Credibility and persuasion in the era of misinformation: digital nursing influencers in Brazil

Abstract

Objective

To analyze the audience and performance of digital nursing influencers in the era of misinformation.

Methods

Cross-sectional, descriptive, exploratory study conducted with data obtained from publicly accessible online social media of digital nursing influencers.

Results

234 profiles of digital influencers in the area of Nursing were mapped: 62.39% have between 10 thousand and 100 thousand followers; 31.2% have between 100 thousand and 500 thousand users; 5.1% reach between 500 thousand and one million followers; and 1.2% have more than one million followers. Together, these communicators reach approximately 32 million users on social media.

Conclusion

Digital nursing influencers are relevant social media communicators and have the potential to influence the opinion of a significant volume of followers that together represent 10% of the Brazilian population identified by the latest census carried out by the Brazilian Institute of Geography and Statistics. They are strategic actors for the dissemination of truthful, complete and reliable information about nursing, health and related topics. On the other hand, they are channels of proliferation of malicious content, inaccurate information, fake news and disinformation.

Social networking; Digital influencers; Nursing; Infodemic

Resumo

Objetivo

Analisar a audiência e o desempenho dos influenciadores digitais da enfermagem em plena era da desinformação.

Métodos

Estudo transversal, descritivo e exploratório, realizado com dados obtidos das mídias sociais online, de acesso público, de influenciadores digitais da enfermagem.

Resultados

Foram mapeados 234 perfis de influenciadores digitais na área da Enfermagem: 62,39% possuem entre 10 mil e 100 mil seguidores; 31,2% têm entre 100 mil e 500 mil usuários; 5,1% alcançam entre 500 mil até um milhão de seguidores; e 1,2% possui mais de um milhão de adeptos. Juntos, esses comunicadores atingem aproximadamente 32 milhões de usuários nas redes sociais.

Conclusão

Os influenciadores digitais da enfermagem são comunicadores relevantes nas redes sociais, com potencial de influenciar a opinião de um volume expressivo de seguidores que, somados, representam 10% da população brasileira apontada pelo último censo realizado pelo Instituto Brasileiro de Geografia e Estatística. São atores estratégicos para a veiculação de informações verdadeiras, completas e confiáveis sobre enfermagem, saúde e assuntos correlatos. Por outro lado, verifica-se que também são canais para a proliferação de conteúdos maliciosos, informações imprecisas, notícias falsas e desinformação.

Redes sociais; Influenciadores digitais; Enfermagem; Infodemia

Resumen

Objetivo

Analizar el público y el desempeño de los influencers digitales de la enfermería en plena era de la desinformación.

Métodos

Estudio transversal, descriptivo y exploratorio, realizado con datos obtenidos de las redes sociales digitales, de acceso público, de influencers digitales de enfermería.

Resultados

Fueron mapeados 234 perfiles de influencers digitales del área de enfermería: el 62,39 % tiene entre 10.000 y 100.000 seguidores, el 31,2 % tiene entre 100.000 y 500.000 usuarios, el 5,1 % llega a tener entre 500.000 y un millón de seguidores y el 1,2 % tiene más de un millón de adeptos. Juntos, estos comunicadores llegan a aproximadamente 32 millones de usuarios en las redes sociales.

Conclusión

Los influencers digitales de enfermería son comunicadores relevantes en las redes sociales, con el potencial de influir en la opinión de un volumen significativo de seguidores que, en conjunto, representan el 10 % de la población brasileña según el último censo realizado por el Instituto Brasileño de Geografía y Estadística. Son actores estratégicos para la difusión de información verídica, completa y confiable sobre enfermería, salud y temas relacionados. Por otro lado, se observa que también son canales para la proliferación de contenidos maliciosos, información imprecisa, noticias falsas y desinformación.

Red social; Influenciadores digitales; Enfermería; Infodemía

Introduction

The internet and social networks continue to undergo rapid transformation. When the home connection emerged in the 1990s, it offered graphics and speeds incapable of reproducing audiovisual content. As mobile devices and technologies such as 5G advance, the speed of individual browsing has increased enormously and digital platforms have become more diverse, rich, personalized and dynamic, providing innovative experiences, tools and creation possibilities based on graphics and interfaces that spark interaction between users and influence consumer decision-making.¹

The current generation of the World Wide Web enables the collective and open use of social networks with an imminent practical effect: anyone with little or a lot of knowledge on a given subject can create, insert and remove content from the network. Even though the structure of society appears to be vertical, the technology of online social networks was designed, idealized and built to promote horizontal relationships.

