Health Communication

ISSN: 1041-0236 (Print) 1532-7027 (Online) Journal homepage: http://www.tandfonline.com/loi/hhth20

When Information from Public Health Officials

is Untrustworthy: The Use of Online News,
Interpersonal Networks, and Social Media during
the MERS Outbreak in South Korea

Kyungeun Jang & Young Min Baek

To cite this article: Kyungeun Jang & Young Min Baek (2018): When Information from
Public Health Officials is Untrustworthy: The Use of Online News, Interpersonal Networks,
and Social Media during the MERS Outbreak in South Korea, Health Communication, DOI:
10.1080/10410236.2018.1449552

To link to this article: https://doi.org/10.1080/10410236.2018.1449552

Published online: 20 Mar 2018.

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HEALTH COMMUNICATION
https://doi.org/10.1080/10410236.2018.1449552

When Information from Public Health Officials is Untrustworthy: The Use of Online
News, Interpersonal Networks, and Social Media during the MERS Outbreak in South
Korea
Kyungeun Janga and Young Min Baekb
a
Graduate School of Communication and Arts, Yonsei University; bCollege of Communication, Yonsei University

ABSTRACT
Public health officials (PHOs) are responsible for providing trustworthy information during a
public health crisis; however, there is little research on how the public behaves when their
expectations for such information are violated. Drawing on media dependency theory and source
credibility research as our primary theoretical framework, we tested how credibility of information
from PHOs is associated with people’s reliance on a particular communication channel in the
context of the 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea. Using
nationally representative data (N = 1036) collected during the MERS outbreak, we found that less
credible information from PHOs led to more frequent use of online news, interpersonal networks,
and social media for acquiring MERS-related information. However, credibility of information from
PHOs was not associated with the use of television news or print newspapers. The theoretical and
practical implications of our results on communication channels usage are discussed.

A public health crisis, defined as the outbreak of a spe-
cific disease or an upsurge in health risks due to environ-
mental hazards or lifestyle factors (World Health
Organization, 2013), typically involves high levels of
uncertainty among the general public (Reynolds &
Seeger, 2005). Accordingly, facing a public health crisis
requires information on the nature, severity, and relevant
guidelines on how to avoid exposure or respond to
ongoing risks (Reynolds & Seeger, 2005). Public health
officials (PHOs), as institutionalized communication
sources, are key actors responsible for communicating
such information and fostering an effective response in
the general public (Covello, McCallum, & Pavlova, 2012).
By facilitating the public’s awareness of the severity of the
crisis and their ability to make informed decisions, infor-
mation from PHOs plays a central role during public
health crises. In this regard, previous research has reached
a consensus that PHOs should provide trustworthy infor-
mation in a timely and transparent manner (Covello
et al., 2012; Reynolds & Seeger, 2005) so that the public
can trust and make the best use of the information given
to them in order to manage uncertainty and respond to
the crisis (Hyer & Covello, 2005; Johnson & Slovic, 2015).
Most previous research has focused on the perspective
of information providers (i.e., PHOs), which has caused
an important question to go largely unanswered: if infor-
mation receivers (i.e., the general public) perceive the
information provided by PHOs as untrustworthy during
a public health crisis, how do the public obtain the infor-
mation they desire? Unfortunately, crisis information
delivered by public authorities often fails to meet the
public’s expectations. Particularly, laypeople often report
that they feel frustrated with PHO-delivered information,
finding it inaccurate, delayed, or distorted; they also often
perceive that such officials are not interested in their
concerns (Covello, von Winterfeldt, & Slovic, 1987;
Sandman & Lanard, 2005). In this context, media emerges
as a critical communication channel that might fill the
gaps in desired information (Covello et al., 1987; Hyer &
Covello, 2005).
Moreover, with advances in communication technologies,
the communication channels people utilize during a public
health crisis have changed. Past research has shown that
communication channels such as traditional news media and
interpersonal channels were the predominant sources of
information in a public health crisis (Spence, Lachlan,
Burke, & Seeger, 2007a), whereas more recent studies have
shown that online news or social media are now the favored
channels during a crisis (Liu, Fraustino, & Jin, 2016). As the
range of media channels for acquiring information broadens,
people no longer need to rely on a single official source during
a public health crisis (Sutton, Palen, & Shklovski, 2008).
Despite these changes, there are few studies investigating
how the credibility of information from PHOs is associated
with people’s use of various types of communication channel
during a public health crisis. Drawing upon media

