Act sooner rather than later

It is crucial to reach people before conspiratorial beliefs have a chance to take hold. While some worry that discussing conspiracy theories will only expose more people to them, unfortunately, the advent of social media has steeply increased the likelihood that people will eventually be exposed to conspiratorial ideas.10 Simply avoiding discussing them is unlikely to appreciably slow their spread. Furthermore, debunking conspiratorial beliefs after they take hold has been met with mixed results and can sometimes produce a backfire effect in which people actually strengthen their belief in the conspiracy theory.11 Instead, evidence suggests that acting quickly to reach people before or as they are exposed to conspiratorial ideas is more effective than waiting until they have already encountered them.

Prebunking, which involves delivering counter arguments to people before they are exposed to a conspiracy theory, can effectively combat conspiracy theories that are spreading but have not yet reached everyone. Studies have found that people who read anti-conspiracy arguments before encountering a vaccination conspiracy theory showed greater vaccination intentions than those who read the same material after exposure.12 This effect holds even when people know that the goal of presenting counterarguments is to prevent them from adopting the conspiracy theory.13 Other studies have found that exposing the manipulative persuasion tactics used to spread conspiracy theories14 can also reduce the adoption of conspiratorial beliefs if done before exposure. Healthcare leaders can employ these prebunking techniques by refuting the specific claims of new conspiracy theories and by exposing common tactics used to spread conspiracy theories, such as the use of emotional language or fake experts that sow doubt about the scientific consensus.

Another effective approach is encouraging people to be more critical consumers of conspiratorial ideas. This can be especially useful when it is done close in time to when people are first exposed to a conspiracy theory. When people are encouraged to think about how convincing a conspiracy theory is, they are less likely to believe in it when exposed immediately afterward.15 The increased cognitive engagement of thinking about how convinced one was by a conspiracy theory seems to unlock greater critical thinking and reduce subsequent conspiratorial beliefs.16 This type of intervention is effective even when people are primed to think critically about a topic unrelated to the conspiracy theory. For example, when participants were asked to judge the accuracy of an unrelated headline, they were less likely to share separate misinformation that they encountered afterward.17 This suggests that a healthcare leader may want to find ways to generally encourage more critical thinking in their followers. In addition, when confronted by conspiracy theory believers, it may be helpful to respond by asking people to think about how convincing the conspiracy theory really is. This is unlikely to change the mind of conspiracy theory believers, but it may persuade onlookers being exposed to the conspiracy theory for the first time, and it avoids getting into a potentially counterproductive point-by-point discussion with the conspiracy theory believer.

Bolster people’s sense of control

During periods of crisis, increased uncertainty and feelings of lack of control can make people particularly susceptible to conspiracy theories.10 18 This is especially true in situations such as the current COVID-19 infodemic. The infodemic is an overabundance of information—both accurate and inaccurate—which can overwhelm people and make it hard for them to know what information to trust. This can heighten people’s feelings of uncertainty or lack of control, increasing their susceptibility to conspiratorial beliefs. Fortunately, research has demonstrated that the relationship between one’s sense of control and conspiratorial beliefs is hydraulic, meaning that as one rises the other falls.19 When people’s feelings of control are bolstered, they reduce their conspiratorial beliefs. By virtue of their position as leaders, healthcare leaders can counter the pandemic-induced increase in susceptibility to conspiratorial beliefs by acting in ways that bolster people’s sense of control. People turn to leaders to help them make sense of their environments, especially during periods of change or uncertainty.20 Helping followers interpret information and craft coherent narratives are some of the primary ways that leaders help followers manage crises like the COVID-19 pandemic.21 In other words, simply helping people navigate the infodemic by acting as a trusted source of information and sense-making is one way that healthcare leaders can help combat conspiratorial beliefs.

Another effective tactic for healthcare leaders to combat the spread of conspiratorial beliefs within their organisations is to give their employees more control. Healthcare workers may feel a loss of control as a result of the repeated waves of COVID-19 infections, some of which have appeared unexpectedly and have at times overwhelmed healthcare systems. One way to combat this is to create a sense of structure and order by engaging in open communication and setting clear expectations.22 In rapidly evolving crises like the COVID-19 pandemic, it can be tempting for leaders to delay decision-making and avoid sharing information until more is known. However, this can exacerbate people’s feelings of uncertainty and lack of control. Leaders can help their followers effectively navigate crises—and bolster sense of control at the same time—by not waiting to make decisions and by communicating with followers frequently and transparently.23

A final method for increasing sense of control in both followers and the general public is to highlight the control that people already have. The most effective leaders use language that helps increase the self-efficacy of followers and spurs them towards action.24 One way that healthcare leaders can accomplish this is by focusing on the things people can do during the COVID-19 pandemic—such as getting vaccinated and wearing masks—and by providing information that will help people take action. In addition, by focusing on what people can do to achieve positive outcome, rather than preventing negative outcomes, leaders can further reduce followers’ tendencies to adopt conspiratorial beliefs.22 25 In this context of COVID-19, this might mean framing the goal as slowing the spread of COVID-19 rather than avoiding getting sick.