Recent data indicate that approximately 165.3 million Brazilian users of the internet adopt it to stay informed, carry out research, shop, maintain friendships, prospect contacts and follow influencers and trends. The most used platforms are WhatsApp (96.4%), Instagram (90.1%), Facebook (88.2%) and TikTok (69.6%). The most followed pages and accounts are those of known people, artists, influencers and entertainment.²

Approximately 83% of the Brazilian population uses social networks as a source of news.³ In this context, social networks offer the differential of real-time communication with the elimination of geographical distances and optimized content selection tools free of charge that enable the integration of users with common interests.⁴

The work of content producers capable of influencing consumer behavior gains increasingly relevance and notoriety within an environment characterized by audience competition and the search for legitimacy.⁵,⁶ Known as bloggers or vloggers until 2014, these social actors are currently known as digital influencers. They are personalities who expose themselves, express opinions, gain an audience, influence behavior and interfere in decision-making processes.⁵

Furthermore, influencers are considered trendsetters in different niches and have ancestry among users with specific interests.⁷ These characteristics resonate in the field of nursing, a world-renowned science on which influencers are based to serve as a reference for information and knowledge for the public interested in health-related topics on digital platforms.⁸

The advent and popularization of relationship platforms where these characters operate, perpetrated by health crises on a global scale, such as the COVID-19 pandemic, led to a wide and rapid dissemination of information, although not always truthful. This phenomenon, known as infodemic,⁹ projects worrying risks associated with health misinformation.

The etymology of the term infodemic comes from the combination of information and epidemic. The word means the exponential increase in information, accurate or not, about a certain health subject in a short period of time caused by a specific event, which makes it difficult to find appropriate sources and reliable guidance, when this is necessary to protect oneself and the community.¹⁰

It is scientifically proven that the infodemic about the new coronavirus stimulated the circulation of false, sensationalist, fanciful or misleading news, which impressed and caused strong emotions in the public to the detriment of the circulation of official, truthful and reliable information that mainly showed a tedious and difficult reality to be faced.⁹

According to the WHO, in March 2020 alone, 361 million videos, 19,200 articles and 550 million tweets were published on the internet with the terms: “coronavirus, corona virus, COVID19, COVID-19, covid_19 or pandemic”.¹¹ In the midst of this information epidemic, misinformation found fertile ground to proliferate in the imagination of a fearful and anxious population, leading individuals to deception and, in some cases, death.¹²

Infodemiology, which is a type of epidemiology of disinformation in health, deals with this communicational phenomenon. It consists of continuous monitoring of strategic information, marking false content, improving scientific evidence, creating a permanent relationship of trust with communities, among other information management measures.¹³

Before this paradox, it is important to analyze the volume and panorama of communication by nursing influencers, evaluating the benefits and risks of the actions of these personalities.¹⁴

Measuring the numbers achieved by these communicators and understanding the level of persuasion of digital influencers in the area of nursing is an interesting task to promote the advancement of studies on this phenomenon in the field of health, which is inseparable from mass communication.

In this sense, the aim of this study is to analyze the audience and performance of digital nursing influencers in the era of misinformation.

Methods

This is a cross-sectional, descriptive and exploratory study conducted with data obtained from publicly accessible online social media of nursing influencers. Exploratory research was chosen for allowing greater proximity to the object of study, which tends to favor the collection of information and the formulation of ideas and hypotheses that guide the study in its various phases of execution.

The procedures for systematizing and analyzing profiles on online social networks have been carried out with some frequency by digital marketing researchers, who normally use interaction data on Facebook or Twitter.¹⁵,¹⁶ Omena (2019) considers that digital methods involve manual work and active monitoring, such as, for example, constant verification of collected data or production of exploratory visualizations.¹⁷

All profiles and pages of digital nursing influencers with a minimum of ten thousand followers were compiled in this study, allowing a graphic and quantitative presentation of theories based on social concepts (Senyapar, 2024).¹⁸

Based on the classification by Gulberti (2019)¹⁹ and Camargo, Estevanim and Silveira (2017)²⁰, the individual profiles recognized as relevant reference groups for Brazilian Nursing were selected to develop the empirical models.

Then, the following selection procedures for Nursing opinion leaders were defined:

1. Profile analysis following the theoretical criteria defined by Flynn, Goldsmith and Eastman (1996)²¹ for identifying opinion leaders - those who influence others through opinions. To avoid problems of choice bias, the selected profiles were checked to confirm if they were of nursing professionals based on the Federal Nursing Council (Portuguese acronym: Cofen).

