Addressing Misinformation in Rural Communities: Snapshot from the KFF Health Misinformation Tracking Poll Pilot

Why Rural Adults?

Understanding beliefs, attitudes, and information gaps that may be associated with health behaviors and decisions can provide important insights for those working to promote positive health outcomes in different communities. Adults in rural communities are more likely to be older, White, and have lower levels of educational attainment than U.S. adults in suburban and urban communities. Additionally, rural adults are more likely to identify with the Republican party than urban adults. The KFF Health Misinformation Tracking Poll Pilot has found that each of these indicators is correlated with being more likely to say that items of health misinformation items in this survey are “definitely” or “probably true.” Previously, the KFF COVID-19 Vaccine Monitor consistently found that U.S. adults in rural areas were less likely than those living in urban or suburban areas to say they were vaccinated or intended to get vaccinated against COVID-19. Other studies found that, on the county level, lower rates of COVID-19 vaccinations were associated with capacity problems at rural hospitals. Understanding and addressing information needs in rural communities is one component of promoting public health and hopefully improving outcomes in future public health emergencies.

Key Takeaways for the Field

• Large shares of adults in rural communities in the U.S. have been exposed to pieces of health information, but most are not completely bought in. A majority of rural adults say that each of the items of misinformation surveyed are “probably true” or “probably false.” Few – about one in five or fewer – say that any item is “definitely true.” On the other hand, across all items, about one-third or fewer correctly say that each is “definitely false.” With many rural adults landing in the “muddled middle” – believing the items were either “probably true” or “probably false” – there is an opportunity to address information gaps through channels that adults in rural communities regularly seek out or trust most.
• Addressing misinformation about gun violence among rural residents is of particular importance given high rates of gun ownership in rural communities. A majority of rural residents say they or someone in their household is a gun owner compared to about three in ten urban residents. Rural residents are also more likely than their urban counterparts to say the false claim that “armed school police guards have been proven to prevent school shootings” (73% among rural adults v. 56% among urban residents) and the claim that “people who have a firearm in their home are less likely to be killed by a gun than those who do not have a firearm” are definitely or probably true (50% vs. 40%). Rural gun owners and those who live in households with gun owners stand out when compared their counterparts in suburban and urban areas as being most likely to say that it is true that “people who have a firearm in their home are less likely to be killed by a gun than those who do not have a firearm” are definitely or probably true.
• Local news sources may be particularly well-positioned to address health misinformation among rural residents. Among the news sources included in the survey, rural adults are most likely to report regularly watching their local TV news station and national news networks to keep up-to-date. Half of adults living in rural areas also say they read their local newspapers regularly, compared to about a third of suburban adults and four in ten urban adults. Along with being among the most frequently used sources, local TV news stations, local papers and national network news are also the most trusted traditional media sources of health information for rural communities.
• Rural adults are about ten percentage points less likely than urban adults to say they regularly use social media to keep up-to-date with the news or to access health advice or information. Nonetheless, though a large share of rural adults say they regularly use Facebook (72%) and YouTube (60%), only about four in ten say they would trust health information they came across on these platforms at least “a little,” with one in ten or fewer saying they would have “a lot” of trust.
• Similar to adults overall, doctors are key messengers of health issues with more than nine in ten adults in rural communities saying they trust their own doctor to give the right recommendations. Rural adults are much more trusting of their own doctor compared to government sources on health recommendations, though most rural residents say they have at least a fair amount of trust in the CDC, the FDA, and in their local public health officials. Only about a third express trust in the Biden Administration to make the right recommendation on health issues. As the beginnings of the 2024 Presidential election campaigns start to take shape, about half of rural residents have at least a fair amount of trust in former President Donald Trump to make the right recommendations on health issues.

Exposure to and Belief in Health Misinformation

While notable shares of rural adults are exposed to health-related misinformation, fewer are buying into specific false claims about COVID-19, reproductive health, and firearm violence and safety examined in the KFF Health Misinformation Tracking Poll Pilot. The survey first asks respondents if they have heard or read specific claims of health misinformation. Then, regardless of whether they have heard or read specific items of misinformation, the survey asks respondents whether they think each claim is definitely true, probably true, probably false, or definitely false.

Between four in ten and seven in ten rural adults have heard each of the items of health misinformation included in the survey. The most commonly heard items among rural adults are that “COVID-19 vaccines have caused thousands of sudden deaths in otherwise healthy people,” “the measles, mumps, rubella vaccines (MMR) have been proven to cause autism in children,” “armed school police guards have been proven to prevent school shootings,” and “most gun homicides in the U.S. are gang-related.”

