DISCUSSION
This study reveals a range of important findings about the evaluation of the effects of fear of COVID-19 on the reliability perceptions and the use of health information sources in university students studying at a state university in Turkey. In this study, which included 323 university students, the mean of the participants’ fear of COVID-19 was 2.30±0.93 which was generally lower than other studies28-31conducted in Turkey. As the participants in the current study were all university students and that these students were younger and had higher self-confidence compared to the participants in other studies, and because the chaos and uncertainty of information gradually disappeared during the research period, these factors may have been effective in this result.
In this study, the most used health information source by the participants was the Internet. The rate of individuals using the Internet in Turkey in 2022 was 85%; for university graduates, this rate was 99%.32 Of Americans 72% and 83% of Europeans use the internet as a source for health information.14As in the present study, many studies12,16,22,33 found that social media and online information sources, and therefore the Internet, were the most-used information sources in the pandemic. The Internet may be used for various reasons, whereas TV and radio programs only provide information at certain times of the day, the internet allows us to get information instantly whenever we want. Commonly used devices such as smartphones and computers play the most important role in obtaining information on the Internet. The Internet is often preferred because it provides easy access to information.9 Although the Internet was the most-used health information source in the current study, it was only sixth in terms of reliability perception. In addition, as their fear of COVID-19 levels increased, university students used the Internet less to access health information. According to Gallegati et al.6 the rate of those who used social media was 47%; however, the rate of those who relied on them was only 5.3%. Szmuda et al.7reported that content quality of YouTube videos about COVID-19 was low. In a study20 conducted in Turkey, those who used social media and online sources for information had a higher fear of COVID-19. According to Superio et al.34 those who used Facebook as health information source had higher levels of severe/extreme fear. Although relying on the news provides some means of control in chaotic times, continuous access can cause negative psychological, emotional, and physical distress among users. Sultana et al.24 found that fear of COVID-19 triggers avoidance of online information. Although the Internet is the most used health information source, it is not one of the most trusted sources and it can be said that the infodemic is especially effective in reducing its use with fear.
After the Internet, the participants mostly used doctors as their health information source. Additionally, doctors were the most trusted source of health information. As the fear of COVID-19 levels among the participants increased, they used doctors more as a source of information. Szmuda et al.7 determined that doctor talks were among the most watched videos on YouTube and according to the content quality analysis, all the highest rated videos belong to doctor speakers. Gallegati et al.6 found that the group that mostly includes doctors (family doctor/other physicians/pharmacists) was the most-trusted health information source. Chen et al.4 reported that physicians had a more positive image after the pandemic than previously. Because doctors provide evidence-based information and they have a high level of health knowledge and experience, these attributes may have been effective in making doctors one of the most trusted and one of the most-used sources of information.
Although nurses were the third most-used health information source after the internet and doctors, they were the second most-trusted health information source after doctors. In addition, with the increase in the level of fear increased the use of nurses the most (b =0.83;p <0.05). People mostly preferred to receive information about the symptoms, diagnosis, treatment, and measures against the spread of COVID-19 during the pandemic.9Alsharif35determined that approximately three-quarters of the nurses (71.90%) had sufficient and good knowledge about the causes, transmission, symptoms, treatment, and death rate of COVID-19. El-Monshed et al.36 found that the vast majority of nurses (81.6%) had an acceptable level of knowledge of COVID-19. In times of crisis, evidence-based information plays a key role in helping nurses deliver the best care.37 Since nurses, like doctors, provide evidence-based information and have knowledge and professional experience, their training may have been effective in making them one of the most-trusted and used sources of information.
Pharmacists had a moderate level of use and reliability perception; however, their perception of reliability was slightly higher. As the fear of COVID-19 levels of the participants increased, they used the pharmacist more as a source of information. In another study6 the group of health professionals, including pharmacists, was the most-trusted source of health information. Similar to this study, in the mentioned study, the rate of those who used the group of pharmacists as a source of information was lower (32.8%); however, the rate of those who trusted them was higher (61.8%). Among health professionals, pharmacists are highly educated people and have good knowledge of the ingredients and use of drugs. Pharmacists have improved health communication and can convey information to their customers while practicing their profession; these factors may have affected the formation and development of trust among people.
Scientific articles were the third-lowest health information source in terms of usage, but third-highest in terms of reliability perception. In other words, although university students do not widely use scientific articles as a health information source, they have relatively higher trust in this information source. In addition, as the fear of COVID-19 levels of the participants increased, they used scientific articles much more to acquire health information. Gallegati et al.6found that the group of scientific articles or medical, health and wellness websites was the second most-used and the first most-trusted source of information. Doganer and Zhang9 reported that among the most-watched YouTube videos, those with scientific content were watched more, and these had a higher reliability. Scientific articles have scientific content and are well known by university students, they may have been effective in achieving high reliability. Therefore, it can be said that scientific sources are perceived as more reliable.
Radio and newspapers/magazines were the least-used and least-trusted sources of information. However, their use also increased with increases in fear. According to Gallegati et al.6 TV/Radio was a moderately used (54.6%) but a less-trusted (29.0%) information source. Karahan et al.20 found in their study conducted in Turkey that the information sources least used by the participants were radio and newspapers. Alnohair et al.33 also reported that radio was the least-used source of information. According to Mamun22 the use of the newspaper as a source of information was relatively low and using newspapers as a source of COVID-19 information is associated with lower fears of COVID-19. Interestingly, in the current study, as the fear of COVID-19 levels of the participants increased, their confidence in only radio and newspapers/magazines as health information sources increased. Less use of these sources of information may have been effective in producing that result. Jain8 reported that high exposure to news led to lower levels of trust. Chao et al.38found that the use of new media rather than traditional media was associated with negative psychological outcomes. The fact that no newspaper was distributed during the peak of the COVID-19 pandemic, the decrease in interest in traditional media, the increase in internet usage and the shift of rating wars to the online environment may have had an impact on the current results.
The use of television and the perception of reliability were at a moderate level. In some studies20,28 conducted in Turkey, television was one of the sources of information most preferred during the pandemic. Because the participants were older in the afore-mentioned studies may have been effective in the preference of television. In the current study, the use of television for accessing health information increased as the fear of COVID-19 level increased. In a study20 conducted in Turkey, those who used television as a source of information reportedly had a higher fear of COVID-19.
When a general evaluation is made in terms of reliability perception and usage, generally the correlations between reliability perception and use of the same information sources were higher. As the trust of the participants in the related health information source increased, the use of that source also increased. The highest of these was between the reliability perception and the use of television. When an evaluation is made separately and within themselves in terms of reliability perception and use of health information sources, the correlations between health workforce information sources (doctor, nurse, pharmacist, other health professionals) were generally higher. In addition, the perception of reliability and the use of health workforce information sources were generally higher than other health information sources. Doganer and Zhang9 found that videos containing information provided by health professionals were watched more frequently than other videos. Superio et al.34 reported in their study conducted with university students in the Philippines that medical personnel were the most reliable source of health information among interpersonal channels. In the current study, the media itself may have been effective in using and trusting health workforce information resources more than traditional media. The media have used the pandemic as an opportunity to increase the positive image of physicians.4 While many people stayed at home due to restrictions, the media portrayed all healthcare professionals, especially doctors and nurses, who had to work in healthcare institutions, as heroes; that has increased the respect, trust, and interest in them.