CONTACT Young Min Baek ymbaek@yonsei.ac.kr College of Communication, Yonsei University, 50 Yonsei-ro Seodaemun-gu, Seoul 03744, South Korea.
© 2018 Taylor & Francis Group, LLC
2 K. JANG AND Y. M. BAEK
dependency theory and source credibility research, we exam-
ine how the perceived credibility of information from PHOs
can lead to people’s reliance on a variety of communication
channels during the Middle East Respiratory Syndrome cor-
onavirus (MERS-CoV; hereafter MERS) outbreak in South
Korea in 2015.
Study context: The 2015 MERS outbreak in South
Korea
MERS is an infectious disease causing severe acute respiratory
illness with symptoms of fever, cough, and shortness of breath
and a mortality rate of about 36% (World Health
Organization, 2015). In early 2015, reports on the MERS
were confined to the Arabian Peninsula. However, in May
2015, the first case of MERS infection was reported in South
Korea, after which the number of infected cases quickly esca-
lated to around 186. Of these, 38 cases died. Furthermore,
approximately 3,000 schools closed and roughly 17,000 indi-
viduals were quarantined (Korea Centers for Disease Control
and Prevention, 2015). In the initial stage of the outbreak, the
Korea Centers for Disease Control and Prevention announced
that the MERS would not spread widely, meaning that the
public did not need to fear the disease unless they had been
directly exposed to an infected person. However, the MERS
spread rapidly, and the news media reported an upsurge of
infected cases within a few days. As the MERS outbreak
became a nationwide topic of interest, Koreans sought the
information on avoiding exposure to infected cases, such as
the hospital names or locations where (potentially) infected
people were cared for or quarantined. This information, how-
ever, was withheld by PHOs.
During this period of information withholding, people
began seeking and sharing information on the perceived
locations of MERS patients. Specifically, such information
circulated rapidly via word of mouth through Facebook and
KakaoTalk (a popular Korean mobile instant messaging
application) as well as interpersonal conversations in offline
settings. Although PHOs have not disclosed this informa-
tion to the public, the list of MERS-affected hospitals or
communities was easily accessible through both social
media and interpersonal channels. Even after PHOs
decided to publicize the information, social media and
interpersonal channels continued as the main information
channels for most Koreans. Besides updates on the number
of MERS infectors and MERS-affected areas, a wide range
of MERS-related information and warnings (e.g., medical
knowledge about the disease and advice on preventing the
diffusion of MERS) were shared via both online commu-
nication channels and interpersonal networks during the
outbreak.
In sum, the 2015 MERS outbreak in South Korea has two
important characteristics: (1) information from PHOs was
neither reliable nor sufficient to meet the general public’s
information needs, and (2) information on the outbreak was
circulated extensively through both online and offline social
networks. These characteristics suggest that the perceived
credibility of information from PHOs might be related to a
reliance on particular communication channels as alternative
sources of information. This study aims to explain and test
this possibility based on media dependency theory and source
credibility research.
Dependence on media, source credibility, and
selective media exposure
Media dependency theory is an attempt to explain how and
why people have become dependent upon media from an
ecological perspective, viewing media use and its effects as
the result of an interplay between audiences, media, and
society (Ball-Rokeach, 1985; Ball-Rokeach & DeFleur, 1976).
Based on the assumption that media use is goal-directed
behavior, dependency can be defined as “a relationship in
which the satisfaction of needs or the attainment of goals by
one party is contingent upon the resources of another party”
(Ball-Rokeach & DeFleur, 1976, p. 6). Specifically, focusing on
the correspondence between people’s information needs and
the capacity of a media system to collect and deliver informa-
tion, media dependency theory suggests that information
need is a major reason that individuals rely on media.
Accordingly, people’s dependence on media information
resources increases in the presence of ambiguity (Ball-
Rokeach & DeFleur, 1976).
Media dependency theory notes that people or societies
experience ambiguity when information is insufficient or con-
flicting. Ambiguity tends to escalate when threats (e.g., natural
disasters or socio-political changes) arise in the surrounding
environment, which causes people to become more dependent
on media (Ball-Rokeach & DeFleur, 1976, p. 9). The ambi-
guity in these situations can be resolved when media collect
and deliver information that can help define the ongoing
situation and promote behavior to avert threats. However,
ambiguity can increase further when the initial information
source provides insufficient information (Ball-Rokeach, 1973;
Ball-Rokeach & DeFleur, 1976). High ambiguity can give rise
to further attempts to seek information and tends to be
resolved through heavier exposure to available information
channels (Ball-Rokeach, 1973; Ball-Rokeach & DeFleur, 1976).
From a media dependency perspective, Tai and Sun (2007)
argued that the Chinese government’s information control
during the SARS epidemic in China led Chinese people to
rely more on the Internet and short message services to
resolve ambiguity.
Media dependency theory is a good starting point to
explain how information needs and ambiguity experienced
by Koreans during the 2015 MERS outbreak encouraged the
use of various communication channels. Meanwhile, to
empirically examine why Koreans relied on particular com-
munication channels such as online and offline social net-
works, it is necessary to highlight what makes the Korean
MERS outbreak such a unique case—namely, the fact that a
large amount of the ambiguity was created and controlled by
the core information source (i.e., PHOs). Thus, source cred-
ibility could be a major factor contributing to the intense use
of particular communication channels during the outbreak. In
other words, the extent to which individuals perceive infor-
mation from PHOs as credible might influence the degree and
type of communication channels they relied on.

