Scottish Health Information Integrity Strategy

The Three Pillars

This strategy details an approach to false health information based upon three pillars:

• Leadership and Coordination
• Building Scotland’s Resilience to False Health Information
• Rapid Response to False Health Information

These pillars are discussed in more depth in the coming pages.

Pillar One - Leadership and Coordination

Leadership to address false information requires dedicated time, expertise and professional networks. This is a dynamic field, with rapid developments both domestically and internationally. Much of the research and guidance drawn on for this strategy was published in 2024. The Scottish Government and partners will push this agenda forward, sitting at the interface (as shown in Figure 2) between UK and international partners on one side, and Scottish partners on the other.

Pillar Two – Building Scotland’s Resilience to False Health Information

What does a society resilient to the effects of false health information look like? A resilient society has high levels of social trust and solidarity. When the public trusts its public institutions and health systems, measures to address public health emergencies are more likely to be effective. From individuals to institutions, all have a role to play.

Engaging Communities

Addressing false health information ultimately hinges on trust. Guidance emphasises the importance of engaging directly with communities — not only to communicate effectively but to listen, understand, and respond to the concerns and rumours shaping public belief.^[39] In a context where public trust in government is at a historic low, those individuals and institutions who retain high trust must be empowered to play a more active role.

In the UK, healthcare professionals stand out as one of the most trusted groups in society. According to the Ipsos Veracity Index, approximately 90% of respondents trust nurses and doctors to tell the truth.^[40] Scientists also rank highly, with growing international support for their more direct involvement in policymaking and public dialogue. Our engagement confirms that frontline NHS staff frequently encounter false health information — particularly relating to vaccines and reproductive health — yet often feel ill-equipped to respond. With a clinical workforce of around 100,000 and touchpoints across nearly every community in Scotland, NHS Scotland is uniquely positioned in its role as a trusted source of public health information.

Beyond science and health, community figures have a vital role to play. Recent research in Scotland conducted by the University of Glasgow, Mhor Collective and Ofcom shows how online false health information impacts even on communities of people who are offline, meaning that our response needs to be nuanced and understanding of communities facing wider inequalities.^[41] It is up to our health and governmental institutions to foster strong relationships with clinical and community networks and ensure they are supported with the right information and tools, which they feel confident and comfortable to share, to empathically and sensitively respond to situations influenced by false health information. Importantly, this exchange goes in both directions; what goes on in the online environment may not reflect true community concerns. Listening to these concerns requires two-way communication and strong relationships between the on-the-ground experience of grassroots organisations and our national health and governmental institutions. In addition to working with networks and intermediaries, we also need to engage directly with our core audiences, understanding their barriers and drivers to desired outcomes around topics that are likely to be the subject of false health information.

Equipping Institutions

An effective response to false health information requires that our healthcare institutions and government take a joined-up approach. As new research and guidance rapidly develops, it is up to national organisations including Scottish Government and Public Health Scotland to provide evidence-based leadership, setting the tone for a consistent response from local to national levels. Over time, our institutions will learn to adapt and safely respond to the effects of false information. Ensuring that work in this area is visible, learning is captured and skills are developed across our institutions will be fundamental, all while adhering to the principles set out on page 21.

Empowering Individuals

Media, digital and health literacy are essential in empowering individuals to critically assess health information, particularly in the digital age where misinformation can spread rapidly. Having the critical thinking skills to assess what we see online can help us to discern true from false information.^[42]

Much work already takes place in Scotland to boost these literacies. For example, the Making It Easier Health Literacy Action Plan^[43] has led to a range of work such as the development of online resources for practitioners including the Health Literacy Place^[44] and online training.^[45] Efforts to address digital exclusion – defined as the inability to equitably access the digital space^[46] – also align with wider efforts to tackle the entrenched inequalities which persist in the Scottish population. Connecting Scotland – a Scottish Government initiative managed by the Scottish Council of Voluntary Organisations – is an example of this in action.^[47] Furthermore, many projects or programmes may boost media, digital and health literacy without explicitly using these terms. We therefore seek opportunities to add value to what is already being done.

One approach is the development of short media, digital and health literacy interventions to support healthcare professionals when having patient conversations that have been influenced by false health information. We will explore this further with the public and our partners, ensuring that anything we do is co-designed and grounded by scientific evidence.

Case Study: Mhor Collective

Mhor Collective, a community interest company based in Scotland, combats the harms of false health information by addressing digital inequality through a holistic, community-driven approach. With a commitment to co-design and centering lived experience, Mhor ensures that media literacy initiatives are accessible and tailored to the real-world challenges faced by diverse communities. By fostering trusted relationships and embedding digital support within participatory frameworks, Mhor empowers individuals to critically evaluate online content, recognise biases, and navigate the digital landscape in meaningful ways, which can then feed into national approaches. Their strategic approach integrates research-backed methodologies with grassroots engagement, ensuring that false health information is tackled at its source: within the spaces where people seek and share information. Through collaboration with public and third sector organisations, frontline staff, volunteers, and community members, Mhor cultivates resilience against digital manipulation in the context of peoples’ lives.

