journal of intercultural communication research impact factor

Journal of Intercultural Communication

Subject Area and Category

• Strategy and Management
• Communication
• Cultural Studies
• Gender Studies
• Linguistics and Language
• Public Administration

Taylor and Francis Ltd.

Publication type

Information.

How to publish in this journal

[email protected]

The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values.

The SJR is a size-independent prestige indicator that ranks journals by their 'average prestige per article'. It is based on the idea that 'all citations are not created equal'. SJR is a measure of scientific influence of journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from It measures the scientific influence of the average article in a journal, it expresses how central to the global scientific discussion an average article of the journal is.

Evolution of the number of published documents. All types of documents are considered, including citable and non citable documents.

This indicator counts the number of citations received by documents from a journal and divides them by the total number of documents published in that journal. The chart shows the evolution of the average number of times documents published in a journal in the past two, three and four years have been cited in the current year. The two years line is equivalent to journal impact factor ™ (Thomson Reuters) metric.

Evolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.

Evolution of the number of total citation per document and external citation per document (i.e. journal self-citations removed) received by a journal's published documents during the three previous years. External citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents.

International Collaboration accounts for the articles that have been produced by researchers from several countries. The chart shows the ratio of a journal's documents signed by researchers from more than one country; that is including more than one country address.

Not every article in a journal is considered primary research and therefore "citable", this chart shows the ratio of a journal's articles including substantial research (research articles, conference papers and reviews) in three year windows vs. those documents other than research articles, reviews and conference papers.

Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those not cited during the following year.

Evolution of the percentage of female authors.

Evolution of the number of documents cited by public policy documents according to Overton database.

Evoution of the number of documents related to Sustainable Development Goals defined by United Nations. Available from 2018 onwards.

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Journal of Intercultural Communication (JICC) (ISSN 1404-1634) is an international, peer review, and open-access journal. The goal of the journal is to encourage scholars to publish their experimental and theoretical research and promote research but also Communication, Cultural Studies, Strategy and Management, Education, Linguistics and Language, Gender Studies, and Public Administration in the area of intercultural communication. The journal is an outgrowth of the activities of NIC – the Nordic Network for Intercultural Communication. The great interest shown in the activities of NIC has pointed to a need for more journals employing a peer review procedure within the area of intercultural communication. We hope that by starting this journal, we will be able to encourage more research, facilitate contact between interested researchers, and provide better opportunities for peer-reviewed publication.

• Open Access : This means free for readers, with article processing charges (APC) paid by authors or their institutions
• Publisher : ICR Publications ltd, United Kingdom
• Indexed in:  Scopus , Cnkt.net, EBSCO Education Source, JGATE, IBZ Online, International Bibliography of Social Sciences, Linguistic Bibliography
• Metrics : SJR. Q2
• Evaluated in: CARHUS Plus+ 2018, ERIHPlus
• Rapid Publication: JICC published 4 issues in a year (March, July, September, and November). Initial validation and desk review decisions occur within 21 days of submission; acceptance to publication occurs within 90 days.
• Acceptance rate (2023-01-01 — 2024-04-06): 22%
• Token of appreciation: For their efforts, reviewers who provide timely peer-review reports will receive a discount on the APC of their next publication in JICC. Reviewers are strongly encouraged to endorse the journal at publons.

Current Issue

Upcoming issue.

Vol. 24 No. 1 (2024)

Includes special collections:

-Linking Gender To Creativity: Role of Risk Taking and Support For Creativity Towards Creative Potential of Employees

-I wish that I could have friends: The Intercultural Friendship Experience of Omani Students at US Universities

-Workers’ Perceptions Regarding Approaches To Intercultural Communication In The Workplace: A Study In A South African University

Linking Gender To Creativity: Role of Risk Taking and Support For Creativity Towards Creative Potential of Employees

The interplay of culture mixing aversion and acculturative flourishing: an exploration among mainland chinese sojourners in hong kong, i wish that i could have friends: the intercultural friendship experience of omani students at us universities, skills and strategic planning: unveiling the nexus in smes - a case study, environmental, technical, and resources challenges facing agroforestry: a case of sustainable land management in malaysia, listeners’ engagement and interactivity in news radio twitter in indonesia, mot nini tradition: dialogue with ancestors in noemuti village, the significance of postcolonial studies for the cognitive, socio-affective, and procedural objectives in multicultural foreign language teaching, a corpus-based evaluation of english-mandarin cultural references between fansubbing and official subtitling, developing intercultural competences in the study-abroad programme semester at sea (sas), western balkans: it’s complicated an inter-ethnic communication interdisciplinary examination, the importance of participatory communication in development planning deliberations for agritourism village enhancement, effect of counter-narratives and credibility of sources on emotional response: a study of instagram and whatsapp followers, workers’ perceptions regarding approaches to intercultural communication in the workplace: a study in a south african university, a advancing higher vocational english reading instruction: the development protocol of the intercultural awareness experiential teaching (iaet) model, on ambiguity in the arabic language: scrutinizing translation issues through machine translation from english and french into arabic, the social neuroscience of persuasion approach to the religious intercultural communication: a conceptual evidence from sidhwa’s novel ‘an american brat’, persuasive strategies in email marketing: an analysis of appeal and influence in business communication, online pravda’s communicative intentions regarding the war in ukraine: a cda-based study of the website’s opinion articles, critical discourse analysis of intercultural communication through the lens of multiculturality and interraciality, how do chinese street food youtubers robustly communicate cross-cultural tourism destination, revolutionizing efl instruction: jordanian teachers' perspectives on interactive whiteboards for word identification enhancement, semiotic analysis of sundanese culture spells: exploring its discursive level and cultural connotation, black women’s lived experiences of informal street trading in east london, south africa, analysis of gender discourse bias and gender discrimination in social media: a case study of the tiktok platform, nano-punk and nanotechnology genre in literature: a scientific and cultural analysis of neal stephenson’s the diamond age, elaboration of underpinning methods and data analysis process of directed qualitative content analysis for communication studies, crossing linguistic bridges: unravelling the art of persuasion among albanian writers in greek, efl college programmes in egypt and saudi arabia: advantages and difficulties in intercultural instruction.

