“Misinformation” has a variety of synonyms in the literature, including fake news, spam, and trolling [13]. In this paper, similar to the study by Wu et al [13], we use “misinformation” in its broadest sense, including any false information regardless of the source or intent.

Social media, comprised of multiple information ecologies, refers to any internet-based or digital space where individuals can form and maintain connections as well as gather and share new information [14]. Information ecologies are systems made up of the individuals using the platforms, the technologies facilitating the platforms, and the values that drive the use of the platforms [7].

International students may be passive users of their host country health care systems due to language barriers and possessing limited information about their new host countries [11]. COVID-19 has resulted in a transition to telehealth worldwide [15], meaning that new arrivals must learn how to navigate health care systems digitally. International students have been shown to experience disconnectedness from their host countries, and digital spaces offer a line of connection to their communities [16]. Thus, international students often transcend digital ecologies as they interact with different groups of people in different geographic locations and with different cultural values [6]. Furthermore, COVID-19 policies vary across countries, which may influence international students’ knowledge and perception of host country policies [12].

When navigating new digital ecologies, international students may turn to social media to gather health information from personal connections and have “guidance in clinical decision-making” [6,10]. They may also draw on their home country media sources for health information in their first language [10,11]. While moving through new digital ecologies for which they have limited context, international students rely on the limited information available on social media platforms to determine reliability [6]. If the international student is unaware that they are encountering misinformation, their experience will be functionally comparable to when they are encountering real information [6]; that is, if the misinformation resonates with them, they may acquire (mis)information [17,18]—information that is actually misinformation.

During the COVID-19 pandemic, there has been an increase in misinformation [19]. A study done on a sample of tweets related to COVID-19 showed that 24.8% of tweets contained misinformation, and 17.4% had unverifiable information [19]. International students who transcend digital ecologies may experience a doubling of misinformation across different digital ecologies. This can be damaging, as research shows if people view a story enough times, they are more likely to believe it, even if the story is being disproved [20]. Furthermore, research has demonstrated that context influences how misinformation is interpreted [21]. International students may encounter the same misinformation across digital ecologies. What might be framed accurately in one ecology could be framed inaccurately or in a biased manner in another. Biased information is a form of misinformation [13]. This difference in framing may influence international students’ behavior when they encounter misinformation across ecologies. Moreover, the values international students have developed in their home country’s digital ecologies may impact their misinformation encounters in the host country’s digital ecologies [6].

A total of 11 students from 3 Australian universities and 5 cultural backgrounds took part in the study.

Participants were recruited via various social and student networks. Although there was the possibility of bias, recruitment posts were public. Participants were limited to international students studying in Australia to ensure that the local context was the same for all participants. Participants were required to use 2 or more social media platforms such as Facebook, Twitter, or Weibo. However, the use of platforms and immigration status were defined by the participants. Participation was voluntary, and participants were free to withdraw at any point. Participant demographics are described in Table 1.

Data were collected in August 2021 as part of a larger study and through 3 instruments: a preinterview questionnaire, a semistructured interview, and a health misinformation-identification exercise. This research design adopts a combination of epistemological perspectives. By distinguishing the posts as information and misinformation, there is a general “truth” identified, with a post being objectively valuable because it is “true” [22]. However, especially because marginalized communities often have different experiences from those of dominant communities, truth can also be culturally constructed [23]. Interview questions were designed to elucidate how participants constructed meaning from (mis)information they came across. The objective was to understand how international students’ different backgrounds and their different cultural contexts or preexisting presumptions impacted the way they interpreted information and misinformation.

The interviews were conducted and recorded using Zoom. Each of the interviews lasted 53-87 minutes. This time duration included the health misinformation-identification exercise. Interviews were conducted until 11 were complete, when data saturation was achieved. At that point, no new information emerged from the interviews. No incentives were offered to the participants.

This study was approved by The University of Melbourne’s Office of Research Ethics and Integrity (2021-22022-18386-2).

Similar to previous research [28,29], qualitative thematic analysis was done on the data collected between September and October 2021. Coding of the data was done by the first author (RB) in conjunction with 2 other researchers. The first author is an international student who arrived in Australia the year the pandemic started. This author was thus already sensitized to some of the experiences reported by the participants and well placed to understand the context around the participants. However, the questions asked were open-ended and designed to get participants to share their experiences rather than reflect any assumptions the first author might have had.

