The moderating effect of fake news on the relationship between behavioral patterns and vaccines

Abstract

Before the pandemic, one of the phenomena that attracted significant attention to scholars in different fields of knowledge was fake news. This phenomenon is considered misleading elements within news content or a social context. This definition also considers false information, mainly published and distributed through the internet. In this way, this phenomenon has been essential to understanding social adaptation processes to the new conditions in the context of the pandemic and post-pandemic. This adaptation process has required the vaccination of the world population, mainly to deal with the spread of the Covid-19 virus. So, this research analyzes the moderating effect of fake news on the relationship between behavioral factors (moral standards, environmental concern, and health consciousness) and the Intention to be vaccinated. Information was collected from 530 undergraduate students, and an experiment was used to test the relationship. Participants were invited to the system laboratory to analyze the factors that determine vaccination when consumers are influenced by fake news about vaccines, such as Sinovac. The results show that behavioral factors, such as moral norms and environmental concerns, and health consciousness positively influence vaccination intention. Regarding the moderating effects of fake news, moral norms and environmental concerns had a strong influence; vaccination intentions decreased when their influence was low. There was no sustainable difference between participants who read fake or true news for trustworthy news.

Keywords:

• Fake news
• planned behavior theory
• intention to get vaccinated
• lab experiments

Public interest statement

The implications of fake news in the social life of people today permeate all fields, from the political to the individual. In this way, Fake news has become one of the social phenomena that have generated the greatest interest in various scientific disciplines. In this condition, the present study demonstrates the influence of fake news on the relationship between social norms, environmental concern, and health consciousness on the intention to get vaccinated. Among the results, it was found that a solid value system, the need to constantly validate the exposure to information, and be more aware of the negative consequences. These results clarify dealing effectively with the effects of fake news in the change generated in people’s behavior.

1. Introduction

Fake news as a social phenomenon has attracted considerable attention because it is not a regional or a country problem; now, it is global (Apuke & Omar, 2021; Cheng & Chen, 2020; Melro & Pereira, 2019; Neuwirth, 2021). Groups of countries such as the European ones have created groups of professionals specializing in fake news that allow them to identify ways to combat it (Sádaba & Salaverría, 2023). Its current degree of importance is so substantial that it is perceived as a threat to governments around the world (Neuwirth, 2021).

In this way, the present research focuses on how behavioral factors (moral standards, environmental concern, and health consciousness) affect an intentional behavior such as vaccination. This context is characterized by an intense dynamic of fake news messages in a population that is highly exposed to this type of message (Tkhostov et al., 2022). According to the World Economic Forum (2021), the problem in the current conditions is misinformation, also known as an infodemic. This problem has worsened with the pandemic, but it has also been present in presidential elections in the United States and processes related to Brexit in the United Kingdom. In Latin America, the peace negotiation processes in Colombia are an example of this problem. A considerable amount of information has permeated these processes. This kind of information could confuse people about what is truly happening.

From a theoretical perspective, a field of great interest is emerging concerning how fake news influences behavior, specifically self-regulation theory and the theory of planned behavior. There are three gaps to which this study attempts to contribute: the roles of variables related to fake news, the types of measurements, and verification in different social contexts, such as health studies. Many scholars have suggested investigating the different variables that affect the Intention to perform a specific behavior in conditions of fake news (Gwyther & Holland, 2015; Liddelow et al., 2021). Similarly, it is necessary to explore the appropriate types of measurements to understand this phenomenon.

Scholars of the theory of planned behavior highlight the importance of research exploring measurements and different population segments (Liddelow et al., 2021). Another important aspect is identifying variables with moderating roles that can be considered predictors of behavior (Liddelow et al., 2021).

A large part of the sources used to disseminate this type of information are social networks (Melro & Pereira, 2019), which have become ideal means to generate this type of information (Silverman & Singer-Vine, 2016). Europe has not escaped this information dynamically. According to Globesec Policy Institute (2017), more than 10 million Europeans believe in fake news and in the pages that host this type of news. The youngest populations show a greater disposition to use this type of information.

