critical thinking and covid 19

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The case for critical thinking: the covid-19 pandemic and an urgent call to close the critical thinking gap in education.

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When critical thinking is literally a matter of life or death, we can no longer afford to keep ... [+] treating it like a luxury good.

The world’s greatest health crisis in 100 years has forced educators to rapidly transform learning spaces from brick and mortar settings to distance learning settings. The most discussed aspect of this transition is the vast number of students lacking access to the devices and connectivity they need to engage in distance learning .

This is not really news. Before this crisis, it was already known that although 70% of teachers in United States assigned homework that requires internet access , 15% of student households lack high-speed internet. For families earning under $30,000 annually, this rate jumps to 33%. Despite the awe-inspiring efforts of school systems and communities rallying to get devices and connectivity sorted out for hundreds of thousands of students, initial data suggests that nationwide, vast numbers of students are not logging in . With public schools shut down in every state and 15 states deciding to not reopen for the remainder of the school year, meaningful access to technology will play a crucial role in distance learning.

Technology, however, is far from the be-all, end-all to educational success. Prior to this crisis, schools serving high numbers of students from low income families would often celebrate when they reached a 1:1 student-to-technology device ratio. This speaks to a surprisingly different type of digital divide than the one we typically worry about. While these students rely heavily on screens for learning, some students in more affluent communities attend schools that ban screen time altogether , relying more on human interaction and play-based learning.

Why is it that Steve Jobs did not let his children near iPads when they were young? How could it be that Tim Cook refused to let his nephew be on social media networks? Does it make sense that Bill Gates banned his children from having cell phones until they were teens? Clearly, a device and a wifi hotspot is not a cure-all. If we are truly concerned about issues of access, t here is a larger, more inequitable issue that is even more critical than access to technology: access to critical thinking instruction.

The Critical Thinking Gap

Nanotechnology. Automation. Artificial intelligence. Big data. It is impossible to hear an expert pontificate on the future of work without pointing out all the ways basic knowledge and skills alone are no longer sufficient. Futurist Alvin Toffler explained that “the illiterate of the 21st century will not be those who cannot read and write. It will be those who can not learn, unlearn, and relearn.” Bill Daggett often shares the dire prediction that if “you can write an algorithm for a task, the job is gone.” If we are sincere in our goal to prepare young people to solve problems the likes of which we have never seen, using technologies that have not been created, in career fields that do not exist, education systems should obsess over critical thinking.

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Yet, critical thinking is still a luxury good . This crucial set of skills and dispositions, including reasoning, analyzing multiple perspectives, and displaying the healthy sense of skepticism needed to seek evidence to support or refute claims is notoriously hard to teach . Complicating manners further, critical thinking is even harder to teach across different contexts. The critical thinking required to ponder complex questions in medicine, for instance, requires insight into subject-specific expertise and contexts vastly different questions a social media marketer or agricultural expert would explore. But difficulty alone cannot explain the cognitive dissonance that exists when we claim critical thinking is such a crucial aspect of future-readiness for all students, but face a reality where only  1 in 10 educators teach critical thinking.

The critical thinking gap is one of the most significant, yet overlooked equity challenges in education today. Right now, systems leaders are going full throttle to figure out the access challenges related to distance learning at a time when most states are cancelling standardized tests until things get back to normal. From an equity perspective, however, “normal” means returning to a system where poor students of color disproportionately fail these exams. For those who lament the idea of “ teaching to a test ,” it helps to understand that these tests are typically not the simple fill-in-the-blank or easy multiple choice questions of yesteryear, but complex, multi-step questions that require critical thinking to succeed.

With critical thinking embedded into the main tool states use for accountability, one would presume this would be another reason critical thinking should be prioritized. But if you walked into most classrooms where critical thinking is taught, you would immediately recognize a separate and unequal education , even within the same school building. You would likely see critical thinking in gifted and talented programs that are consistently far less racially and socioeconomically diverse than the school system’s demographics. Critical thinking is often a focus of selective magnet schools and specialized high schools that face similar diversity challenges, particularly in New York City . T NTP’s Opportunity Myth report  dived even further into these inequities, finding that “classrooms that served predominantly students from higher-income backgrounds spent twice as much time on grade-appropriate assignments and five times as much time with strong instruction, compared to classrooms with predominantly students from low-income backgrounds.” If critical thinking is so important, why is it still treated like a luxury good?

The COVID-19 Pandemic and the Case for Critical Thinking

There is a clear case for critical thinking now, more than ever before. With the mass shutdowns across the country and throughout the world, this is a live example of the type of thinking young people need to navigate the uncertainties they will undoubtedly face when they come of age. This pandemic, and our reactions to this once-in-a-century health crisis, drive home the need to equip all young people with critical thinking skills and dispositions. Our challenges reveal an urgent need to emphasize several key aspects of critical thinking.

The world watched as Wuhan, China, the city of 11 million people where the COVID-19 pandemic originated, struggled mightily to contain this outbreak. The first reported case occurred on November 17, 2019, and Wuhan’s recently-ended strict quarantine measures started on January, 23, 2020.

The United States reported its first patient infected with the novel coronavirus on January 20, 2020. On January 31, the Trump administration suspended travel into the United States from any foreign nationals from China (with a consequential exception for the immediate family members of permanent residents and United States citizens).

This is a prime example where the mere ability to observe, assess, and adjust is not enough. Leaders tasked with solving complex challenges must also be willing to engage in these thinking processes. For instance, the limited travel ban from China on January 23, 2020 ignored the reality that over 5 million people left the Wuhan province in the days prior to their strict quarantine. This ban also overlooked the nearly 400,000 travelers from China who entered after the outbreak’s origination, but prior to the ban’s enactment. And it is unclear whether the ban accounted for the 40,000 people who would later travel from China under the ban’s exceptions with inconsistent screening practices upon entry.

Without a willingness to observe, assess, and adjust, warnings like this January 29, 2020 excerpt from a memo written by Peter Navarro, President Trump’s trade advisor, had no chance of being impactful: “The lack of immune protection or an existing cure or vaccine would leave Americans defenseless in the case of a full-blown coronavirus outbreak on U.S. soil,” Mr. Navarro’s memo said. “This lack of protection elevates the risk of the coronavirus evolving into a full-blown pandemic, imperiling the lives of millions of Americans.”

Adopting this willingness requires a fundamental shift of leadership values. Decisive, bold actions may conform with stereotypes of what strong leaders should do. But in complex, rapidly changing situations where risk is high and information is limited, this style is far inferior than one based on thoughtful decisions made carefully with humility and constant awareness of the unknown. All students would benefit from instructional models that help them develop a strong sense of inquisitiveness and the ability to collect and make sense of information.

Speaking of information, even though technology makes it possible to have much of the world’s information at your fingertips, information alone is insufficient for critical thinking. This information is meaningless without the desire and ability to ask the right questions, identify conflicting information, assess the credibility and accuracy of that information, and determine what actions ought to be taken in response.

For instance, in late January 2020 , China’s National Health Commission director offical Ma Xiaowei noted that infected, asymptomatic people may still be able infect others. This would make the disease much more challenging to manage and control. However, the Centers for Disease Control and Prevention did not have “any clear evidence patients’ being infectious before symptom onset” but was “actively investigating that possibility” during this same time period.

This is where another important critical thinking dispositions comes into play that contradicts another traditional leadership hierarchy. Being right is often the goal in traditional leadership models. But when the critical thinking disposition is involved that values doing right over being right, it necessitates a much more careful and people-centered analysis. Weighing these two conflicting statements requires an understanding of the potential risks. This information came out at a time when the United States’ novel coronavirus cases were in the single digits. This was also around two months after China acknowledged receiving its first case, giving the United States clear insight into the exponential growth model of this disease and the drastic impact of a massive lockdown to stop the spread of the virus.

A public health official from China spoke freely about the risks of virus transmission posed by patients who are infected, but do not show any symptoms yet. This is from a country with an unfavorable history of imposing harsh consequences on those who spoke out against the risks of this disease. In late January, Chinese health officials also had two more months of experience dealing with this disease than the United States did. Imagine leaders involved in this decision making were trained as early as kindergarten to ask questions why “what are the hardships of being a blind mouse, and why might these three blind mice be running after the farmer’s wife?” This might lead to a mindset shift resulting in a very different set of questions for these real-world challenges.

When faced with prospect of millions of people dying in the case of a viral outbreak, would you prefer to act on research that found that infected, asymptomatic patients can transmit the virus before symptoms occur? Or would you prefer to rely on your country’s finding that they did not find “any clear evidence,” but were still looking to confirm that reality? If it is more important to be right, then you will always want to rely on your people over others. But if the focus is doing right, instead, then your analysis must go to the merits of the conflicting information and evaluate the vastly different costs of being wrong. If United States health officials mistakenly “played it safe” by taking earlier, strong actions on testing and social distancing guidance, then they made an expensive overreaction. We now know that China’s health official was correct about how the virus worked for patients without symptoms. The cost of getting this wrong is likely part of why, at time of publication of this article, the United States has seen 468,895 novel coronavirus cases, over 30,000 new cases a day, and over 16,697 deaths.

When critical thinking is literally a matter of life or death, we can no longer afford to keep treating it like a luxury good.

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• Principal Leadership
• Volume 21 (2020-2021)
• Principal Leadership: October 2020

Critical Thinking During COVID: October 2020

In uncertain times, it’s human to react with stress and fear. As school leaders, you’re tasked with making big decisions and providing reassurance to staff, students, and families. Crises such as the COVID-19 pandemic require us to lead by example through critical thinking. Critical thinking is a research-validated tool in crisis management because it helps us sort through information, gain an accurate view of the situation, and make decisions.

Tapping Into Critical Thinking

Critical thinking requires us to dig deep and focus on facts and credible sources. Applying critical thinking skills helps us wade through uncertainty and reach sound conclusions.

As a reference point, consider the “9 Traits of Critical Thinking™” from Mentoring Minds:

• Adapt: I adjust my actions and strategies to accomplish tasks.
• Examine: I use a variety of methods to explore and to analyze.
• Create: I use my knowledge and imagination to express new and innovative ideas.
• Communicate : I use clear language to express my thoughts and to share information.
• Collaborate: I work with others to achieve better outcomes.
• Inquire: I seek information that excites my curiosity and inspires my learning.
• Link: I apply knowledge to reach new understandings.
• Reflect: I review my thoughts and experiences to guide my actions.
• Strive: I use effort and determination to focus on challenging tasks.

These traits can help individuals of any age navigate unfamiliar circumstances. The pandemic has had an undeniable impact on education, but critical thinking can help us all cope with the changes and challenges presented by COVID-19.

To keep education moving forward during COVID-19 while also supporting your school community, consider the following tips:

• Seek out factual information, not fast information. Make reasoned, informed decisions by understanding facts, evidence-based data, and credible sources. While it is essential to gather and rely on a variety of information and data, critical thinkers know it’s necessary to check the accuracy and bias of what is read and heard. Inquire: Encourage parents, teachers, and students to ask questions. A crisis causes anxiety, stress, and fear if individuals don’t feel permitted to investigate essential questions. Here are a few examples: How will the COVID-19 pandemic impact jobs? What instructional changes might occur? How will grading procedures change? Technology allows us quick access to an abundance of information, some contradictory and misleading. If we forget to pause and carefully review information, it can be dangerous to us and others. Examine: Caution the use of believing everything that is presented in the media. Remind others of the importance of examining information first. Seek out a variety of credible sources. When information is accurate, it can be used to resolve challenges. Misinformation is common, and it’s also harmful. In fact, the U.N. Secretary-General António Guterres recently remarked that the “global ‘misinfo-demic’ is spreading … hatred is going viral, stigmatizing and vilifying people and groups.” While networking platforms such as Facebook work to combat the overabundance of false content, it’s up to us as consumers of media to assess what we read first—and then share it with others. In a crisis, information changes by the minute. A critical thinker knows updates will be forthcoming and how crucial it is to assimilate the latest facts. Because of the vast amount of content available to us, we must continuously remind ourselves to listen to those in the know and to source trusted information—such as the COVID-19 resources NASSP is compiling.
• Practice proactive planning. Be ready to adapt routines as situations change. School leaders have been tasked with hefty responsibilities. As a principal, you’re accountable for the success of your students and staff—a daunting task on the most normal of days. Link: Use your prior knowledge and experiences to problem-solve. As a school leader, you recognize the importance of making connections—if a crisis exists, then effects appear. Discuss potential barriers and challenges with staff members and identify the various ways students and their families may be impacted. We must prepare our school communities to embrace disruption as learning takes on a new image. Educators are not only trying to plan and deliver academic lessons, but they’re also addressing the social aspect of learning in an entirely new format. Collaborate: Offer guidance and support to your colleagues. Set an example by showing how collaboration can help us navigate the new modes of teaching and learning in which we currently find ourselves. Some parents or caregivers might be recently unemployed, others may be struggling to hold onto their jobs, and some may not have the right equipment for remote learning. There are even parents—and teachers—who are trying to manage their schedules while supervising nonschool-aged children. Communicate: Pave the way for two-way communication. Ensure that information sent to students and families is clear and concise. Offer a range of ways for students to interact and ask questions. Provide an avenue for open communication with parents and teachers. As leaders, we must guide our teachers to support parents in establishing new routines while welcoming flexibility in tasks and choice in activities. Remember to integrate time for reflection or downtime within home-based learning. Help parents see the importance of maintaining certain hours for completing tasks or assignments and managing workload.
• Prioritize positive relationship-building. Be confident and recognize the importance of validating the feelings and perspectives of others. Educators are going the distance to keep learning moving forward while maintaining excellence. School leaders realize the importance of retaining the human element in education. Offering reassurance to one another, our students, and their families is vital. Create: Invite faculty to contribute their ideas for the summer and fall semester. Are there instructional practices that should change? Innovative thinking will be a critical piece of successfully returning to school. Never has it been more important to connect with parents and students. We must encourage them and thank them for embracing this new partnership of virtual communication. We must recognize that all situations and classrooms at home are just as diverse as the classrooms in brick-and mortar buildings. Adapt: You have the power to guide others in adapting to new situations. Educators are teaching from their homes; students are learning in their kitchens and living rooms—diverse, at-home situations require flexibility. We can use this as an opportunity to adapt our practices. Whether it’s offering support for parents, hosting “office” hours for students, or providing devices to those in need, change may be required. Let’s work to openly communicate and collaborate, examine the pulse of others, and frequently inquire about their thoughts. We should model talking about today’s issues so we can emulate the importance of analyzing and interpreting information to solve problems—big or small. Strive: Principals recognize the importance of modeling. While planning high-quality online learning isn’t the easiest task, it is possible when you remain focused. When students see their principal and teachers demonstrating “strive,” they can follow suit. Reflect: Take time to reflect on how you can take care of yourself. Crises are draining. We can easily become impatient, weary, and reactive, which makes situations even more problematic. We must pace ourselves, taking moments to pause and consider our own needs as important. Reflecting helps us push through challenges, improve upon past actions, and face our fears. How can we make better choices? How has COVID-19 changed our lives? What support do we need? By voicing our personal experiences, we can dig deeper to reveal strengths and opportunities.

Put Critical Thinking Into Practice

No matter the crisis, the nine traits can assist individuals of any age in making important decisions about their actions or finding an approach for resolution. We all have the capacity to think skillfully. When we incorporate critical thinking into our personal and professional lives, we can better support the growth of ourselves and our school communities. A critical thinker does not give up, but instead seeks ways to improve or resolve problems. Now is the time for principals to recognize the relevancy of thinking beyond the surface.

Sandra Love, EdD, is the director of education insight and research for Mentoring Minds, an organization that provides critical thinking resources to educators. She is a former elementary principal and recipient of the National Distinguished Principal Award.

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ORIGINAL RESEARCH article

“fake news” or real science critical thinking to assess information on covid-19.

• 1 Department of Applied Didactics, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
• 2 IES Ramón Cabanillas, Xunta de Galicia, Cambados, Spain

Few people question the important role of critical thinking in students becoming active citizens; however, the way science is taught in schools continues to be more oriented toward “what to think” rather than “how to think.” Researchers understand critical thinking as a tool and a higher-order thinking skill necessary for being an active citizen when dealing with socio-scientific information and making decisions that affect human life, which the pandemic of COVID-19 provides many opportunities for. The outbreak of COVID-19 has been accompanied by what the World Health Organization (WHO) has described as a “massive infodemic.” Fake news covering all aspects of the pandemic spread rapidly through social media, creating confusion and disinformation. This paper reports on an empirical study carried out during the lockdown in Spain (March–May 2020) with a group of secondary students ( N = 20) engaged in diverse online activities that required them to practice critical thinking and argumentation for dealing with coronavirus information and disinformation. The main goal is to examine students’ competence at engaging in argumentation as critical assessment in this context. Discourse analysis allows for the exploration of the arguments and criteria applied by students to assess COVID-19 news headlines. The results show that participants were capable of identifying true and false headlines and assessing the credibility of headlines by appealing to different criteria, although most arguments were coded as needing only a basic epistemic level of assessment, and only a few appealed to the criterion of scientific procedure when assessing the headlines.

Introduction: Critical Thinking for Social Responsibility – An Urgent Need in the Covid-19 Pandemic

The COVID-19 pandemic is a global phenomenon that affects almost all spheres of our life, aside from its obvious direct impacts on human health and well-being. As mentioned by the UN Secretary General, in his call for solidarity, “We are facing a global health crisis unlike any in the 75-year history of the United Nations — one that is spreading human suffering, infecting the global economy and upending people’s lives.” (19 March 2020, Guterres, 2020 ). COVID-19 has revealed the vulnerability of global systems’ abilities to protect the environment, health and economy, making it urgent to provide a responsible response that involves collaboration between diverse social actors. For science education the pandemic has raised new and unthinkable challenges ( Dillon and Avraamidou, 2020 ; Jiménez-Aleixandre and Puig, 2021 ), which highlight the importance of critical thinking (CT) development in promoting responsible actions and responses to the coronavirus disease, which is the focus of this paper. Despite the general public’s respect of science and scientific advances, denial movements – such as the ones that reject the use of vaccines and advocate for alternative health therapies – are increasing during this period ( Dillon and Avraamidou, 2020 ). The rapid global spread of the coronavirus disease has been accompanied by what the World Health Organization (WHO) has described as the COVID-19 social media infodemic. The term infodemic refers to an overabundance of information (real or not) associated with a specific topic, whose growth can occur exponentially in a short period of time [ World Health Organization (WHO), 2020 ]. The case of the COVID-19 pandemic shows the crucial importance of socio-scientific instruction toward students’ development of critical thinking (CT) for citizenship.

