was quite high
(89.4%). Faced with this increasingly worrying scenario, it is
necessary to invest in the dissemination and implementation
of services and measures to combat fake news.
AUTHORS’ CONTRIBUTIONS
ETZ, GPMW, IKB: Project conceptualization, Methodology, Data
curation, Formal analysis, Investigation, Writing – original draft,
Writing – review & editing. LHK, DP: Project conceptualization,
Methodology, Data curation. EMCPM: Project conceptualization,
Methodology, Project administration, Supervision, Validation.
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