What contributes to COVID-19 online disinformation among Black Canadians: a qualitative study
=============================================================================================

* Janet Kemei
* Dominic A. Alaazi
* Adedoyin Olanlesi-Aliu
* Modupe Tunde-Byass
* Ato Sekyi-Otu
* Habiba Mohamud
* Bukola Salami

## Abstract

**Background:** Black Canadians are disproportionately affected by the COVID-19 pandemic, and the literature suggests that online disinformation and misinformation contribute to higher rates of SARS-CoV-2 infection and vaccine hesitancy in Black communities in Canada. Through stakeholder interviews, we sought to describe the nature of COVID-19 online disinformation among Black Canadians and identify the factors contributing to this phenomenon.

**Methods:** We conducted purposive sampling followed by snowball sampling and completed in-depth qualitative interviews with Black stakeholders with insights into the nature and impact of COVID-19 online disinformation and misinformation in Black communities. We analyzed data using content analysis, drawing on analytical resources from intersectionality theory.

**Results:** The stakeholders (*n* = 30, 20 purposively sampled and 10 recruited by way of snowball sampling) reported sharing of COVID-19 online disinformation and misinformation in Black Canadian communities, involving social media interaction among family, friends and community members and information shared by prominent Black figures on social media platforms such as WhatsApp and Facebook. Our data analysis shows that poor communication, cultural and religious factors, distrust of health care systems and distrust of governments contributed to COVID-19 disinformation and misinformation in Black communities.

**Interpretation:** Our findings suggest racism and underlying systemic discrimination against Black Canadians immensely catalyzed the spread of disinformation and misinformation in Black communities across Canada, which exacerbated the health inequities Black people experienced. As such, using collaborative interventions to understand challenges within the community to relay information about COVID-19 and vaccines could address vaccine hesitancy.

Black Canadians are disproportionately affected by the COVID-19 pandemic.1 For example, as of September 2020, data tracking of COVID-19 cases in Toronto showed Black people accounted for 24% of positive cases despite constituting only 9.3% of the city’s total population.2 Black people and other racialized communities in Canada are also more likely to be admitted to hospital with COVID-19 than White and East Asian people.3 Further, evidence shows a universal vaccine hesitancy across countries and subgroups.4 Disinformation and misinformation about COVID-19 contributes to health disparities by posing a threat to the acceptance of the SARS-CoV-2 vaccine among Black Canadians.5–10

The susceptibility of Black Canadians to online COVID-19 disinformation, vaccine hesitancy, infections and hospital admissions may be attributed to several individual- and structural-level factors, including socioeconomic status, crowded living environments, cultural barriers, racial discrimination, poor access to health care and poor housing, that make it difficult for this population to adhere to public health directives.11 Similarly, anti-Black racism and structural inequities within Canadian institutions expose Black people to socioeconomic vulnerabilities, which increase the burden of COVID-19 morbidity and death to this population,12,13 thus increasing vaccine skepticism and hesitancy. On completing a scoping review of online disinformation among Black people,14 we wanted to deepen our knowledge and situate the findings from our scoping review within the Canadian context. Despite the negative health behaviours promoted by disinformation, there is a paucity of qualitative studies examining online COVID-19 disinformation in Black communities in Canada. We aimed to describe the nature of online COVID-19 disinformation and misinformation among Black Canadians and identify the factors contributing to this phenomenon.

## Methods

We conducted a descriptive qualitative study.15 We purposively invited Black community leaders, Black-led organization executives, Black policy-makers, and Black health care providers to participate as advisory committee members for our study. We recruited 7 advisory committee members including Black community leaders, Black medical doctors and executive leaders of Black organizations in Canada. The research team developed an interview guide (Appendix 1, available at [www.cmajopen.ca/content/11/3/E389/suppl/DC1](http://www.cmajopen.ca/content/11/3/E389/suppl/DC1)) with input from an advisory committee. One of the authors (J.K.), a female postdoctoral fellow and a Black researcher, developed a database of Black organizations in Canada, from which we purposively recruited participants who were Black community leaders, Black-led organization leaders and Black service providers. We also used snowballing to recruit additional participants as we had difficulty finding participants for our study.