Credibility, in general, is related with trustworthiness, fair-
ness, completeness, usefulness, and accuracy (Metzger,
Flanagin, Eyal, Lemus, & McCann, 2003). Early communica-
tion research defined source credibility as a receiver’s judg-
ments about an information provider’s expertise and
trustworthiness (Hovland, Janis, & Kelley, 1953, p. 21), and
examined how it affects message persuasiveness. Later, the
definition of “source” was extended to cover organizations
(e.g., the government), the communication channels convey-
ing the information, and the information issued by a particu-
lar communication channel (Metzger et al., 2003).
Subsequently, a large volume of research has examined how
source credibility is related to one’s reliance on specific com-
munication channels. The general conclusion is that source
credibility influences the particular communication channel
that one relies on (Johnson & Kaye, 1998; Tsfati & Cappella,
2003); in other words, people tend to selectively expose them-
selves to specific communication resources that they trust
(Tsfati & Cappella, 2003). For example, people consume
mainstream media because the news information offered by
that media is perceived as credible (Tsfati & Cappella, 2003).
Likewise, individuals perceiving political information offered
by online newspapers and online news magazines as credible
are more likely to acquire political information from those
channels (Johnson & Kaye, 1998). One interesting finding in
Tsfati and Cappella’s (2003) study is that people perceiving
low source credibility (e.g., perceiving journalists in main-
stream media as unfair and biased) are more likely to seek
alternative communication channels, such as political talk
radio or the Internet, to obtain news information they desire.
These findings indicate that when source credibility is
doubted, people seek out alternative sources that are expected
to fulfill their information needs.
Applying media dependency theory and source credibility
research to Korea’s MERS outbreak, it is theoretically plausi-
ble that individuals perceiving information from PHOs as low
in credibility were more likely to rely on communication
channels that could resolve their ambiguity. Such communi-
cation channels would not be those heavily contingent on the
initial source (i.e., PHOs), but rather channels offering diver-
sity in sources and content such as online news, interpersonal
networks, and social media. To develop hypotheses on the
relationships between source credibility and the use of specific
communication channels in the MERS outbreak context, it is
necessary to elucidate the potential of each channel for ful-
filling people’s information needs in a public health crisis.
This potential is discussed in the following sections.
Traditional news media
Traditional news media, such as television news and print
newspapers, have been suggested to be the primary channels
for both the public and PHOs during crises (Reynolds &
Seeger, 2005). These platforms serve a surveillance function,
offering news programs or articles that inform people of the
events occurring in their society (Shoemaker, 1996).
Accordingly, television news and newspapers are expected to
deliver immediate reports during a public health crisis, and
exposure to these channels is the most common gateway for
HEALTH COMMUNICATION 3
the public to receive crisis information (Reynolds & Seeger,
2005). However, in the pursuit of objectivity, reports from
unofficial or unidentified sources tend to be filtered out of
television news and print newspapers, which might hinder
viewpoint diversity. Traditional media instead generally rely
on press releases or reports from public officials (Shoemaker,
Eichholz, Kim, & Wrigley, 2001). Indeed, traditional media
are regarded as “major transmitters” of PHOs’ voice in a
public health crisis (Chew & Eysenbach, 2010, p. 1).
However, the limited diversity of content and sources in
these channels often causes individuals to perceive them as
having less of a potential to deliver desired information (Chan
& Leung, 2005). Based on these characteristics of traditional
media, the following research questions are presented. Note
that “source credibility” in the present study refers to the
degree to which individuals perceived the information from
PHOs during the MERS outbreak as trustworthy and useful.
RQ1: During Korea’s MERS outbreak, to what extent was the
credibility of information from PHOs associated with the use
of television news for information acquisition?
RQ2: During Korea’s MERS outbreak, to what extent was the
credibility of information from PHOs associated with the use
of print newspapers for information acquisition?
Online news
Online news can be a favorable environment for fulfilling
one’s information needs (Deuze, 2003; Tewksbury, 2005).
There are thousands of online news services, including
online versions of television news or print newspapers as
well as newspapers published online only (Chung, Nam, &
Stefanone, 2012). Tewksbury (2005) argues that the variety
of content options derived from the countless number of
online news outlets allows individuals to use those chan-
nels “in [their] pursuit of focused interests and needs” (p.
335). In other words, through online news outlets, people
can efficiently seek out in-depth and specified information
(Tewksbury, 2005). In addition, as online news incorpo-
rates interactivity, viewers can navigate to other informa-
tion sites by clicking hyperlinks and obtain further
information on the content via feedback or comments
from other viewers (Deuze, 2003). Given these benefits,
searching news articles on the Internet is nowadays ubi-
quitous, particularly in crisis situations. For example, a
survey conducted during the 2015 MERS outbreak in
South Korea revealed that 94.7% of respondents used
online news to seek information concerning the outbreak,
which outweighed the media ratings of broadcast television
news (93.1%) and print newspapers (49.7%; Kim & Yang,
2015). Furthermore, Google News searches on “Zika” in
