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.