2. The selected profiles are recognized by their audience through publications or specialized nursing opinion as opinion leaders;

3. Profiles created before the start of the COVID-19 pandemic, in 2020, were considered for demonstrating a certain tradition and longevity on the social network.

Micro, Inter, Macro and Mega profiles were considered for the study. Social media follower numbers were updated month by month for this subset of the most active on social media. Statistical criteria for selection were established based on the number of followers of each profile.

Data collection was organized through exhaustive exploratory sampling on online social networks: Instagram, Facebook, TikTok, Twitter and Youtube from July 2022 to October 2023. The following variables were evaluated: platform used, audience, profile and topic addressed in the respective online social networks for identification, data crossing and analysis of the profiles of nursing influencers.

Data were consolidated into an online spreadsheet and analyzed descriptively. The audience and performance of digital nursing influencers were analyzed.

As these are public profiles with open access information, and considering the provisions of item II of the paragraph 1 of Article 1 of CNS Resolution Number 510 of April 7, 2016, consideration of the study by the Research Ethics Committee was not necessary. Although all mapped profiles were public, they were anonymized for data protection and privacy as recommended by the Association of Internet Researchers (AoIR).²²

Results

In total, 234 digital nursing influencers were identified, the majority on Instagram with 10-100 thousand followers. The list of intermediate pages is also considerable and demonstrates the growth trend of influencers in this segment of activity. The detailed information highlights the capillarity and spread of these personalities across different online social networks (Table 1) to meet the diversity of public demand for content related to the profession.

Table 1
Distribution of profiles of digital nursing influencers

Social media	Number of profiles
	Micro (10 thousand to 100 thousand)	Inter (100 thousand to 500 thousand)	Macro (500 thousand to 1 million)	Mega (more than 1 million)	Total
	n(%)	n(%)	n(%)	n(%)	n(%)
Instagram	104(70.2)	38(25.6)	5(3.3)	1(0.6)	148(63.2)
YouTube	22(64.7)	11(32.3)	1(2.9)	-(-)	34(14.5)
Twitter	4(100)	-(-)	-(-)	-(-)	6(1.7)
TikTok	9(45)	8(40)	1(5)	2(10)	20(8.5)
Facebook	7(25)	16(57.1)	5(17.9)	-(-)	28(11.9)
Total	146(62.4)	74(31.6)	11(4.7)	3 (1.3)	234 (100)

The performance capacity of nursing influencers can be measured by the audience they reach. According to research data, the 234 profiles analyzed reach more than 32 million followers on social networks together (Table 2). The largest audience range is reached by intermediate pages with between 100 thousand and 500 thousand followers.

Table 2
Audience according to classification by influencers

Social media	Number of followers
	Micro (10 thousand to 100 thousand	Inter (100 thousand to 500 thousand)	Macro (500 thousand to 1 million)	Mega (more than 1 million)	Total
	n(%)	n(%)	n(%)	n(%)	n(%)
Instagram	3905100(25.6)	7515000(49.2)	2112000(13.8)	1200000(7.8)	15263100(46.5)
YouTube	893200(20.4)	2744000(62.7)	733000(16.7)	-(-)	4370200(13.3)
Twitter	80700(100)	-(-)	-(-)	-(-)	80700(0.2)
TikTok	589600(10.6)	1554700(28.1)	584200(10.5)	2800000(50.6)	5528500(16.8)
Facebook	378000(5)	4379000(57.8)	2816000(37.1)	-(-)	7573000(23)
Total	5846600(17.8)	16192700(49.3)	6245200(19)	4000000(19.9)	32815500(100)

Although the absolute majority of profiles are of a personal nature, the number of pages whose author is not explicitly identified is considerable (Table 3). In this universe of anonymity, lies a relevant concern regarding the hidden interests behind the publications made by these personalities.

Table 3
Nature of influencer profiles

Type	Instagram	YouTube	Twitter	TikTok	Facebook	Total
	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)
Personal	113(68)	30(18)	1(0.6)	16(9.6)	6(3.6)	166(70.9)
Impersonal	31(51.6)	2(3.3)	3(5)	4(6.6)	20(33.5)	60(25.7)
Business	4(50)	2(25)	-(-)	-(-)	2(25)	8(3.4)
Total	148(63.2)	34(14.5)	4(1.7)	20(8.5)	28(12)	234(100)

The topics addressed by nursing influencers are diverse, ranging from the profession’s specialties to satire and comedy, the fight for rights and in defense of the category’s professional prerogatives (Table 4).