the United States peaked when it was not a major topic of
interest in the mainstream news media in the incipient
period of the epidemics (Southwell, Dolina, Jimenez-
Magdaleno, Squiers, & Kelly, 2016). Accordingly, the fol-
lowing hypothesis is proposed.
4 K. JANG AND Y. M. BAEK
H1: During Korea’s MERS outbreak, the lower the perceived
credibility of information from PHOs, the more likely people
were to utilize online news for information acquisition.
Interpersonal networks
Information obtained through interpersonal networks during
a crisis plays a critical role in informing others, especially
people who have not yet been exposed to other channels or
who have insufficient information about a current crisis situa-
tion. Particularly, it helps people recognize the severity of a
risk and appropriately respond to the situation (Spence et al.,
2007a; Spence, Lachlan, & Griffin, 2007b). One distinctive
feature of interpersonal communication during a crisis is
that it can offer unique and unfiltered information derived
from laypeople’s personal observations and experiences,
which would otherwise have been filtered out, or at least not
be made readily available, on other channels (Sutton et al.,
2008). Specifically, individuals (in)directly affected by a crisis
might provide vivid and detailed accounts regarding various
aspects of the crisis event, and the circulation and further
discussion of this information can be an opportunity for
other individuals to better identify the ongoing situation
(Spence et al., 2007b; Sutton et al., 2008). In this sense, it is
suggested that interpersonal channels serve as a means of
backchannel communication—unofficial or irregular commu-
nication circulated by grassroots—that can offer additional
information beyond that offered by official and formal chan-
nels (Sutton et al., 2008). Accordingly, the following hypoth-
esis is suggested.
H2: During Korea’s MERS outbreak, the lower the perceived
credibility of information from PHOs, the more likely people
were to utilize interpersonal channels for information
acquisition.
Social media
With the aid of technological advances, information circu-
lated via interpersonal channels has become more visible and
transmittable with social media (Veil, Buehner, & Palenchar,
2011). Social media provide an optimal environment to
create or share information on both a one-to-one and a
one-to-many basis at a rapid pace in a visualized format,
making word-of-mouth news more tangible and interactive
(Liu et al., 2016). Recently, people’s reliance on social media
has become an important part of risk or crisis communica-
tion. For example, during the Haitian Cholera Outbreak in
2010, people posted local incidents on Twitter, even as PHOs
struggled with collecting data and were therefore unable to
provide official information to the public (Chunara,
Andrews, & Brownstein, 2012). In addition, during the
2007 California wildfires, residents in the affected commu-
nities reported on the movement of the fire on Twitter
before journalists reported the event, and exchanged further
information about road closures and established shelter loca-
tions on community forums (Sutton et al., 2008).
These cases indicate that social media play a vital role
during crises, serving as both a firsthand information chan-
nel on the scene as well as a supplementary channel offer-
ing specific information demanded by people directly
involved in the crisis. Interviews with residents affected by
the California wildfires revealed that social media filled a
notable communication gap, with information from public
officials being deemed as inaccurate and slow (Sutton et al.,
2008). Moreover, several studies have indicated that people
perceive information presented on social media during a
crisis as reliable and authoritative, given that it presents
viable information needed for an appropriate response
(Sutton et al., 2008; Veil et al., 2011). Thus, we expect a
negative relationship between source credibility and social
media use in the context of the Korean MERS outbreak.
H3: During Korea’s MERS outbreak, the lower the perceived
credibility of information from PHOs, the more likely people
were to utilize social media for information acquisition.
Method
Data
A web-based survey was conducted in South Korea
between June 15 and June 21, 2015, in the midst of the
MERS outbreak. The survey was administered by a pro-
fessional survey agency with approximately 300,000 online
panel members. The panel members consisted of indivi-
duals who represent the Korean population in terms of
gender, age, education, and income, and who agreed to
voluntarily respond to a survey when invited to through
email. To recruit the sample of this study, a computer
algorithm randomly selected 11,157 panel members and
sent out email invitations to them. Of the 11,157 who
received email invitations, 1,744 individuals visited the
study website. Because a quota sampling method in
terms of gender, age, and residential area was applied,
705 individuals who visited the study website but did
not meet the assigned quota did not ultimately participate
in this study. Among the 1,039 individuals who did par-
ticipate, 1,036 completed the survey. Thus, the final sam-
ple size of this study was 1,036. Respondents received a
reward worth around two US dollars for their
participation.
The average age of respondents was 42.8 (SD = 12.7,
Mdn = 42, range: 20–69), with the percentage of respon-
dents in their 20s, 30s, 40s, 50s, and 60s being 17.6%,
25.3%, 25.0%, 19.0%, and 13.1%, respectively. Among all
respondents, 46.1% were female and 66.2% were married.
Approximately 62.4% of respondents had a college degree,
23.4% had graduated high school, and 1.3% had a middle
school education or lower. The median monthly household
income level was 3.00–3.99 million Korean won (US$3,600–
4,800). Of the 1,036 respondents, 262 (25.3%) reported that
their community had been affected by MERS (i.e., con-
tained hospitals where MERS-infected individuals had vis-
ited or were hospitalized).
 HEALTH COMMUNICATION 5