Critical thinking is embedded within the framework of “21st century skills” and is considered one of the goals of education ( van Gelder, 2005 ). Despite its importance, there is not a clear consensus on how to better promote CT in science instruction, and teachers often find it unclear what CT means and requires from them in their teaching practice ( Vincent-Lacrin et al., 2019 ). CT is understood in this study as a set of skills and dispositions that enable students and people to take critical actions based on reasons and values, but also as independent thinking ( Jiménez-Aleixandre and Puig, 2021 ). It is also considered as a dialogic practice that students can enact and thereby become predisposed to practice ( Kuhn, 2019 ). We consider that CT has two fundamental roles in SSI instruction: one role linked to the promotion of rational arguments, cognitive skills and dispositions; and the other related to the idea of critical action and social activism, which is consistent with the characterization of CT provided by Jiménez-Aleixandre and Puig (2021) . Although research on SSIs has provided us with empirical evidence supporting the benefits of SSI instruction, particularly argumentation and students’ motivation toward learning science, there is still scarce knowledge on how CT is articulated in these contexts. One challenge with promoting CT, especially in SSIs, is linked to new forms of communication that generate a rapid increase of information and easy access to it ( Puig et al., 2020 ).

The study was developed in an unprecedented scenario, during the lockdown in Spain (March–May 2020), which forced the change of face-to-face teaching to virtual teaching, involving students in online activities that embraced the application of scientific notions related to COVID-19 and CT for assessing claims published in news headlines related to it. Previous studies have pointed out the benefits of virtual environments to foster CT among students, particularly asynchronous discussions that minimize social presence and favor all students expressing their own opinion ( Puig et al., 2020 ).

In this research, we aim to explore students’ ability to critically engage in the assessment of the credibility of COVID-19 claims during a moment in which fake news disseminated by social media was shared by the general public and disinformation on the virus was easier to access than real news.

Theoretical Framework

We will first discuss the crucial role of CT to address controversial issues and to fight against the rise of misinformation on COVID-19; and then turn attention to the role of argumentation in students’ development of CT in SSI instruction in epistemic education.

Critical Thinking on Socio-Scientific Instruction to Face the Rise of Disinformation

SSIs are compelling issues for the application of knowledge and processes contributing to the development of CT. They are multifaceted problems, as is the case of COVID-19, that involve informal reasoning and elements of critique where decisions present direct consequences to the well-being of human society and the environment ( Jiménez-Aleixandre and Puig, 2021 ). People need to balance subject matter knowledge, personal values, and societal norms when making decisions on SSIs ( Aikenhead, 1985 ) but they also have to be critical of the discourses that shape their own beliefs and practices to act responsibly ( Bencze et al., 2020 ). According to Duschl (2020) , science education should involve the creation of a dialogic discourse among members of a class that focuses on the teaching and learning of “how did we come to know?” and “why do we accept that knowledge over alternatives?” Studies on SSIs during the last decades have pointed out students’ difficulties in building arguments and making critical choices based on evidence ( Evagorou et al., 2012 ). However, literature also indicates that students find SSIs motivational for learning and increase their community involvement ( Eastwood et al., 2012 ; Evagorou, 2020 ), thus they are appropriate contexts for CT development. While research on content knowledge and different modes of reasoning on SSIs is extensive, the practice of CT is understudied in science instruction. Of particular interest in science education are SSIs that involve health controversies, since they include some of the challenges posed by the post-truth era, as the health crisis produced by coronavirus shows. The COVID-19 pandemic is affecting most countries and territories around the world, which is why it is considered the greatest challenge that humankind has faced since the 2nd World War ( Chakraborty and Maity, 2020 ). Issues like COVID-19 that affect society in multiple ways require literate citizens who are capable of making critical decisions and taking actions based on reasons. As the world responds to the COVID-19 pandemic, we face the challenge of an overabundance of information related to the virus. Some of this information may be false and potentially harmful [ World Health Organization (WHO), 2020 ]. In the context of growing disinformation related to the COVID-19 outbreak, EU institutions have worked to raise awareness of the dangers of disinformation and promoted the use of authoritative sources ( European Council of the European Union, 2020 ). Educators and science educators have been increasingly concerned with what can be done in science instruction to face the spread of misinformation and denial of well-established claims; helping students to identify what is true can be a hard task ( Barzilai and Chinn, 2020 ). As these authors suggest, diverse factors may shape what people perceive as true, such as the socio-cultural context in which people live, their personal experiences and their own judgments, that could be biased. We concur with these authors and Feinstein and Waddington (2020) , who argue that science education should not focus on achieving the knowledge, but rather on gaining appropriate scientific knowledge and skills, which in our view involves CT development. Furthermore, according to Sperber et al. (2010) , there are factors that affect the acceptance or rejection of a piece of information. These factors have to do either with the source of the information – “who to believe” – or with its content – “what to believe.” The pursuit of truth when dealing with SSIs can be facilitated by the social practices used to develop knowledge ( Duschl, 2020 ), such as argumentation understood as the evaluation of claims based on evidence, which is part of CT development.

We consider CT and argumentation as overlapping competencies in their contexts of practice; for instance, when assessing claims on COVID-19, as in this study. According to Sperber et al. (2010) , we now have almost no filters on information, and this requires a much more vigilant, knowledgeable reader. As these authors point out, individuals need to become aware of their own cognitive biases and how to avoid being victims themselves. If we want students to learn how to critically evaluate the information and claims they will encounter in social media outside the classroom, we need to engage them in the practice of argumentation and CT. This raises the question of what type of information is easier or harder for students to assess, especially when they are directly affected by the problem. In this paper we aim to explore this issue by exploring students’ arguments while assessing diverse claims on COVID-19. We think that students’ arguments reflect their ability to apply CT in this context, although this does not mean that CT skills always produce a well-reasoned argument ( Halpern, 1998 ). Students should be encouraged to express their own thoughts in SSI instruction, but also to support their views reasonably ( Puig and Ageitos, 2021 ). Specifically, when they must assess the validity of information that affects not only them as individuals but also the whole society and environment. CT may equip citizens to discard fake news and to use appropriate criteria to evaluate information. This requires the design and implementation of specific CT tasks, as this study presents.

Argumentation to Enhance Critical Thinking Development in Epistemic Education on SSIs

While the concept of CT has a long tradition and educators agree on its importance, there is a lack of agreement on what this notion involves ( Thomas and Lok, 2015 ). CT has been used with a wide range of meanings in theoretical literature ( Facione, 1990 ; Ennis, 2018 ). In 1990, The American Philosophical Association convened an authoritative panel of forty-six noted experts on CT to produce a definitive account of the concept, which was published in the Delphi Report ( Facione, 1990 ). The Delphi definition provides a list of skills and dispositions that can be useful and guide CT instruction. However, as Davies and Barnett (2015) point out, this Delphi definition does not include the phenomenon of action. We concur with these authors that CT education should involve students in “CT for action,” since decision making – a way of deciding on a course of action – is based on judgments derived from argumentation using CT. Drawing from Halpern (1998) , we also think that CT requires awareness of one’s own knowledge. CT requires, for instance, insight into what one knows and the extent and importance of what one does not know in order to assess socio-scientific news and its implications ( Puig and Ageitos, 2021 ).

Critical thinking and argumentation share core elements like rationality and reflection ( Andrews, 2015 ). Some researchers suggest understanding CT as a dialogic practice ( Kuhn, 2019 ) has implications in CT instruction and development. Argumentation on SSIs, particularly on health controversies, is receiving increasing attention in science education in the post-truth era, as the coronavirus pandemic and denial movements related to its origin, prevention, and treatment show. Science education should involve the creation of a dialogic discourse among members of a class that enable them to develop CT. One of the central features in argumentation is the development of epistemic criteria for knowledge evaluation ( Jiménez Aleixandre and Erduran, 2008 ), which is a necessary skill to be a critical thinker. We see the practice of CT as the articulation of cognitive skills through the practice of argumentation ( Giri and Paily, 2020 ).

This article argues that science education needs to explore learning experiences and ways of instruction that support CT by engaging learners in argumentation on SSIs. Despite CT being considered a seminal goal in education and the large body of research on CT supporting this ( Dominguez, 2018 ), debates still persist about the manner in which CT skills can be achieved through education ( Abrami et al., 2008 ). Niu et al. (2013) remark that educators have made a striking effort to foster CT among students, showing that the belief that CT can be taught and learned has spread and gained support. Therefore, CT has slowly made its way into general school education and specific instructional interventions. Problem-based learning is one of the most widely used learning approaches nowadays in CT instruction ( Dominguez, 2018 ) because it is motivating, challenging, and enjoyable ( Pithers and Soden, 2000 ; Niu et al., 2013 ). We see active learning methodologies and real-word problems such as SSIs as appropriate contexts for CT development.

The view that CT can be developed by engagement in argumentation practices plays a central role in this study, as Kuhn (2019) suggested. However, the post-truth condition poses some challenges to the evaluation of sources of information and scientific evidence disseminated by social media. According to Sinatra and Lombardi (2020) , the post-truth context raises the need for critical evaluation of online information about SSIs. Students need to be better prepared to assess science information they can easily find online from a variety of sources. Previous studies described by these authors emphasized the importance of source evaluation instruction to equip students toward this goal ( Bråten et al., 2019 ), however, this is not sufficient. Sinatra and Lombardi (2020) note that students should learn how to evaluate the connections between sources of information and knowledge claims. This requires, from our view, engaging students in CT and epistemic performance. If we want students to learn to think critically about the claims they will encounter on social media, they need to practice argumentation as critical evaluation.

We draw on research on epistemic education ( Chinn et al., 2018 ) which considers that learning science entails students’ participation in the science epistemic goals ( Kelly and Licona, 2018 ); in other words, placing scientific practices at the center of SSI instruction. Our study is framed in a broader research project that aims to embed CT in epistemic design and performance. In Chinn et al. (2018) AIR model, epistemic cognition has three core elements that represent the three letters of the acronym: epistemic Aims, goals related to inquiry; epistemic Ideals, standards and criteria used to evaluate epistemic products, such as explanations or arguments; and Reliable processes for attaining epistemic achievements. Of particular interest for our focus on CT is that the AIR model also proposes that epistemic cognition has a social nature, and it is situated. The purpose of epistemic education ( Barzilai and Chinn, 2017 ) should be to enable students to succeed in epistemic activities ( apt epistemic performance ), such as constructing and evaluating arguments, and to assess through meta-competence when success can be achieved. This paper attends to one aspect of epistemic performance proposed by Barzilai and Chinn (2017) , which is cognitive engagement in epistemic assessment. Epistemic assessment encompasses in our study the evaluation of the content of claims disseminated by media. Aligned with these authors we understand that this process requires cognitive and metacognitive competences. Thus, epistemic assessment needs adequate disciplinary knowledge, but also meta-cognitive competence for recognizing unsupported beliefs.

Goal and Research Questions

This paper examines students’ competence to engage in argumentation and CT in an online task that requires them to critically assess diverse information presented in media headlines on COVID-19. Competence in general can be defined as “a disposition to succeed with a certain aim” ( Sosa, 2015 , p. 43) and epistemic competence, as a special case of competence, is at its core a dispositional ability to discern the true from the false in a certain domain. For the purposes of this paper, the attention is on epistemic competence, being the research questions that drive the analysis of the following:

1. What is the competence of students to assess the credibility of COVID-19 information appearing in news headlines?

2. What is the level of epistemic assessment showed in students’ arguments according to the criteria appealed while assessing COVID-19 news headlines?

Materials and Methods

Context, participants, and design.

A teaching sequence about COVID-19 was designed at the beginning of the lockdown in Spain (Mid-March 2020) in response to the rise of misinformation about coronavirus on the internet and social media. The design process involved collaboration between the first and second author (researchers in science education) and the third author (a biology teacher in secondary education).

The participants are a group of twenty secondary students (14–15 years old), eleven of them girls, from a state public school located in a well-known seaside village in Galicia (Spain). They were mostly from middle-class families and within an average range of ability and academic achievement.

Students were from the same classroom and participated in previous online activities as part of their biology classes, taught by their biology teacher, who collaborated on previous studies on CT and learning science through epistemic practices on health controversies.

The activities were integrated in their biology curriculum and carried out when participants received instruction on the topics of health, infectious diseases, and the immune system.

Google Forms was used for the design and implementation of all activities included in the sequence. The reason to select Google Forms is that it is free and a well-known tool for online surveys. Besides, all students were familiar with its use before the lockdown and the teacher valued its usefulness for engaging them in online debates and in their own evaluation processes. This online resource provides anonymous results and statistics that the teacher could share with the students for debates. It needs to be highlighted that during the lockdown students did not have the same work conditions; particularly, quality and availability of access to the internet differed among them. Thus, all activities were asynchronous. They had 1 week to complete each task and the teacher could be consulted anytime if they had difficulties or any question regarding the activities.

The design was inspired by a previous one carried out by the authors when the first case of Ebola disease was introduced in Spain ( Puig et al., 2016 ), and follows a constructivist and scientific-based approach. The sequence began with an initial task, in which students were required to express their own views and knowledge on COVID-19 and health notions related with it, before then being progressively involved in the application of knowledge through the practice of modeling and argumentation. The third activity engaged them in critical evaluation of COVID-19 information. A more detailed description of the activities carried out in the different steps of the sequence is provided below.

Stage 1: General Knowledge on Health Notions Related to COVID-19

An individual Google Forms survey around some notions and health concepts that appear in social media during the lockdown, such as “pandemic”, “virus,” etc.

Stage 2: Previous Knowledge on Coronavirus Disease

This stage consisted of three parts: (2.1) Individual online survey on infectious diseases; (2.2) Introduction of knowledge about infectious diseases provided in the e-bugs project website 1 and activities; virtual visit to the exhibition “Outbreaks: epidemics in a connected world” available in the Natural History Museum website (blinded for review); (2.3) Building a poster with the chain of infection of the COVID-19 disease and some relevant information to consider in order to stop the spread of the disease.

Stage 3: COVID-19, Sources of Information

This stage consisted first of a virtual forum in which students shared their own habits when consulting scientific information, particularly coronavirus-related, and debated on the main media sources they used to consult for this purpose. Secondly, students had to analyze ten news headlines on COVID-19 disseminated by social media during the outbreaks; six corresponded to fake news and four were true. They were asked to critically assess them and distinguish which they thought were true, providing their arguments. Media sources were not provided until the end of the task, since the act of asking for the source was considered as part of the data analysis (see Table 1 ). The second part of this stage is the focus of our analysis.

Table 1. COVID-19 News Headlines provided to students.

Stage 4: Act and Raise Awareness on COVID-19

The sequence ended with the creation of a short video in which the students had to provide some tips to avoid the transmission of the virus. The information provided in the video must be supported and based on established scientific knowledge.

Data Corpus and Analysis

Data collection includes all individual surveys and activities developed in Google Forms. We analyzed students’ individual responses ( N = 28) presented in Stage 3. The research is designed as a qualitative study that utilizes the methods of discourse analysis in accordance with the data and the purpose of the study. Discourse analysis allows the analysis of the content (implicit or explicit) of written arguments produced by students, and so the examination of the research questions. Our analysis focuses on students’ arguments and criteria used to assess the credibility of COVID-19 headlines (ten headlines in total). It was carried out through an iterative process in which students’ responses were read and revised several times in order to develop an open-coded scheme that captures the arguments provided. To ensure the internal reliability of our codes, each student response was examined by the first and the second author separately and then contrasted and discussed until 100% agreement was achieved. The codes obtained were established according to the following criteria, summarized in Table 2 .

Table 2. Code scheme for research questions 1 and 2.

For Research Question 1, we distributed the arguments in two main categories: (1) Arguments that question the credibility of the information ; (2) Arguments that do not question the credibility of the information.

For Research Question 2, we classify arguments that question the credibility of the headline in accordance with the level of epistemic assessment into three levels (see Table 2 ). The level of epistemic assessment (basic, medium, and high) was established by the authors based on the criteria that students applied and expressed explicitly or implicitly in their arguments. These criteria emerged from the data, thus the categories were not pre-established; they were coded by the authors as the following: content (using the knowledge that each student has about the topic), source (questioning the origin of the information), evidence (appealing to empirical evidence as real live situations that students experienced), authority (justifying according to who supports or is behind the claim) and scientific procedure (drawing on the evolution of scientific knowledge).

Students’ Competence to Critically Assess the Credibility of COVID-19 Claims

In general, most students were able to distinguish fallacious from true headlines, which was an important step to assess their credibility. For those that were false, students were able to question their credibility, providing arguments against them. On the contrary, for true news headlines, as it was expected, most participants developed arguments supporting them. Thus, they did not question their content. In both cases, the arguments elaborated by students appealed to different criteria discussed in the next section of results.

As shown in Table 3 , 147 arguments were elaborated by students to question the false headlines; they created just 22 arguments to assess the true ones. This finding was expected by the authors, as arguments for questioning or criticality appear more frequently when the information presented differs from students’ opinions.

Table 3. Number of students who questioned or not each news headline on COVID-19.

Students showed a higher capacity for questioning those claims they considered false or fake news , which can be related to the need to justify properly why they consider them false and/or what should be said to counter them.

The headlines that were most controversial, meaning they created diverse positions among students, were these three: “The COVID-19 virus can be transmitted in areas with hot and humid climates,” “Skin manifestations (urticaria, chilblains, rashes…) could be among the mild symptoms of coronavirus” and “Antibiotics are effective in preventing and treating coronavirus infection.”

The first two were questioned by 11 students out of 28, despite being real headlines. According to students’ answers, they were not familiar with this information, e.g., “I think the heat is not good for the virus.” On the contrary, 17 students did not question these headlines, arguing for instance as this student did: “because it was shown that both in hot climates and in cold climates it is contagious in the same way.”