Table 4
Distribution of profiles by topic

Platform	Instagram	YouTube	Twitter	TikTok	Facebook	Total
Topic	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)
Breastfeeding	2(0.8)	-(-)	-(-)	-(-)	-(-)	2(0.8)
Political actor	16(6.8)	-(-)	-(-)	-(-)	-(-)	16(6.8)
Professional performance	6(2.5)	-(-)	-(-)	-(-)	-(-)	6(2.5)
Autism	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Business	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Courses and Training	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Nursing Law	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Entrepreneurship	8(3.4)	1(0.4)	-(-)	-(-)	-(-)	9(3.8)
Forensic Nursing	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
General Nursing	36(15.3)	3(1.2)	2(0.8)	5(2.1)	24(10.2)	70(29.9)
Intensive Nursing	2(0.8)	1(0.4)	-(-)	-(-)	-(-)	3(1.3)
Gynecological Obstetric Nursing	8(3.4)	1(0.4)	-(-)	-(-)	-(-)	9(3.8)
Palliative Nursing	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Pediatric Nursing	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Nursing Teaching	31(13.2)	27(11.5)	-(-)	5(2.1)	3(1.3)	66(28.2)
Aesthetics	3(1.3)	-(-)	-(-)	1(0.4)	-(-)	4(1.7)
Hemodialysis	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
History of Nursing	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Nursing Humor	7(3)	-(-)	-(-)	3(1.3)	1 (0.4)	11(4.7)
General Humor	1(0.4)	-(-)	-(-)	2(0.8)	-(-)	3(1.3)
Sports Medicine	1(0.4)	-(-)	-(-)	-(-)	-(-)	1(0.4)
Opportunities in Nursing	-(-)	-(-)	1(0.4)	-(-)	-(-)	1(0.4)
Personal profile	3(1.3)	-(-)	1(0.4)	2(0.8)	-(-)	6(2.5)
Podcast	-(-)	1(0.4)	-(-)	-(-)	-(-)	1(0.4)
Nursing Policy	8(3.4)	-(-)	-(-)	-(-)	-(-)	8(3.4)
Wound care	4(1.7)	-(-)	-(-)	-(-)	-(-)	4(1.7)
Urgency and Emergency	3(1.3)	-(-)	-(-)	2(0.8)	-(-)	5(2.1)
Total	146(63.2)	34(14.5)	6(1.7)	20(8.5)	28(12)	234(100.)

Audience segmentation reveals the hegemony of Instagram, but the presence of all other social media is significant (Table 5). In other words, the public interested in nursing-related topics demands information on all the online social networks analyzed and the outlook for profile growth appears to be quite promising.

Table 5
Audience segmented by subject and social network

Platform	Instagram	YouTube	Twitter	TikTok	Facebook	Total
Topic	n(%)	n(%)	n(%)	n(%)	n(%)	n(%)
Breastfeeding	36400(0.1)	-(-)	-(-)	-(-)	-(-)	36400(0.1)
Political actor	835500(2.5)	-(-)	-(-)	-(-)	-(-)	835500(2.5)
Professional performance	358100(1)	-(-)	-(-)	-(-)	-(-)	358100(1)
Autism	76600(0.2)	-(-)	-(-)	-(-)	-(-)	76600(0.2)
Business	93200(0.2)	-(-)	-(-)	-(-)	-(-)	93200(0.2)
Courses and Training	17400(0.05)	-(-)	-(-)	-(-)	-(-)	17400(0.05)
Nursing Law	108000(0.3)	-(-)	-(-)	-(-)	-(-)	108000(0.3)
Entrepreneurship	284800(0.8)	184.000(0.5)	-(-)	-(-)	-(-)	468800(1.4)
Forensic Nursing	33100(0.1)	-(-)	-(-)	-(-)	-(-)	33100(0.1)
General Nursing	5528400(16.8)	437000(1.3)	38100(0.1)	399500(1.2)	6514000(19.8)	12917000(39.4)
Intensive Nursing	200400(0.6)	52700(0.07)	-(-)	-(-)	-(-)	253100(0.7)
Gynecological Obstetric Nursing	418700(1.2)	22100(0.1)	-(-)	-(-)	-(-)	440800(1.3)
Palliative Nursing	81400(0.2)	-(-)	-(-)	-(-)	-(-)	81400(0.2)
Pediatric Nursing	25600(0.08)	-(-)	-(-)	-(-)	-(-)	25600(0.08)
Nursing Teaching	3252100(9.9)	3652600(11)	-(-)	732000(2.2)	333000(1)	7970300(24.3)
Aesthetics	42400(0.1)	-(-)	-(-)	26900(0.08)	-(-)	69300(0.2)
Hemodialysis	41700(0.1)	-(-)	-(-)	-(-)	-(-)	41700(0.1)
History of Nursing	18100(0.06)	-(-)	-(-)	-(-)	-(-)	18100(0.06)
Nursing Humor	1788600(5.4)	-(-)	-(-)	987200(3.1)	726000(2.2)	3501800(10.6)
General Humor	13400(0.04)	-(-)	-(-)	2800000(8.5)	-(-)	2813400(8.5)
Sports Medicine	24000(0.07)	-(-)	-(-)	-(-)	-(-)	24000(0.07)
Opportunities in Nursing	-(-)	-(-)	26700(0.08)	-(-)	-(-)	26700(0.08)
Personal profile	1268600(3.8)	-(-)	15900(0.05)	161700(0.5)	-(-)	1446200(4.4)
Podcast	-(-)	21800(0.07)	-(-)	-(-)	-(-)	21800(0.07)
Nursing Policy	355700(1)	-(-)	-(-)	-(-)	-(-)	355700(1)
Wound care	174200(0.5)	-(-)	-(-)	-(-)	-(-)	174200(0.5)
Urgency and Emergency	144300(0.4)	-(-)	-(-)	420600(1.2)	-(-)	564900(1.7)
Total	15220700(46.4)	4370200(13.3)	80700(0.2)	5528500(16.8)	7573000(23.1)	32773100(100.0)