Measures for whether a respondent resided in a community affected by

Communication channel use for information acquisition
The use of each communication channel for MERS-related
information acquisition was measured by asking the following
question: “Since the outbreak of MERS in South Korea, how
many times have you noticed MERS-related information
through [broadcast television news/cable television news/
print newspapers/online news/friends and family/Facebook/
KakaoTalk]?” This same question was repeated for each of
the seven channels. Here, the use of broadcast television news
and cable television news represented the use of “television
news,” while the use of Facebook and KakaoTalk represents
the use of “social media.” The measures were assessed on an
8-point scale (1 = “never,” 2 = “1 to 5 times,” 3 = “6 to 10
times,” 4 = “11 to 15 times,” 5 = “16 to 20 times,” 6 = “21 to
25 times,” 7 = “26 to 30 times,” and 8 = “more than 31
times”). Respondents chose online news as the most fre-
quently used platform (M = 5.48, SD = 2.26), followed by
broadcast television news (M = 5.31, SD = 2.25), cable televi-
sion news (M = 4.63, SD = 2.37), friends and family (M = 3.77,
SD = 1.91), print newspaper (M = 3.45, SD = 2.43), KakaoTalk
(M = 2.52, SD = 1.32), and Facebook (M = 2.23, SD = 1.48).
Source credibility
Previous studies have highlighted that providing trustworthy
and useful information needed for appropriate responses to a
crisis are essential for building a trusting relationship between
the public and PHOs (Hyer & Covello, 2005). Accordingly,
source credibility was measured by asking respondents to
indicate the degree to which they agreed with the following
two statements: “I trust what PHOs have addressed about the
MERS outbreak,” and “I believe MERS-related information
presented by PHOs is useful.” Both items were assessed on a
7-point scale (1 = “strongly disagree”; 7 = “strongly agree”).
The two items were highly correlated (r = .83, p < .001) and
averaged to construct a single scale (M = 2.87, SD = 1.48).
Control variables
In the analysis, we controlled for demographic variables
including gender, age, education (1 = “elementary school or
lower”; 5 = “graduate school or higher”), monthly household
income (1 = “500,000 Korean won or below”; 10 = “8 million
Korean won or above”), and marital status. We also controlled
the MERS outbreak (1 = “yes”; 0 = “no”).
In addition, factors that might influence health informa-
tion seeking or communication channel use behavior, such as
subjective health status and health information efficacy, were
controlled for. Subjective health status was assessed on a 5-
point scale (1 = “very poor”; 5 = “very good”; M = 3.51,
SD = 0.79). Health information efficacy—namely, the degree
to which one is confident about searching health information
—can influence the frequency of using communication chan-
nels in a broad range of health-related contexts (Basu &
Dutta, 2008). This construct was assessed via five items
adopted from Kim et al.’s (2015) study (e.g., “I am confident
in searching for health information in which I am interested”;
“I am confident in navigating the Internet to search desired
health information”). All five items were assessed on a 7-point
scale (1 = “not confident at all”; 7 = “very confident”;
Cronbach’s α = .92; M = 4.68, SD = 1.10).
Analyses
A series of hierarchical regression analyses were conducted.
The control variables were entered first, followed by the pre-
dictor variable, source credibility. We tested the same model,
respectively, for each of the seven communication channels.
Table 1 shows the results of the hierarchical regression
analyses.
Results
With regard to RQ1, the results revealed that credibility of
information from PHOs was not associated with the use of
either broadcast television news (β = –.05, p = n.s.) or cable
television news (β = –.01, p = n.s.). As for RQ2, the results
revealed that source credibility was not associated with the use
of print newspapers (β = .03, p = n.s.).
Regarding H1, we found a negative relationship between
source credibility and online news use (β = –.19, p < .001).
This indicates that the lower the perceived credibility of
information from PHOs, the more frequently participants
sought crisis-related information from online news; thus, H1
was supported. H2 was also supported, as evidenced by the
negative relationship between source credibility and the use of

