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<article article-type="letter" dtd-version="2.0" xmlns:xlink="http://www.w3.org/1999/xlink">
  <front>
    <journal-meta>
      <journal-id journal-id-type="publisher-id">JMIR</journal-id>
      <journal-id journal-id-type="nlm-ta">J Med Internet Res</journal-id>
      <journal-title>Journal of Medical Internet Research</journal-title>
      <issn pub-type="epub">1438-8871</issn>
      <publisher>
        <publisher-name>JMIR Publications</publisher-name>
        <publisher-loc>Toronto, Canada</publisher-loc>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id">v27i1e64430</article-id>
      <article-id pub-id-type="pmid"/>
      <article-id pub-id-type="doi">10.2196/64430</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Letter to the Editor</subject>
        </subj-group>
        <subj-group subj-group-type="article-type">
          <subject>Letter to the Editor</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Concerns Regarding the Methodology of a Psychological Inoculation Meta-Analysis on Misinformation</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="editor">
          <name>
            <surname>Leung</surname>
            <given-names>Tiffany</given-names>
          </name>
        </contrib>
      </contrib-group>
      <contrib-group>
        <contrib id="contrib1" contrib-type="author" corresp="yes">
          <name name-style="western">
            <surname>Loughnan</surname>
            <given-names>Daniel</given-names>
          </name>
          <degrees>MSc</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <address>
            <institution>Behavioural Science Institute</institution>
            <institution>Radboud University</institution>
            <addr-line>Maria Montessorigebouw</addr-line>
            <addr-line>Thomas van Aquinostraat 4</addr-line>
            <addr-line>Nijmegen, 6525GD</addr-line>
            <country>The Netherlands</country>
            <phone>31 644866936</phone>
            <email>dan.loughnan@ru.nl</email>
          </address>
          <ext-link ext-link-type="orcid">https://orcid.org/0009-0009-8963-0749</ext-link>
        </contrib>
        <contrib id="contrib2" contrib-type="author">
          <name name-style="western">
            <surname>van Stekelenburg</surname>
            <given-names>Aart</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-9978-0224</ext-link>
        </contrib>
        <contrib id="contrib3" contrib-type="author">
          <name name-style="western">
            <surname>Pouwels</surname>
            <given-names>J Loes</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0002-9586-392X</ext-link>
        </contrib>
        <contrib id="contrib4" contrib-type="author">
          <name name-style="western">
            <surname>Kleemans</surname>
            <given-names>Mariska</given-names>
          </name>
          <degrees>PhD</degrees>
          <xref rid="aff1" ref-type="aff">1</xref>
          <ext-link ext-link-type="orcid">https://orcid.org/0000-0003-0634-1298</ext-link>
        </contrib>
      </contrib-group>
      <aff id="aff1">
        <label>1</label>
        <institution>Behavioural Science Institute</institution>
        <institution>Radboud University</institution>
        <addr-line>Nijmegen</addr-line>
        <country>The Netherlands</country>
      </aff>
      <author-notes>
        <corresp>Corresponding Author: Daniel Loughnan <email>dan.loughnan@ru.nl</email></corresp>
      </author-notes>
      <pub-date pub-type="collection">
        <year>2025</year>
      </pub-date>
      <pub-date pub-type="epub">
        <day>28</day>
        <month>8</month>
        <year>2025</year>
      </pub-date>
      <volume>27</volume>
      <elocation-id>e64430</elocation-id>
      <history>
        <date date-type="received">
          <day>17</day>
          <month>7</month>
          <year>2024</year>
        </date>
        <date date-type="accepted">
          <day>18</day>
          <month>8</month>
          <year>2025</year>
        </date>
      </history>
      <copyright-statement>©Daniel Loughnan, Aart van Stekelenburg, J Loes Pouwels, Mariska Kleemans. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 28.08.2025.</copyright-statement>
      <copyright-year>2025</copyright-year>
      <license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by/4.0/">
        <p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research (ISSN 1438-8871), is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.</p>
      </license>
      <self-uri xlink:href="https://www.jmir.org/2025/1/e64430" xlink:type="simple"/>
      <related-article related-article-type="correction-forward" xlink:title="See correction statement in:" xlink:href="https://www.jmir.org/2025/1/e80134" vol="27" page="e80134"> </related-article>
      <related-article related-article-type="commentary-article" id="v25i1e49255" ext-link-type="doi" xlink:href="10.2196/49255" vol="25" page="e49255" xlink:type="simple">https://www.jmir.org/2023/1/e49255/</related-article>

      <kwd-group>
        <kwd>psychological inoculation</kwd>
        <kwd>misinformation</kwd>
        <kwd>discernment</kwd>
        <kwd>sharing</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>The study “Psychological Inoculation for Credibility Assessment, Sharing Intention, and Discernment of Misinformation: Systematic Review and Meta-Analysis” [<xref ref-type="bibr" rid="ref1">1</xref>] was published in volume 25 of the <italic>Journal of Medical Internet Research</italic>. It is the only meta-analysis we know of that aims to synthesize effects pertaining to all inoculation interventions against misinformation. It has been cited widely, including within an American Psychological Association consensus statement [<xref ref-type="bibr" rid="ref2">2</xref>]. The importance of the reliability of these findings to this domain of research cannot be overstated.</p>