### Study setting

With the pandemic restrictions and the diverse location of our participants, J.K. conducted all interviews by way of Zoom or telephone, as per the participant’s choice. The interviews were completed from Feb. 9 to Apr. 9, 2022, during the Omicron wave of the pandemic. Participants were given the option to interview in either English or French. Interviews lasted about 1 hour and were audio-recorded and transcribed verbatim.

### Data collection

We conducted in-depth individual interviews with Black stakeholders with insights into experiences of Black communities during the pandemic. During the interview, we asked participants to discuss what they know about online disinformation among Black people in Canada and the effect of online COVID-19-related disinformation for Black Canadians, and to provide us with their perspective on evidence-based practices to address online COVID-19-related disinformation among Black Canadians. We collected data on sex from all participants and did not restrict demographic questions on sex to binary conceptualizations (Appendix 2, available at [www.cmajopen.ca/content/11/3/E389/suppl/DC1](http://www.cmajopen.ca/content/11/3/E389/suppl/DC1)). We disaggregated demographic data by age, or sex, place of origin, location in Canada, religion, vaccination status and role within the Black community. We also recognize that Black communities are a heterogeneous group. Thus, we strived for representation from African immigrants, Caribbean immigrants, members of historic Black communities in Canada and Black people from the United States. One author (J.K.) wrote field notes after each interview.

### Data analysis

The data collection and analysis processes were iterative. We conducted an inductive content analysis,15 drawing on analytical resources from intersectionality theory.16 Intersectionality spotlights how the diverse elements of people’s unique social identities could overlap to influence their experiences.16 During the analysis, we considered issues related to age, sex, race, embedded inequalities and intersecting influences. Three authors (J.K., D.A.A. and A.O.A.) independently read 3 transcripts to familiarize themselves with the data and develop a coding framework. The advisory committee and the principal investigator (B.S.) reviewed the draft coding framework and provided input. Using NVivo 12 software, J.K. read all transcripts and applied the coding framework to complete the data coding and analysis. Preliminary results were shared with the advisory team members for their feedback to ensure the quality of data. Research team members observed reflexivity throughout the research process by maintaining subjective awareness of their multiple privileges, intentions and assumptions.

### Ethics approval

The University of Alberta Ethics Board approved our study (Pro00114392).

## Results

We reached data saturation after interviewing 30 participants (20 purposively sampled and 10 recruited by way of snowball sampling), which included 16 males and 14 females. Our participants were 15 Black stakeholders from Alberta, 10 from Ontario, 2 from Nova Scotia, and 1 each from British Columbia, Manitoba and Saskatchewan. All participants chose to be interviewed in English. Details on the sociodemographic characteristics of participants are provided in Table 1. In reporting our results, where fewer than 5 participant views are presented, we have used the term some, and where more than 5 participants are presented, we have used the term most. We have made it clear for single participants’ views (a representative example of a view from 1 participant).

View this table:
[Table 1:](http://www.cmajopen.ca/content/11/3/E389/T1)

Table 1: 
Sociodemographic characteristics of participants

### Main themes

We identified 2 main themes: the nature of online COVID-19 disinformation and the facilitators of COVID-19 disinformation. Participant quotes supporting analysis of data are shown in Table 2.

View this table:
[Table 2:](http://www.cmajopen.ca/content/11/3/E389/T2)

Table 2: 
Themes

### Nature of online COVID-19 disinformation and misinformation

According to participants, online COVID-19 disinformation and misinformation was widespread in Black communities and typically included misconceptions of COVID-19 as a fallacy and SARS-CoV-2 vaccines as ineffective drugs with microchips. Some participants (< 5 participants) indicated the belief that COVID-19 was a hoax at the beginning of the pandemic led to a slower acceptance of recommended public health interventions and delays in seeking health care (P024, female, 58 yr). Lack of knowledge on vaccine development led to misinformation about vaccine safety, given its fast development, as expressed by most participants (P008, male, 50 yr). Others believed a person could acquire COVID-19 by getting vaccinated and that the vaccines were not essential, given that vaccinated people were still susceptible to the SARS-CoV-2 infection (P024, female, 58 yr). Another participant explained that inconsistent information about vaccine dosages raised concerns about the efficacy of the vaccines within the community (P010, female, 40 yr).