Table 1. Hierarchical regression analyses predicting communication channel use during the Korean MERS outbreak.
Broadcast news Cable news Print newspapers Online news Friends and family Face-book Kakao-talk
Control variables
Gender (1 = female) −.01 −.02 −.10** < .01 .08* −.02 <.01
Age .15*** .17*** .11** −.10* −.14*** −.24*** −.06
Education −.01 −.02 <.01 .05 −.02 .04 .06
Income .07* .05 .12*** .08* .10** .01 .06
Marital status (1 = married) .12** .03 <.01 .09* .04 −.06 .03
Affected-community (1 = affected) −.01 <.01 .03 −.02 .08* .05 .07*
Subjective health <.01 −.03 .01 −.05 <.01 .05 .01
Information efficacy .15*** .15*** .09** .24*** .17*** .12*** .12**
Incremental R2 (%) 10.60*** 7.47*** 5.97*** 8.33*** 7.33*** 10.10*** 3.64***
Predictor variable
Source credibility −.05 −.01 .03 −.19*** −.10** −.08* −.08**
Incremental R2 (%) .20 .02 .07 3.13*** .85** .53* .53*
Total R2 (%) 10.79*** 7.49*** 6.04*** 11.46*** 8.17*** 10.64*** 4.17***
*p < .05, **p < .01, ***p < .001. N = 1036. Entries are final standardized regression coefficients. Detailed statistical information on each variable, including the
correlations between variables, can be obtained by contacting the authors.
6 K. JANG AND Y. M. BAEK
interpersonal channels for information acquisition during the
MERS outbreak (β = –.10, p = .002). Regarding H3, our results
revealed that source credibility was negatively associated with
the use of Facebook (β = –.08, p = .01) and KakaoTalk
(β = –.08, p = .01). Therefore, H3 was supported. These results
imply that the lower the perceived credibility of the informa-
tion offered by PHOs during a public health crisis, the more
frequently individuals rely on social media to obtain desired
information.
Discussion
Through observing people’s information searching endeavors
during the 2015 Korea MERS outbreak, we attempted to
explain why people heavily relied on online media and offline
social networks when information from PHOs was perceived
as untrustworthy. Using media dependency theory and source
credibility research as the primary theoretical framework, we
empirically examined how credibility of information from
PHOs is associated with the use of particular communication
channels among a wide array of alternatives. Our major find-
ing was that lower perceived credibility of information from
PHOs was associated with a greater tendency to use online
news, interpersonal networks, and social media for acquiring
MERS-related information. As anticipated by media depen-
dency theory and source credibility research, our findings
indicate that people demand information as ambiguity
increases, but when the credibility of their primary informa-
tion sources is doubted, they tend to turn to alternative com-
munication channels to resolve the ambiguity.
It is important to note that the level of credibility of
information from PHOs was not associated with the use of
television news or print newspapers in the present study.
Interestingly, as indicated by the descriptive statistics, the
frequency of use of television news or print newspapers for
MERS-related information acquisition was not so low when
compared to that of online news, interpersonal networks, or
social media use. Such findings imply that, while television
news and print newspapers are familiar channels that indivi-
duals appear to habitually access to obtain general informa-
tion regarding a public health crisis, people do not appear to
expect them to offer information beyond what PHOs report.
Therefore, when the credibility of information from PHOs is
perceived as poor, people seek alternative communication
channels that can deliver information that PHOs fail to
address. Online news, for example, offers considerable diver-
sity in terms of content and sources and is updated in real
time (Nguyen, 2010). Additionally, both online and offline
social networks provide unique and unfiltered information
from laypeople’s personal observations and experiences