The true impact of misinformation on population segments and especially on economic, cultural, and political dimensions remains unknown. Lazer et al. (2018) suggest that research on the impact of misinformation on the implementation of public policies is nonexistent even though misinformation can have substantial implications for people’s behavior, including cynicism and apathy towards specific issues of great importance as those related to vaccination.

Regarding the definition of fake news, a wide variety of definitions can be seen. For authors such as Rini (2017), fake news is defined as a report that describes events in the real world that, knowing its creators, is false and is broadcast by a large audience. On the other hand, authors such as Shu et al. (2017), defines it as low-quality news with the intention of disseminating false information. For the present investigation, consider the definition of Bakir and McStay (2018), who establish fake news as a set of misleading elements within a news content or a social context with ambiguous objectives. Additionally, fake news also considers all kinds of false information, mainly published and distributed mainly through the internet Zhang and Ghorbani (2020).

Despite the efforts made in different fields to understand the dynamics of fake news, evidence in health is still scarce (El-Far Cardo et al., 2021). Recently, we have begun to observe a series of works that contemplate the theoretical stakes and allow us to understand the phenomenon. Among them is the theory of planned behavior (Black et al., 2017). This theory is considered one of the traditional approaches to behavior and prediction (Ajzen, 1991). One of its most recent criticisms is the limited predictive power of the theory when considering intentions (Black et al., 2017). Therefore, its analysis is insufficient when considering additional factors that could interfere with the Intention or ability to execute an action (Caudwell et al., 2016; Sheeran, 2002).

However, a perspective is beginning to emerge that makes it possible to address this gap: temporal self-regulation theory. This theory proposes that the set of beliefs and norms about behavior results predicts the Intention to engage in the behavior. Similarly, it maintains that the immediate benefits and the expected consequences of behavior can affect Intention. The commitment to a particular behavior is predicted by one’s Intention, the degree of automaticity of the behavior, and the capacity for self-regulation. In this way, the theory of temporal self-regulation provides a possible way to understand the factors that determine Intention in behavior (Black et al., 2017).

This paper attempts to answer the following question: ¿what are the effects of fake news on the motivators of the Intention to get vaccinated during the pandemic? The paper contributes to understanding the dynamics of fake news and its impact on the perceptions of people who intend to receive a COVID-19 vaccine.

This paper is structured as follows. The first part discusses the theoretical perspectives that explain the influence of fake news in the context of COVID-19 vaccination. The second part shows the methodological approach through experiments. The third part summarizes the results and concludes the study.

2. Theoretical framework

2.1. Theory of planned behavior

Some theories allow identifying the factors that affect the behavior of individuals. Such perspectives range from the theory of reasoned action (TRA; Fishbein & Ajzen, 1977) to the theory of planned behavior (TPB) (Ajzen, 1991; Ghazizadeh et al., 2012), which have served to carry out studies in different fields of knowledge since the technology to health. Despite this variety of perspectives, the theory of planned behavior allows us to identify behavioral tendencies that influence a defined behavior. In this way, the theory of planned behavior (TPB) is considered an essential psychological model that explains people’s behaviors. This model assumes that three factors influence behavior and establish specific trends: attitudes, subjective norms, and perceived behavioral control (Ajzen, 1991).

The TPB is perhaps one of the most frequently tested approaches, especially in consumption. Recently, several scholars have tested new constructs that allow the theory to achieve more robustness in behavioral predictions (Yazdanpanah & Hasheminezhad, 2016). For example, some scholars have added three new factors to the theory: moral norms, environmental concern, and health consciousness.

Moral norms contribute to a clearer understanding of individual intentions governed by moral rules, which allow self-regulation through reward and punishment (Arvola et al., 2008). These moral rules make individuals seek their benefit and that of their peers. For this reason, their behavior will be related to a result that is beneficial both individually and collectively (Arvola et al., 2008). In the context of the pandemic, the search for collective and individual benefits pushes people to develop a sense of obligation to follow the rules to allow for a healthy coexistence; thus, they receive COVID-19 vaccinations.