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The women’s empowerment model based on cultural literature to realize tourism aware villages in sustainable development.

Journal of Intercultural Communication - Impact Score, Ranking, SJR, h-index, Citescore, Rating, Publisher, ISSN, and Other Important Details

Published By: University of Goteborg

Abbreviation: J. Intercult. Commun.

Impact Score The impact Score or journal impact score (JIS) is equivalent to Impact Factor. The impact factor (IF) or journal impact factor (JIF) of an academic journal is a scientometric index calculated by Clarivate that reflects the yearly mean number of citations of articles published in the last two years in a given journal, as indexed by Clarivate's Web of Science. On the other hand, Impact Score is based on Scopus data.

Important details, about journal of intercultural communication.

Journal of Intercultural Communication is a journal published by University of Goteborg . This journal covers the area[s] related to Cultural Studies, Communication, etc . The coverage history of this journal is as follows: 2011-2022. The rank of this journal is 17309 . This journal's impact score, h-index, and SJR are 0.98, 10, and 0.239, respectively. The ISSN of this journal is/are as follows: 14041634 . The best quartile of Journal of Intercultural Communication is Q2 . This journal has received a total of 50 citations during the last three years (Preceding 2022).

Journal of Intercultural Communication Impact Score 2022-2023

The impact score (IS), also denoted as the Journal impact score (JIS), of an academic journal is a measure of the yearly average number of citations to recent articles published in that journal. It is based on Scopus data.

Prediction of Journal of Intercultural Communication Impact Score 2023

Impact Score 2022 of Journal of Intercultural Communication is 0.98 . If a similar upward trend continues, IS may increase in 2023 as well.

Impact Score Graph

Check below the impact score trends of journal of intercultural communication. this is based on scopus data., journal of intercultural communication h-index.

The h-index of Journal of Intercultural Communication is 10 . By definition of the h-index, this journal has at least 10 published articles with more than 10 citations.

What is h-index?

The h-index (also known as the Hirsch index or Hirsh index) is a scientometric parameter used to evaluate the scientific impact of the publications and journals. It is defined as the maximum value of h such that the given Journal has published at least h papers and each has at least h citations.

Journal of Intercultural Communication ISSN

The International Standard Serial Number (ISSN) of Journal of Intercultural Communication is/are as follows: 14041634 .

The ISSN is a unique 8-digit identifier for a specific publication like Magazine or Journal. The ISSN is used in the postal system and in the publishing world to identify the articles that are published in journals, magazines, newsletters, etc. This is the number assigned to your article by the publisher, and it is the one you will use to reference your article within the library catalogues.

ISSN code (also called as "ISSN structure" or "ISSN syntax") can be expressed as follows: NNNN-NNNC Here, N is in the set {0,1,2,3...,9}, a digit character, and C is in {0,1,2,3,...,9,X}

Journal of Intercultural Communication Ranking and SCImago Journal Rank (SJR)

SCImago Journal Rank is an indicator, which measures the scientific influence of journals. It considers the number of citations received by a journal and the importance of the journals from where these citations come.

Journal of Intercultural Communication Publisher

The publisher of Journal of Intercultural Communication is University of Goteborg . The publishing house of this journal is located in the Sweden . Its coverage history is as follows: 2011-2022 .

Call For Papers (CFPs)

Please check the official website of this journal to find out the complete details and Call For Papers (CFPs).

Abbreviation

The International Organization for Standardization 4 (ISO 4) abbreviation of Journal of Intercultural Communication is J. Intercult. Commun. . ISO 4 is an international standard which defines a uniform and consistent system for the abbreviation of serial publication titles, which are published regularly. The primary use of ISO 4 is to abbreviate or shorten the names of scientific journals using the technique of List of Title Word Abbreviations (LTWA).

As ISO 4 is an international standard, the abbreviation ('J. Intercult. Commun.') can be used for citing, indexing, abstraction, and referencing purposes.

How to publish in Journal of Intercultural Communication

If your area of research or discipline is related to Cultural Studies, Communication, etc. , please check the journal's official website to understand the complete publication process.

Acceptance Rate

• Interest/demand of researchers/scientists for publishing in a specific journal/conference.
• The complexity of the peer review process and timeline.
• Time taken from draft submission to final publication.
• Number of submissions received and acceptance slots
• And Many More.

The simplest way to find out the acceptance rate or rejection rate of a Journal/Conference is to check with the journal's/conference's editorial team through emails or through the official website.

Frequently Asked Questions (FAQ)

What is the impact score of journal of intercultural communication.

The latest impact score of Journal of Intercultural Communication is 0.98. It is computed in the year 2023.

What is the h-index of Journal of Intercultural Communication?

The latest h-index of Journal of Intercultural Communication is 10. It is evaluated in the year 2023.

What is the SCImago Journal Rank (SJR) of Journal of Intercultural Communication?

The latest SCImago Journal Rank (SJR) of Journal of Intercultural Communication is 0.239. It is calculated in the year 2023.

What is the ranking of Journal of Intercultural Communication?

The latest ranking of Journal of Intercultural Communication is 17309. This ranking is among 27955 Journals, Conferences, and Book Series. It is computed in the year 2023.

Who is the publisher of Journal of Intercultural Communication?