(Sutton et al., 2008). Such alternative communication chan-
nels would be perceived as advantageous for individuals who
are seeking more detailed and desired information when
information from PHOs is perceived as unhelpful or untrust-
worthy (Spence et al., 2007b; Sutton et al., 2008).
Furthermore, the effect of source credibility should be
highlighted in comparison with those of health status and
information efficacy, which were included as control variables
in our study. Poor health status (Cotten & Gupta, 2004) and a
strong sense of information efficacy (Basu & Dutta, 2008)
have been suggested as significant antecedents of engagement
in health-information seeking behavior in more general con-
texts. However, our results show that subjective health status
was not associated with the use of any type of information
channel, whereas information efficacy was positively asso-
ciated with the use of all types of channel. In other words,
both subjective health status and information efficacy failed to
explain people’s use of a particular information channel in
this study. Given that public health crisis situations differ
from general health contexts because of their characteristic
urgency and ambiguity, the role of source credibility should
be considered and further examined in future studies as a key
motivation for choosing specific information channels.
Our findings have meaningful implications regarding indi-
viduals’ active and autonomous roles in searching for infor-
mation crucial to their own health and lives. It is difficult for
PHOs to always release all of the required information during
a crisis (Covello et al., 1987). As such, it is heartening to see
that people will seek out desired information via alternative
communication channels such as online news, interpersonal
networks, and social media when they find the information
from PHOs insufficient or untrustworthy. Such active infor-
mation seeking behavior might play an important role in
cultivating appropriate risk sensing and responses in a crisis
context, and should urge PHOs and public health profes-
sionals to make stronger efforts to meet the public’s need
for high-quality information (Avery, 2010).
However, it should be noted that when information deliv-
ered by PHOs is perceived as untrustworthy, misleading
information might begin to proliferate among laypeople in
other channels. While some studies have shown that crisis
information circulated through social media is as accurate as
information reported by official sources (e.g., Chunara et al.,
2012), others have reported that social media can be a channel
through which laypeople disseminate misinformation or false
rumors (e.g., Oyeyemi, Gabarron, & Wynn, 2014) and that
online news outlets might deliver inaccurate content for the
sake of immediacy or to grab attention (Thurman, 2008).
Misinformation circulation during a public health crisis can
lead to unnecessary fear and panic among the public and
cause serious conflicts with public health guidelines (Centers
for Disease Control and Prevention, 2012). Given that PHOs
are often frustrated by the uncontrolled spread of misinfor-
mation during crises (Covello et al., 1987), our finding sug-
gests that PHOs must acknowledge that laypeople will become
more vulnerable to misinformation, rumors, or fake news
when the information they deliver is perceived as
untrustworthy.
Our study contributes to communication research by
extending media dependency theory and source credibility
research in the context of a public health crisis. The basic
assumption of media dependency theory is that people
become especially dependent on media to fulfill their infor-
mation needs when threats exist in the environment.
However, media dependency patterns have rarely been exam-
ined in an empirical manner in such a threatening context.
Moreover, most media dependency research has dealt with the
contexts in which people’s desired information is readily