A similar situation happened with the third headline, which is false. A proportion of students (9 out of 28) accepted that antibiotics could help to treat COVID-19, showing in their answers some misunderstanding regarding the use of antibiotics and the diseases they could treat. The rest of the participants (19 out of 28) questioned this headline, affirming that “because antibiotics are used to treat bacterial infections and coronavirus is a virus,” among other justifications for why it was false.

Levels of Epistemic Assessment in Students’ Arguments on COVID-19 News Headlines

To analyze the level of epistemic assessment showed in students’ arguments when dealing with each headline, attention was focused on the criteria students applied (see Table 2 ). As Table 4 summarizes, almost all arguments included only one criterion (139 out of 169), and 28 out of 169 did not incorporate any criterion. These types of arguments can be interpreted as low epistemic assessment, or even without epistemic assessment if no criterion is included.

Table 4. Arguments used by students to assess the credibility of each COVID-19 headline.

In the category of Basic Epistemic Assessment , we include all students’ arguments that included one criterion: Content or Empirical Evidence. Students assessed the content of the claim appealing to their own knowledge about that piece of information or to empirical evidence, without posing critical questions for assessing the credibility of the source of information. These two criteria, content and evidence, were included in students’ arguments with a frequency of 86 and 23, respectively, with this category the most common (109 out of 169) when questioning false and true headlines. In the case of true headlines, arguments under this category were identified in relation to headlines 2 and 4, whose credibility were questioned by appealing to the content, such as: “those are not the symptoms (skin manifestations) ” . Examples of arguments assessing the content of false headlines are provided below:

“Because the virus is inside the body, and even if you injected alcohol into the body it would only cause intoxication”

This student rejects headline 5, appealing to the fact that alcohol causes intoxication rather than the elimination of coronavirus.

“I know a person who had coronavirus and they only gave him paracetamol”

In this example, the student rejects headline 6 and appeals to his/her own experience during the pandemic, particularly a close person who had coronavirus, as evidence against the use of antibiotics for coronavirus disease treatment.

The category Medium Epistemic Assessment gathers arguments that make critical questions, particularly those asking for information about the authority or the source of information. For us, these criteria reflect a higher level of epistemic performance since they imply questioning beyond the veracity of the headline itself to its sources and authorship. There are 20 out of 169 arguments coded within this category.

The assessment of true headlines includes arguments that question the authority and source, e.g., “because they said it on the news” (headline 2), “that news does not seem very reliable to me” (headline 4). It is also an ordinary category in questioning false headlines, since students appealed to the source (16), “because in the news they clarified that it was a fake news and because it is not credible either” (headline 10) or the authority (4), “because the professionals said they were more vulnerable (people over 70 years old) but not that it only affected them” (headline 7).

For the highest category, High Epistemic Assessment , we consider those arguments (12 out of 169) in which students appealed to the scientific procedure (11) to justify why the headline is false, which manifests students’ reliance on epistemic processes, e.g., “because treatments that protect against coronavirus are still being investigated” (headline 9). Also, under this category we include arguments that combined more than one criterion, content and scientific procedure “Because antibiotics don’t treat those kinds of infections. In addition, no medication has yet been discovered that can prevent the coronavirus” (headline 6). Students’ arguments included in this category were elaborated to assess false headlines.

Lastly, a special mention is afforded to those arguments that did not include any criteria (28), which are contained in the category Non-Epistemic Assessment. It appears more frequently in students’ answers to headlines 8 and 10, as these examples show: “I don’t think it’s true because it doesn’t make much sense to me” (headline 8) or “I never heard it and I doubt it’s true” (regarding drinking alcohol, headline 10).

The findings of our study indicate that students were able to deal with fake news , identifying it as such. They showed capacity to critically assess the content of these news headlines, considering their inconsistencies in relation to their prior knowledge ( Britt et al., 2019 ). As Evagorou (2020) pointed out, SSIs are appropriate contexts for CT development and to value the relevance of science in our lives.

The examination of RQ1 shows that a proportion of students were able to perceive the lack of evidence behind them or even identified that those statements contradict what science presents. This is a remarkable finding and an important skill to fight against attempts to diminish trust in science produced in the post-truth condition ( Dillon and Avraamidou, 2020 ). CT and argumentation are closely allied ( Andrews, 2015 ) but as the results show, knowledge domain seems to play an important role in assessing SSIs news and their implications. Specific CT requires some of the same skills as generalizable CT, but it is highly contextual and requires particular knowledge ( Jones, 2015 ).

Students’ prior knowledge influenced the critical evaluation of some of the COVID-19 headlines provided in the activity. This is particularly relevant in responses to headline 6 (false) “Antibiotics are effective in preventing and treating coronavirus infection.” A previous study on the interactions between the CT and knowledge domain on vaccination ( Ageitos and Puig, 2021 ) showed that there is a correspondence between them. This points to the importance of health literacy for CT development, although it would not be sufficient to provide students with adequate knowledge only, as judgment skills, in this case regarding the proper use of antibiotics, are also required.

We found that the level of epistemic assessment (RQ2) linked to students’ CT capacity is low. A big majority of arguments were situated in a basic epistemic assessment level, and just a few in a higher epistemic assessment. One reason that might explain these results could be related to the task design and format, in which students worked autonomously in a virtual environment. As CT studies in e-learning environments have reinforced ( Niu et al., 2013 ), cooperative or collaborative learning favors CT skills, particularly when students have to discuss and justify their arguments on real-life problems. The circumstances in which students had to work during the outbreak did not allow them to work together since internet connections were not good for all of them, so synchronous activities were not possible. This aspect is a limitation for this research.

There were differences in the use of criteria, and thus in the level of epistemic assessment, when students dealt with true and false headlines. This could be related to diverse factors, such as the language. The claims are marred by language and they are formulated in a different way. Particularly, it is quite nuanced in true statements while certain and resolute in false headlines. The practice of CT requires an understanding of the language, the content under evaluation and other cognitive skills ( Andrews, 2015 ).

In the case of false headlines, most arguments appealed to their content and less to the criteria of source, authority, and the scientific procedure, whereas in the case of true headlines most of them appealed to the authority and/or source. According to the AIR model ( Chinn and Rinehart, 2016 ), epistemic ideals are the criteria used to evaluate the epistemic products, such as claims. In the case of COVID-19 claims, students need to have an ideal of high source credibility ( Duncan et al., 2021 ). This means that students acknowledge that information should be gathered from reliable news media that themselves obtained information from reliable experts.

Only few students used the criterion of scientific procedure when assessing false headlines, which shows a high level of epistemic assessment. Promoting this type of assessment is important since online discourse in the post-truth era is affected by misinformation and by appeals to emotions and ideology.

Conclusion and Implications

This research has been conducted during a moment in which the lives of people were paralyzed, and citizens were forced to stay at home to stop the spread of the coronavirus disease. During the lockdown and even after, apart from these containment measures, citizens in Spain and in many countries had to deal with a huge amount of information about the coronavirus disease, some of it false. The outbreak of COVID-19 has been accompanied by dissemination of inaccurate information spread at high speed, making it more difficult for the public to identify verified facts and advice from trusted sources ( World Health Organization (WHO), 2020 ). As the world responds to the COVID-19 pandemic, many studies have been carried out to analyze the impact of the pandemic on the life of children from diverse views ( Cachón-Zagalaz et al., 2020 ), but not from the perspective of exploring students’ ability to engage in the epistemic assessment of information and disinformation on COVID-19 under a situation of social isolation. This is an unprecedented context in many aspects, where online learning replaced in-person teaching and science uncertainties were more visible than ever.

Participants engaged in the epistemic assessment of coronavirus headlines and were able to put into practice their CT, arguing why they considered them as true or false by appealing to different criteria. We are aware that our results have limitations. Once such limitation is that students performed the activity independently, without creating a collaborative virtual environment, understood by the authors as one of the e-learning strategies that better promote CT ( Puig et al., 2020 ). Furthermore, despite the fact that teachers were available for students to solve any questions regarding the task, the remote and asynchronous process did not allow them to guide the activity in a way that helped the students to carry out a deeper analysis. CT development and epistemic cognition depends on many factors, and teachers have an important role in achieving these goals ( Greene and Yu, 2016 ; Chinn et al., 2020 ).

The analysis of arguments allows us to identify some factors that are crucial and directly affect the critical evaluation of headlines. Some of the students did not question the use of antibiotics for coronavirus disease. This result highlights the importance of health literacy and its interdependency with CT development, as previous studies on vaccine controversies and CT show ( Puig and Ageitos, 2021 ). Although it is not the focus of this paper; the results point to the importance of making students aware of their knowledge limitations for critical assessment. A key instructional implication from this work is making e-learning activities more cooperative, as we have noted, and epistemically guided. Moreover, CT dimensions could be made explicit in instructional materials and assessments. If we want to prepare students to develop CT in order to face real/false news spread by social media, we need to engage them in deep epistemic assessment, namely in the critical analysis of the content, the source, procedures and evidence behind the claims, apart from other tasks. Promoting students’ awareness and vigilance regarding misinformation and disinformation online may also promote more careful and attentive information use ( Barzilai and Chinn, 2020 ), thus activities oriented toward these goals are necessary.

Our study reinforces the need to design more CT activities that guide students in the critical assessment of diverse aspects behind controversial news as a way to fight against the rise of disinformation and develop good knowledge when dealing with SSIs. Students’ epistemological views can influence their performance on argumentation thus, if uncertainty of knowledge is explicitly address in SSI instruction and epistemic activities, students’ epistemological views may be developed, and such development may in turn influence their argumentation competence and consequently their performance on CT.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

Written informed consent was obtained from the participants’ legal guardian/next of kin to participate in this study in accordance with the National Legislation and the Institutional Requirements.

Author Contributions

BP conducted the conceptual framework and designed the research study. PB-A conducted the data analysis and collaborated in manuscript preparation. JP-M implemented the didactical proposal and collected the data. All authors contributed to the article and approved the submitted version.

This work was supported by the project ESPIGA, funded by the Spanish Ministry of Science, Education and Universities, partly funded by the European Regional Development Fund (ERDF) Grant code: PGC2018-096581-B-C22.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

This study was carried out within the RODA research group during the lockdown in Spain due to COVID-19 pandemic. We gratefully acknowledge all the participants for their implication, despite such difficult circumstances.

• ^ https://www.e-bug.eu

Abrami, P. C., Bernard, R. M., Borokhovski, E., Wade, A., Surkes, M. A., Ramim, R., et al. (2008). Instructional interventions affecting critical thinking skills and dispositions: a stage 1 meta-analysis. Rev. Educ. Res . 78, 1102–1134. doi: 10.3102/0034654308326084

CrossRef Full Text | Google Scholar

Ageitos, N., and Puig, B. (2021). “Critical thinking to decide what to believe and what to do regarding vaccination in schools. a case study with primary pre-service teachers,” in Critical Thinking in Biology and Environmental Education. Facing Challenges in a Post-Truth World , eds B. Puig and M. P. Jiménez-Aleixandre (Berlin: Springer).

Google Scholar

Aikenhead, G. S. (1985). Collective decision making in the social context of science. Sci. Educ . 69, 453–475. doi: 10.1002/sce.3730690403

Andrews, R. (2015). “Critical thinking and/or argumentation in highr education,” in The Palgrave Handbook of Critical Thinking in Higher Education , eds M. Davies, R. Barnett, et al. (New York, NY: Palgrave Macmillan), 93–105.

Barzilai, S., and Chinn, C. A. (2017). On the goals of epistemic education: promoting apt epistemic performance. J. Learn. Sci . 27, 353–389. doi: 10.1080/10508406.2017.1392968

Barzilai, S., and Chinn, C. A. (2020). A review of educational responses to the “post-truth” condition: four lenses on “post-truth” problems. Educ. Psychol. 55, 107–119. doi: 10.1080/00461520.2020.1786388

Bencze, L., Halwany, S., and Zouda, M. (2020). “Critical and active public engagement in addressing socioscientific problems through science teacher education,” in Science Teacher Education for Responsible Citizenship , eds M. Evagorou, J. A. Nielsen, and J. Dillon (Berlin: Springer), 63–83. doi: 10.1007/978-3-030-40229-7_5

Bråten, I., Brante, E. W., and Strømsø, H. I. (2019). Teaching sourcing in upper secondary school: a comprehensive sourcing intervention with follow-up data. Read. Res. Q . 54, 481–505. doi: 10.1002/rrq.253

Britt, M. A., Rouet, J. F., Blaum, D., and Millis, K. K. (2019). A reasoned approach to dealing with fake news. Policy Insights Behav. Brain Sci . 6, 94–101. doi: 10.1177/2372732218814855

Cachón-Zagalaz, J., Sánchez-Zafra, M., Sanabrias-Moreno, D., González-Valero, G., Lara-Sánchez, A. J., and Zagalaz-Sánchez, M. L. (2020). Systematic review of the literature about the effects of the COVID-19 pandemic on the lives of school children. Front. Psychol . 11:569348. doi: 10.3389/fpsyg.2020.569348

PubMed Abstract | CrossRef Full Text | Google Scholar

Chakraborty, I., and Maity, P. (2020). COVID-19 outbreak: migration, effects on society, global environment and prevention. Sci. Total Environ . 728:138882. doi: 10.1016/j.scitotenv.2020.138882

Chinn, C., and Rinehart, R. W. (2016). “Epistemic cognition and philosophy: developing a new framework for epistemic cognition,” in Handbook of Epistemic Cognition , eds J. A. Greene, W. A. Sandoval, and I. Braten (New York, NY: Routledge), 460–478.

Chinn, C. A., Barzilai, S., and Duncan, R. G. (2020). Disagreeing about how to know. the instructional value of explorations into knowing. Educ. Psychol . 55, 167–180. doi: 10.1080/00461520.2020.1786387

Chinn, C. A., Duncan, R. G., and Rinehart, R. (2018). “Epistemic design: design to promote transferable epistemic growth in the PRACCIS project,” in Promoting Spontaneous Use of Learning and Reasoning Strategies. Theory, Research and Practice for Effective Transfer , eds E. Manalo, Y. Uesaka, and C. A. Chinn (Abingdon: Routledge), 243–259.

Davies, M., and Barnett, R. (2015). The Palgrave Handbook of Critical Thinking in Higher Education . London: Palgrave MacMillan. doi: 10.1057/9781137378057

Dillon, J., and Avraamidou, L. (2020). Towards a viable response to COVID-19 from the science education community. J. Activist Sci. Technol. Educ . 11, 1–6. doi: 10.33137/jaste.v11i2.34531

Dominguez, C. (2018). A European Review on Critical Thinking Educational Practices in Higher Education Institutions. Vila Real: UTAD. Available online at: https://www.researchgate.net/publication/322725947_A_European_review_on_Critical_Thinking_educational_practices_in_Higher_Education_Institutions

Duncan, R. G., Caver, V. L., and Chinn, C. A. (2021). “The role of evidence evaluation in critical thinking,” in Critical Thinking in Biology and Environmental Education. Facing Challenges in a Post-Truth World , eds B. Puig and M. P. Jiménez-Aleixandre (Berlin: Springer).

Duschl, R. (2020). Practical reasoning and decision making in science: struggles for truth. Educ. Psychol . 3, 187–192. doi: 10.1080/00461520.2020.1784735

Eastwood, J. L., Sadler, T. D., Zeidler, D. L., Lewis, A., Amiri, L., and Applebaum, S. (2012). Contextualizing nature of science instruction in socioscientific issues. Int. J. Sci. Educ . 34, 2289–2315. doi: 10.1080/09500693.2012.667582

Ennis, R. (2018). Critical thinking across the curriculum. Topoi 37, 165–184. doi: 10.1007/s11245-016-9401-4

European Council of the European Union (2020). Fighting Disinformation . Available online at: https://www.consilium.europa.eu/en/policies/coronavirus/fighting-disinformation/

Evagorou, M. (2020). “Introduction: socio-scientific issues as promoting responsible citizenship and the relevance of science,” in Science Teacher Education for Responsible Citizenship , eds M. Evagorou, J. A. Nielsen, and J. Dillon (Berlin: Springer), 1–11. doi: 10.1007/978-3-030-40229-7_1

Evagorou, M., Jimenez-Aleixandre, M. P., and Osborne, J. (2012). ‘Should we kill the grey squirrels?’ a study exploring students’ justifications and decision-making. Int. J. Sci. Educ . 34, 401–428. doi: 10.1080/09500693.2011.619211

Facione, P. A. (1990). Critical Thinking: a Statement of Expert Consensus for Purposes of Educational Assessment and Instruction. Fullerton, CA: California State University.

Feinstein, W. N., and Waddington, D. I. (2020). Individual truth judgments or purposeful, collective sensemaking? rethinking science education’s response to the post-truth era. Educ. Psychol . 55, 155–166. doi: 10.1080/00461520.2020.1780130

Giri, V., and Paily, M. U. (2020). Effect of scientific argumentation on the development of critical thinking. Sci. Educ . 29, 673–690. doi: 10.1007/s11191-020-00120-y

Greene, J. A., and Yu, S. B. (2016). Educating critical thinkers: the role of epistemic cognition. Policy Insights Behav. Brain Sci . 3, 45–53. doi: 10.1177/2372732215622223

Guterres, A (2020). Secretary-General Remarks on COVID-19: A Call for Solidarity . Available at: https://www.un.org/sites/un2.un.org/files/sg_remarks_on_covid-19_english_19_march_2020.pdf (accessed March 19, 2020).

Halpern, D. F. (1998). Teaching critical thinking for transfer across domains. dispositions, skills, structure training, and metacognitive monitoring. Am. Psychol . 53, 449–455. doi: 10.1037/0003-066x.53.4.449

Jiménez Aleixandre, M. P., and Erduran, S. (2008). “Argumentation in science education: an overview,” in Argumentation in Science Education: Perspectives from Classroom-Based Research , eds S. Erduran and M. P. Jiménez Aleixandre (Dordrecht: Springer), 3–27. doi: 10.1007/978-1-4020-6670-2_1

Jiménez-Aleixandre, M. P., and Puig, B. (2021). “Educating critical citizens to face post-truth: the time is now,” in Critical Thinking in Biology and Environmental Education. Facing Challenges in a Post-Truth World , eds B. Puig and M. P. Jiménez-Aleixandre (Berlin: Springer).

Jones, A. (2015). “A disciplined approach to CT,” in The Palgrave Handbook of Critical Thinking in Higher Education , eds M. Davies, R. Barnett, et al. (New York, NY: Palgrave Macmillan), 93–105.