Journal of Intercultural Communication is published by University of Goteborg. The publication country of this journal is Sweden.

What is the abbreviation of Journal of Intercultural Communication?

This standard abbreviation of Journal of Intercultural Communication is J. Intercult. Commun..

Is "Journal of Intercultural Communication" a Journal, Conference or Book Series?

Journal of Intercultural Communication is a journal published by University of Goteborg.

What is the scope of Journal of Intercultural Communication?

• Cultural Studies
• Communication

For detailed scope of Journal of Intercultural Communication, check the official website of this journal.

What is the ISSN of Journal of Intercultural Communication?

The International Standard Serial Number (ISSN) of Journal of Intercultural Communication is/are as follows: 14041634.

What is the best quartile for Journal of Intercultural Communication?

The best quartile for Journal of Intercultural Communication is Q2.

What is the coverage history of Journal of Intercultural Communication?

The coverage history of Journal of Intercultural Communication is as follows 2011-2022.

Credits and Sources

• Scimago Journal & Country Rank (SJR), https://www.scimagojr.com/
• Journal Impact Factor, https://clarivate.com/
• Issn.org, https://www.issn.org/
• Scopus, https://www.scopus.com/

Note: The impact score shown here is equivalent to the average number of times documents published in a journal/conference in the past two years have been cited in the current year (i.e., Cites / Doc. (2 years)). It is based on Scopus data and can be a little higher or different compared to the impact factor (IF) produced by Journal Citation Report. Please refer to the Web of Science data source to check the exact journal impact factor ™ (Thomson Reuters) metric.

Impact Score, SJR, h-Index, and Other Important metrics of These Journals, Conferences, and Book Series

Check complete list

Journal of Intercultural Communication Impact Score (IS) Trend

Top journals/conferences in cultural studies, top journals/conferences in communication.

Cultural Relativity and Acceptance of Embryonic Stem Cell Research

Article sidebar.

Main Article Content

There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4]  Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I.     Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a.     US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b.     Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole. Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF.  Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c.     Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d.     Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e.     Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45]  Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II.     Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III.     A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders.  This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV.     Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

[1] Poliwoda, S., Noor, N., Downs, E., Schaaf, A., Cantwell, A., Ganti, L., Kaye, A. D., Mosel, L. I., Carroll, C. B., Viswanath, O., & Urits, I. (2022). Stem cells: a comprehensive review of origins and emerging clinical roles in medical practice.  Orthopedic reviews ,  14 (3), 37498. https://doi.org/10.52965/001c.37498

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[3] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk ; Kimmelman, J., Hyun, I., Benvenisty, N.  et al.  Policy: Global standards for stem-cell research.  Nature   533 , 311–313 (2016). https://doi.org/10.1038/533311a

[4] International Society for Stem Cell Research. (2023). Laboratory-based human embryonic stem cell research, embryo research, and related research activities . International Society for Stem Cell Research. https://www.isscr.org/guidelines/blog-post-title-one-ed2td-6fcdk

[5] Concerning the moral philosophies of stem cell research, our paper does not posit a personal moral stance nor delve into the “when” of human life begins. To read further about the philosophical debate, consider the following sources:

Sandel M. J. (2004). Embryo ethics--the moral logic of stem-cell research.  The New England journal of medicine ,  351 (3), 207–209. https://doi.org/10.1056/NEJMp048145 ; George, R. P., & Lee, P. (2020, September 26). Acorns and Embryos . The New Atlantis. https://www.thenewatlantis.com/publications/acorns-and-embryos ; Sagan, A., & Singer, P. (2007). The moral status of stem cells. Metaphilosophy , 38 (2/3), 264–284. http://www.jstor.org/stable/24439776 ; McHugh P. R. (2004). Zygote and "clonote"--the ethical use of embryonic stem cells.  The New England journal of medicine ,  351 (3), 209–211. https://doi.org/10.1056/NEJMp048147 ; Kurjak, A., & Tripalo, A. (2004). The facts and doubts about beginning of the human life and personality.  Bosnian journal of basic medical sciences ,  4 (1), 5–14. https://doi.org/10.17305/bjbms.2004.3453

[6] Vazin, T., & Freed, W. J. (2010). Human embryonic stem cells: derivation, culture, and differentiation: a review.  Restorative neurology and neuroscience ,  28 (4), 589–603. https://doi.org/10.3233/RNN-2010-0543

[7] Socially, at its core, the Western approach to ethics is widely principle-based, autonomy being one of the key factors to ensure a fundamental respect for persons within research. For information regarding autonomy in research, see: Department of Health, Education, and Welfare, & National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1978). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research.; For a more in-depth review of autonomy within the US, see: Beauchamp, T. L., & Childress, J. F. (1994). Principles of Biomedical Ethics . Oxford University Press.

[8] Sherley v. Sebelius , 644 F.3d 388 (D.C. Cir. 2011), citing 45 C.F.R. 46.204(b) and [42 U.S.C. § 289g(b)]. https://www.cadc.uscourts.gov/internet/opinions.nsf/6c690438a9b43dd685257a64004ebf99/$file/11-5241-1391178.pdf

[9] Stem Cell Research Enhancement Act of 2005, H. R. 810, 109 th Cong. (2001). https://www.govtrack.us/congress/bills/109/hr810/text ; Bush, G. W. (2006, July 19). Message to the House of Representatives . National Archives and Records Administration. https://georgewbush-whitehouse.archives.gov/news/releases/2006/07/20060719-5.html

[10] National Archives and Records Administration. (2009, March 9). Executive order 13505 -- removing barriers to responsible scientific research involving human stem cells . National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/removing-barriers-responsible-scientific-research-involving-human-stem-cells

[11] Hurlbut, W. B. (2006). Science, Religion, and the Politics of Stem Cells.  Social Research ,  73 (3), 819–834. http://www.jstor.org/stable/40971854

[12] Akpa-Inyang, Francis & Chima, Sylvester. (2021). South African traditional values and beliefs regarding informed consent and limitations of the principle of respect for autonomy in African communities: a cross-cultural qualitative study. BMC Medical Ethics . 22. 10.1186/s12910-021-00678-4.