Discussion

We are living in an unprecedented moment in the history of healthcare, in which nurses can become information references and even social media celebrities, accumulating thousands and even millions of followers eager for personalized content.²³ This is the current stage of digital influencers in nursing, a phenomenon that has gained strength especially in the last four years and raises important questions about the actions of these characters, especially in relation to the impact of the messages they convey in the field of public health.

To understand this scenario, 234 profiles of nursing influencers who accumulate more than 32 million followers on the most popular online social networks in Brazil - Instagram, YouTube, Twitter, TikTok and Facebook - were mapped in this study. The results are revealing and lead to a reflection on the power of these influencers and the challenges they face in communicating with the public.

The most significant volume of users in the segment is on Instagram, Facebook and YouTube, in that order of importance. Even though the profiles on these platforms and other analyzed have the largest number of followers, the smaller and meso pages concentrate a larger audience and influence a greater number of people who use social networks as a means of information about the profession and matters related to the exercise of the activity.

According to the results indicated in this study, 62.4% of nursing influencer profiles have between 10 thousand and 100 thousand followers; 31.6% have a follower base of between 100 thousand and 500 thousand users; 4.7% reach between 500 thousand and one million followers; and 1.3% have more than one million followers.

The topics covered by nursing influencers are diverse, ranging from specialties of the profession, politics, work and education, health treatments, medications and therapies, to humor, gossip and social criticism. The production of satirical content draws attention, capable of arousing emotional reactions and expressive actions on users, mainly in relation to the problems that affect the category, among which we can highlight the exhausting working hours, the difficulty in implementing the floor remuneration, violence committed by SUS users and persistent cases of moral harassment.

Given the statistical minority participation in the surveyed group, the largest profiles consequently register the highest average number of followers. Special attention is drawn to these influencers in relation to content monetization and especially with regard to the bias of publications in those of a scientific, informative, institutional, ideological and political nature. In other words, observation allows us to infer there is a risk to society when economic or commercial interests are the main driving force of a channel that deals with nursing, public health, vaccines, treatments and health emergencies.

Although profiles of a personal nature predominate, the authors and interests are not explicitly revealed in a considerable number of pages. This impersonality generates ethical concerns, as it becomes difficult to identify individual responsibilities in cases of inappropriate conduct, generating discussion about the limits of communication in nursing and public health, considering that the nursing practice in its most diverse specialties is regulated in Brazil.

The credibility of nursing is one of the factors that contributes to public engagement. Nurses are expected to be truthful and provide accurate and substantiated information in a neutral manner, although this is not always the case. The COVID-19 crisis is an example that highlighted how some of these digital influencers engage in misinformation on social media and elsewhere, causing confusion between fact and rumor and doing the public a disservice.