When it comes to the verity of the statements, small shares of rural adults (fewer than 11%) say that false claims about COVID-19, vaccines, and reproductive health are “definitely true.” A slightly larger share, about two in ten, of rural adults say false claims related to firearms and gun safety are definitely true. However, between five percent and 35% reject these misinformation items as “definitely false.” Overall, most rural adults are in a larger middle group that express some uncertainty, saying these false claims are “probably true” or “probably false.”

For most of the misinformation items included in the survey, between one-quarter and half of rural adults say they are “definitely true” or “probably true,” while one item garners 73% of rural adults saying it is true (“Armed school police guards have been proven to prevent school shootings.”) Combining these measures, smaller shares of rural adults (between 18% and 44%) both have heard each claim and believe it is probably or definitely true.

Most rural adults express uncertainty about the truthfulness of the false claims tested in the survey, with a majority saying each is either “probably true” or “probably false.” Small shares – about one-third or fewer – recognize any of the claims as “definitely false,” and about one in five or fewer say that any of these claims are “definitely true.”

Notably, nearly three-fourths of rural adults say that the false claim that “armed school police guards have been proven to prevent school shootings” is “definitely” or “probably true,” including one in five who say this is “definitely true.” Further, half of rural adults say it is probably or definitely true that “people who have firearms at home are less likely to be killed by a gun than people who do not have a firearm,” including one in five who say this is “definitely true.” Rural adults are more likely than urban adults to say both of these falsehoods are true, which may be related to the larger share of gun households in rural communities. The survey finds that a majority of rural adults say they or someone in their household is a gunowner (55%), compared to fewer suburbanites and urban residents (42% and 28% respectively).

Gun owners overall are more likely than those who do not own a gun to say each of the firearm-related pieces of misinformation are true, a finding consistent with studies showing that gun owners feel safer with a gun in their household than they would without it. However, even among gun owners and those who live in households with gun owners, those who live in rural areas stand out as being even more likely than those living in suburban and urban areas to believe that people who have firearms at home are less likely to be killed by a gun than people who do not have a firearm (two-thirds of rural adults in a gun-owning household say this is probably or definitely true, compared to fewer than half of urban and suburban adults in gun-owning households).

Media Consumption and Trust

Consumption of News, Social Media, and Health Information

A majority of rural adults say they regularly consume news from their local TV news station (59%) and national news networks such as ABC, CBS, or NBC (55%). Half say they read their local newspapers regularly, and 45% consume news from Fox News and digital news aggregators. Fewer regularly watch, listen to, or read MSNBC (35%), CNN (33%), NPR (26%), New York Times (18%), the Wall Street Journal (14%), Newsmax (12%) and OANN (6%).

The most used social media platforms among rural adults are Facebook and YouTube, with seven in ten and six in ten saying they use these platforms at least once per week respectively. Fewer use TikTok (33%), Instagram (28%), Snapchat (20%), Reddit (13%), Twitter (12%), or WhatsApp (6%) at least weekly. The distribution of social media platforms used in rural communities likely reflects the fact that they are older on average than urban or suburban communities.

When it comes to how rural adults engage with social media, half say they use social media at least once per week to keep up to date on news and current events. About one-fourth say they use social media for news and current events once a month or occasionally, and one in five say they never use social media for this purpose. A majority of rural adults say they use social media for health information and advice at least occasionally, though few (20%) use it this way at least once per week. Forty-five percent of rural adults say they “never” use social media for health advice.

Trust in Sources of Information

When it comes to sources of health recommendations, rural adults are at least twice as likely to trust their own doctors a great deal than the advice of government sources. More than half (56%) of rural adults say they trust their own doctor to make the right recommendations about health “a great deal” compared to about one in five or fewer who trust the recommendations from the CDC (21%), the FDA (17%) and their state and local public health officials (8%) “a great deal.” However, majorities trust each of these government sources at least “a fair amount.”

Reflecting the partisanship of adults in rural communities, rural adults are least trusting of the health recommendations from the Biden administration, with one-third (35%) of rural adults saying they trust the Biden administration, including just 8% who say they trust the Administration “a great deal.” An additional third (36%) say they do not trust the health recommendations from the Biden administration “at all.” Rural adults are split in their trust of former President Donald Trump’s recommendations, as one-fourth say they trust Trump to make the right recommendations when it comes to health issues “a great deal,” and a similar share (28%) say they do not trust him “at all.”

There are a range of news sources and platforms that rural adults find at least somewhat trustworthy when it comes to health information. A large majority say they would trust health information at least a little if it was reported by their local TV news, local newspaper, and network news. A smaller majority say they would trust information reported by digital or online news aggregators, Fox News, CNN, and MSNBC. Although fewer than three in ten say they would trust each of these sources “a lot,” this basis of trust can be used to address misinformation among rural communities.

One in ten or fewer say that they would have “a lot of trust” in information related to health reported on social media platforms.