Environmental concern is a behavior characterized by an interest in nature conservation and is related to the management of environmental awareness (Sobhani et al., 2018). This factor influences behavioral changes to obtain environmentally friendly products (Yadav & Pathak, 2016). Recent studies have shown a direct relationship between environmental concerns and the COVID-19 pandemic. According to Lucarelli et al. (2020), environmental problems and processes of individual prioritization establish a new structure of urgency in people’s lives. This phenomenon is evident when an individual’s environmental concern is affected by the appearance of an emergency that significantly impacts people.

The COVID-19 pandemic has generated a situation in which environmental protection behaviors are affected by a health emergency. This phenomenon can occur in two ways. First, the appearance of a health emergency can overshadow the concern for the environment. Second, the emergency can reinforce the idea that if the environment is not protected, worse pandemics could appear (Maiella et al., 2020). Some studies have shown that concern for the environment is related to infectious diseases (Patz et al., 2004). This paper explores the relationship between environmental concern and vaccination intention in the current pandemic context.

3. Self-regulation theory

Self-regulation theory is an emerging perspective that facilitates the study of variables that affect intention behavior. This theory proposes that the set of beliefs and norms about behavior results predict the Intention to engage in the behavior. Similarly, it establishes that the immediate benefits and the expected consequences of the behavior can directly affect Intention. The commitment to behavior is predicted by Intention, the degree of automaticity of the behavior, and the capacity for self-regulation. The theory of self-regulation provides a possible way to understand the factors that determine Intention in behavior (Black et al., 2017; Chen et al., 2021).

Scholars have suggested the need to conduct empirical studies that verify the relationships between variables through experimental designs with random conditions (Bayless et al., 2021; Gwyther & Holland, 2015) with the understanding that causes can be identified among the variables under study.

One of the main criticisms of the TPB is that it is a weak predictor of current behavior (Gwyther & Holland, 2015; Ajzen, 2011). The need to conduct additional explorations is suggested to allow a more detailed study of how behaviors are influenced (Jones & Schüz, 2021). Therefore, the self-regulation theory emerges as an extension of the TPB (Lee et al., 2021).

Self-regulation theory incorporates two aspects. One of them is Intention as a rational choice, and the other is a habit as an automatic choice that allows the establishment of behavioral predictions (Black et al., 2017). This perspective proposes that a moderating behavior influences the variables that impact a specific behavior (Hall & Fong, 2007; Inzlicht et al., 2021). For scholars such as Evans et al. (2017), this theory has been accepted, especially in studies related to healthy behavior. This last condition is because it allows for identifying potential relationships between important variables.

This component of self-regulation is aligned with the ability to regulate and control empowerment, thoughts, and behaviors (Baumeister & Vohs, 2007; Dauman & Dauman, 2021), which have been shown to have a meaningful impact on the adoption of healthy behavior (Allom et al., 2018). It is important to note that self-regulation and self-control are directly related to developing the ability to regulate emotions, behaviors consciously, and impulses (Black et al., 2017; Moon et al., 2021).

Health consciousness is defined as the degree to which an individual is attentive to his or her health during daily activities. This attention includes consumers’ preferences for healthy products (Sobhani et al., 2018). Some studies have shown that individuals who take better health care develop specific attitudes towards wholesome consumption and activities that improve their wellbeing (Imani et al., 2021).

Given the above, the following hypotheses are proposed:

H1: Moral norms have a direct and positive influence on vaccination intention.

H2: Environmental concern has a direct and positive influence on vaccination intention.

H3: Health consciousness has a direct and positive influence on vaccination intention.

4. Fake news as a field of knowledge

Misinformation, disinformation, or malinformation? One of the terms that have attracted the most attention among scholars is “fake news.” In much of the literature, the concept is used to describe phenomena involving different types of information, including humor, parody, satire, manipulation, and advertising (Evans-Paulson et al., 2021).