[13] Source for further reading: Tangwa G. B. (2007). Moral status of embryonic stem cells: perspective of an African villager. Bioethics , 21(8), 449–457. https://doi.org/10.1111/j.1467-8519.2007.00582.x , see also Mnisi, F. M. (2020). An African analysis based on ethics of Ubuntu - are human embryonic stem cell patents morally justifiable? African Insight , 49 (4).

[14] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics , 22 (2), 112–122. https://doi.org/10.1111/dewb.12324

[15] Jecker, N. S., & Atuire, C. (2021). Bioethics in Africa: A contextually enlightened analysis of three cases. Developing World Bioethics, 22(2), 112–122. https://doi.org/10.1111/dewb.12324

[16] Jackson, C.S., Pepper, M.S. Opportunities and barriers to establishing a cell therapy programme in South Africa.  Stem Cell Res Ther   4 , 54 (2013). https://doi.org/10.1186/scrt204 ; Pew Research Center. (2014, May 1). Public health a major priority in African nations . Pew Research Center’s Global Attitudes Project. https://www.pewresearch.org/global/2014/05/01/public-health-a-major-priority-in-african-nations/

[17] Department of Health Republic of South Africa. (2021). Health Research Priorities (revised) for South Africa 2021-2024 . National Health Research Strategy. https://www.health.gov.za/wp-content/uploads/2022/05/National-Health-Research-Priorities-2021-2024.pdf

[18] Oosthuizen, H. (2013). Legal and Ethical Issues in Stem Cell Research in South Africa. In: Beran, R. (eds) Legal and Forensic Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-32338-6_80 , see also: Gaobotse G (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[19] United States Bureau of Citizenship and Immigration Services. (1998). Tunisia: Information on the status of Christian conversions in Tunisia . UNHCR Web Archive. https://webarchive.archive.unhcr.org/20230522142618/https://www.refworld.org/docid/3df0be9a2.html

[20] Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[21] Kooli, C. Review of assisted reproduction techniques, laws, and regulations in Muslim countries.  Middle East Fertil Soc J   24 , 8 (2020). https://doi.org/10.1186/s43043-019-0011-0 ; Gaobotse, G. (2018) Stem Cell Research in Africa: Legislation and Challenges. J Regen Med 7:1. doi: 10.4172/2325-9620.1000142

[22] Pang M. C. (1999). Protective truthfulness: the Chinese way of safeguarding patients in informed treatment decisions. Journal of medical ethics , 25(3), 247–253. https://doi.org/10.1136/jme.25.3.247

[23] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[24] Wang, Y., Xue, Y., & Guo, H. D. (2022). Intervention effects of traditional Chinese medicine on stem cell therapy of myocardial infarction.  Frontiers in pharmacology ,  13 , 1013740. https://doi.org/10.3389/fphar.2022.1013740

[25] Li, X.-T., & Zhao, J. (2012). Chapter 4: An Approach to the Nature of Qi in TCM- Qi and Bioenergy. In Recent Advances in Theories and Practice of Chinese Medicine (p. 79). InTech.

[26] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[27] Luo, D., Xu, Z., Wang, Z., & Ran, W. (2021). China's Stem Cell Research and Knowledge Levels of Medical Practitioners and Students.  Stem cells international ,  2021 , 6667743. https://doi.org/10.1155/2021/6667743

[28] Zhang, J. Y. (2017). Lost in translation? accountability and governance of Clinical Stem Cell Research in China. Regenerative Medicine , 12 (6), 647–656. https://doi.org/10.2217/rme-2017-0035

[29] Wang, L., Wang, F., & Zhang, W. (2021). Bioethics in China’s biosecurity law: Forms, effects, and unsettled issues. Journal of law and the biosciences , 8(1).  https://doi.org/10.1093/jlb/lsab019 https://academic.oup.com/jlb/article/8/1/lsab019/6299199

[30] Chen, H., Wei, T., Wang, H.  et al.  Association of China’s two-child policy with changes in number of births and birth defects rate, 2008–2017.  BMC Public Health   22 , 434 (2022). https://doi.org/10.1186/s12889-022-12839-0

[31] Azuma, K. Regulatory Landscape of Regenerative Medicine in Japan.  Curr Stem Cell Rep   1 , 118–128 (2015). https://doi.org/10.1007/s40778-015-0012-6

[32] Harris, R. (2005, May 19). Researchers Report Advance in Stem Cell Production . NPR. https://www.npr.org/2005/05/19/4658967/researchers-report-advance-in-stem-cell-production

[33] Park, S. (2012). South Korea steps up stem-cell work.  Nature . https://doi.org/10.1038/nature.2012.10565

[34] Resnik, D. B., Shamoo, A. E., & Krimsky, S. (2006). Fraudulent human embryonic stem cell research in South Korea: lessons learned.  Accountability in research ,  13 (1), 101–109. https://doi.org/10.1080/08989620600634193 .