Kelly, G. J., and Licona, P. (2018). “Epistemic practices and science education,” in History, Philosophy and Science Teaching , ed. M. R. Matthews (Dordrecht: Springer), 139–165. doi: 10.1007/978-3-319-62616-1_5

Kuhn, D. (2019). Critical thinking as discourse. Hum. Dev . 62, 146–164. doi: 10.1159/000500171

Niu, L., Behar-Horenstein, L. S., and Garvan, C. W. (2013). Do instructional interventions influence college students’ critical thinking skills? a meta-analysis. Educ. Res. Rev . 9, 114–128. doi: 10.1016/j.edurev.2012.12.002

Pithers, R. T., and Soden, R. (2000). Critical thinking in education: a review. Educ. Res . 42, 237–249.

Puig, B., and Ageitos, N. (2021). “Critical thinking to decide what to believe and what to do regarding vaccination in schools. a case study with primary pre-service teachers,” in Critical Thinking in Biology and Environmental Education. Facing Challenges in a Post-Truth World , eds B. Puig and M. P. Jiménez-Aleixandre (Berlin: Springer).

Puig, B., Blanco Anaya, P., and Bargiela, I. M. (2020). “A systematic review on e-learning environments for promoting critical thinking in higher education,” in Handbook of Research in Educational Communications and Technology , eds M. J. Bishop, E. Boling, J. Elen, and V. Svihla (Cham: Springer), 345–362. doi: 10.1007/978-3-030-36119-8_15

Puig, B., Blanco Anaya, P., Crujeiras Pérez, B., and Pérez Maceira, J. (2016). Ideas, emociones y argumentos del profesorado en formación acerca del virus del Ébola. Indagatio Didactica 8, 764–776.

Sinatra, G. M., and Lombardi, D. (2020). Evaluating sources of scientific evidence and claims in the post-truth era may require reappraising plausibility judgments. Educ. Psychol . 55, 120–131. doi: 10.1080/00461520.2020.1730181

Sosa, E. (2015). Judgment and Agency. Oxford: Oxford University Press.

Sperber, D., Clement, F., Heintz, C., Mascaro, O., Mercier, H., Origgi, G., et al. (2010). Epistemic vigilance. Mind Lang . 25, 359–393. doi: 10.1111/j.1468-0017.2010.01394.x

Thomas, K., and Lok, B. (2015). “Teaching critical thinking: an operational framework,” in The Palgrave Handbook of Critical Thinking in Higher Education , eds M. Davies, R. Barnett, et al. (New York, NY: Palgrave Macmillan), 93–105. doi: 10.1057/9781137378057_6

van Gelder, T. (2005). Teaching critical thinking. some lessons from cognitive science. Coll. Teach . 53, 41–48. doi: 10.3200/CTCH.53.1.41-48

Vincent-Lacrin, S., González-Sancho, C., Bouckaert, M., de Luca, F., Fernández-Barrera, M., Jacotin, G., et al. (2019). Fostering Students’ Creativity and Critical Thinking: What it Means in School, Educational Research and Innovation. Paris: OED Publishing.

World Health Organization (WHO) (2020). Managing the COVID-19 Infodemic: Promoting Healthy Behaviours and Mitigating the Harm from Misinformation and Disinformation. Available online at: https://www.who.int/news/item/23-09-2020-managing-the-covid-19-infodemic-promoting-healthy-behaviours-and-mitigating-the-harm-from-misinformation-and-disinformation

Keywords : critical thinking, argumentation, socio-scientific issues, COVID-19 disease, fake news, epistemic assessment, secondary education

Citation: Puig B, Blanco-Anaya P and Pérez-Maceira JJ (2021) “Fake News” or Real Science? Critical Thinking to Assess Information on COVID-19. Front. Educ. 6:646909. doi: 10.3389/feduc.2021.646909

Received: 28 December 2020; Accepted: 09 March 2021; Published: 03 May 2021.

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*Correspondence: Blanca Puig, [email protected]

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Article Contents

Current chl definitions leading to chl-p, public health challenges of the covid-19 pandemic that relate to chl-p, some theoretical considerations for chl in a pandemic, towards a definition of critical health literacy in a pandemic, chl-p, summary and conclusion.

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Critical health literacy in pandemics: the special case of COVID-19

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Thomas Abel, David McQueen, Critical health literacy in pandemics: the special case of COVID-19, Health Promotion International , Volume 36, Issue 5, October 2021, Pages 1473–1481, https://doi.org/10.1093/heapro/daaa141

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In the current COVID-19 pandemic the active participation of the public is of central importance, however, certain factors found in this new pandemic disease complicates the participation. Addressing these complications needs public health and health promotion experts to understand the role of critical health literacy in a pandemic. We present the case for a definition of critical health literacy in a pandemic, CHL-P. We suggest that CHL-P can help professionals to support individuals and communities as agents for effectively dealing with the unique features of this pandemic.

In the absence of effective pharmacological interventions to control the pandemic, it has been necessary to depend almost entirely on public health measures. Consequently, the current COVID-19 crisis is characterized by the central role of individuals’ cooperation and agency; basic guidelines of hygiene, physical distancing and wearing masks need to be followed, however, the application of these guidelines, their adaptations in the different living and working contexts, requires individual and collective decision making and agency. On the individual level, there are numerous challenges ranging from critically assessing information to taking a value stand on self- and collective responsibility. Individuals have to weigh the pros and cons of following the proscribed COVID-19 behaviours in the face of uncertainty of scientific knowledge, often-inconsistent information and political failure. These conditions create considerable difficulties for individuals to engage in critical thinking and reflection.

In this infectious disease pandemic where a newly emergent virus, SARSCoV2 ( WHO, 2019 ), not only challenges bio-medical research fields, particular characteristics create a situation most difficult for promoting and achieving behavioural change at the population level. Typically, with a new virus scientific understanding is in the early stages of research while at the same time early stage intervention measures are most urgently needed. Societal institutions, and in particular governments and government agencies responsible for public health, cannot wait for completed scientific findings, instead they have to act on a more limited stock of scientific knowledge, often hampered by uncertainty. Not only is the scientific basis uncertain, the effects and broad ranging consequences of political and economic actions taken are very complex and in large part unpredictable. Overall, the pandemic situation is characterized by a high degree of complexity. Still, given the urgency of the situation, public health and health promotion experts need to provide guidance in what behavioural guidelines for the population are crucial (in this paper, we take the current state of the COVID-19 crisis, late 2020, as our starting point and focus our discussion on infectious disease pandemics. Key issues addressed here (such as extreme urgency of interventions) make infectious disease pandemics particular; however, many other characteristics like complexity of interventions may also apply to other pandemics such as the so-called obesity pandemic).

Under such conditions, professionals also have to understand that in an acute pandemic traditional health education approaches and behavioural rules may not be equally suited for those in varied social positions in the community. In addition, the likely information overload that may contain misleading or overwhelming information causes demand for critical assessment because careful selection and analysis of information sources and reflection skills are needed. The concept of critical health literacy has been suggested to address pertinent issues around finding trustworthy health information, understanding and using it ( Nutbeam, 2000 ). Mostly, it has been applied in health promotion research and NCD prevention.

In the case of a newly emerging pandemic, the situation is typically characterized by urgency of actions yet, challenged by uncertain scientific knowledge and a high degree of complexity at all levels of action. Those features of a pandemic are major factors determining the situation in which individuals have to make their decisions. For instance, individuals are challenged to select and assess the value of sources related to COVID-19 ( Okan et al. , 2020 ) and to understand the importance of collective action and shared responsibility ( Abel and McQueen, 2020 ). However, in conditions of information overflow, combined with political propaganda, uncertainty in what measures are most appropriate to take appears as a challenge. In addition, the possibility of unavoidable ambivalence in terms of personal freedoms versus collective health arises. Thus, critical health literacy is not just about careful selection and use of information available, but is to a large degree about individuals being able to reflect on the conditions and consequences of their actions in a public health emergency that vastly affects not only them and their families but also the society as a whole. Our observations and reflections on the current pandemic aim to provide a point of reference for systematic development of a health promotion concept of critical health literacy that can inform future public health theory and action on this pandemic as well as future such pandemics (we focus on issues to be considered by public health and health promotion experts when working with a health literacy concept. A different approach has been taken by others whose work focuses on what individuals should know and do in the current pandemic [e.g. ( Okan et al., 2020 )]).

The terms and basic ideas of CHL were early on stated in Donald Nutbeam’s typology of functional, interactive and critical HL. Starting from critical literacy as ‘…more advanced cognitive skills which, together with social skills, can be applied to critically analyse information, and to use this information to exert greater control over life events and situations.’ ( Nutbeam, 2000 ) he applied the basic idea more specifically to health issues. Until today this definition serves as a reference point for the concept of CHL and following were various efforts to advance the concept, mostly focussing on suggestions to include and/or elaborate on issues related to the Social Determinants of Health, empowerment, participation and political action ( Abel, 2007 ; Chinn, 2011 ; Mogford, 2011 ). Reflecting on Nutbeam’s definition of CHL and considering some of later efforts leads to some specific definitional issues that support the development of a concept of CHL-P.

Nutbeam referred to ‘… skills which investigate the political feasibility and organizational possibilities of various forms of action to address social, economic and environmental determinants of health’. In addition, he described CHL as ‘…linked to population benefit, alongside benefits to the individual’. Thus, links to pandemic conditions are quite apparent, as for instance the current COVID-19 crisis has made clear the need for the broad population to understand the challenges around political and organizational responses ( Abel and McQueen, 2020 ). Moreover, the issues of individual and population benefit addressed in the basic definition of CHL can allude to pertinent challenges in a pandemic and lead us to consider questions on individual and collective responsibility for a definition of CHL-P.

Chinn and McCarthy stressed the ‘…. willingness to assert personal control over healthcare decisions and a positive view about the possibilities of individual contribution to community health outcomes’ [( Chinn and McCarthy,2013 ), p. 252]. Those features refer again to issues of individual and collective responsibility; they also relate to individual agency whose features can be applied to the current COVID-19 challenges (see the section of theoretical considerations below).

Sykes et al. summarized the discussion of CHL at the time, confirming the critical appraisal of health information as a key component of CHL and a standard in the various definitions. The authors advanced the concept and suggested to define CHL as to include ‘… a process in which citizens become aware of issues, participate in critical dialogue, and become involved in decision making for health’ [( Sykes et al. , 2013 ), p. 2]. While there were scant more publications on CHL, e.g. those addressing interventions to promote CHL, Sykes and Wills ( Sykes and Wills, 2018 ) point out that little has been added since then in terms of the basic assumptions and the constituent elements of CHL.

The literature to date implies four major components of a definition of CHL: CHL (−) allows critically appraising information, (−) contributes to ‘awareness’ of issues, (−) facilitates ‘participation’ in communication and (−) encourages ‘involvement’ in decisions, all related to health. While these components are relevant for a focussed consideration of CHL in a pandemic, we see some limitations when it comes to a new and sufficiently focussed concept of CHL-P. (−) Individual empowerment is a central focus in the previous definitions but this focus is challenged in a pandemic situation when public health and health promotion experts need to convey to individuals to accept some severe restrictions in their daily lives. (−) Most current definitions still have a focus on cognitive skills when in a crisis situation like that of COVID-19 experts have to understand that at the population level value issues and emotional challenges are a key factor. (−) Implicitly, most definitions of critical health literacy appear to take for granted a solid stock of scientific knowledge available when in fact, in a new pandemic this is hardly the case.

Pandemics have a special meaning in the history and scope of public health. In contrast to endemic infectious diseases, pandemics have an unstable and often difficult pattern of occurrence. In addition, they spread without regard to basic geopolitical boundaries ( Garrett, 1994 ). The most notable previous pandemic of influenza in 1918 − 19 spread throughout the world and was exacerbated by war, poverty and global population movement. In the early 21st century, it is safe to assert that these underlying conditions are far different from that time particularly global movement of populations. An important characteristic of a pandemic is that when it occurs the current state of clinical medicine has limited ability to treat the disease and the infection runs its course unless mitigated by non-clinical factors ( Anderson and Nokes, 2005 ). Essentially, a public health approach is the only effective way to diminish the initial impact and course of a pandemic until a time of effective medical treatment and/or a vaccine is produced ( CDC, 2018 ). Without any effective intervention, the infectious agent will continue its course until herd immunity is obtained. At that point, the disease generally reverts to an endemic phase where it will occur occasionally among people without immunity. In short, only public health measures can adequately control a pandemic.

As of October 2020, though understanding of the disease and its control are improving, there remains scientific uncertainty on many characteristics of this pandemic, notably the mechanisms of spread and the best approaches to preventing its spread ( Fisher et al. , 2020 ). Current prognosis is that the pandemic will continue for some time. This state of the art presents challenges to decide what prudent emphases should CHL-P assign that have a higher probability of being relevant for the time until COVID-19 is no longer a population threat. To date the variability of successful management of the pandemic has varied greatly. It is notable to see the documented efforts and assess how they have taken into account as science, social and political factors. For example, at the international level there has been wide variation in success dependent on the political leadership found in different nation states. There is also an observed gradient in success of recovery from COVID-19 related to measures of social inequity ( Chowkwanyun and Reed, 2020 ; Laster Pirtle, 2020 ; Shah et al. , 2020 ) ( Box 1 ).

CHL-P should reflect on the more successful outcomes and the actions taken to obtain success. We want to emphasize those actions most important for application of CHL-P. These include urgency of action, understanding the complexity of the pandemic, recognizing the need for community action, taking actions based on advice from scientific experts and taking clear and decisive personal behaviours.

The wide variation in how information about COVID-19 has been delivered to date, from institutional bodies [e.g. ( WHO, 2020 )] to national political leaders to leading public health experts, presents a particular challenge to any concept of CHL-P because of the variation in message deliverers. What is missing is a solid analysis and careful consideration of the different contexts in which individuals receive the messages about actions to be taken with regard to the pandemic. What seems to be clear in all observations of these factors is that where the guidance of public health experts following the best scientific judgments is emphasized there are better outcomes.

CHL-P rests on a public health and health promotion base that is distinct from clinical medicine and medical care. It centres on health promotion, disease prevention, control and mitigation. A global infectious disease pandemic is one of the most critical concerns of public health, including its conceptual ideas and its institutional manifestation. However, CHL-P that relates to COVID-19, requires careful focus on those dimensions of public health that are most salient in dealing with a crisis that is current, threatening, global and difficult to manage and/or control, including recognition of the epidemiological dimensions of the pandemic, the need for long-term quarantine or lockdown, understanding of social and/or spatial distancing and assessing urgency and consistency of action.

The spread of a highly contagious virus such as COVID-19 reveals what people should do to reduce susceptibility. First, it is clear from a public health action perspective that time is of the essence. The disease acts in real time and in the special case of COVID-19 the disease may be spread by those who are asymptomatic making both traditional quarantine less useful and strengthening the idea that isolation, spatial distancing and masking may be appropriate even in a period of time where few or no cases are apparent. This approach arises in part because of the relatively problematic data available on how many cases, asymptomatic or actual, may be inaccurately appraised. Thus, the unknowns around the mechanisms of spread of COVID-19 make public health strategies very complicated and challenging. Nonetheless, timeliness of necessary action shows the need for urgency of action by all concerned. Adding to the complexity is the lack, in many cases, of consistent messages. CHL-P must engage with the issues of complexity and uncertainty that are not seen in well-established and understood diseases (CHL-P is not limited to the acute and early phases of the pandemic. A pandemic may be long lived and change over time. As the pandemic enters later stages, issues related to degree of mitigation, development of herd immunity, better understanding of the communicability and, of course, the use of medicines and vaccines will continue to be important ( Anderson and Nokes, 2005 ). Many of the ideological challenges raised by individuals to wearing masks or those arising with challenges to vaccination will call for CHL-P).

Obviously, the urgency for professionals to act and promote appropriate behavioural changes in the populations is extremely high in the case of a pandemic. Some experts may be wary/sceptical about theoretical approaches at this time. Nonetheless, some theoretical guidance helps to clarify the basic challenges to be considered in comprehensive interventions. The idea that ‘good public information’ alone is sufficient to get the population ‘on board’ overlooks the reality that the behavioural change challenges in this crisis are complex and the theoretical grounds on which to develop the best interventions are often lacking.

We place the concept of CHL-P in the sociological perspective of individual and collective agency ( Giddens, 1991 ; Hewson, 2010 ), emphasizing that individuals even in situations where strong political regulation is called for are not to be reduced to objects but, understood and addressed as subjects making decisions for themselves and others. Individuals are agents whose behaviours either reproduce or can change structural conditions ( Abel and Frohlich, 2012 ). Most obviously, individuals are agents of changes in their own lifestyles and in case of collective agency; their behaviour has major implications on the structural level as well ( Sykes and Wills, 2018 ). Our assertion is that a theoretical perspective of agency can guide public health and health promotion experts to address the full potential of collaborative efforts at all level and thus, to push back on trends towards fatalism and paternalism. We argue here that the concept of CHL-P can account for supporting this form of individual and collective agency as a key element in pandemic crises (there are many forms of agency in the current crisis, among them activities of lobby groups, e.g. for re-opening certain segments of the market (e.g. tourism) after lock down. In this paper, we focus on individuals’ and collective agency that is linked to CHL-P).

In the COVID-19 crisis urgency of actions, complexity of decisions and uncertainty in the knowledge base make behavioural action difficult. CHL-P is an attempt to address these challenges while at the same time, avoiding paternalist views. CHL-P instead addresses individuals as agents, citizens and partners in a collaborative effort to mitigate the consequences of the current crisis. To understand the potential role of CHL-P, public health and health promotion experts should account for individual agency and the structural condition of individuals’ decision-making and action.