    <p>Following assessment of the work and communication with one of the authors, we have some serious concerns we wish to share.</p>
    <sec>
      <title>Incorrect Inclusion and Exclusion of Effects (by Dependent Variable)</title>
      <sec>
        <title>Misinformation Credibility Assessment</title>
        <p>At least 11 (weighted 35.7%) studies should have been excluded: 8 pertained to constructs other than a misinformation credibility assessment, and 3 included results for composite scales only.</p>
      </sec>
      <sec>
        <title>Real Information Credibility Assessment</title>
        <p>At least 11 (weighted 41.1%) studies should have been excluded as the effects pertained to different constructs. At least 1 additional reviewed study should have been included.</p>
      </sec>
      <sec>
        <title>Credibility Discernment</title>
        <p>By the stated decision rules, at least 2 other studies appearing in both the misinformation and real information credibility assessment categories should have been included (N=1215).</p>
      </sec>
      <sec>
        <title>Misinformation Sharing Intention</title>
        <p>At least 1 (weighted 8.2%) study should have been excluded as it compared two inoculation conditions that were not randomly assigned.</p>
      </sec>
      <sec>
        <title>Real Information Sharing Intention</title>
        <p>At least 3 (weighted 19.3%) studies should have been excluded as they pertained to different constructs or did not include a no-intervention control.</p>
      </sec>
    </sec>
    <sec>
      <title>Wrong Experimental Conditions Included</title>
      <p>Six sets of extracted data pertained to experimental groups that did not represent the effect of interest. This affected meta-analytic findings for credibility assessments of misinformation and real information, and intentions to share real information.</p>
    </sec>
    <sec>
      <title>Implausible Sample Size Estimates</title>
      <p>The authors estimated the SE from the standardized effect sizes (<italic>d</italic>) and sample sizes by condition (n) [<xref ref-type="bibr" rid="ref3">3</xref>]. Where only unstandardized effects were reported, n was also used to calculate <italic>d.</italic> As such, the <italic>d</italic> and their SEs were functions of n. Importantly, n, <italic>d</italic>, and SE constitute all the information used in the meta-analysis.</p>
      <p>For 3 studies reporting unstandardized effects, authors made implausible, notably incorrect estimates of n. This affected findings for credibility assessments of misinformation and real information. Multiple other errors regarding n values were also noted.</p>
    </sec>
    <sec>
      <title>Incorrect Conceptualization: Active Versus Passive</title>
      <p>Lu et al [<xref ref-type="bibr" rid="ref1">1</xref>] include a moderation analysis by intervention type: active versus passive. In active inoculation, participants contribute to the refutation process [<xref ref-type="bibr" rid="ref4">4</xref>,<xref ref-type="bibr" rid="ref5">5</xref>], but Lu et al [<xref ref-type="bibr" rid="ref1">1</xref>] erroneously classified interventions by medium rather than participant contributions to the refutation process. Incorrect classification occurred for at least 9 high-powered studies.</p>
      <p>These represent the most important findings of our analysis, which was constrained to appraisals of the supplementary materials, the primary studies, and two email exchanges with a representative author. We request this letter’s publication to raise awareness of these concerns. We further ask that all issues detailed in the full report be adequately addressed.</p>
    </sec>
  </body>
  <back>
    <app-group>
      <supplementary-material id="app1">
        <label>Multimedia Appendix 1</label>
        <p>Full report on Lu et al.</p>
        <media xlink:href="jmir_v27i1e64430_app1.pdf" xlink:title="PDF File  (Adobe PDF File), 358 KB"/>
      </supplementary-material>
      <supplementary-material id="app2">
        <label>Multimedia Appendix 2</label>
        <p>Supplement to the full report on Lu et al.</p>
        <media xlink:href="jmir_v27i1e64430_app2.pdf" xlink:title="PDF File  (Adobe PDF File), 75 KB"/>
      </supplementary-material>
      <supplementary-material id="app3">
        <label>Multimedia Appendix 3</label>
        <p>Primary studies included in Lu et al's meta-analysis.</p>
        <media xlink:href="jmir_v27i1e64430_app3.pdf" xlink:title="PDF File  (Adobe PDF File), 82 KB"/>
      </supplementary-material>
      <supplementary-material id="app4">
        <label>Multimedia Appendix 4</label>
        <p>Data spreadsheet for full report on Lu et al.</p>
        <media xlink:href="jmir_v27i1e64430_app4.xlsx" xlink:title="XLSX File  (Microsoft Excel File), 258 KB"/>
      </supplementary-material>
    </app-group>
    <notes>
      <sec>
        <title>Data Availability</title>
        <p>The full report and supplementary documents are available in the Open Science Framework repository [<xref ref-type="bibr" rid="ref6">6</xref>] and in <xref ref-type="supplementary-material" rid="app1">Multimedia Appendices 1</xref>-<xref ref-type="supplementary-material" rid="app4">4</xref>.</p>
      </sec>
    </notes>
    <fn-group>
      <fn fn-type="conflict">
        <p>None declared.</p>
      </fn>
    </fn-group>
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