Case Study: Co-Production work undertaken in prison settings across NHS Greater Glasgow and Clyde (NHS GGC)

In November 2024 NHS GGC commissioned a piece of co-production work within prison settings in relation to vaccination and immunisation. Focus groups were undertaken with people living in prison and highlighted key themes, including:

• misconception that younger adults do not require vaccinations
• that there is an information void in prisons around vaccination
• the need to address misconceptions and myths
• that information and messaging should be simple and concise

To address the themes identified from the focus groups, a plan to develop film clips, talking heads for prison radio and other resources was agreed. The film clips were made by people who live in prison for people who live in prison. They acknowledge that false information exists around vaccination and that public health vaccination campaigns often have lower reach in prison settings. The key messages from these resources are:

• your risk of infection is increased living in close quarters
• your health matters
• you have the right to be vaccinated and it is not possible to be over-vaccinated
• being vaccinated protects you, those around you and family and friends

The clips discuss vaccination, the body’s immune response, hygiene and the number of lives saved annually due to vaccines, ending with a message to ‘protect yourself now and for the future’ and to ‘take care of tomorrow today’. Work is ongoing as these resources are rolled-out and evaluated.

Embedding in Education

To ensure a society resilient to false information, we must build our approaches from the ground up. Empowering our children and young people is key; it is no coincidence that highly information literate societies such as Finland have embedded this from early years.^[48]

Schools also sit at the heart of our communities. They provide trusted support to our children and young people. They also play a fundamental role in supporting families. As such, they have been a target for false health information. During the COVID-19 pandemic, Scottish schools were directly targeted with false information regarding vaccination by several groups, requiring a government and police response.^[49]

Engagement by Education Scotland has found false information continues to be a key concern of teachers and a challenge they frequently face. Education Scotland’s consultation with young people, conducted in late 2024, showed they are often unclear how to identify trustworthy sources of information. Research also tells us that children and young people are particularly vulnerable to the effects of false information.^[50] This may lead to health choices that would not have otherwise been made; the 2025 Edelman Trust Barometer found that 58% of young people surveyed had made a health decision they regret due to false information.^[51]

Work to embed this into Scottish school education has been underway for some time. As part of an ongoing Curriculum for Excellence improvement cycle, work to develop cross-cutting ‘core competencies’ has been undertaken in collaboration with pupils and teachers. Political Literacy, a core competency first introduced in 2014, seeks to develop ‘responsible citizens’ who are able ‘to participate in society’s decision-making processes’.^[52] Political literacy has subsequently broadened in scope. False information was recently identified as one of the four ‘big ideas’ of this competency, for which young people need to understand how to access accurate information across all aspects of their education, including information about their health. This strategy will support work to embed these concepts across primary and secondary curricula, empowering Scotland’s children and young people to better understand and navigate today’s complex information landscape.

Pillar Three – Rapid Response to False Health Information

Information travels fast; false information even more so. To ensure that the right information reaches the right audiences, our systems must be agile and responsive enough to understand false narratives circulating in communities and online. They must be able to rapidly respond where needed in a safe, justifiable and empathetic manner. Building on the latest evidence, the planning and implementation must be underway before another major public health emergency occurs.

Scotland is not alone in considering how best to build a coordinated response to the threats of false health information. The UK Government and international institutions including WHO and the Johns Hopkins Center for Health Security have developed detailed guidance which set out the key steps required to create systems which are responsive to circulating false information (page 20). These approaches are evidence-based and consider both the ‘how’ and the ‘when’ to respond. Trust remains fundamental; technical approaches must be accompanied by strong community networks – both to understand public concern and to address it.

The assets – human, social, cultural and institutional resources – to coordinate a rapid response are already established in the Scottish system. Efforts to implement international best practice are likely to involve coordination of existing capabilities, rather than creation of a completely new information service or institution. At a high level, it involves the ability to understand the true and false information circulating on- and offline, summarise this, apply a risk assessment process for public health impact and, where appropriate, respond (Figure 3).

Understanding public concerns on- and offline requires the capability to understand both social media and community concerns. However, the online world may not always reflect true public concern; distortion by social media algorithms can amplify the loudest voices, and this can be further distorted by large scale deployment of artificial accounts (bots) to vastly increase reach. Our relationships with communities will continue to underpin our approach. There is no substitute for talking to people to understand their concerns.

Responding to false health information can be done in a variety of ways. From amplifying true health information via existing platforms like NHS Inform, to specifically debunking something which is untrue; each has a specific time and place. We will approach this carefully, ensuring that these responses reflect the needs of the Scottish population and are informed by evidence. This may be done via direct communication to the public, or via our wide range of partners in the healthcare system, schools and communities (Figure 4). This approach is not new; it builds on well-established communication practices and a strong tradition of partnership working.

Case Study: RADAR

Rapid Action Drug Alerts and Response (RADAR) is Scotland’s drugs early warning system. Using innovative data collection methods, RADAR validates, assesses and shares information to reduce the risk of drug-related harm by identifying new and emerging harms recommending rapid and targeted interventions and publishing accessible, up-to-date information on services, harms and emerging drug trends. Recognising the importance of RADAR as a key component in harm reduction, Simon Community Scotland has built RADAR alerts into By My Side, an app co‑designed by women who use drugs, ensuring they receive timely and reliable health information about emerging risks.

Case Study: New York City Health Department Misinformation Response Unit

We have looked to global examples to inform our approach. One such example is the New York City Department of Health and Mental Hygiene’s Misinformation Response Unit, which was established as part of their emergency response structure to respond the spread of false health information during the COVID-19 pandemic. The Unit worked at a local level, monitoring social media and engaging directly with community stakeholders to better understand the information landscape and support communities impacted by misinformation. For instance, it actively responded to widespread concerns about the impact of COVID-19 vaccines on fertility. This represents a strategic, evidence-based, and relationship-driven approach to tackling the harms caused by false health information.