Most population-based measures to reduce the spread of the COVID-19 virus include an appeal to an individual’s sense of community and collective responsibility. At the same time, most measures leave some leeway for personal decisions: submitting to curfew rules, following properly the rules of hygiene, wearing masks and keeping the recommended spatial distance are individual choices. Such choices will depend, in part, on how much they are based on scientific evidence (properly communicated) and who delivers the message (trusting the messengers). In any case, the current crisis has clearly shown that individuals need to critically assess incomplete evidentiary suggestions (especially when issued by governments with political motivations superseding scientific understanding), thus the decision not to follow ‘poor’ recommendations belongs to individual agency. These behaviours affect an individual’s risk as well as the community COVID-19 risks. In the form of collective (risk) behaviours they show profound structural effects as was apparent for instance, in the shortage of ICUs in many (not all) countries. ‘Flattening the curve’ or mitigation was a striking example of how much the structural functioning of the health care systems depended on individuals’ decision to follow or not follow certain advice. One might expect that with the consecutive lifting of structural measures the leverage of individual decision making and thus agency factors are likely to gain in relative importance.

While some parts of the public focussed on notions such as ‘loss of individual freedom’ due in part to drastic political interventions, this should not be confused with loss of agency. In fact, following the guidelines meant exercising agency: by accepting the given risks and the collective responsibility as a citizen, individuals rendered their agency strengthening the structural measures (our assumption is that many individuals who apply COVID-19 pandemic guidelines, based on a sense of community, decide that their personal behaviour contributes to the protection of vital societal functions. This sense of the commons varies in different societies and subpopulations across the globe. It remains a task for social science research to study the links of sense of the commons and agency in pandemic crises). Staying home and mitigating the spread of the virus helped in supporting vulnerable people in the neighbourhood (often with the help of municipalities) and created and strengthened structural forces (Van den Brouke, 2020). These phenomena suggest considering CHL-P as part of ‘constructive agency’ at the population level in pandemic situations ( Box 2 ) (notably other forms of patterned behaviours that might be called ‘destructive agency’, undermining public health efforts through pro-actively contributing to mis-information, distributing conspiracy theories and. intentionally or unintentionally weakening the structural measures exist. A concept of ‘destructive agency’ in a pandemic may sound provocative and awaits further development in future research).

‘…it is too easy to focus on people making bad choices rather than on people having bad choices. People should practice humility regarding the former and voice outrage about the latter’. ( Marcus, 2020 )

It was ‘discovered’ rather late in the COVID-19 crisis that this public health crisis is socially stratified, that although it affects all strata in our societies, the impact was and still is very different according to social class, race, ethnicity ( Berkowitz et al. , 2020 ; Mesa Vieira et al. , 2020 ). When appealing to ‘the population’ today it needs to be understood that individuals’ decisions and actions in response to COVID-19 are based on their position in the social structure, on the knowledge they were provided with, their job conditions and on the material and non-material resources available to them. Housing conditions (e.g. social housing) often make spatial distancing extremely difficult. Buying masks, even in affluent countries as Switzerland, has become an issue for low-income families who may have to compromise on other necessary expenditures to afford the appropriate use of masks ( SKOS, 2020 ). Given the enormous social inequality issues in the current pandemic ( Berkowitz et al. , 2020 ; Takian et al. , 2020 ) CHL-P needs to be discussed also as part of the social reproduction of health inequalities in pandemics. Here again an agency perspective that accounts for the given structural constraints can be helpful ( Abel and Frohlich, 2012 ; Sykes and Wills, 2018 ). In line with this perspective, CHL as part of people’s agency has been found a key factor to explain structural, here urban−rural variations in successful coping with the COVID-19 crisis ( Chen and Chen, 2020 ). And, we like to add here that the ‘humility’ referred to by Julia Marcus above is or at least could be part of improved CHL-P.

Our design of CHL-P is based on the observation that in special public health emergencies there arise unique challenges for both professionals and individuals. In the case of the COVID-19 pandemic profound challenges are related to the uncertainty of current knowledge, with the inherent complexity of issues and the attempts to misuse the crisis for political interests. Therefore, CHL-P should include an increased awareness by the population of the pitfalls of information [e.g. social media echo chambers ( Haque, 2010 ) and various forms of propaganda], skills to critically assess the information available, understanding and balancing individual and collective consequences of their behaviours and responsibilities and the skill to work with the best public health advice while accepting the uncertainties in scientific knowledge. In the current COVID-19 crisis, these individual competences underlay CHL-P. At the collective level CHL-P can function as a major resource for societies in the mitigation of the pandemic.

Public health and health promotion experts should understand the relevance of these components of CHL-P for and in the populations they work with and consequently aim at approaches that facilitate and draw on these competences. To support individuals as active citizens, health promoters should rely on guidance from a perspective of individual and collective agency. In addition, there is the need to understand and consider that the chances and opportunities to acquire and apply CHL-P are unequally distributed across social classes.

The contextual conditions generic to a pandemic like the current COVID-19 crisis are marked by three challenges: the urgency of action at all levels (individual and community action), complexity (requiring a basic understanding of the reasons and consequences of public health measures) and acceptance of the changes of what is scientifically known as knowledge develops over time. Within these conditions, individuals need to decide and act and we propose that CHL-P is needed to guide and support their actions.

The concept of CHL-P is population based; it addresses individuals as citizens and agents in their specific living conditions. We do not see CHL-P as a new form of classifying individuals into groups with ‘sufficient’ or ‘insufficient’ health literacy. Instead, we understand CHL-P as a resource warranted in a pandemic crisis but unequally distributed based on well-established forms of social inequalities (the possibility should be explored that CHL-P is not only an expression of social inequity but might play an active role in the social reproduction of health inequalities in a pandemic [on the potential risk of health literacy approaches increasing health inequalities ( Abel, 2008 ; Paakari and George, 2018)]).

With this, we define that CHL-P:

comprises the competences needed in a pandemic to understand and effectively respond to the urgency of action on all levels, the complexity involved in the causes and consequences, and the changes in the scientific basis over time;

supports individuals in the development of their ability to critically assess and reflect on the contextual conditions needed to carry out appropriate actions;

strengthens individual and collective agency in communities and contributes to more comprehensive societal responses to this pandemic and those occurring in the future.

The notion of critical health literacy was introduced as a generic concept in health promotion through which the social, economic and political determinants of health could be linked to an individual’s advanced skills to critical analyse and use health information ( Nutbeam, 2000 ; Abel 2008) . We have taken a topic specific approach to a current public health crisis by focussing on those elements that warrant a better understanding namely, the competences needed for the population to become a positive driving force in reducing the spread and mitigating the consequences of the pandemic. Referring to the major challenges in the current COVID-19 crisis, we developed a definition of critical health literacy in a pandemic. Our definition includes links to the current generic definitions of CHL such as the competences to assess the trustworthiness of sources or an increased awareness among individuals and the populations at large ( Sykes and Wills, 2018 ). Without explicitly referring to the concept of critical health literacy, experts have recently listed a number of health literacy issues that apply in the COVID-19 crisis ( Okan et al. , 2020 ; Van den Broucke, 2020 ). The list includes items such as ‘encouraging people to cross check the accuracy and credibility of information, to check the source of information (where does it come from, who is behind the information, what is the intention, why was it shared, when was it published), to verify the information by consulting a second source, to consult family members and trusted health professionals about information that is ‘doubtful’, and to think twice before sharing information that has not been fact-checked’. Those approaches are helpful in that they support the development of practical advice lists applicable in a pandemic crisis.

Our CHL-P concept differs from former health literacy concepts and critical health literacy approaches in several respects:

(−) Inherent to CHL-P is a focus on an acute situation and its consequences. The urgency of the acute health threat is a defining criterion of CHL-P. The urgent need is to critically assess COVID-19 related information and balance the pros and cons of decisions needed to stop spreading the virus.

(−) Understanding the relevance of CHL-P prepares public health and health promotion experts to consider and explicitly address the underlying challenges that individuals face when making their decisions. It draws attention to questions on personal and collective values, moral standards, sense of responsibility, sense of community and citizenship. CHL-P calls for including and strengthening individuals’ critical thinking and reflection during a pandemic.

(−) In pandemic situations, scientific knowledge may be limited, ‘evolving’ and often unstable. CHL-P accounts for and addresses the related uncertainties.

(−) Context is of central importance in the CHL-P approach. As an example, context may be seen as related to social class as well as other sociocultural factors. It acknowledges the need for contextualization of health messages and accounts for the fact that individuals are or need to become experts on how to adjust pandemic recommendation to their own individual living conditions. Context is also key for individuals to acquire and apply critical health literacy and achieve the behavioural changes needed. CHL-P urges health professionals to understand and account for context effects on all levels of intervention.

(−) CHL-P provides an attempt to anchor its approach in a social theory. By using theoretical guidance from a human agency perspective, the concept relates to bigger questions like those of ‘citizenship and health’ or the ‘reproduction of social health inequalities’ in a pandemic. Moreover, applying a structure-agency perspective would allow the elaboration of the concept of CHL-P and at the same time re-connecting it to the original concept that saw CHL closely related to the social determinants of health ( Sykes and Wills, 2018 ; Nutbeam and Lloyd, 2021 ).

Those features of CHL-P may be seen as conceptual advancements to date. This effort only is a beginning to develop the concept of CHL-P as a useful health promotion approach in a pandemic crisis. Much more work needs to be done to achieve the full potential of this approach. We list here some of the challenges for future research and practice on CHL-P.

(−) A sound theoretical basis needs to be developed for CHL-P. It can support the approach for instance, by defining the rage of themes best addressed in a CHL-P approach. In our understanding and supported by a theoretical perspective of structure and agency the CHL-P approach can help addressing issues on governance (in particular the role of government agencies) and collective agency examining the conditions of appropriate behaviours at the population level. Moreover, social theory can and should guide the choice of appropriate empirical methods in future CHL-P research.

(−) Innovative empirical approaches are called for in the design of new measures assessing critical health literacy and its distribution among the different population groups ( Abel, 2008 ). Empirical investigations on CHL-P (qualitative and quantitative) are needed for instance, to better understand how risk is assessed and interpreted and how that perception of risk is translated into agency, individual and collective.

(−) Context-specific interventions are necessary for a systematic application of CHL-P approach in health promotion. CHL-P requires individual skills of critical thinking and reflection and future studies should provide answers on how and where these generic competences can best be promoted school settings being a case in point ( Paakkari and Paakkari, 2012 ).

Urgency of measures, complexity of actions and uncertainty of scientific knowledge characterize the COVID-19 pandemic. At the same time, the success of any measure depends strongly on the active participation of the public. Indeed, we argue that there is a need and a significant potential for individual and collective agency in this crisis but that factors including poor policies, information overflow, media failure and propaganda have obstructed public health measures. Moreover, almost all pandemic recommendations need adjustment to the particular social class-based conditions requiring individual competencies we call critical health literacy in a pandemic. Public health and health promotion experts should build on the concept of CHL-P to facilitate and strengthen the significant potential of individual and collective agency in mitigating the consequences of the current crisis and prepare for similar pandemics in the future. The concept awaits further theoretical and empirical advancements.

Abel T. ( 2007 ) Cultural capital in health promotion. In McQueen D. V. , Kickbusch I. (eds), Health and Modernity: The Role of Theory in Health Promotion . Springer , New York , pp. 43− 73 .

Google Scholar

Google Preview

Abel T. ( 2008 ) Measuring health literacy: moving towards a health – promotion perspective. Editorial . International Journal of Public Health , 53 , 169 – 170 .

Abel T. , Frohlich K. L. ( 2012 ) Capitals and capabilities: linking structure and agency to reduce health inequalities . Social Science & Medicine (1982) , 74 , 236 – 244 .

Abel T. , McQueen D. ( 2020 ) Critical health literacy and the COVID-19 crisis. Letter to the Editor . Health Promotion International , doi: 10.1093/heapro/daaa040.

Anderson R. , Nokes D. J. ( 2005 ) Mathematical models of transmission and control. In Detels R. , McEwen J. , Beaglehole R. , Tanaka H. (eds), Oxford Textbook of Public Health , 4th edition, Chapter 6.14. Oxford University Press , New York , pp. 715− 744 .

Berkowitz S. A. , Cené C. W. , Chatterjee A. ( 2020 ) Covid-19 and health equity - time to think big . New England Journal of Medicine , 383 , e76 .

CDC. ( 2018 ) Public Health Emergency Preparedness and Response Capabilities . National Standards for State, Local, Tribal, and Territorial Public Health. October 2018, updated January 2019. https://www.cdc.gov/cpr/readiness/00_docs/CDC_PreparednesResponseCapabilities_October2018_Final_508.pdf (last accessed 3 August 2020).

Chen X. , Chen H. ( 2020 ) Differences in preventive behaviors of COVID-19 between urban and rural residents: lessons learned from a cross-sectional study in China . International Journal of Environmental Research and Public Health , 17 , 4437 .

Chinn D. ( 2011 ) Critical health literacy: a review and critical analysis . Social Science & Medicine , 73 , 60 – 67 .

Chinn D. , McCarthy C. ( 2013 ) All Aspects of Health Literacy Scale (AAHLS): developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings . Patient Education and Counseling , 90 , 247 – 253 .

Chowkwanyun M. , Reed A. L. Jr. ( 2020 ) Racial health disparities and Covid-19 - caution and context . New England Journal of Medicine , 383 , 201 – 203 .

Fisher K. A. , Barile J. P. , Guerin R. J. , Vanden Esschert K. L. , Jeffers A. , Tian L. H. et al.  ( 2020 ) Factors associated with cloth face covering use among adults during the COVID-19 pandemic—United States, April and May 2020 . Mmwr. Morbidity and Mortality Weekly Report , 69 , 933 – 937 .

Garrett L. ( 1994 ) The Coming Plague: Newly Emerging Diseases in a World out of Balance . Penguin , New York .

Giddens A. ( 1991 ) Modernity and Self-Identity: Self and Society in the Late Modern Age . Stanford University Press , Stanford .

Haque U. ( 2010 ) The Social Media Bubble. Harvard Business Review , 23 March 2010. https://hbr.org/2010/03/the-social-media-bubble (last accessed 3 August 2020).

Hewson M. ( 2010 ) Agency. In Mills A. , Durepos G. , Wiebe E. (eds.), Encyclopedia of Case Study Research , SAGE Publications , Thousand Oaks, CA , pp. 13− 17 .

Laster Pirtle W. N. ( 2020 ) Racial Capitalism: a fundamental cause of novel coronavirus (COVID-19) pandemic inequities in the United States . Health Education & Behavior , 47 , 504 – 508 .

Marcus J. ( 2020 ) Quarantine Fatigue Is Real. The Atlantic , 11 May 2020. https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/ (last accessed 3 August 2020)

Mesa Vieira C. , Franco O. H. , Gómez Restrepo C. , Abel T. ( 2020 ) COVID-19: the forgotten priorities of the pandemic . Maturitas , 136 , 38 – 41 .

Mogford E. , Gould L. , Devoght A. ( 2011 ) Teaching critical health literacy in the US as a means to action on the social determinants of health . Health Promotion International , 26 , 4 – 13 .

Nutbeam D. ( 2000 ) Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century . Health Promotion International , 15 , 259 – 267 .

Nutbeam D. , Lloyd J. ( 2021 ) Understanding and responding to health literacy as a social determinant of health . Annual Review of Public Health , 42 , 3.1 – 3.15 .

Okan O. , Sørensen K. , Messer M. ( 2020 ) COVID-19: a guide to good practice on keeping people well informed. The Conversation , 19 March 2020. https://theconversation.com/covid-19-a-guide-to-good-practice-on-keeping-people-well-informed-134046 (last accessed 3 August 2020).

Paakkari L. , Paakkari O. ( 2012 ) Health literacy as a learning outcome in schools . Health Education , 112 , 133 – 152 .

Paakkari L. , George S. ( 2018 ) Ethical underpinnings for the development of health literacy in schools: ethical premises ('why'), orientations ('what') and tone ('how') . BMC Public Health , 18 , 326 .

Shah G. H. , Shankar P. , Schwind J. S. , Sittaramane V. ( 2020 ) The detrimental impact of the COVID-19 crisis on health equity and social determinants of health . Journal of Public Health Management and Practice , 26 , 317 – 319 .

SKOS ( 2020 ) Finanzierung von Masken für sozialhilfebeziehende Personen. https://skos.ch/aktuell/artikel/finanzierung-von-masken-fuer-sozialhilfebeziehende-personen/ ; (last accessed 3 August 2020).

Sykes S. , Wills J. , Rowlands G. , Popple K. ( 2013 ) Understanding critical health literacy: a concept analysis . BMC Public Health , 13 , 150 .

Sykes S. , Wills J. ( 2018 ) Challenges and opportunities in building critical health literacy . Global Health Promotion , 25 , 48 – 56 .

Takian A. , Kiani M. M. , Khanjankhani K. ( 2020 ) COVID-19 and the need to prioritize health equity and social determinants of health . International Journal of Public Health , 65 , 521 – 523 .

Van den Broucke S. ( 2020 ) Why health promotion matters to the COVID-19 pandemic, and vice versa . Health Promotion International , 35 , 181 – 186 .

WHO. ( 2019 ) Country & Technical Guidance – Coronavirus disease (COVID-19) . https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications (last accessed 3 August 2020).

WHO. ( 2020 ) Novel Coronavirus(2019-nCoV): Situation Report, 12 . https://apps.who.int/iris/handle/10665/330777 (last accessed 3 August 2020).

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Coronavirus Resources: Teaching, Learning and Thinking Critically

A page we will continue to update with ideas for working, at school or at home, with content from The Times and other reliable sources about this global pandemic.

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By Katherine Schulten

Updated: April 20

As we continue to publish new student-centered resources related to this pandemic every weekday, you can find all our coronavirus content all in one place, in this column .

For example, we are posting regular writing prompts for teenagers about every aspect of life right now, from managing social distancing and online school to staying fit and finding comfort. Here are some of our latest favorite comments, under the headline, “ What Students Are Saying About Remote Learning .“

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From ‘deadly enemy’ to ‘covidiots’: Words matter when talking about  COVID-19

PhD, Philosophy of Language, Faculty of Applied Science, Emeritus, University of British Columbia

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Ruth Derksen does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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So much has been said and written about the COVID-19 pandemic. We’ve been flooded with metaphors, idioms, symbols, neologisms, memes and tweets. Some have referred to this deluge of words as an infodemic .

And the words we use matter. To paraphrase the philosopher Ludwig Wittgenstein: the limits of our language are the limits of our world . Words place parameters around our thoughts.