Some participants suggested that Black community members believed the SARS-CoV-2 vaccine contained microchips that Bill Gates and other Western leaders could use to track people who were vaccinated (P025, male, 34 yr), thus compromising their privacy and increasing their vulnerability to racial profiling. Hence, the SARS-CoV-2 workplace vaccination requirements and proof of vaccination to enter public places such as restaurants, further increased this suspicion and skepticism among the Black population as explicated by most participants (P029, female, 57 yr). These misconceptions contributed to vaccine hesitancy in Black communities and increased the risks of infection.

A few mentioned that social media interactions among Black people were dominated by a lack of knowledge about the vaccines, which raised concerns about vaccine shedding, adverse effects on reproductive health, and infertility caused by the vaccines (P020, male, 40 yr). Other participants cited controversies surrounding previous mandatory vaccine programs in some African countries, linking vaccines with anti-fertility agents (P025, male, 34 yr). Moreover, some participants believed the vaccines were a scam to depopulate Black communities (P021, female, 40 yr).

### Facilitators of online COVID-19 disinformation and misinformation

#### Miscommunication

Participants identified a lack of credible information sources, distribution of unverified information and overwhelming conflicting information as facilitators of the spread of online COVID-19 disinformation and misinformation in Black communities. Most participants were concerned that credible information about COVID-19 was not readily available to Black communities, causing anxieties and panic within Black communities and pushing people to rely on social media, friends and family for information (P003, male, 32 yr). They indicated that credible information about the disease from governments and health authorities was not accessible to most Black community members. Most participants expressed that Black communities prefer face-to-face communication, but much of the credible information from these sources was distributed by way of electronic and print media, such as television and newspaper outlets (P009, male, 54 yr). This made credible information less accessible, especially to Black people who worked frontline jobs or multiple jobs and lacked time to access these sources (P017, male, 43 yr). Some participants asserted that Black people with limited digital literacy faced barriers to accessing credible information, causing them to depend on COVID-19 information relayed by others, which increased their risk of exposure to disinformation and misinformation (P025, male, 34 yr).

Black communities also faced many conflicting messages from multiple sources, including social media, governments, health authorities, health care practitioners, expert opinions and international organizations such as the World Health Organization. Some participants indicated that the conflicting messages from these sources degraded the credibility of information from public health agencies (P004, male, 44 yr). This made Black communities susceptible to online COVID-19 disinformation and misinformation, including inaccurate messages that downplayed the seriousness of the pandemic and the efficacy of SARS-CoV-2 vaccines.

Although most participants predominantly consisted of immigrants who use social media to maintain transnational ties with family or friends residing in their home countries, an overwhelming abundance of unverified COVID-19 information circulated within the networks of Black communities regardless of their country of origin. With the lockdowns, social media platforms such as Facebook and WhatsApp offered more accessible ways to interact and share information about the pandemic. Therefore, some participants explicated that social media became a source of information fatigue through which COVID-19 disinformation and misinformation spread (P020, male, 40 yr).

#### Cultural and religious factors

Most participants explained how Black Canadians are highly attached to their countries of origin. Thus, rumours originating in their land of birth spread quickly in the diaspora community because of those strong ties (P009, male, 54 yr). Such culture-based disinformation included beliefs suggesting religious faith and natural health remedies were more effective than vaccines in combatting the spread of the SARS-CoV-2 infection. One participant illuminated that because most Black people are religious, they were readily susceptible to this kind of disinformation and misinformation, and even more so if such rumours were spread by religious leaders (P009, male, 54 yr). Although all participants reported being vaccinated, they observed that some Black community members opposed SARS-CoV-2 vaccines. In particular, some Black people viewed these vaccines and their developers as anti-Christ agents; misrepresentation of the scriptures created fear and contributed to refusal and a delayed acceptance of SARS-CoV-2 vaccines in Black communities (P009, male, 54 yr).