[35] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

[36] Association for the Advancement of Blood and Biotherapies.  https://www.aabb.org/regulatory-and-advocacy/regulatory-affairs/regulatory-for-cellular-therapies/international-competent-authorities/saudi-arabia

[37] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia.  BMC medical ethics ,  21 (1), 35. https://doi.org/10.1186/s12910-020-00482-6

[38] Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: Interviews with researchers from Saudi Arabia. BMC medical ethics , 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6

Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

[39] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[40] Ababneh, M. A., Al-Azzam, S. I., Alzoubi, K., Rababa’h, A., & Al Demour, S. (2021). Understanding and attitudes of the Jordanian public about clinical research ethics.  Research Ethics ,  17 (2), 228-241.  https://doi.org/10.1177/1747016120966779

[41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East.  Nature  510, 189. https://doi.org/10.1038/510189a

[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France.  Biotechnology Law Report ,  32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ...  Revista do Colegio Brasileiro de Cirurgioes ,  41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe   

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights.  Cultura (Iasi, Romania) ,  14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent?  Research Ethics ,  13 (1), 23-41.  https://doi.org/10.1177/1747016116650235

[52] The Qur'an  (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52.  https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation.  Journal of Religion and Health ,  30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law).  Journal of assisted reproduction and genetics ,  25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.),  Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues  (pp. 79-94). Berkeley: University of California Press.  https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979).  The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services.  https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes.  Journal of assisted reproduction and genetics ,  35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

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[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry.  Voices in Bioethics ,  8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis.  Voices in Bioethics ,  3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation,  New Genetics and Society , 30:2, 141-153, DOI:  10.1080/14636778.2011.574375

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Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License .

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Published on 14.5.2024 in Vol 26 (2024)

Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment

Authors of this article:

Original Paper

• Rui Zhao 1 , PhD   ; 
• Xuerong Lu 2 , PhD   ; 
• Jiayi Yang 3 , PhD   ; 
• Biao Li 4 , PhD  

1 School of Journalism and Communication, Minzu University of China, Beijing, China

2 School of Communication, Oregon State University, Corvallis, OR, United States

3 School of Chinese Language and Literature, University of International Business and Economics, Beijing, China

4 School of Journalism, Renmin University of China, Beijing, China

Corresponding Author:

Biao Li, PhD

School of Journalism

Renmin University of China

19 Zhong Guancun Street

Beijing, 100081

Phone: 86 18810386586

Email: [email protected]

Background: Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners.

Objective: The aim of this study was to investigate the impact of communicating uncertainty about COVID-19–related threats and solutions on individuals’ risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions.

Methods: A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses.

Results: Individuals were more susceptible to believing false COVID-19–related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals’ perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention.

Conclusions: Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals’ cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public’s expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis.

Introduction

The question of how to communicate uncertainty to the general public has been raked up during the COVID-19 pandemic, which is considered to be the most threatening public health crisis that emerged over the past 10 years, characterized by a high level of uncertainty. Since its outbreak, news coverage of COVID-19 has largely been emphasizing the “unknowns” about the source, infectivity, treatment, prevention, and control measures of the virus [ 1 ]. However, whether (or not) uncertainties should be communicated to the general public remains a controversial issue, given the general low tolerance of the public for uncertainty along with a high expectation for information transparency. On the one hand, uncertainty is an undesirable experience in which people fear losing control of their lives, leading to negative consequences [ 2 , 3 ]. On the other hand, uncertainty may also have positive effects, as some scholars suggest that when uncertainty is perceived, people tend to actively seek for information to ease this feeling, and in this process can gain more information and a deeper understanding of the event [ 4 ]. Thus, it is important to understand whether the uncertainty presented in news articles influences individuals’ cognitive and behavioral intentions during public health emergencies.

In actual news framing, uncertainty does not appear as a monolithic entity, and each new challenge presented by COVID-19 involves different aspects (eg, threats and solutions) with varying degrees of uncertainty [ 5 ]. According to the Centers for Disease Control and Prevention, the uncertainties related to threats and solutions are the two greatest concerns among the public during public health emergencies [ 6 ]. Therefore, this study focused on the uncertainties related to threats and solutions associated with COVID-19 that the news media might (or might not) communicate to the public, with the goal of exploring how this communication of uncertainty might influence individuals’ health behaviors.

Impacts of Uncertainty on Risk Perception and Misinformation Vulnerability

Risk perception is always associated with uncertainty in the public health context. It is assumed that individuals will only begin to manage uncertainty through information processing or preventive behaviors when they perceive a given issue to be associated with a certain level of risk [ 7 ]. The perceived risk by individuals includes the severity and susceptibility of a public health crisis. Severity refers to the magnitude of harm caused by the threat, whereas susceptibility refers to the probability of occurrence of a threat to a specific subject [ 8 ]. Empirically, Lalot et al [ 9 ] found that individuals’ uncertainty about how the novel coronavirus would affect people significantly increased their perceived threat of the pandemic. Pine et al [ 10 ] found that the partial and changing information would cultivate the uncertainty surrounding COVID-19, which would further influence individuals’ risk perception of the pandemic.

Moreover, the potential impact of uncertainty on exacerbating the misinformation effect has been raised as a concern in recent years. Lu et al [ 11 ] found that communicating uncertainty about preliminary evidence related to COVID-19 was positively associated with the number of likes and retweets of related misinformation on social media. Consequently, the communication of uncertainty during a pandemic might unexpectedly facilitate engagement with misinformation.

To better understand the impact of threat uncertainty and solution uncertainty that are communicated to the general public during a public health crisis, we established the following research question: How, if at all, does the uncertainty frame of a threat and solution exert main and interaction effects on individuals’ risk perceptions and misinformation vulnerability?