These parameters are the lenses we look through. According to literary theorist Kenneth Burke, “ terministic screens ” are defined as the language through which we perceive our reality. The screen creates meaning for us, shaping our perspective of the world and our actions within it. The language acting as a screen then determines what our mind selects and what it deflects.

This selective action has the capacity to enrage us or engage us. It can unite us or divide us, like it has during COVID-19.

Metaphors shape our understanding

Think about the effect of seeing COVID-19 through the terministic screen of war. Using this military metaphor , U.K. Prime Minister Boris Johnson has described COVID-19 as an “enemy to be beaten.” He asserts that this “enemy can be deadly,” but the “fight must be won.”

Read more: War metaphors used for COVID-19 are compelling but also dangerous

The effect of this military language conflicts with the perpetuated myth that “we are all in this together.” But rather, it invokes aggressive combat against an enemy. It signals an us-versus-them divide, promoting the creation of a villain through scapegoating and racist attitudes . Naming COVID-19 as the “China virus,” “Wuhan virus” or “Kung Flu” places the blame directly on China and increases racism. Attacks against Asian people have dramatically increased globally.

Read more: The Atlanta attacks were not just racist and misogynist, they painfully reflect the society we live in

Conversely, what would be the effect of a replacing the terministic screen of war with a tsunami? A metaphor that encourages “waiting out the storm?” Or working to help a neighbour? What would be the effect if the metaphor of “soldiers” were replaced with “ fire fighters ?” This could increase our perception of working together. Re-framing COVID-19 in this way has the capacity to convince us that we actually are “all in this together.”

An inspiring initiative, #ReframeCovid , is an open collective intended to promote alternative metaphors to describe COVID-19. The profound effect of altering the language is clear – to reduce division and generate unity.

Taking away our critical thinking

In a blog post, linquist Brigitte Nerlich compiled a list of metaphors used during the pandemic .

Although the metaphors of war and battle are foremost, others include bullet trains, an evil trickster, a petri dish, a hockey game, a football match, Whack-a-mole and even a grey rhino. Then there is the omnipresent light at the end of the tunnel .

And while they offer a way to re-frame our reality, helping the unfamiliar become familiar and rationalize our perceptions, there is danger lurking. Metaphors can substitute for critical thinking by offering easy answers to complex issues. Ideas can remain unchallenged if glossed over, falling prey to the trap of metaphors .

But metaphors also have the capacity to augment insight and understanding. They can foster critical thinking. One such example is the dance metaphor . It has been effectively used to describe the longer term effort and evolving global collaboration needed to keep COVID-19 controlled until vaccines are widely distributed.

COVID-19 buzzwords

Besides metaphors, other linguistic structures act as our terministic screens as well. Buzzwords related to the current pandemic have also increased.

We grimace or laugh at covidiot , covideo party and covexit . Then there is Blursday , zoom-bombing and quaran-teams .

According to a British language consultant, the pandemic has fostered more than 1,000 new words .

Why has this happened? According to a socio-linguistic analysis, new words can bond us like “ a lexical social glue .” Language can unite us in a common struggle of expressing our anxiety and facing the chaos. Common linguistic expressions decrease isolation and increase our engagement with others.

In a similar way, memes can reduce the space between us and foster social engagement. Most often sarcastic or ironic, memes about COVID-19 have been plentiful. Like metaphors, these buzzwords, puns and images embody symbols that invoke responses and motivate social action.

More recently, resisters of COVID language have flooded social media sites. Frustrated with the never-ending ordeal, online contributors refuse to name the pandemic. Instead they use absurd “pan-words”; calling it a panini, a pantheon, a pajama or even a pasta dish. These ludicrous words frolic with the terministic screen of “pandemic,” deconstructing the word to expose the bizarre meaningless nature of the virus and the heightened frustration with it.

Read more: How to cope with pandemic fatigue by imagining metaphors

The language used in relation to COVID-19 matters. As the effects of the pandemic intensify, so does the importance of the choice of language. Words, as terministic screens, can enable our perceptions in remarkable ways – they can unite us or divide us, enrage us or engage us, all while moving us to action.

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Critical Thinking, COVID-19 Vaccines, and Deadly Consequences

Critical thinking is sorely missing in our decision-making about the COVID vaccines—and it is having tragic results.

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Americans are being bombarded with all kinds of information about the COVID-19 vaccines . As we can see every day, this information can be partial, fragmented, conflicting, inaccurate, or downright wrong. Information can be distorted by politics or religion or conspiracy theories. What is needed—and has been sorely missing—is critical thinking by all Americans. And until we apply critical thinking to the issue of vaccines, our nation will continue to flail and remain on its deadly course. It does not have to be this way. All mental health professionals should be voicing their opinions about the vital role of critical thinking in individuals’ lives. Critical thinking refers to the objective analysis and evaluation of an issue. It requires 5 central steps: identification of an issue; open-mindedness in bringing to light all sides of the issue; evaluation of the factualness of each piece of information; synthesizing the best facts into a cohesive whole; and formulating superior conclusions. Historically, schools have done a terrible job of teaching us critical thinking. Most of us had classes where information was provided to us, we memorized it, and then we recited it back on exams. High grades reflected strong memorization. But the ability to think critically was seldom taught, even in high schools. Colleges and universities have made critical thinking a priority in their classrooms. But, of course, only 42% of Americans have a college education. That means the vast majority of citizens have not had the opportunity to learn critical thinking. Thus, we are inept at conquering complicated—and potentially deadly—national problems. Let us apply critical thinking to the COVID-19 vaccines. If we do, here is what we know for certain: vaccines are effective and safe; upward of 90% of Americans must be vaccinated or have had the coronavirus for the pandemic to be soundly defeated; our national history of vaccinations has been extremely impressive; and decisions about vaccines must be based on medical and scientific evidence. Our country is founded on the ideals of freedom and individual liberties. No one wants to take those away. But at this moment, when anti-science aggression is running wild, critical thinking must be far more salient in our decision-making than individual wishes, desires, politics, or religion. Critical thinking can debunk lies, conspiracy theories, and misinformation. It can lead us to the truth. Until critical thinking is widely accepted about vaccines, thousands of Americans will continue to die each week. This is profoundly sad and tragic since these deaths are almost totally preventable. All Americans must be vaccinated as soon as possible. It is the vehicle by which we can defeat this deadly pandemic. This is a certainty. This is the truth. Critical thinking can save lives. We just need to use it. Mental health professionals can be a role model for its use. Dr Blotcky is a clinical psychologist in private practice in Birmingham, Alabama.

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Clinical supervisor’s experiences of peer group clinical supervision during COVID-19: a mixed methods study

• Owen Doody   ORCID: orcid.org/0000-0002-3708-1647 1 ,
• Kathleen Markey   ORCID: orcid.org/0000-0002-3024-0828 1 ,
• James Turner   ORCID: orcid.org/0000-0002-8360-1420 2 ,
• Claire O. Donnell   ORCID: orcid.org/0000-0003-2386-7048 1 &
• Louise Murphy   ORCID: orcid.org/0000-0003-2381-3963 1  

BMC Nursing volume  23 , Article number:  612 ( 2024 ) Cite this article

Metrics details

Providing positive and supportive environments for nurses and midwives working in ever-changing and complex healthcare services is paramount. Clinical supervision is one approach that nurtures and supports professional guidance, ethical practice, and personal development, which impacts positively on staff morale and standards of care delivery. In the context of this study, peer group clinical supervision provides allocated time to reflect and discuss care provided and facilitated by clinical supervisors who are at the same grade/level as the supervisees.

To explore the clinical supervisor’s experiences of peer group clinical supervision a mixed methods study design was utilised within Irish health services (midwifery, intellectual disability, general, mental health). The Manchester Clinical Supervision Scale was used to survey clinical supervisors ( n  = 36) and semi-structured interviews ( n  = 10) with clinical supervisors were conducted. Survey data were analysed through SPSS and interview data were analysed utilising content analysis. The qualitative and quantitative data’s reporting rigour was guided by the CROSS and SRQR guidelines.

Participants generally had a positive encounter when providing clinical supervision. They highly appreciated the value of clinical supervision and expressed a considerable degree of contentment with the supervision they provided to supervisees. The advantages of peer group clinical supervision encompass aspects related to self (such as confidence, leadership, personal development, and resilience), service and organisation (including a positive working environment, employee retention, and safety), and patient care (involving critical thinking and evaluation, patient safety, adherence to quality standards, and elevated levels of care).

There are many benefits of peer group clinical supervision at an individual, service, organisation, and patient level. Nevertheless, there is a need to address a lack of awareness and misconceptions surrounding clinical supervision to create an environment and culture conducive to realising its full potential. It is crucial that clinical supervision be accessible to nurses and midwives of all grades across all healthcare services, with national planning to address capacity and sustainability.

Peer Review reports

Within a dynamic healthcare system, nurses and midwives face growing demands, underscoring the necessity for ongoing personal and professional development. This is essential to improve the effectiveness and efficiency of care delivery for patients, families, and societies. Despite the increased emphasis on increasing the quality and safety of healthcare services and delivery, there is evidence highlighting declining standards of nursing and midwifery care [ 1 ]. The recent focus on re-affirming and re-committing to core values guiding nursing and midwifery practice is encouraging such as compassion, care and commitment [ 2 ], competence, communication, and courage [ 3 ]. However, imposing value statements in isolation is unlikely to change behaviours and greater consideration needs to be given to ways in which compassion, care, and commitment are nurtured and ultimately applied in daily practice. Furthermore, concerns have been raised about global staff shortages [ 4 ], the evidence suggesting several contributing factors such as poor workforce planning [ 5 ], job dissatisfaction [ 6 ], and healthcare migration [ 7 ]. Without adequate resources and staffing, compromising standards of care and threats to patient safety will be imminent therefore the importance of developing effective strategies for retaining competent registered nurses and midwives is paramount in today’s climate of increased staff shortages [ 4 ]. Clinical supervision serves as a means to facilitate these advancements and has been linked to heightened job satisfaction, enhanced staff retention, improved staff effectiveness, and effective clinical governance, by aiding in quality improvements, risk management, and heightened accountability [ 8 ].

Clinical supervision is a key component of professional practice and while the aim is largely known, there is no universally accepted definition of clinical supervision [ 8 ]. Clinical supervision is a structured process where clinicians are allowed protected time to reflect on their practice within a supportive environment and with the purpose of developing high-quality clinical care [ 9 ]. Recent literature published on clinical supervision [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] highlights the advantages and merits of clinical supervision. However, there are challenges also identified such as a lack of consensus regarding the meaning and goal, implementation issues, variations in approaches in its operationalisation, and an absence of research evidence on its effectiveness. Duration and experience in clinical supervision link to positive benefits [ 8 ], but there is little evidence of how clinical supervision altered individual behaviours and practices. This is reinforced by Kuhne et al., [ 15 ] who emphasise that satisfaction rather than effectiveness is more commonly examined. It is crucial to emphasise that reviews have pinpointed that clinical supervision lowers the risks of adverse patient outcomes [ 9 ] and demonstrates enhancements in the execution of certain care processes. Peer group clinical supervision is a form of clinical supervision whereby two or more practitioners engage in a supervision or consultation process to improve their professional practice [ 17 ]. There is limited evidence regarding peer group clinical supervision and research on the experiences of peer clinical supervision and stakeholders is needed [ 13 ]. In Ireland, peer group clinical supervision has been recommended and guidelines have been developed [ 18 ]. In the Irish context, peer clinical supervision is where both clinical supervisees and clinical supervisors are peers at the same level/grade. However, greater evidence is required to inform future decisions on the implementation of peer group clinical supervision and the purpose of this study is to explore clinical supervisors’ experiences of peer group clinical supervision. As the focus is on peer group supervisors and utilising mixed methods the experiences of the other stakeholders were investigated and reported separately.

A mixed methods approach was used (survey and semi-structured interviews) to capture clinical supervisor’s experiences of clinical supervision. The study adhered to the Consensus-Based Checklist for Reporting of Survey Studies guidelines [ 19 ] (Supplementary File S1 ) and Standards for Reporting Qualitative Research guidelines [ 20 ] (Supplementary File S2 ).

Participants

This study was conducted with participants who successfully completed a professionally credited award: clinical supervision module run by a university in Ireland (74 clinical supervisors across 5 programmes over 3 years). The specific selection criteria for participants were that they were registered nurses/midwives delivering peer group clinical supervision within the West region of Ireland. The specific exclusion criteria were as follows: (1) nurses and midwives who haven’t finished the clinical supervision module at the University, (2) newly appointed peer group clinical supervisors who have yet to establish their groups and initiate the delivery of peer group clinical supervision.

Measures and procedures

The Manchester Clinical Supervision Scale-26 was used to survey participants in February/March 2022 and measure the peer group clinical supervisors’ overall experiences of facilitating peer group clinical supervision. The Manchester Clinical Supervision Scale-26 is a validated 26-item self-report questionnaire with a Likert-type (1–5) scale ranging from strongly disagree (1) to strongly agree (5) [ 21 ]. The Manchester Clinical Supervision Scale-26 measures the efficiency of and satisfaction with supervision, to investigate the skills acquisition aspect of clinical supervision and its effect on the quality of clinical care [ 21 ]. The instrument consists of two main sections to measure three (normative, restorative, and formative) dimensions of clinical supervision utilising six sub-scales: (1) trust and rapport, (2) supervisor advice/support, (3) improved care/skills, (4) importance/value of clinical supervision, (5) finding time, (6) personal issues/reflections and a total score for the Manchester Clinical Supervision Scale-26 is also calculated. Section two consisted of the demographic section of the questionnaire and was tailored to include eight demographic questions concerning the supervisor’s demographics, supervisee characteristics, and characteristics of clinical supervision sessions. There were also two open field questions on the Manchester Clinical Supervision Scale-26 (model of clinical supervision used and any other comments about experience of peer group clinical supervision). The main question about participants’ experiences with peer clinical supervision was “What was your experience of peer clinical supervision?” This was gathered through individual semi-structured interviews lasting between 20 and 45 min, in March/April 2022 (Supplementary file 3 ).

Ethical considerations

Health service institutional review boards of two University hospitals approved this study (Ref: 091/19 and Ref: C.A. 2199). Participants were recruited after receiving a full explanation of the study’s purpose and procedure and all relevant information. Participants were aware of potential risks and benefits and could withdraw from the study, or the survey could be stopped at any time. Informed consent was recorded, and participant identities were protected by using a pseudonym to protect anonymity.

Data analysis method

Survey data was analysed using the data analysis software package Statistical Package for the Social Sciences, version 26 (SPSS Inc., Chicago, Il, USA). Descriptive analysis was undertaken to summarise responses to all items and categorical variables (nominal and ordinal) were analysed using frequencies to detail the number and percentage of responses to each question. Scores on the Manchester Clinical Supervision Scale-26 were reverse scored for 9 items (Q1-Q6, Q8, Q20,21) and total scores for each of the six sub-scales were calculated by adding the scores for each item. Raw scores for the individual sub-scales varied in range from 0 to 20 and these raw scores were then converted to percentages which were used in addition to the raw scores for each sub-scale to describe and summarise the results of the Manchester Clinical Supervision Scale-26. Cronbach’s alpha coefficient was undertaken with the 26 questions included within the Manchester Clinical Supervision Scale-26 and more importantly with each of the dimensions in the Manchester Clinical Supervision Scale-26. The open-ended questions on the Manchester Clinical Supervision Scale-26 and interviews were analysed using content analysis guided by Colorafi and Evans [ 22 ] and categories were generated using their eight steps, (1) creating a coding framework, (2) adding codes and memos, (3) applying the first level of coding, (4) categorising codes and applying the second level of coding, (5) revising and redefining the codes, (6) adding memos, (7) visualising data and (8) representing the data.

Research rigour

To ensure the validity and rigour of this study the researchers utilised the Manchester Clinical Supervision Scale-26 a recognised clinical supervision tool with good reliability and wide usage. Interviews were recorded, transcribed, and verified by four participants, data were collected until no new components appeared, data collection methods and analysis procedures were described, and the authors’ biases were minimised throughout the research process. The Manchester Clinical Supervision Scale-26 instrument internal consistency reliability was assessed which was overall good (α = 0.878) with individual subscale also good e.g., normative domain 0.765, restorative domain 0.864, and formative domain 0.900. Reporting rigour was demonstrated using the Consensus-Based Checklist for Reporting of Survey Studies guidelines [ 19 ] and Standards for Reporting Qualitative Research guidelines [ 20 ].

Quantitative data

Participant and clinical supervision characteristics.

Thirty-six of the fifty-two (69.2%) peer group clinical supervisors working across a particular region of Ireland responded to the Manchester Clinical Supervision Scale-26 survey online via Qualtrics. Table 1 identifies the demographics of the sample who were predominantly female (94.4%) with a mean age of 44.7 years (SD. 7.63).

Peer group clinical supervision session characteristics (Table  2 ) highlight over half of peer group clinical supervisors ( n  = 20, 55.6%) had been delivering peer group clinical supervision for less than one year and were mainly delivered to female supervisees ( n  = 28, 77.8%). Most peer group clinical supervision sessions took place monthly ( n  = 32, 88.9%) for 31–60 min ( n  = 27, 75%).

Manchester Clinical Supervision Scale-26 results

Participants generally viewed peer group clinical supervision as effective (Table  3 ), the total mean Manchester Clinical Supervision Scale-26 score among all peer group clinical supervisors was 76.47 (SD. 12.801) out of 104, Surpassing the clinical supervision threshold score of 73, which was established by the developers of the Manchester Clinical Supervision Scale-26 as the benchmark indicating proficient clinical supervision provision [ 21 ]. Of the three domains; normative, formative, and restorative, the restorative domain scored the highest (mean 28.56, SD. 6.67). The mean scores compare favourably to that of the Manchester Clinical Supervision Scale-26 benchmark data and suggest that the peer group clinical supervisors were satisfied with both the level of support, encouragement, and guidance they provided and the level of trust/rapport they had developed during the peer group clinical supervision sessions. 83.3% ( n  = 30) of peer group clinical supervisors reported being either very satisfied ( n  = 12, 33.3%) or moderately satisfied ( n  = 18, 50%) with the peer group clinical supervision they currently delivered. Within the peer group clinical supervisor’s supervisee related issues ( n  = 17, 47.2%), work environment-related issues ( n  = 16, 44.4%), staff-related issues ( n  = 15, 41.7%) were reported as the most frequent issues, with patient/client related issues being less frequent ( n  = 8, 22.2%). The most identified model used to facilitate peer group clinical supervision was the Proctors model ( n  = 8, 22.22%), which was followed by group ( n  = 2, 5.55%), peer ( n  = 2, 5.55%), and a combination of the seven-eyed model of clinical supervision and Proctors model ( n  = 1, 2.77%) with some not sure what model they used ( n  = 2, 5.553%) and 58.33% ( n  = 21) did not report what model they used.