Most studies have focused on topics such as political elections (Evans-Paulson et al., 2021; Lee, 2021), social networks (Arquam et al., 2021; Ceron et al., 2021; Kapsikar et al., 2020; Meel & Vishwakarma, 2021; Silva et al., 2021; Verma et al., 2021), psychology (Kumari et al., 2021; Mashuri et al., 2021; Osmundsen et al., 2020; Samal, 2021), and health (Cohen et al., 2021; El-Far Cardo et al., 2021).

Shao et al. (2017) define fake news as false content, including reports, conspiracy theories, and rumors. Silverman (2017) suggests that fake news refers to false information aimed at specific purposes, such as profit generation and political intentions. The conceptualization of fake news is important to clarify the concept and understand how it impacts people.

According to Lazer et al. (2018), fake news is specifically related to three elements: fabrication, the Intention of the creator to confuse people, and the use of new communication formats. The direct implications of this type of misinformation are linked to the Intention to confuse people. Van der Linden et al. (2021) notes that there is a research agenda that uses psychological theories to investigate the effects of fake news on people’s perceptions and motivations at an individual level. This agenda allows for the understanding of the complexities of this emerging field and ways to measure them.

Many scholars (e.g., Lewandowsky et al., 2017) highlight the consequences of fake news on society, democratic processes, and even science. This effect is even more problematic during the current pandemic. Despite awareness of the importance of fake news, scholars have called for consideration of different psychological perspectives to understand the unexplored aspects of the spread of misinformation (Lewandowsky et al., 2020). At the same time, there is a need to investigate the effect of fake news on specific population segments that are more susceptible than others.

The segments of the population that are more susceptible to fake news tend to develop specific consumption patterns. One of the most important ways of understanding the consumption patterns of younger generations is to identify the different kinds of information they use. This information contributes to the type of reality they face Melro & Pereira, 2019). It is thus essential to analyze the role that information plays in their perception of reality. At the same time, it is necessary to analyze the influence of social media, which allows us to understand how the new practices that shape the lives of younger generations are institutionalized (Peters & Broersma, 2013). Currently, most people are constantly exposed to information through electronic devices such as smartphones, tablets, and PCs; they also regularly use many different social networks (Gonçalves, 2015; Melro & Pereira, 2019).

Some studies have shown a clear relationship between existing norms and people’s behavior (e.g., Boté-Vericad et al., 2020). Therefore, when people are exposed to fake news, they tend to make decisions based on false information. These actions generate negative consequences for the wellbeing of a population. One example is the electoral process, when voters base their judgments on information they have not validated. In this case, it is necessary to have efficient mechanisms that allow them to identify fraudulent claims to safeguard such a necessary societal process (Bullock et al., 2019). Strong moral norms influence the validation of available information, which affects decisions related to a specific behavior (Boté-Vericad et al., 2020; Manzanero & Ramírez, 2018). Based on this, the following hypothesis is proposed:

H4: Fake news has a negative moderating effect on the relationship between moral norms and vaccination intention.

Regarding environmental concerns, scholars such as Lutzke et al. (2019) argue that the false information individuals receive influences their beliefs and cognitive processes at a deep level. People tend to feel protected from the evidence that may conflict with their perception of reality. Fake news influences people whose beliefs are aligned with the type of information they receive and may make people less motivated to engage in critical reflection (Nir, 2011). Fake news has a more significant effect on the relationship between environmental concern and vaccination intention among individuals who exhibit low levels of critical thinking. This condition makes people more susceptible to this type of information (Lutzke et al., 2019). The following hypothesis is thus proposed:

H5: Fake news has a positive moderating effect on the relationship between environmental concern and vaccination intention.

One of the negative aspects of the pandemic is related to fake news about possible damage to people’s health from vaccination. Information disseminated through the internet has highly influenced this phenomenon, especially on social networks. It is thus necessary to take action to improve the quality of information concerning the pandemic (Viola et al., 2021). It is also essential to understand the role that information plays during crises. Information management requires a balanced approach to avoid causing panic (Cowper, 2020). Another vital aspect to consider is health education (Nutbeam, 2000). Education plays a fundamental role in the perception of the situation and the habits that promote improvements in life expectancy (Ross & Wu, 1995). Fake news directly influences the relationship between health consciousness and vaccination intention despite the efforts of different government bodies to promote transparency and access to information (Gao et al., 2020). (See Figure 1)

H6: Fake news has a positive moderating effect on the relationship between health consciousness and vaccination intention.