Impacts of Uncertainty on Information Processing

Information seeking is regarded as a key communication outcome during a public health crisis, guiding individuals to understand public health issues and consequently adopt appropriate health behaviors (eg, [ 7 , 12 ]). Information seeking refers to individuals’ active information-searching activity through human interaction [ 13 ], online inquiry [ 14 ], and passive observation [ 15 ]. Theoretical and empirical evidence suggests that individuals tend to engage in information-seeking behaviors when experiencing psychological discomfort such as confusion and anxiety resulting from exposure to uncertainty (eg, [ 16 , 17 ]). Although the motivations for information-seeking behaviors according to various demographic characteristics such as age, gender, and health status have been extensively examined in the public health context (eg, [ 12 , 18 ]), little is known about how uncertainty communicated by the media and experts influences individuals’ information-seeking behavior.

Case et al [ 19 ] pointed out that individuals might also engage in information avoidance to reduce feelings of uncertainty. They found that the mental discomfort that arises due to uncertainty, especially in a health context, could facilitate information-avoidance behaviors. Information avoidance refers to an individual’s absence from or ignorance of information and its source [ 4 ].

Thus, we further aimed to understand whether (or not) and how the uncertainty framed in the news would motivate individuals’ information-seeking and information-avoiding behavior differently.

Additionally, the relationship between risk perception and information processing has been documented in the health risk literature. Goodall and Reed [ 20 ] suggested that individuals would seek more information when the perceived threat is high. Conversely, Jiang et al [ 21 ] found that a higher risk perception of the COVID-19 pandemic would reduce individuals’ information-seeking behavior. They also found that individuals’ propensity to believe COVID-19 misinformation would also influence their additional information-seeking behavior.

Therefore, we sought to examine how, if at all, uncertainty framed in severity and susceptibility influences information processing (ie, information seeking and information avoidance) through risk perceptions and misinformation vulnerability.

Information Seeking and Avoidance Influence Preventive Behaviors

In the context of COVID-19, studies on how organizations and individuals perceive risks during crises have centered on the changes in preventive behaviors during infectious disease outbreaks and how these behavioral shifts can be facilitated by engagement in informational behaviors.

Previous studies suggest that information seeking through different channels and sources is positively associated with preventive behaviors during crises (eg, [ 22 , 23 ]). Individuals who engage in more effortful information seeking and processing are more likely to develop risk-related cognitions, attitudes, and behaviors [ 24 ]. However, the health information environment in a pandemic is often filled with uncertain information, false claims, or even conspiracy theories [ 25 ], which can bias people’s pandemic-related beliefs and impede their adoption of effective actions [ 26 ].

Nevertheless, this situation does not imply that refraining from active information seeking is a wise choice. By contrast, the impact of information avoidance on preventive behaviors is not less significant than that of information seeking [ 27 ]. While information avoidance minimizes the chances of interaction with unnecessary information, it simultaneously diminishes the opportunities to receive relevant information. From a cognitive perspective, individuals have limited capacity to process information, and if not adequately addressed, the outcome can be information overload [ 28 ]. Avoiding information acquisition may lead individuals to make preventive decisions based on limited information [ 29 ]. Particularly when faced with uncertain information, information avoidance may lead to incorrect preventive behaviors. Therefore, we sought to determine how, if at all, preventative behavioral intentions might be associated with information seeking (1) and information avoidance (2) separately.

Research Design

This study adopted a controlled experiment approach. Based on the question “ Will asymptomatic cases lead to an uncontrolled epidemic? ” a 2×2 (threat certainty vs uncertainty×solution certainty vs uncertainty) online experiment was designed using asymptomatic cases, an emerging challenge in the COVID-19 epidemic, as a risk scenario. Data were collected in May 2020 through this anonymous online experiment. Participants were recruited from Sojump, which is the largest online survey platform in China. As the context of the experiment, at this time, China was gradually implementing measures to prevent and control the COVID-19 epidemic. However, at the same time, the detection of an increasing number of asymptomatic cases was raising concern. On March 31, 2020, China’s National Health Commission announced that as of the following day (April 1), it would disclose the detection, transition, and management of asymptomatic cases in its daily briefings on the epidemic to respond to these societal concerns in a timely manner [ 30 ]. The risk threat posed by the emerging challenge and COVID-19 prevention measures were still being explored and discussed at that time and were fraught with uncertainties. Based on this context, we developed 4 simulated online news reports based on real news coverage and expert interview data; the details of the simulations are provided in Multimedia Appendix 1 with a brief summary in Table 1 .

Although the content orientation of the simulated news coverage differed across the 4 scenarios, the format, word count, structural design, and information volume of the news coverage remained consistent. Participants were randomly assigned to one of the scenarios and were asked to read the simulated news coverage before completing the questionnaire. A total of 592 people participated in the study online and 371 valid questionnaires were obtained after postchecking, including 88 valid questionnaires for condition 1, 99 for condition 2, 88 for condition 3, and 96 for condition 4.

Figure 1 shows the general flow of participants in the study. Participants were from a wide range of age groups. The sample included a relatively equal sex ratio (with 41.80% of the sample identifying as female), and the majority of the participants had an education level of college degree or above (73%). Table 2 summarizes the main sociodemographic characteristics of the sample.

Ethical Considerations

The Institutional Review Board office of Renmin University of China approved the research protocol, and responses were collected via Sojump. Before the experiment, participants were asked if they agree to participate in the research voluntarily for receiving compensation. Participants received a reward of RMB 7 (US $1). The final data set is anonymized, without any identifiable private information connected to participants.

Perceived Severity

Perceived severity was measured with five items adapted from a previous study [ 8 ]: (1) I think asymptomatic cases are a serious problem for us; (2) At some point in the future, we could all be threatened by asymptomatic cases; (3) I think asymptomatic cases have very serious consequences; (4) I think asymptomatic cases are a very serious problem; and (4) I think the presence of asymptomatic cases is a serious threat to my health (mean 5.26, SD 1.18; Cronbach α=0.89).