Survey open-ended question

‘Please enter any additional comments , which are related to your current experience of delivering Peer Group Clinical Supervision.’ There were 22 response comments to this question, which represented 61.1% of the 36 survey respondents, which were analysed using content analysis guided by Colorafi & Evans [ 22 ]. Three categories were generated. These included: personal value/benefit of peer group clinical supervision, challenges with facilitating peer group clinical supervision, and new to peer group clinical supervision.

The first category ‘personal value/benefit of peer group clinical supervision’ highlighted positive experiences of both receiving and providing peer group clinical supervision. Peer group clinical supervisors reported that they enjoyed the sessions and found them both worthwhile and beneficial for both the group and them as peer group clinical supervisors in terms of creating a trusted supportive group environment and motivation to develop. Peer group clinical supervision was highlighted as very important for the peer group clinical supervisors working lives and they hoped that there would be more uptake from all staff. One peer group clinical supervisor expressed that external clinical supervision was a ‘lifeline’ to shaping their supervisory journey to date.

The second category ‘challenges with facilitating peer group clinical supervision’, identified time constraints, lack of buy-in/support from management, staff shortages, lack of commitment by supervisees, and COVID-19 pandemic restrictions and related sick leave, as potential barriers to facilitating peer group clinical supervision. COVID-19 was perceived to have a negative impact on peer group clinical supervision sessions due to staff shortages, which resulted in difficulties for supervisees attending the sessions during work time. Peer group clinical supervisors felt that peer group clinical supervision was not supported by management and there was limited ‘buy-in’ at times. There was also a feeling expressed that peer group clinical supervision was in its infancy, as COVID-19 and its related restrictions impacted on this by either slowing down the process of commencing peer group clinical supervision in certain areas or having to move online. However, more recently improvements in managerial support and supervisee engagement with the peer group clinical supervision process are noted.

The final category ‘new to peer group clinical supervision’ highlighted that some peer group clinical supervisors were new to the process of providing peer group clinical supervision and some felt that this survey was not a true reflection of their experience of delivering peer group clinical supervision, as they were not fully established yet as clinical supervisors due to the impact of COVID-19. Peer group clinical supervisors identified that while they were new to providing peer group clinical supervision, they were enjoying it and that it was a learning curve for them.

Qualitative data

The qualitative phase explored peer group clinical supervisors’ ( n  = 10) own experiences of preparation received and experiences of being a peer group clinical supervisor. Three themes were identified through data analysis, building the foundations, enacting engagement and actions, and realities (Table  4 ).

Building the foundations

This theme highlights the importance of prior knowledge, awareness, and training but also the recruitment process and education in preparing peer group clinical supervisors.

Knowledge and awareness

Participant’s prior knowledge and awareness of peer group clinical supervision was mixed with some reporting having little or no knowledge of clinical supervision.

I’m 20 years plus trained as a nurse , and I had no awareness of clinical supervision beforehand , I really hadn’t got a clue what all of this was about , so it was a very new concept to me (Bernie) .

Others were excited about peer group clinical supervision and while they could see the need they were aware that there may be limited awareness of the value and process of clinical supervision among peers.

I find that there’s great enthusiasm and passion for clinical supervision as it’s a great support mechanism for staff in practice , however , there’s a lack of awareness of clinical supervision (Jane) .

Recruitment

Some participants highlighted that the recruitment process to become a peer group clinical supervisor was vague in some organisations with an unclear and non-transparent process evident where people were chosen by the organisation’s management rather than self-selecting interested parties.

It was just the way the training was put to the people , they were kind of nominated and told they were going and there was a lot of upset over that , so they ended up in some not going at all (Ailbhe) .

In addition, the recruitment process was seen as top loaded where senior grades of staff were chosen, and this limited staff nurse grade opportunities where there was a clear need for peer group clinical supervisors and support.

We haven’t got down to the ground level like you know we’ve done the directors , we’ve done the CNM3s the CNM2s we are at the CNM1s , so we need to get down to the staff nurse level so the nurses at the direct frontline are left out and aren’t receiving supervision because we don’t have them trained (Bernie) .

Training and education

Participants valued the training and education provided but there was a clear sense of ‘imposter syndrome’ for some peer group clinical supervisors starting out. Participants questioned their qualifications, training duration, and confidence to undertake the role of peer group clinical supervisor.

Because it is group supervision and I know that you know they say that we are qualified to do supervision and you know we’re now qualified clinical supervisors but I’m not sure that a three-month module qualifies you to be at the top of your game (Maria) .

Participants when engaged in the peer group clinical supervisor educational programme did find it beneficial and the true benefit was the actual re-engagement in education and published evidence along with the mix of nursing and midwifery practice areas.

I found it very beneficial , I mean I hadn’t been engaged in education here in a while , so it was great to be back in that field and you know with the literature that’s big (Claire) .

Enacting engagement and actions

This theme highlights the importance of forming the groups, getting a clear message out, setting the scene, and grounding the group.

Forming the groups

Recruitment for the group was of key importance to the peer group clinical supervisor and they all sent out a general invitation to form their group. Some supervisors used invitation letters or posters in addition to a general email and this was effective in recruiting supervisees.

You’re reaching out to people , I linked in with the ADoN and I put together a poster and circulated that I wasn’t ‘cherry picking , and I set up a meeting through Webex so people could get a sense of what it was if they were on the fence about it or unsure if it was for them (Karen) .

In forming the peer clinical supervision groups consideration needs to be given to the actual number of supervisees and participants reported four to six supervisees as ideal but that number can alter due to attendance.

The ideal is having five or six consistent people and that they all come on board and that you get the dynamics of the group and everything working (Claire) .

Getting a clear message out

Within the recruitment process, it was evident that there was a limited and often misguided understanding or perception of peer group clinical supervision.

Greater awareness of what actually clinical supervision is , people misjudge it as a supervision where someone is appraising you , when in fact it is more of a support mechanism , I think peer support is the key element that needs to be brought out (Jane) .

Given the lack of clarity and understanding regarding peer group clinical supervision, the participants felt strongly that further clarity is needed and that the focus needs to be on the support it offers to self, practice, and the profession.

Clinical supervision to me is clinical leadership (Jane) .

Setting the scene and grounding the group

In the initial phase of the group coming together the aspect of setting the scene and grounding the group was seen as important. A key aspect of this process was establishing the ground rules which not only set the boundaries and gave structure but also ensured the adoption of principles of trust, confidentiality, and safety.

We start with the ground rules , they give us structure it’s our contract setting out the commitment the expectation for us all , and the confidentiality as that’s so important to the trust and safety and building the relationships (Brid) .

Awareness of group dynamics is important in this process along with awareness of the group members (supervisees) as to their role and expectations.

I reiterate the role of each person in relation to confidentiality and the relationship that they would have with each other within the group and the group is very much aware that it is based on respect for each person’s point of view people may have a fear of contributing to the group and setting the ground rules is important (Jane) .

To ground the group, peer group clinical supervisors saw the importance of being present and allowing oneself to be in the room. This was evident in the time allocated at the start of each session to allow ‘grounding’ to occur in the form of techniques such as a short meditation, relaxation, or deep breathing.

At the start , I do a bit of relaxation and deep breathing , and I saw that with our own external supervisor how she settled us into place so very much about connecting with your body and you’ve arrived , then always come in with the contract in my first sentence , remember today you know we’re in a confidential space , of course , you can take away information , but the only information you will take from today is your own information and then the respect aspect (Mary Rose) .

This settling in and grounding was seen as necessary for people to feel comfortable and engage in the peer group clinical supervision process where they could focus, be open, converse, and be aware of their role and the role of peer group clinical supervision.

People have to be open, open about their practice and be willing to learn and this can only occur by sharing, clinical supervision gives us the space to do it in a space where we know we will be respected, and we can trust (Claire) .

This theme highlights the importance of the peer group clinical supervisors’ past experiences, delivering peer group clinical supervision sessions, responding to COVID-19, personal and professional development, and future opportunities.

Past experiences

Past experiences of peer group clinical supervisors were not always positive and for one participant this related to the lack of ground rules or focus of the sessions and the fact it was facilitated by a non-nurse.

In the past , I suppose I would have found it very frustrating as a participant because I just found that it was going round in circles , people moaning and you know it wasn’t very solution focused so I came from my situation where I was very frustrated with clinical supervision , it was facilitated by somebody that was non-nursing then it wasn’t very , there wasn’t the ground rules , it was very loose (Caroline) .

However, many did not have prior experience of peer group clinical supervision. Nonetheless, through the education and preparation received, there was a sense of commitment to embrace the concept, practice, and philosophy.

I did not really have any exposure or really much information on clinical supervision , but it has opened my eyes , and as one might say I am now a believer (Brid) .

Delivering peer group clinical supervision

In delivering peer group clinical supervision, participants felt supervisees were wary, as they did not know what peer group clinical supervision was, and they had focused more on the word supervision which was misleading to them. Nonetheless, the process was challenging, and buy-in was questioned at an individual and managerial level.

Buy-in wasn’t great I think now of course people will blame the pandemic , but this all happened before the pandemic , there didn’t seem to be you know , the same support from management that I would have expected so I kind of understood it in a way because then there wasn’t the same real respect from the practitioners either (Mary Rose) .

From the peer group clinical supervisor’s perspective, they were all novices in delivering/facilitating peer group clinical supervision sessions, and the support of the external clinical supervisors, and their own peer group clinical supervision sessions were invaluable along with a clinical supervision model.

Having supervision myself was key and something that is vital and needed , we all need to look at our practice and how we work it’s no good just facilitating others without being part of the process yourself but for me I would say the three principles of clinical supervision , you know the normative , formative and restorative , I keep hammering that home and bring that in regularly and revisit the contract and I have to do that often you know (Claire) .

All peer group clinical supervisors commented on the preparation for their peer group clinical supervision sessions and the importance of them having the right frame of mind and that often they needed to read over their course work and published evidence.

I want everybody to have a shared voice and you know that if one person , there is something that somebody feels very strongly and wants to talk about it that they e-mail in advance like we don’t have a set agenda but that’s agreed from the participant at the start (Caroline) .

To assist this, the peer group clinical supervisors noted the importance of their own peer group clinical supervision, the support of their peers, and external clinical supervisors. This preparation in an unpredictable situation can be difficult but drawing on one’s experience and the experience within the group can assist in navigating beyond unexpected situations.

I utilise the models of clinical supervision and this helps guide me , I am more of a facilitator of the group we are experts in our own area and our own role but you can only be an expert if you take the time to examine your practice and how you operate in your role (Brid) .

All clinical supervisors noted that the early sessions can be superficial, and the focus can be on other practice or management issues, but as time moves on and people become more engaged and involved it becomes easier as their understanding of supervision becomes clearer. In addition, there may be hesitancy and people may have difficulty opening up with certain people in the group and this is a reality that can put people off.

Initially there was so much managerial bashing and I think through supervision , I began to kind of think , I need the pillars of supervision , the governance , bringing more knowledge and it shifted everything in the room , trying to marry it with all the tensions that people have (Mary Rose) .

For some clinical supervisors, there were expected and unexpected challenges for them as clinical supervisors in terms of the discussions veering off course and expectations of their own ability.

The other big challenge is when they go off , how do you bring him back , you know when they veer off and you’re expected to be a peer , but you have to try and recoil that you have to get the balance with that right (Mary Rose) .

While peer group clinical supervision is accepted and seen as a valuable process by the peer group clinical supervisors, facilitating peer group supervision with people known to you can be difficult and may affect the process.

I’d love to supervise a group where I actually don’t know the people , I don’t know the dynamics within the group , and I’d love to see what it would be like in a group (Bernie) .

Of concern to clinical supervisors was the aspect of non-attendance and while there may be valid reasons such as COVID-19 the absence of a supervisee for several sessions can affect the group dynamics, especially if the supervisee has only engaged with early group sessions.

One of the ones that couldn’t attend because of COVID and whatever , but she’s coming to the next one and I just feel there’s a lot of issues in her area and I suppose I’m mindful that I don’t want that sort of thing to seep in , so I suppose it’s just for me just to keep reiterating the ground rules and the boundaries , that’s something I just have to manage as a facilitator , but what if they don’t attend how far will the group have progressed before she attends (Caroline) .

Responding to COVID-19

The advent of COVID-19 forced peer group clinical supervisors to find alternative means of providing peer group clinical supervision sessions which saw the move from face-to-face to online sessions. The online transition was seen as seamless for many established groups while others struggled to deliver sessions.

With COVID we did online for us it was fine because we were already formed (Corina) .

While the transition may have been positive many clinical supervisors came across issues because they were using an online format that would not be present in the face-to-face session.

We did have a session where somebody was in the main office and they have a really loud booming voice and they were saying stuff that was not appropriate to say outside of clinical supervision and I was like are you in the office can you lower it down a bit can you put your headphones on (Maria) .

However, two peer group clinical supervisors ceased or hasted the progress of rolling out peer group clinical supervision sessions mainly due to redeployment and staff availability.

With COVID it just had to be canceled here , it’s just the whole thing was canceled so it was very , very difficult for people (Mary Rose) .

It was clear from clinical supervisors that online sessions were appropriate but that they felt they were only appropriate for existing established groups that have had the opportunity to build relationships, develop trust, embed the ground rules, and create the space for open communication and once established a combined approach would be appropriate.

Since we weren’t as established as a group , not everybody knew each other it would be difficult to establish that so we would hold off/reschedule , obviously COVID is a major one but also I suppose if you have an established group now , and again , you could go to a remote one , but I felt like since we weren’t established as a group it would be difficult to develop it in that way (Karen) .

Within practice COVID-19 took priority and other aspects such as peer group clinical supervision moved lower down on the priority list for managers but not for the clinical supervisors even where redeployment occurred.

With COVID all the practical side , if one of the managers is dealing with an outbreak , they won’t be attending clinical supervision , because that has to be prioritised , whereas we’ve prioritised clinical supervision (Maria) .

The valuing of peer group clinical supervision was seen as important by clinical supervisors, and they saw it as particularly needed during COVID-19 as staff were dealing with many personal and professional issues.

During the height of COVID , we had to take a bit of a break for four months as things were so demanding at work for people but then I realised that clinical supervision was needed and started back up and they all wanted to come back (Brid) .

Having peer group clinical supervision during COVID-19 supported staff and enabled the group to form supportive relationships.

COVID has impacted over the last two years in every shape and they needed the supervision and the opportunity to have a safe supportive space and it gelled the group I think as we all were there for each other (Claire) .

While COVID-19 posed many challenges it also afforded clinical supervisors and supervisees the opportunity for change and to consider alternative means of running peer group clinical supervision sessions. This change resulted in online delivery and in reflecting on both forms of delivery (face-to-face and online) clinical supervisors saw the benefit in both. Face-to-face was seen as being needed to form the group and then the group could move online once the group was established with an occasional periodic face-to-face session to maintain motivation commitment and reinforce relationships and support.

Online formats can be effective if the group is already established or the group has gone through the storming and forming phase and the ground rules have been set and trust built , then I don’t see any problem with a blended online version of clinical supervision , and I think it will be effective (Jane) .

Personal and professional development

Growth and development were evident from peer group clinical supervisors’ experiences and this growth and development occurred at a personal, professional, and patient/client level. This development also produced an awakening and valuing of one’s passion for self and their profession.

I suppose clinical supervision is about development I can see a lot of development for me and my supervisees , you know personally and professionally , it’s the support really , clinical supervision can reinvigorate it’s very exciting and a great opportunity for nursing to support each other and in care provision (Claire) .

A key to the peer group clinical supervisor’s development was the aspect of transferable skills and the confidence they gained in fulfilling their role.

All of these skills that you learn are transferable and I am a better manager because of clinical supervision (Maria) .

The confidence and skills gained translated into the clinical supervisor’s own practice as a clinical practitioner and clinical supervisor but they were also realistic in predicting the impact on others.

I have empowered my staff , I empower them to use their voice and I give my supervisees a voice and hope they take that with them (Corina) .

Fundamental to the development process was the impact on care itself and while this cannot always be measured or identified, the clinical supervisors could see that care and support of the individual practitioner (supervisee) translated into better care for the patient/client.

Care is only as good as the person delivering it and what they know , how they function and what energy and passion they have , and clinical supervision gives the person support to begin to understand their practice and how and why they do things in a certain way and when they do that they can begin to question and even change their way of doing something (Brid) .

Future opportunities

Based on the clinical supervisor’s experiences there was a clear need identified regarding valuing and embedded peer group clinical supervision within nursing/midwifery practice.

There has to be an emphasis placed on supervision it needs to be part of the fabric of a service and valued by all in that service , we should be asking why is it not available if it’s not there but there is some work first on promoting it and people knowing what it actually is and address the misconceptions (Claire) .

While such valuing and buy-in are important, it is not to say that all staff need to have peer group clinical supervision so as to allow for personal choice. In addition, to value peer group clinical supervision it needs to be evident across all staffing grades and one could question where the best starting point is.

While we should not mandate that all staff do clinical supervision it should become embedded within practice more and I suppose really to become part of our custom and practice and be across all levels of staff (Brid) .

When peer group clinical supervision is embedded within practice then it should be custom and practice, where it is included in all staff orientations and is nationally driven.

I suppose we need to be driving it forward at the coal face at induction , at orientation and any development for the future will have to be driven by the NMPDUs or nationally (Ailbhe) .

A formalised process needs to address the release of peer group clinical supervisors but also the necessity to consider the number of peer group clinical supervisors at a particular grade.

The issue is release and the timeframe as they have a group but they also have their external supervision so you have to really work out how much time you’re talking about (Maria) .

Vital within the process of peer group clinical supervision is receiving peer group clinical supervision and peer support and this needs to underpin good peer group clinical supervision practice.