Figure 1. Theoretical model.

Note: Analysis to describe the hypotheses and their relations

5. Methodology

To analyze the connection of the theoretical model, a structural equation model is created. It is a modelling approach for structural equations that generates various models using data from different participants that have been exposed to different stimuli (fake news or factual news). This design consists of a mixed-factorial experimental design that includes two levels of news (images about news: trustworthy and untrustworthy news) and two designs (for a broader range of stimuli). In the control condition, participants were told they would be shown an image and news on autonomous vehicles before being asked questions about what they had seen.

5.1. Experiment

A total of 530 undergraduates were interviewed in Colombia. All the participants were informed that they had the option to exit the trial and signed an informed consent form. The participants were predominantly female and ranged in age from 18 to 55 (M = 36.54, STD = 0.92) (59.1%). Most people lived in Bogota (35%), followed by Medellin (26%), Cali (24%), and Barranquilla (14%).

The participants were provided background information and told that they would see photographs of Sinovac vaccine news. They were told they might begin answering the survey about the images once they completed this stage.

During the pretest phase, 30 participants were divided into two groups and shown images. The first group was shown trustworthy information, while the second group was shown fake news about this vaccine. In this stage, the participants completed our survey in 35 minutes. Five questions were altered to clarify ideas, and three questions were omitted since they were similar to others. We ensured that all of the computers’ speeds and conditions were comparable.

The participants were shown one stimulus (trustworthy news, false news, or control news about the Sinovac vaccine) during the treatment stage, and we informed them that they would be tested on the content. This instruction was designed to encourage the participants to concentrate on the factual material before completing the survey.

The final step was the posttest, which was created using identical settings as the first. The participants were shown the same photos but were unaware of the repeats. They were given the same test, and their answers were confirmed.

6. Measures

In this study, we used a questionnaire to collect the data with personal interviews. Through Polling firm. The questionnaire had 2 parts: Socioeconomic questions: Ages, Education, Gender, Socioeconomic level, and city. In the second part, we asked about our scales (moral norms, environmental concern, health consciousness, and Intention to get vaccinated). All scales were measured with likert options: 1 completely disagreeable and 7 Completely agree.

• Moral norms scale was measured with four items to identify how norms are evaluated and internalized in Society with three items: It is ethically responsible …; it is my moral responsibility … to other people and/or my health that I get any vaccination).

• Healthy consciousness was measured with three factors to consider when evaluating health-related decisions: Most essential individuals in my life believe that I should be vaccinated; most key people in my life would approve of my being vaccinated; and most important people in my life have been vaccinated.

• Environment concerns was measured with four items: I have many opportunities to vaccinate; vaccinating is simple; the local government gives adequate possibilities for vaccinating; and I am aware that vaccinating is environmentally responsible.

• The intention scale was assessed using four questions that tested the participants’ behavior options for becoming vaccinated. Finally, fake news was measured as dichotomous: (1) participants who had been exposed to false news completed the survey, and (0) participants who had been exposed to trustworthy news completed the survey.

7. Model

The measurement models are validated using confirmatory composite analysis. Furthermore, Stata SEM, a method that has already found broad implementation, supports the measurement models’ acceptability. This paradigm is useful when measuring variables using scales and when creating latent constructs to assess topics with a high level of complexity, such as social concerns.