Perceived Susceptibility

Perceived susceptibility was measured with two items taken from an existing scale [ 8 ]: (1) I feel that I am also at risk of being infected by asymptomatic cases and (2) I feel that I may also be infected by asymptomatic cases (mean 4.86, SD 1.76; Pearson r =0.83, P <.001).

Information Seeking

Information seeking was measured based on the scale developed by Brashers et al [ 31 ] with the following eight items: (1) I would like to learn more information on asymptomatic cases than what is provided in this report; (2) I may discuss asymptomatic cases with people close to me (eg, friends, family); (3) I may ask my doctor about asymptomatic cases; (4) I may seek other news reports about asymptomatic cases; (5) I may pay close attention to news reports about asymptomatic cases that I encounter in the future; (6) I may check the internet for other information about asymptomatic cases; (7) I am likely to pay close attention to information on asymptomatic cases that I encounter on the internet in the future; and (8) I may read the scientific research literature on asymptomatic cases (mean 5.46, SD 1.30; Cronbach α=0.94).

Information Avoidance

Information avoidance was measured using the scales developed by Afifi and Weiner [ 13 ] and Evans et al [ 14 ] with the following six items: (1) I may try to change the subject if people close to me (eg, friends and family) discuss the issue of asymptomatic cases; (2) I may try to change the subject if my doctor discusses asymptomatic cases; (3) I may avoid exposure to other news reports about asymptomatic cases; (4) I may avoid exposure to information on the internet about asymptomatic cases; (5) I may try not to think too much about asymptomatic cases; and (6) I may try to forget about asymptomatic cases (mean 2.76, SD 1.73; Cronbach α=0.96).

Willingness to Adopt Preventive Behaviors

Willingness to adopt preventive behaviors was measured via 10 items using a 7-point Likert scale (1=strongly agree to 7=strongly disagree), which measured respondents’ willingness to adopt a range of preventive behaviors such as strengthening protection, following health instructions, trying more preventive measures, and getting vaccinated. The specific items were: (1) I have decided to strengthen my preventive measures against COVID-19 immediately; (2) I intend to strengthen my protective measures against COVID-19 in the future; (3) I will pay more attention to asymptomatic cases; (4) I will persuade people around me to pay more attention to asymptomatic cases; (5) I will strictly follow professional health instructions to prevent catching the disease; (6) I will persuade people around me to strictly follow professional health instructions to prevent disease; (7) I will try as many ways as possible to prevent disease; (8) I will persuade those around me to try as many ways as possible to prevent disease; (9) I will get vaccinated as soon as a COVID-19 vaccine is developed; and (10) I will persuade those around me to get vaccinated as soon as a COVID-19 vaccine is developed (mean 5.54, SD 1.27; Cronbach α=0.89).

Vulnerability to False Information

Vulnerability to false information was measured by presenting respondents with 10 pieces of false news on COVID-19 (with five real news articles provided as distractors) to measure their trust in the false news. Sample items included the following:

Isatis root is suitable for treating conditions such as the common cold and viral influenza with heat symptoms. It has an antiviral effect and can help to prevent COVID-19.

Tobacco particles are at the nanometer scale and can evenly cover the surface of lung cells, forming a barrier that keeps viruses out of the body. Therefore, smoking can reduce the infection of the novel coronavirus.

The novel coronavirus is primarily a respiratory infection virus. Gargling with saline solution can eliminate the novel coronavirus bacteria that enter through the mouth.

These items were measured on a scale of 1 (strongly disbelieve) to 10 (strongly believe) (mean 3.68, SD 1.46; Cronbach α=0.89).

Data Analysis

To answer the four research questions, ANOVA was performed to examine the main and interaction effects of the manipulated independent variables (ie, uncertainty) on dependent outcomes (ie, risk perceptions and misinformation vulnerability). The mediation model was used as a posthoc analysis to estimate statistically significant differences between experimental conditions on outcomes. SPSS (version 28.0) and PROCESS (version 4.2) were used for all statistical analyses.

Effects of Uncertainty Framing in News Coverage

According to the ANOVA results ( Figure 2 ), there was a significant interaction effect of threat uncertainty and solution uncertainty on individuals’ vulnerability to misinformation ( F 1, 367 =5.10, P =.02; partial η 2 =0.01). Figure 2 provides the complete data on group comparisons. Specifically, individuals who read news containing a certain threat and uncertain solution (mean 3.86, SD 0.15) were more likely to believe misinformation than those who read news containing a certain threat and certain solution (mean 3.47, SD 0.16). However, there was neither a significant main effect of threat uncertainty (partial η 2 =0.00) nor a significant main effect of solution uncertainty (partial η 2 =0.00) on individuals’ vulnerability to false information ( Table 3 ).

In terms of information processing ( Table 4 ), the threat uncertainty of health information showed a significant effect in promoting information-seeking behavior (partial η 2 =0.012). This implies that people who read news with the presence of an uncertain threat were more likely to search for additional relevant information than those who read news with absence of an uncertain threat. However, the uncertainty framing in the news, regardless of the type of uncertainty, did not affect individuals’ information avoidance behaviors.

Sequential Mediation Analysis

Serial linear regression with PROCESS macro model 81 was used to analyze how the dummy-coded variables (1=uncertain threat and certain solution, 2=certain threat and uncertain solution, 3=uncertain threat and uncertain solution, and reference (0)=certain threat and certain solution) influence preventive behavioral intention through the factors perceived severity, information seeking, and information avoidance. A significant serial mediation model was detected, in which the perceived severity and information seeking would sequentially mediate the relationship between the exposure to news containing a certain threat and an uncertain solution (point estimate 0.17, SE 0.08; 95% CI 0.02-0.33) or news containing an uncertain threat and an uncertain solution (point estimate 0.18, SE 0.08; 95% CI 0.03-0.34) and the protective behavioral intention (see Figure 3 for the path significance and coefficients).