Some participants eluded that consistent with traditional African worldviews, Black people were inclined to believe misinformation about herbal supplements being an effective preventive remedy or treatment for SARS-CoV-2 infection (P030, female, 53 yr). These participants explained that these beliefs mainly spread through social media (P001, female, 36 yr), bringing about a false sense of security that exposed more community members to the disease and discouraging their use of approved care supports (P008, male, 50 yr).

#### Distrust of health care systems

Some participants referenced the history of medical racism and continuous exploitation of Black people in the medical system as a factor that diminished trust in governments and health organizations. Participants referenced past injustices, such as the Tuskegee experiment (1932–1972), in which US Public Health allowed African-American men with syphilis to go untreated as a way of chronicling the progression of the disease (P001, female, 36 yr). Participants acknowledged the cumulative trauma to Black communities caused by racism in health systems that have continuously failed them (P001, female, 36 yr). These histories increased Black people’s skepticism about COVID-19 and its vaccines, rendering them vulnerable to alternative truths about the disease (P019, female, 44–54 yr [participant provided an age range]).

Systemic racism has consistently posed challenges to the health of Black people and exacerbated the health disparities they face. Participants highlighted how exposure to racism and discrimination has left the community feeling disregarded, reinforcing mistrust of health care organizations and diminishing efforts at increasing vaccine acceptance (P024, female, 58 yr). Participants suggested that many Black people would rather believe the information obtained from social media than messages communicated by health care professionals. This attitude served to undermine public health responses to the pandemic. Participants also indicated that inequitable distribution of the vaccines and testing kits reinforced the distrust Black people had with health care systems. Specifically, despite reporting a higher number of SARS-CoV-2 infections and deaths, Black communities were not prioritized when test kits were distributed; yet, they were being increasingly asked to get vaccinated (P018, male, 48 yr). Thus, addressing racism represented a more pressing need for Black communities besides adherence to public health interventions.

#### Distrust of governments

Participants described disinformation and misinformation within the Black community that occurred because of experiences of discrimination and differential treatment based on race and skin colour. Racism has perpetuated distrust of governments owing to the lack of commitment to addressing inequities faced by Black Canadians, especially in the areas of education, employment, housing, policing, child care and health care (P019, female, 44–54 yr). According to participants, Black people’s perceptions of government influenced how they responded to public health interventions addressing the pandemic (P014, male, 28 yr). For instance, 1 participant explained that more Black Canadians, compared with other ethnoracial groups, worked in front-line jobs and used public transportation, where a lack of opportunities for physical distancing increased their risk of SARS-CoV-2 infection (P003, male, 32 yr). Thus, the Black communities’ belief that governments are indifferent to their plight increased their skepticism of COVID-19 interventions, including vaccines. Some participants expressed that governments should address anti-Black racism within institutions and should work on building trust with Black communities (P003, male, 32 yr; P008, male, 50 yr).

## Interpretation

Social media, especially instant messaging platforms such as Facebook and WhatsApp, became a conduit through which COVID-19 disinformation and misinformation spread in Black communities. This form of information exchange also carried the dangers of disinformation and misinformation, affirming the risks of SARS-CoV-2 infections and poor health outcomes among Black Canadians. Most participants suggested racism and underlying systemic discrimination against Black Canadians promoted distrust of the government or health institutions and immensely catalyzed the spread of disinformation and misinformation in Black communities across Canada. Although our participants were all fully vaccinated, they noted that some members of their communities were vaccine-hesitant owing to distrust of vaccine manufacturers, health care systems and governments. They indicated that this hesitancy results from current and historical experiences of racist medical procedures. Most participants referred to the Tuskegee experiments when discussing health disparities and racism in health care in the Canadian context. It is apparent that the Black community in Canada strongly relates to the Tuskegee experiments and the health care system’s history with Black communities in Canada, thus affecting how they respond to the SARS-CoV-2 vaccine. Some participants indicated that communication by health care authorities and the government during the beginning of the pandemic was not culturally appropriate to some Black people owing to conflicting messages and language barriers (besides their own experiences, participants were asked to provide rich information about the impacts of COVID-19 in their communities), prompting an overreliance on their community members over social media. Further, firm beliefs in cultural practices such as religious faith and natural health remedies contributed to disinformation and misinformation within Black communities.