To eliminate mistakes, the invariance of its measurements must be determined and used to investigate the comparative impact and establish if it is moderating or not. As a consequence, multigroup analysis can help groups decide if predefined data exists. Ping (1996) confirmed that if there’s a moderation variable in SEM (Structural Equation Modelling), the combination of items from the independent variable and items from the moderation variable is required. The new variable is calculated in this example by combining the elements of Fake news and intention to be vaccinated. In summary, the model of moderating effects under SEM technique is modelled as follows:

$\begin{array}{c}\mathrm{V}\mathrm{a}\mathrm{r}\left(\mathrm{x}1\mathrm{x}1\right)=\mathrm{V}\mathrm{a}\mathrm{r}\left[\left(\lambda x1\mathrm{X}+\in \mathrm{x}1\right)\left(\lambda x1\mathrm{X}+\in \mathrm{x}1\right)\right]\mathrm{V}\mathrm{a}\mathrm{r}\mathrm{x}1\mathrm{x}1=\mathrm{V}\mathrm{a}\mathrm{r}\lambda \mathrm{x}1\mathrm{X}+\in \mathrm{x}1\lambda \mathrm{x}1\mathrm{X}+\in \mathrm{x}1\\ =\lambda 2\mathrm{x}1\lambda \mathrm{x}1\mathrm{V}\mathrm{a}\mathrm{r}\left(\mathrm{X}2\right)+4\lambda 2\mathrm{x}1\mathrm{V}\mathrm{a}\mathrm{r}\left(\mathrm{X}\right)\mathrm{V}\mathrm{a}\mathrm{r}\left(\in \mathrm{x}1\right)=\lambda \mathrm{x}12\lambda \mathrm{x}12\mathrm{V}\mathrm{a}\mathrm{r}\mathrm{X}2+4\lambda \mathrm{x}12\mathrm{V}\mathrm{a}\mathrm{r}\mathrm{X}\mathrm{V}\mathrm{a}\mathrm{r}\in \mathrm{x}1\\ +\mathrm{V}\mathrm{a}\mathrm{r}\left(\in \mathrm{x}1\right)+Var\in x1+2\mathrm{V}\mathrm{a}\mathrm{r}2\left(\in \mathrm{x}1\right).+2Var2\in x1.\hspace{0.17em}\end{array}$

8. Results

The initial step was comparing discrepancies between the pretest and post-test scores. In terms of the link between the dependent variable and our independent variables, they were highly correlated. The descriptive statistics are included in Tables 1–3.The link between the dependent and independent variables also showed that they were highly connected (See, Table 1). Vaccination intention had a significant association with moral norms (Cronbach’s alpha: 0.79), environmental concern (Cronbach’s alpha: 0.76), and health consciousness (Cronbach’s alpha: 0.89). Subsequently, CFA (confirmatory factorial analysis) suggested that the scales had a good fit, with scale composite reliability (SCR) indices greater than 0.7 and average variance extracted (AVE) greater than 0.55. We also evaluated the equal factor loading, which confirmed that the instrument’s method of measuring groups had not changed. As a result, measurement invariance testing was used in this study because the chi-square did not vary considerably.

Table 1. Correlations

	Moral Norm	Environmental Concern	Health Consciousness	Intention to get Vaccinated
Moral Norm	1.0000
Environmental C.	0.3669	1.0000
Health Consciousness	0.1727	0.0027	1.0000
Intention to get Vaccinated	0.5980	0.3127	0.1840	1.0000

Table 2. Standard deviation and mean data

	Mean	SD
Moral Norm	5.19	2.43
Environmental C.	4.82	1.48
Health Consciousness	4.87	1.49
Intention to get Vaccinated	4.6	0.98

Table 3. Structural equation model

Relationships	Total		Trustworthy news		Fake news
	Coefficient	T-test	Coefficient	T-test	Coefficient	T-test
Moral Norms	0,23	1,98**	0,252	1,18	0,445	4.54***
Environmental Concern	0,242	2,12***	0,271	1,30	0,331	3.21***
Health Consciousness	0,256	2,19***	0,289	1,39	0,356	3.65***
X^2 = 10,925.87, GFI = .0941, RMSEA = 0,038

Comparison between relationships between trustworthy and fake news

When compared to the total group, the results showed that the multigroup model (trustworthy, false, and total group) reported more significant adjusted results (x² = 10,925.87, GFI = .0941, RMSEA = 0,038). Table 1 shows the multigroup model’s findings for each relationship raised in the theoretical model, divided into three groups. H1 (Hypothesis 1) Hypothesis 1, which asserted that moral norms have a direct and positive influence on vaccination intention, was confirmed (β1 = 0.23, p < 0.05).