The mediation models obtained with PROCESS macro model 81, including misinformation vulnerability, information seeking, and information avoidance as the three mediators, were established with the same three dummy-coded comparison variables described above. Although the serial mediating effect of misinformation vulnerability and information processing on the relationship was nonsignificant, significant associations between misinformation vulnerability on information processing and protective behavioral intention were detected (see Figure 4 for the path significance and coefficients).

Principal Findings

This study explored the impact of incorporating different levels of uncertainty in news articles on individuals’ risk perception, susceptibility to misinformation, subsequent information processing, and intention toward preventive behaviors. These factors play a crucial role in guiding individuals to protect themselves during a public health crisis.

First, as expected, the findings showed that individuals would perceive the crisis to be of greater severity when reading news framed withing a context of solution uncertainty, regardless of whether or not the threat of the crisis was framed as certain or uncertain in the news article. Furthermore, the perceived severity would in turn motivate individuals’ information-seeking and information-avoidance behaviors. As suggested by Gudykunst [ 32 ], the experience of fear and concern is also associated with uncertainty. Individuals’ fear might be evoked when they fail to find a solution to solve the risky problem, which would consequently increase their perception of the severity of the health threat. Meanwhile, to cope with the fear, individuals would either seek more information or avoid more information [ 31 ].

Second, individuals tended to believe false information during a public health crisis, especially after reading a news article containing certain threats and uncertain solutions. Furthermore, posthoc regression analysis suggested that both information seeking and information avoidance were positively associated with misinformation vulnerability. As expected, information seeking was positively associated with protective behavioral intentions, while information avoidance was negatively associated with protective behavioral intention. That said, communicating crisis uncertainty in a news article would be risky in terms of increasing the public’s vulnerability to misinformation. Moreover, misinformation vulnerability would further motivate information avoidance, which would consequently dissuade individuals’ intention to adopt preventive behaviors. However, communicating crisis uncertainty could also be beneficial because the increased misinformation vulnerability that arises after reading news with related uncertainty could simultaneously motivate both expected health information–seeking and protective behaviors.

Third, our findings suggest that compared to an uncertain threat, uncertain solutions are more potentially problematic. An uncertain solution with either an uncertain or certain threat had a greater impact on individuals’ perceived severity of the crisis. Moreover, an uncertain solution with an uncertain threat led to higher vulnerability to misinformation. Although both perceived severity and misinformation vulnerability could motivate expected health information–seeking or protective behavioral intentions, they were likely to trigger information avoidance, which would further impair the protective behavioral intention. Given these conflicting findings, more research is needed to understand the mechanism behind the effects of communicating solution uncertainty, especially during a public health crisis.

Implications and Limitations

A few limitations of this study should be noted to provide inspiring suggestions for further research. First, the generalizability of the findings needs to be addressed. This study is based on an exceptionally unique context of a public health event. In April 2020, the ambiguity surrounding the perceived risk of COVID-19 and the appropriate preventive measures was prevalent. Different regions in China implemented varying degrees of epidemic control measures, leading to divergent strategies. Media coverage of “asymptomatic carriers” and other aspects of the COVID-19 pandemic often exhibited inconsistent or contradictory information. Thus, the diverse experimental scenarios were based on natural contexts for presenting four distinct threat-and-solution scenarios and would not induce a perceptual conflict for the participants. However, when extrapolating to other research topics, it is imperative to consider the coherence between experimental scenarios and real-world settings.

Second, the impact of the research topic on participants with different characteristics requires further discussion. This study endeavored to achieve a balanced representation of participants with respect to sex, education level, and income bracket. Consequently, an exhaustive examination of the differential effects stemming from various sociodemographic factors on the outcomes was not performed. However, in distinct research inquiries, this divergence may prove consequential. Hence, future research endeavors could delve deeper into understanding the perception of information uncertainty and management behaviors across populations with diverse backgrounds and characteristics.

Third, although this type of experimental design typically includes 80-90 participants per group to achieve sufficient statistical power, the unexpected smaller effect size in this study resulted in a reduced statistical power of approximately 60%. This diminutive effect size may compromise the study’s sensitivity in detecting meaningful relationships, thereby affecting the reliability and generalizability of the findings. To enhance statistical power and ensure robust results in similar experimental studies in China, a larger sample size is recommended.

Regarding the implications, this study aimed to elucidate the impact of health information uncertainty on individuals’ information-processing mechanisms. The results thus provide further evidence for the impacts of individuals’ perceptions and behaviors underlying uncertainty management theory. Amid public health events inundated with uncertain information, individuals’ perceptions and behaviors related to uncertainty management often determine their attitudes toward addressing health threats and the potential adoption of health measures. Therefore, comprehending this process contributes to facilitating more effective health communication between the public health system and the general public. Faced with uncertain public health events, participants such as public health institutions, media, and the general public should all take into account the implications of information uncertainty, ensuring the effective dissemination of information throughout all stages of the crisis.

Acknowledgments

This work was supported by the National Social Science Fund of China (project name: Construction and Impact Research of Trust Mechanisms in Health Communication during the “Information Epidemic”; project number 22CXW022).

Conflicts of Interest

None declared.

Simulated news articles presented to the participants in the online experiment under four conditions varying in threat and solution uncertainty about the COVID-19 pandemic.

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Edited by G Eysenbach, L Beri; submitted 16.08.23; peer-reviewed by S Su, X Xu, A Chang; comments to author 06.12.23; revised version received 08.01.24; accepted 12.04.24; published 14.05.24.

©Rui Zhao, Xuerong Lu, Jiayi Yang, Biao Li. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 14.05.2024.

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