Create and highlight social norms

In situations where there are strong social norms, individual differences have less influence over people’s behaviour.29 30 In the context of conspiratorial beliefs, this means that strong social norms can mitigate the negative behaviours that would otherwise result from these beliefs. One study found that when people perceived no established norm regarding vaccinations, conspiracy mentality reduced vaccination intentions. However, when people believed there was a strong social norm supporting vaccinations, conspiracy mentality did not predict vaccination intentions.30 It is important to note that what matters is not the actual behavioural norm, but rather what people perceive to be the behavioural norm; indeed, people often do not accurately perceive the strength of a behavioural norm.31 32 If many members of a group have conspiratorial beliefs, which cause them to incorrectly believe that certain behaviour is very uncommon in their group (eg, vaccination among US Republicans), then correcting this view may reduce the effects of conspiratorial beliefs on that behaviour.33 This may be especially important when the behaviour occurs outside public view, such as with vaccinations. In the case of COVID-19, because many of the conspiratorial beliefs that US Republicans endorse also cause them to believe that few US Republicans have gotten vaccinated, they may be surprised to learn that more than 60% of US Republicans have received at least one dose of the vaccine34; this knowledge may weaken the relationship between their own conspiratorial beliefs and their vaccination intentions. In other words, if conspiratorial beliefs are artificially reducing perceptions of the prevalence of a desired behaviour or increasing perceptions of the prevalence of an undesired behaviour, healthcare leaders can use accurate information about social norms to persuade people to act in productive ways despite their conspiratorial beliefs.

Perceptions of the social norms around the conspiratorial beliefs themselves can also affect people’s behaviours. People tend to overestimate the prevalence of conspiratorial beliefs in their social groups.31 This may occur because conspiracy theory believers’ efforts to spread their beliefs can make these beliefs appear more mainstream than they actually are.10 Correcting misperceptions about the prevalence of conspiratorial beliefs among peers can diminish people’s own endorsement of conspiracy theories,31 which can subsequently alter their behaviour. One recent study found that correcting UK parents’ overestimates of the prevalence of anti-vaccine conspiracy beliefs among other UK parents led to reduced personal conspiratorial beliefs and subsequently increased vaccination intentions.35 It is important to keep in mind that addressing misperceptions about social norms should be done in the context of a relevant social group. Information about social norms tends to be less persuasive when it is involves a group that a person does not strongly identify with.

In addition to highlighting existing social norms, healthcare leaders can help create new ones. For example, mandating masking in the workplace may help create a social norm that carries on into the rest of the community by increasing the number of people seen in public wearing masks. Even without a mandate, leaders can take the following actions to create a social norm in their organisations:

1. Foster the social norm by behaving as a role model for others. If someone is unsure about whether to wear a mask at the workplace, they often look at their leaders’ behaviours as a guide for themselves. Leaders who consistently wear masks are a clear signal for employees. Similarly, if leaders are openly vaccinated and explicitly express the benefits of vaccination, they convey through their actions that getting vaccinated is beneficial.

2. Use rhetorical techniques to build a social norm. Leaders can start by providing clear and specific guidance about what actions to take. They can then help embed the social norm by connecting it to a shared collective identity.36 One way to do this is to use collective pronouns to speak about the norm and connect it to the group’s values and goals. For example, a leader could emphasise that ‘as healthcare workers, we wear masks to protect the public and each other’.

Increase concern for and connection to others

People who hold conspiratorial beliefs tend to show greater concern for themselves and less concern for others.37 Highlighting people’s connections to and impact on others may, therefore, weaken the relationship between their conspiratorial beliefs and behaviours that can be harmful to others.38 This is especially true when it involves people’s connection to, or membership of, groups not associated with the particular conspiratorial beliefs that people hold. Conspiracy theories tend to be strongly connected to particular group identities39 because one of the functions of conspiracy theories is to maintain positive perceptions of the groups that proffer them.18 When people belong to groups whose social identity is bound up with conspiratorial beliefs that disincentivise certain behaviours, partaking in these behaviours risks censure or ostracism from fellow group members. The resulting fear of social sanctions can be a powerful motivator. Ostracism from social groups has been compared with social death and can elicit similar reactions as concerns about one’s own mortality.40 41 This helps explain why people might get vaccinated in secret, without the knowledge of friends and family,42 so as not to visibly break what they see as widespread social norms.

One way to combat the effects of this phenomenon is by increasing the salience of other social identities that are not connected to the problematic conspiracy beliefs. People carry around many social identities that become more or less salient depending on their social context. Increasing the salience of non-conspiratorial social identities has the dual benefit of highlighting our obligations to others and decreasing the salience of conspiratorial beliefs. Conspiratorial social identities often form primarily online, and the importance of these online conspiratorial communities has been heightened during the COVID-19 pandemic due to physical distancing measures.10 As distancing measures are eased, helping people reconnect with their real-world social groups and increasing the salience of related identities should reduce the effects of conspiratorial beliefs on behaviours such as masking and vaccination. Similarly, because conspiratorial beliefs tend to be tied to partisan identities,43 emphasising identities that cut across partisan lines—such as professional or familial identities—could reduce the effects of conspiratorial beliefs. Healthcare leaders can do this by encouraging and providing opportunities for people to reconnect with friends, family and colleagues and emphasising shared organisational and professional identities.