It is a scientific fact that fear, panic, conspiracies and the famous clickbaits are major audience factors and consequently, widely used means for disseminating content and creating financial revenue.²⁴ Observing the general aspects and the large audience reached by the profiles of nursing influencers, there is a need to go further and deepen studies on the nature of the content produced and the effects they produce on the category and the population of SUS users.

An emblematic case summarizes how digital influencers can contribute to the spread of false information and even become victims of their own behavior. A nurse and digital influencer, who became popularly known on social media as an exponent of scientific denialism and conspiracy theories during the pandemic regrettably became a victim of his own misinformation when he died infected by COVID-19. The case reinforces the need to create mechanisms to guide content producers and ensure that nursing influencers respect ethical limits and provide reliable information to the public, always based on quality scientific evidence.

Working on social media has become a professional differentiator. Nursing engages users on relevant topics on social networks: educational opportunities and insights; humor related to the profession; emotions experienced by nurses; and media and narratives, including details of the patient or work context. Although most messages are of a positive nature, ethical and professional problems are perennial in these discussions.

Digital influencers have taken a protagonist role in the relationship between the public and social networks, surpassing traditional media and gaining acceptance from specific audiences. The COVID-19 pandemic has accentuated this reality. Despite the serious and committed work of those acting on this front, false information about vaccines and ineffective treatments are also disseminated in these profiles and impacts public health policies.

Given this panorama, it is necessary to further study the role of digital nursing influencers. Their ethical practices, monetization processes, and the mechanisms that can be used to combat fake news and misinformation require a closer look. Furthermore, it is essential to promote awareness about the importance of credibility in the nursing profession, encouraging influencers to be reliable sources of information for the public.

Creating communities around interest in the same topic and calling people to actions and protests are activities facilitated by influencers. The case of the minimum salary for nursing leaves no doubt about the strength and communication power of these players, who were fundamental in the process of pressure exerted on the political class, leading them to approve in months a right that had been demanded for more than 30 years.

Naturally, it is opportune to find ways to effectively combat misinformation in nursing by demonstrating the damage it causes to health and developing interventions that can mitigate potential negative impacts on the community.¹¹ Above all, influencers can play an important role by disseminating true information, and flagging and removing fake information, although there is still uncertainty about the best approach to dealing with this problem in the field of nursing.

Disinformation begins with a kernel of truth, supported by fact, observation or reasoning that appears scientific or believable. However, while the truth is based on hypotheses that can be refuted, conspiracy theories and fake news are rooted in emotions and do not go through the checking stage.²⁵ It is worth analyzing the communication panorama that permeates the production of nursing influencers for a more comprehensive understanding of the benefits and risks associated with this activity.

In the COVID-19 pandemic, the internet was more effective for vaccine hesitancy than for vaccine acceptance. Faced with this issue, it is essential to adapt and develop communication practices based on the best available evidence to prevent, detect and respond to health misinformation. Influencers and social networks can be part of the solution, as long as they are used responsibly and judiciously.

As far as we know, there is no infallible method for dealing with the problem. The alternatives are experimental and undergoing rapid development in the face of emerging demands. It is a fact that the penetration of technology combined with the evolution of social networks has boosted the ecosystem of digital influencers, revolutionizing the means of communication and generating uncertainty regarding the way information is distributed.

By ensuring global infodemiological collaboration, including through the dialogue of influencers, which can be incorporated into health communication strategies, it is possible to reduce the burden of health care that becomes an excessive weight for professionals working on the front line, especially physicians and nurses.

Nursing digital influencers have the potential to play a significant role in disseminating knowledge about health and defending the values of the profession. On the other hand, they can also amplify information without evidence and promote misinformation. It is essential to maintain a critical eye on this dichotomy in order to scrutinize the exercise of the communicator role coated as health profession.

Conclusion

Evidence indicates that digital nursing influencers are part of a communication ecosystem that has ascendancy, audience and credibility with the public, as well as perspectives of influence and persuasion in relation to a considerable portion of society, especially in the health field.

The significant audience numbers reveal there is care with strategic actors to disseminate truthful, complete and reliable information about nursing, health and other pertinent subjects. On the other hand, content analysis leads to the conclusion that they also constitute channels for the dissemination of malicious content, inaccurate information, fake news and disinformation.

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Edited by

Associate Editor

Alexandre Pazetto Balsanelli (https://orcid.org/0000-0003-3757-1061) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil

Publication Dates

• Publication in this collection
  04 Oct 2024
• Date of issue
  2024

History

• Received
  04 Dec 2023
• Accepted
  06 May 2024