In the case of H2 (Hypothesis 2), the desire to get vaccinated was expressed directly and positively in response to environmental concerns (β2 = 0.242, p < 0.01). Concerning H3 (Hypothesis 3) Hypothesis 3, health consciousness was found to have a direct and positive impact on the desire to be vaccinated (β3 = 0.256; p < 0.01)

The critical contribution of this study is the comparison of people’s reactions and changes in Intention to be vaccinated after being exposed to fake news in a laboratory setting. This study used graph analysis to examine how fake information affects people’s behavior depending on whether they have low or high moral norms, environmental consciousness, and health consciousness. According to Dawson and Richter (2006), representation is required because the multigroup model’s results do not provide for the representation of high or low levels in the independent variables.

Moral norms have two levels in Figure 1, low and high. The moral norm is an independent variable that explains the Intention to be vaccinated when participants are subjected to a fake or trustworthy news experiment. Figure 1 depicts the influence of fake news about the Sinovac vaccine on the link between moral norms and vaccination intentions. When participants read false information about Sinovac and their moral norms were high, the positive effect between moral norms and the Intention to get vaccinated increased; however, if their moral norms were low, the positive effect between moral norms and the Intention to get vaccinated decreased (t-test: 3,54, p < 0,01). The participants’ Intentions to get vaccinated did not change sustainably when they read trustworthy news regardless of whether they had a high or low level of moral values (t-test: 1,2, p > 0,1). In conclusion, Fake news has not a negative moderating effect on the relationship between moral norms and vaccination intention, thus, H4 (Hypothesis 4) was not confirmed.

The Intention to get vaccinated did not change significantly after reading trustworthy news regardless of the level of environmental concern, as shown in Figure 2. If the participants read fake news about Sinovac, however, their level of environmental concern became relevant and influenced their decision to be vaccinated. Therefore, if participants read a fake news article, a high level of environmental concern was relevant to their Intention to be vaccinated (t = 2,05, p < 0,01). However, if participants had a low level of environmental concern and had not read fake news, their desire to get vaccinated did not change (t = 1,65, p > 0,1), thus H5 (Hypothesis 5) which affirmed that Fake news has a positive moderating effect on the relationship between environmental concern and vaccination intention is rejected (See Figure 3)

Figure 2. Intention to get vaccinated.

Intention to get vaccinated increased based on fake news decisions

Figure 3. EC level related to intention to get vaccinated.

Note: Increase in EC level by a lack of environmental health concerns is relevant to the vaccination decision

Finally, the effect of trustworthy news about Sinovac on the Intention to get vaccinated was not significant, as shown in Figure 4. When there is fake news, and the participant has a high level of health consciousness, the Intention to get vaccinated increases significantly compared to when the participant has a low level of health consciousness (t = 3,76, p > 0,1), thus Fake news has a positive moderating effect on the relationship between health consciousness and vaccination intention H6 (Hypothesis 6) was confirmed.

Figure 4. Intention to get vaccinated compared with health consciousness.

Increase in lack of health consciousness with fake news

9. Conclusions

This research aimed to analyze the moderating effects of fake news on the relationships between behavioral factors, such as moral norms, environmental concern, health consciousness, and vaccination intention. We conducted experiments that allowed us to deeply investigate individuals’ different reactions when they are exposed to fake news. Similarly, we analyzed how much this phenomenon affected their Intention to be vaccinated against COVID-19.

The theory of planned behavior was used to interpret the relationships between the variables. This theory is considered a sufficiently robust model to understand individuals’ tendencies regarding a given behavior. This study considered three variables that recent studies have added to the theory and tested.

Moral norms are understood as the set of rules that condition the behavior of individuals in a value system. Therefore, to the extent that moral norms are highly valued, they generate the Intention to be vaccinated. This is because the priority is the fulfillment of the norms that benefit society.