available on diverse communication channels (Tai & Sun,
2007). By identifying people’s media use patterns in a threa-
tening context, particularly in cases where the desired infor-
mation is not offered by core information sources, our study
represents an important addition to the literature.
Another theoretical contribution is reexamination of the
role of PHOs during public health crises in terms of source
credibility and selective media exposure. The primary role of
PHOs during crises is to provide trustworthy information in a
timely and transparent manner (Covello et al., 2012; Reynolds
& Seeger, 2005). However, little has been examined how the
public behave when their expectations concerning credibility
are violated. Utilizing the concept of source credibility and
selective media exposure, we provide empirical evidence that
when information from PHOs is low in credibility, people
increasingly rely on alternative communication channels that
might convey the unofficial reactions of laypeople. However,
reliance on such alternative communication channels can be
problematic in that those channels might prohibit people
from appropriate risk-sensing and/or drive people to ignore
or violate PHOs’ recommendations. Thus, to control the
diffusion of misinformation, PHOs need to disclose trust-
worthy information promptly and preemptively. Practically
put, the “Social Media at CDC” website, run by the United
States Centers for Disease Control and Prevention, might
serve as a helpful guideline (Centers for Disease Control and
Prevention, 2017). The website provides short messages
detailing facts and appropriate responses regarding the cur-
rent public health issues, and lets viewers share the messages
through Twitter or Facebook with one click. As shown on this
website, PHOs’ prompt and preemptive information manage-
ment helps people obtain accurate information and develop
appropriate risk sensing.
Our study suffers from several limitations. First, we used
cross-sectional data, and correlational evidence must not be
taken as causal evidence. Although the correlational findings
are grounded in theoretical explanations derived from pre-
vious research, our findings fail to satisfy methodological
causality criteria. In addition, to assess source credibility, the
present study only employed two items representing the
degree to which respondents perceived information from
PHOs as “trustworthy” and “useful.” Given that source cred-
ibility includes dimensions such as trustworthiness, accuracy,
fairness, usefulness, and completeness of information
(Metzger et al., 2003), our assessment of credibility in this
study was rather limited. Specifically, we focused only on
“trustworthy” and “useful” because they are key factors pro-
moting a trusting relationship between the public and PHOs
during public health crises (Hyer & Covello, 2005; Sandman
& Lanard, 2005). While our credibility measure partially
reflects the concept of source credibility, it is still necessary
to consider that the operationalization of source credibility
varies across researchers and study contexts (Metzger et al.,
2003). Despite the weak content validity, our findings could
help in better understanding and explaining social phenom-
ena in the MERS context. Further, given that the quality of
information circulating online channels is often doubted
(Eysenbach, Powell, Kuss, & Sa, 2002), both the perceived
credibility of communication channels and the actual quality
HEALTH COMMUNICATION 7
of information delivered via these channels might affect the
extent to which one is motivated to use the channel.
Unfortunately, those variables were not seriously dealt with
in this study. We also did not consider the impacts of risk
perception in public health crises. People’s behavior during an
infectious disease outbreak could be associated with perceived
threat (Slovic, 1997) or concerns about health such as suscept-
ibility to the disease (de Zwart et al., 2009). Future research is
encouraged to examine the effects of risk perception when
exploring communication channel usage behavior in the con-
text of public health crises.
Despite these limitations, emphasizing PHOs’ vigilant role
as information providers, our findings demonstrate that com-
munication channels such as online news, social media, and/
or interpersonal networks serve as alternative information
sources when PHOs fail to provide trustworthy information.
Given that such channels have good source and content
diversity, the use of those channels might be beneficial for
individuals who desire further information beyond what is
released by PHOs. Of course, we must note that misinforma-
tion circulated through those channels can have undesirable
consequences. The theoretical and practical implications
found in this study might help scholars and health practi-
tioners better understand the importance of PHOs’ informa-
tion credibility and its influences on people’s communication
behaviors during public health crises.
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