Our findings are similar to other published studies, indicating an upsurge in online disinformation and misinformation, exacerbated health inequities experienced by Black communities and undermined public health interventions to curb the spread and effect of COVID-19.11 Research funded by the Rita Allen Foundation found that anti-vaccine groups weaponized Black people’s historical encounters with health care systems to coerce Black communities into rejecting the SARS-CoV-2 vaccines.17 Our results indicated that some Black people were hesitant to receive vaccinations owing to their religious beliefs, although previously reported findings showed some religious leaders were noted for encouraging their congregations to get vaccinated.18 There is also evidence showing language barriers during the COVID-19 pandemic resulted in decreased adherence to public health directives and recommendations.19,20 Other studies have reported issues relating to biases and lack of culturally appropriate care for Black people in Canada and the United States.21,22

Our study shows the need to engage community-based health care clinics to promote SARS-CoV-2 vaccine uptake and eliminate language and cultural barriers to vaccine access. For instance, such a model in California indicated that community-engaged approaches rooted in principles of authentic partnership that include trust-building, power-sharing and co-learning are crucial for addressing public health crises, such as the COVID-19 pandemic.21 This approach identified barriers to vaccine uptake that were then addressed by providing culturally appropriate care.8 There is also a need to use an antiracist and anti-oppressive framework to guide health agencies in addressing inequalities within the health care system and understand how social and economic conditions, structural racism and systemic discrimination can engender quality-driven trust.23 Practices that stress continuity and communication result in a higher level of confidence in physicians, which is paramount in promoting the use of preventive services.24

Further, religion plays a notable role in the Black communities, rendering the religious institutions essential resources for health care interventions within the Black communities.25–27

### Limitations

Our inability to recruit participants from the Caribbean and some provinces (e.g., Quebec) with large Black populations is a limitation of our study. Further, overreliance on snowball sampling led to a largely homogenous sample in which most participants identified as Christian and cisgender. The participants were all vaccinated, a limitation since their accounts cannot fully represent those in the Black community who are vaccine-hesitant. We acknowledge that older adults are more at risk from COVID-19; however, the analysis of our results was dependent on the perspectives of the participants interviewed. We used purposive sampling and snowball techniques to recruit Black community leaders, Black-led organization leaders and Black service providers, resulting in a younger working age population. Future research should target older adults by recruiting through community-based organizations, senior adult living or long-term care homes.

### Conclusion

Underlying systemic racism and related inequities in Canada created mistrust for public health authorities and contributed to Black people’s preparedness for alternative truths about COVID-19. Therefore, there is a greater need to build trust and adopt collaborative approaches to addressing community concerns; for example, having genuine, respectful discussions of other topical issues affecting Black people, such as employment discrimination, medical racism and anti-racist workplace practices and policies. As such, we recommend supporting and steadily funding existing Black community organizations to develop culturally accessible health education material, including health information flyers and infographics. Funding community-based health centres may help disseminate and increase the uptake of health information and curb the spread of disinformation.

## Footnotes

*   **Competing interests:** None declared.

*   This article has been peer reviewed.

*   **Contributors:** Bukola Salami contributed to the conception and design of the work. Janet Kemei, Dominic Alaazi, Adedoyin Olanlesi-Aliu, Modupe Tunde-Byass and Bukola Salami contributed to the acquisition, analysis and interpretation of the data. Janet Kemei drafted the manuscript. All authors revised the manuscript critically for important intellectual content. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

*   **Funding:** Funding was received from the Digital Citizen Contribution Program, Government of Canada.

*   **Data sharing:** Research data are available on request to Bukola Salami.

*   **Supplemental information:** For reviewer comments and the original submission of this manuscript, please see [www.cmajopen.ca/content/11/3/E389/suppl/DC1](http://www.cmajopen.ca/content/11/3/E389/suppl/DC1).

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: [https://creativecommons.org/licenses/by-nc-nd/4.0/](https://creativecommons.org/licenses/by-nc-nd/4.0/)

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