The coding process was initiated by the first author by reading the transcriptions as well as the interview notes several times to become familiar with the data [30]. Subsequently, an initial round of coding was done by the first author by “asking questions about the data, making comparisons between data…and in doing so, deriving concepts to stand for those data, then developing those concepts in terms of their properties and dimensions” [24]. Similar codes were then grouped together under common themes [31]. Following rounds of refinement occurred in conversation with 2 other researchers to help mitigate bias. Analogous codes were merged to distill key ideas, and themes were finessed to allow for the best possible fit of the codes and themes with the data [32]. Transcripts of interviews and evaluation exercises were reviewed again to find examples for each code derived. The codes and examples were subsequently verified by other authors to ensure there was consensus regarding the fit of the codes with the data.

Analysis of the data revealed 2 key themes and 6 subthemes surrounding international students’ interaction with misinformation across digital ecologies. These themes came from the concurrent analysis of data from the interviews and the exercise. Table 2 gives an overview of the data-derived themes presented in this paper. This list is not exhaustive but focuses on international students’ interactions with health misinformation across digital ecologies. Table 3 provides results of the misinformation-identification exercise.

This research affirms international students’ use of multiple digital ecologies for information [4,5]. Drawing on multiple digital ecologies for information is not without challenges, and the literature highlights that language barriers may hinder international students’ health information seeking in new physical environments [10,11]. This research extends our understanding by showing that language barriers also apply to their health information seeking on social media. International students’ desire for information in a language they can easily interpret pushes them to sources like WeChat, where they can get tailored information from people similar to them [33,34], instead of relying primarily on their host country’s sources of information.

This research shows that similar to the general population [35], international students rely on a lifetime of experience and conditioning to evaluate health information they encounter. However, for international students, this conditioning happens through use of sources in the home country digital ecologies and may then be used to make decisions about health information they encounter in digital ecologies that are not native to them.

In evaluating health information, unlike other students [36], international students evaluate the source of the health information—they rely on trusted contacts. Sometimes these contacts may be personal connections, and other times they may be official sources. In the health misinformation-identification exercise, participants evaluated the social media account sharing the information by checking whether the account was verified and checking the name of the account or news outlet to determine the credibility of the post.

However, international students do not trust all contacts. Several international students reported receiving voluminous amounts of misinformation, particularly regarding COVID-19, from home-based digital sources. In response, they ignored misinformation from their home country digital sources. Although crowd correction is vital to defending against health misinformation [37], previous literature shows that people sometimes self-censor while using social media to avoid disrupting relationships [38]. Literature also shows that if the person perceives information to be biased and influential, they may challenge it to avoid repercussions [39]. By the same token, the findings show that international students challenge health misinformation if they believe there will be adverse consequences for their family’s well-being.

The health misinformation-identification exercise shows that international students can generally identify health misinformation accurately. International students’ exposure to misinformation via multiple digital ecologies affects how they evaluate and react to misinformation. The COVID-19 pandemic has not only led to an increase in misinformation on social media but has also adversely impacted international students worldwide [2]. In Australia, international students were prompted to return to their home countries by the Australian government and excluded from “all federal pandemic assistance programs, such as JobSeeker and JobKeeper” [40]. The increased adversity could have resulted in worse health outcomes for international students who draw on sources from other nations. Although the general Australian population was less likely to believe COVID-19 misinformation [41], there were reports of members of multicultural and linguistically diverse communities being susceptible to misinformation about vaccines and missing out on vital health information [42,43]. However, this study has demonstrated that students who have made the digital transition to a host country ecology compare information found in their multiple ecologies. This comparison supports them in identifying health misinformation.

Multicultural communities do not all seek out information in a similar manner, and painting their experiences with one brush is harmful. International students’ use of multiple ecologies may offer protection against the most negative effects of health misinformation. International students may be uniquely placed to identify it. Having exposure to multiple digital ecologies may do more than support connections with loved ones elsewhere—it may also ward against the biases present in a single ecology. This possibility has significant implications for our understanding of how to prevent the spread of health misinformation, not just among international students but also among other groups, and it is therefore worthy of future research.

This paper sought to understand the nuances surrounding international students’ interaction with health misinformation. The pandemic created an unusual impetus for international students to engage with local sources of information for up-to-date news on an evolving situation.

Findings provide insight into international students’ health misinformation behaviors across digital ecologies. Further, findings reinforce that some international students face challenges in adopting host country sources of information. However, most importantly, findings combat the narrative of migrants’ susceptibility to health misinformation [3,42] by showing that for international students that draw on multiple digital ecologies, there may be a protective effect against misinformation.

In consideration of the findings, health information providers need to explore ways of collaborating with digital platforms to provide vital information in a manner that is in line with how international students access health information. In addition, health information providers might also collaborate with non–health-related organizations such as community organizations and home country organizations to provide information that is easily comprehensible by those who do not share a first language with host country locals. Moreover, health organizations and educational institutes might also incorporate digital transition training into orientation sessions to help familiarize newly arrived international students with accessing health care systems and information in the host country.