Our findings support the theoretical methods of Sobhani et al. (2018), which claim that environmental concern is linked to an interest in environmental conservation and is directly tied to the management of environmental awareness. To the extent that a person has greater concerns about environmental conditions such as climate change or pollution, the individual tends to develop a social desire to help others.

Finally, health consciousness affects behavior similarly to the variables previously presented (Yadav & Pathak, 2016). These variables show that positive behaviors are more relevant in preventing the negative consequences that produce fake news about the Intention to get vaccinated against COVID-19. However, according to the TPB, true news generates concerns and a greater intention to get vaccinated (Lazer et al., 2018).

Furthermore, we included fake news as a moderator variable in our results to assess its effect on the intention to be evacuated. The first relationship to evaluate was in terms of moral standards and if the presence of fake news changes citizens’ attitudes on vaccination.

When fake news discourages vaccination, the information must be validated under an individual’s value system (Moral Norms). Individuals will confirm their Intention to get vaccinated because they seek the common good. However, if the value system is undervalued, fake news can achieve the objective of discouraging vaccination. The results show that the influence of true news on vaccination intention was not significant. When a result, Moral norms bear more weight in the face of the existence of fake news, causing the intention to vaccinate to remain unchanged as false information is presented.

In the case of environmental concerns and consumers who have access to fake news, the Intention to get vaccinated does not change substantially. When individuals receive fake news about Sinovac and have a developed level of this awareness, these people tend to validate their position and be critical of the information they receive. Their Intention to get vaccinated is not affected, and it may even increase. Therefore, it is possible to confirm that the theory of planned behavior provides elements that explain the behavior of consumers in the presence of environmental concerns.

Finally, the relationship among Fake news, healthy consciousness and intention to get vaccination, we concluded that when people are more aware of their health, they tend to be more influenced by fake news because they deal with issues of significant importance to people. Despite being possibly false news, they prefer to avoid a situation in which their health can be involved.

In general, we recommended that environmental and health awareness should be developed or encouraged to help individuals reduce and filter negative news and stop its dissemination based on minimal checks of information sources and belief in any information presented on social media. In addition, public policymakers should generate greater awareness about the effects of fake news through information campaigns that identify pages that often present false news or that inform users about how to detect this type of news.

Despite relevant contributions to social media and communications, this study has limitations. The first limitation is related to the Colombian population and their Intention to get vaccinated. This Intention may be influenced by cultural aspects that were not included in this paper. In this sense, it is important to replicate the analysis in different populations with different cultural dynamics.

Another limitation is related to the experiment range of time, which was conducted for a single year and in a single country to find evidence of the application and relevance of the theory of planned behavior. It is recommended that future lines of research conduct a comparative study with more countries to analyze the effect of fake news on moral norms, health consciousness, and environmental concern. Additionally, time-series studies can be conducted to determine whether this type of news is predominant in the long term or is temporary.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors received no direct funding for this research.

Notes on contributors

Jairo Salas-Paramo

Jairo Salas-Paramo Ph.D., is an Assistant Professor in Business Organization in the Business Department of Pontifical Javeriana University, Colombia. He is an author and co-author of different books and papers. His research interests are Management, Consumer Behavior, Entrepreneurship, and the Internationalization of SMEs. Dr. Jairo Salas-Paramo also serves as an ad-hoc reviewer for different academic journals and has recently published in Sustainability, Tourism Recreation Research and Technology, and Society journals. His research interests are international entrepreneurship, tourism, and consumer behavior.

Diana Escandon-Barbosa

Diana Escandon-Barbosa Ph.D., is an Associate Professor in Business Organization in the Business Department of Pontificia Universidad Javeriana Cali, Colombia, and Researcher Senior (MinCiencias Colombia). She is an author and co-author of different books, chapter books, and papers in national and international academic journals such as Sustainability, Tourism Recreation Research, Frontiers of Psychology, Young consumer, Competitive Review, European Management Journal, and Journal Urban Management, among others. Her research interests are Born Global, the internationalization of SMEs, and international entrepreneurship. Dra Escandon developed her Postdoctoral at Universitat Autonoma de Barcelona.