Receiving peer group supervision helps me , there are times where I would doubt myself , it’s good to have the other group that I can go to and put it out there to my own group and say , look at this , this is what we did , or this is what came up and this is how (Bernie) .

For future roll out to staff nurse/midwife grade resourcing needs to be considered as peer group clinical supervisors who were managers could see the impact of having several peer group clinical supervisors in their practice area may have on care delivery.

Facilitating groups is an issue and needs to be looked at in terms of the bigger picture because while I might be able to do a second group the question is how I would be supported and released to do so (Maria) .

While there was ambiguity regarding peer group clinical supervision there was an awareness of other disciplines availing of peer group clinical supervision, raising questions about the equality of supports available for all disciplines.

I always heard other disciplines like social workers would always have been very good saying I can’t meet you I have supervision that day and I used to think my God what’s this fabulous hour that these disciplines are getting and as a nursing staff it just wasn’t there and available (Bernie) .

To address this equity issue and the aspect of low numbers of certain grades an interdisciplinary approach within nursing and midwifery could be used or a broader interdisciplinary approach across all healthcare professionals. An interdisciplinary or across-services approach was seen as potentially fruitful.

I think the value of interprofessional or interdisciplinary learning is key it addresses problem-solving from different perspectives that mix within the group is important for cross-fertilisation and embedding the learning and developing the experience for each participant within the group (Jane) .

As we move beyond COVID-19 and into the future there is a need to actively promote peer group clinical supervision and this would clarify what peer group clinical supervision actually is, its uptake and stimulate interest.

I’d say it’s like promoting vaccinations if you could do a roadshow with people , I think that would be very beneficial , and to launch it , like you have a launch an official launch behind it (Mary Rose) .

The advantages of peer group clinical supervision highlighted in this study pertain to self-enhancement (confidence, leadership, personal development, resilience), organisational and service-related aspects (positive work environment, staff retention, safety), and professional patient care (critical thinking and evaluation, patient safety, adherence to quality standards, elevated care standards). These findings align with broader literature that acknowledges various areas, including self-confidence and facilitation [ 23 ], leadership [ 24 ], personal development [ 25 ], resilience [ 26 ], positive/supportive working environment [ 27 ], staff retention [ 28 ], sense of safety [ 29 ], critical thinking and evaluation [ 30 ], patient safety [ 31 ], quality standards [ 32 ] and increased standards of care [ 33 ].

In this study, peer group clinical supervision appeared to contribute to the alleviation of stress and anxiety. Participants recognised the significance of these sessions, where they could openly discuss and reflect on professional situations both emotionally and rationally. Central to these discussions was the creation of a safe, trustworthy, and collegial environment, aligning with evidence in the literature [ 34 ]. Clinical supervision provided a platform to share resources (information, knowledge, and skills) and address issues while offering mutual support [ 35 ]. The emergence of COVID-19 has stressed the significance of peer group clinical supervision and support for the nursing/midwifery workforce [ 36 ], highlighting the need to help nurses/midwifes preserve their well-being and participate in collaborative problem-solving. COVID-19 impacted and disrupted clinical supervision frequency, duration and access [ 37 ]. What was evident during COVID-19 was the stress and need for support for staff and given the restorative or supportive functions of clinical supervision it is a mechanism of support. However, clinical supervisors need support themselves to be able to better meet the supervisee’s needs [ 38 ].

The value of peer group clinical supervision in nurturing a conducive working environment cannot be overstated, as it indorses the understanding and adherence to workplace policies by empowering supervisees to understand the importance and rationale behind these policies [ 39 ]. This becomes vital in a continuously changing healthcare landscape, where guidelines and policies may be subject to change, especially in response to situations such as COVID-19. In an era characterised by international workforce mobility and a shortage of healthcare professionals, a supportive and positive working environment through the provision of peer group clinical supervision can positively influence staff retention [ 40 ], enhance job satisfaction [ 41 ], and mitigate burnout [ 42 ]. A critical aspect of the peer group clinical supervision process concerns providing staff the opportunity to reflect, step back, problem-solve and generate solutions. This, in turn, ensures critical thinking and evaluation within clinical supervision, focusing on understanding the issues and context, and problem-solving to draw constructive lessons for the future [ 30 ]. Research has determined a link between clinical supervision and improvements in the quality and standards of care [ 31 ]. Therefore, peer group clinical supervision plays a critical role in enhancing patient safety by nurturing improved communication among staff, facilitating reflection, promoting greater self-awareness, promoting the exchange of ideas, problem-solving, and facilitating collective learning from shared experiences.

Starting a group arose as a foundational aspect emphasised in this study. The creation of the environment through establishing ground rules, building relationships, fostering trust, displaying respect, and upholding confidentiality was evident. Vital to this process is the recruitment of clinical supervisees and deciding the suitable group size, with a specific emphasis on addressing individuals’ inclination to engage, their knowledge and understanding of peer group clinical supervision, and dissipating any lack of awareness or misconceptions regarding peer group supervision. Furthermore, the educational training of peer group clinical supervisors and the support from external clinical supervisors played a vital role in the rollout and formation of peer group clinical supervision. The evidence stresses the significance of an open and safe environment, wherein supervisees feel secure and trust their supervisor. In such an environment, they can effectively reflect on practice and related issues [ 41 ]. This study emphasises that the effectiveness of peer group supervision is more influenced by the process than the content. Clinical supervisors utilised the process to structure their sessions, fostering energy and interest to support their peers and cultivate new insights. For peer group clinical supervision to be effective, regularity is essential. Meetings should be scheduled in advance, allocate protected time, and take place in a private space [ 35 ]. While it is widely acknowledged that clinical supervisors need to be experts in their professional field to be credible, this study highlights that the crucial aspects of supervision lie in the quality of the relationship with the supervisor. The clinical supervisor should be supportive, caring, open, collaborative, sensitive, flexible, helpful, non-judgmental, and focused on tacit knowledge, experiential learning, and providing real-time feedback.

Critical to the success of peer group clinical supervision is the endorsement and support from management, considering the organisational culture and attitudes towards the practice of clinical supervision as an essential factor [ 43 ]. This support and buy-in are necessary at both the management and individual levels [ 28 ]. The primary obstacles to effective supervision often revolve around a lack of time and heavy workloads [ 44 ]. Clinical supervisors frequently struggle to find time amidst busy environments, impacting the flexibility and quality of the sessions [ 45 ]. Time constraints also limit the opportunity for reflection within clinical supervision sessions, leaving supervisees feeling compelled to resolve issues on their own without adequate support [ 45 ]. Nevertheless, time-related challenges are not unexpected, prompting a crucial question about the value placed on clinical supervision and its integration into the culture and fabric of the organisation or profession to make it a customary practice. Learning from experiences like those during the COVID-19 pandemic has introduced alternative ways of working, and the use of technology (such as Zoom, Microsoft Teams, Skype) may serve as a means to address time, resource, and travel issues associated with clinical supervision.

Despite clinical supervision having a long international history, persistent misconceptions require attention. Some of these include not considering clinical supervision a priority [ 46 ], perceiving it as a luxury [ 41 ], deeming it self-indulgent [ 47 ], or viewing it as mere casual conversation during work hours [ 48 ]. A significant challenge lies in the lack of a shared understanding regarding the role and purpose of clinical supervision, with past perceptions associating it with surveillance and being monitored [ 48 ]. These negative connotations often result in a lack of engagement [ 41 ]. Without encouragement and recognition of the importance of clinical supervision from management or the organisation, it is unlikely to become embedded in the organisational culture, impeding its normalisation [ 39 ].

In this study, some peer group clinical supervisors expressed feelings of being impostors and believed they lacked the knowledge, skills, and training to effectively fulfil their roles. While a deficiency in skills and competence are possible obstacles to providing effective clinical supervision [ 49 ], the peer group clinical supervisors in this study did not report such issues. Instead, their concerns were more about questioning their ability to function in the role of a peer group clinical supervisor, especially after a brief training program. The literature acknowledges a lack of training where clinical supervisors may feel unprepared and ill-equipped for their role [ 41 ]. To address these challenges, clinical supervisors need to be well-versed in professional guidelines and ethical standards, have clear roles, and understand the scope of practice and responsibilities associated with being a clinical supervisor [ 41 ].

The support provided by external clinical supervisors and the peer group clinical supervision sessions played a pivotal role in helping peer group clinical supervisors ease into their roles, gain experiential learning, and enhance their facilitation skills within a supportive structure. Educating clinical supervisors is an investment, but it should not be a one-time occurrence. Ongoing external clinical supervision for clinical supervisors [ 50 ] and continuous professional development [ 51 ] are crucial, as they contribute to the likelihood of clinical supervisors remaining in their roles. However, it is important to interpret the results of this study with caution due to the small sample size in the survey. Generalising the study results should be approached with care, particularly as the study was limited to two regions in Ireland. However, the addition of qualitative data in this mixed-methods study may have helped offset this limitation.

This study highlights the numerous advantages of peer group clinical supervision at individual, service, organisational, and patient/client levels. Success hinges on addressing the initial lack of awareness and misconceptions about peer group clinical supervision by creating the right environment and establishing ground rules. To unlock the full potential of peer group clinical supervision, it is imperative to secure management and organisational support for staff release. More crucially, there is a need for valuing and integrating peer group clinical supervision into nursing and midwifery education and practice. Making peer group clinical supervision accessible to all grades of nurses and midwives across various healthcare services is essential, necessitating strategic planning to tackle capacity and sustainability challenges.

Data availability

Data are available from the corresponding author upon request owing to privacy or ethical restrictions.

Zelenikova R, Gurkova E, Friganovic A, Uchmanowicz I, Jarosova D, Ziakova K, Plevova I, Papastavrou E. Unfinished nursing care in four central European countries. J Nurs Manage. 2020;28(8):1888–900. https://doi.org/10.1111/jonm.12896 .

Article   Google Scholar  

Department of Health, Office of the Chief Nursing Officer. Position paper 1: values for nurses and midwives in Ireland. Dublin: The Stationery Office; 2016.

Google Scholar  

Cummings J, Bennett V. Developing the culture of compassionate care: creating a new vision for nurses, midwives and care-givers. London: Department of Health; 2012.

Both-Nwabuwe JM, Dijkstra MT, Klink A, Beersma B. Maldistribution or scarcity of nurses: the devil is in the detail. J Nurs Manage. 2018;26(2):86–93. https://doi.org/10.1111/jonm.12531 .

Squires A, Jylha V, Jun J, Ensio A, Kinnunen J. A scoping review of nursing workforce planning and forecasting research. J Nurs Manage. 2017;25:587–96. https://doi.org/10.1111/jonm.12510 .

Sasso L, Bagnasco A, Catania G, Zanini M, Aleo G, Watson R. Push and pull factors of nurses’ intention to leave. J Nurs Manage. 2019;27:946–54. https://doi.org/10.1111/jonm.12745 .

Gea-Caballero V, Castro-Sánchez E, Díaz‐Herrera MA, Sarabia‐Cobo C, Juárez‐Vela R, Zabaleta‐Del Olmo E. Motivations, beliefs, and expectations of Spanish nurses planning migration for economic reasons: a cross‐sectional, web‐based survey. J Nurs Scholarsh. 2019;51(2):178–86. https://doi.org/10.1111/jnu.12455 .

Article   PubMed   Google Scholar  

Cutcliffe J, Sloan G, Bashaw M. A systematic review of clinical supervision evaluation studies in nursing. Int J Ment Health Nurs. 2018;27:1344–63. https://doi.org/10.1111/inm.12443 .

Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health C. 2016;28(4):447–55. https://doi.org/10.1093/intqhc/mzw059 .

Turner J, Hill A. Implementing clinical supervision (part 1): a review of the literature. Ment Health Nurs. 2011;31(3):8–12.

Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse. 2013;45(1):22–32. https://doi.org/10.5172/conu.2013.45.1.22 .

Buss N, Gonge H. Empirical studies of clinical supervision in psychiatric nursing: a systematic literature review and methodological critique. Int J Ment Health Nurs. 2009;18(4):250–64. https://doi.org/10.1111/j.1447-0349.2009.00612.x .

Pollock A, Campbell P, Deery R, Fleming M, Rankin J, Sloan G, Cheyne H. A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals. J Adv Nurs. 2017;73(8):1825–37. https://doi.org/10.1111/jan.13253 .

Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience: a systematic review. BMC Health Serv Res. 2017;17(1):1–11. https://doi.org/10.1186/s12913-017-2739-5 .

Kühne F, Maas J, Wiesenthal S, Weck F. Empirical research in clinical supervision: a systematic review and suggestions for future studies. BMC Psychol. 2019;7(1):1–11. https://doi.org/10.1186/s40359-019-0327-7 .

Snowdon DA, Sargent M, Williams CM, Maloney S, Caspers K, Taylor NF. Effective clinical supervision of allied health professionals: a mixed methods study. BMC Health Serv Res. 2020;20(1):1–11. https://doi.org/10.1186/s12913-019-4873-8 .

Borders LD. Dyadic, triadic, and group models of peer supervision/consultation: what are their components, and is there evidence of their effectiveness? Clin Psychol. 2012;16(2):59–71.

Health Service Executive. Guidance document on peer group clinical supervision. Mayo: Nursing and Midwifery Planning and Development Unit Health Service Executive West Mid West; 2023.

Sharma A, Minh Duc NT, Lam Thang L, Nam T, Ng NH, Abbas SJ, Huy KS, Marušić NT, Paul A, Kwok CL. Karamouzian, M. A consensus-based checklist for reporting of survey studies (CROSS). J Gen Intern Med. 2021;36(10):3179–87. https://doi.org/10.1007/s11606-021-06737-1 .

Article   PubMed   PubMed Central   Google Scholar  

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014;899:1245–51. https://doi.org/10.1097/ACM.0000000000000388 .

Winstanley J, White E. The MCSS-26©: revision of the Manchester Clinical Supervision Scale© using the Rasch Measurement Model. J Nurs Meas. 2011;193(2011):160–78. https://doi.org/10.1891/1061-3749.19.3.160 .

Colorafi KJ, Evans B. Qualitative descriptive methods in health science research. HERD-Health Env Res. 2016;9:16–25. https://doi.org/10.1177/1937586715614171 .

Agnew T, Vaught CC, Getz HG, Fortune J. Peer group clinical supervision program fosters confidence and professionalism. Prof Sch Couns. 2000;4(1):6–12.

Mc Carthy V, Goodwin J, Saab MM, Kilty C, Meehan E, Connaire S, O’Donovan A. Nurses and midwives’ experiences with peer-group clinical supervision intervention: a pilot study. J Nurs Manage. 2021;29:2523–33. https://doi.org/10.1111/jonm.13404 .

Rothwell C, Kehoe A, Farook SF, Illing J. Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review. BMJ Open. 2021;119:e052929. https://doi.org/10.1136/bmjopen-2021-052929 .

Francis A, Bulman C. In what ways might group clinical supervision affect the development of resilience in hospice nurses. Int J Palliat Nurs. 2019;25:387–96. https://doi.org/10.12968/ijpn.2019.25.8.387 .

Chircop Coleiro A, Creaner M, Timulak L. The good, the bad, and the less than ideal in clinical supervision: a qualitative meta-analysis of supervisee experiences. Couns Psychol Quart. 2023;36(2):189–210. https://doi.org/10.1080/09515070.2021.2023098 .

Stacey G, Cook G, Aubeeluck A, Stranks B, Long L, Krepa M, Lucre K. The implementation of resilience based clinical supervision to support transition to practice in newly qualified healthcare professionals. Nurs Educ Today. 2020;94:104564. https://doi.org/10.1016/j.nedt.2020.104564 .

Feerick A, Doyle L, Keogh B. Forensic mental health nurses’ perceptions of clinical supervision: a qualitative descriptive study. Issues Ment Health Nurs. 2021;42:682–9. https://doi.org/10.1080/01612840.2020.1843095 .

Corey G, Haynes RH, Moulton P, Muratori M. Clinical supervision in the helping professions: a practical guide. Alexandria, VA: American Counseling Association; 2021.

Sturman N, Parker M, Jorm C. Clinical supervision in general practice training: the interweaving of supervisor, trainee and patient entrustment with clinical oversight, patient safety and trainee learning. Adv Health Sci Educ. 2021;26:297–311. https://doi.org/10.1007/s10459-020-09986-7 .

Alfonsson S, Parling T, Spännargård Å, Andersson G, Lundgren T. The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review. Cogn Behav Therapy. 2018;47(3):206–28. https://doi.org/10.1080/16506073.2017.1369559 .

Coelho M, Esteves I, Mota M, Pestana-Santos M, Santos MR, Pires R. Clinical supervision of the nurse in the community to promote quality of care provided by the caregiver: scoping review protocol. Millenium J Educ Technol Health. 2022;2:83–9. https://doi.org/10.29352/mill0218.26656 .

Toros K, Falch-Eriksen A. Structured peer group supervision: systematic case reflection for constructing new perspectives and solutions. Int Soc Work. 2022;65:1160–5. https://doi.org/10.1177/0020872820969774 .

Bifarin O, Stonehouse D. Clinical supervision: an important part of every nurse’s practice. Brit J Nurs. 2017;26(6):331–5. https://doi.org/10.12968/bjon.2017.26.6.331 .

Turner J, Simbani N, Doody O, Wagstaff C, McCarthy-Grunwald S. Clinical supervision in difficult times and at all times. Ment Health Nurs. 2022;42(1):10–3.

Martin P, Tian E, Kumar S, Lizarondo L. A rapid review of the impact of COVID-19 on clinical supervision practices of healthcare workers and students in healthcare settings. J Adv Nurs. 2022;78:3531–9. https://doi.org/10.1111/jan.15360 .

van Dam M, van Hamersvelt H, Schoonhoven L, Hoff RG, Cate OT, Marije P. Hennus. Clinical supervision under pressure: a qualitative study amongst health care professionals working on the ICU during COVID-19. Med Edu Online. 2023;28:1. https://doi.org/10.1080/10872981.2023.2231614 .

Martin P, Lizarondo L, Kumar S, Snowdon D. Impact of clinical supervision on healthcare organisational outcomes: a mixed methods systematic review. PLoS ONE. 2021;1611:e0260156. https://doi.org/10.1371/journal.pone.0260156 .

Article   CAS   Google Scholar  

Hussein R, Salamonson Y, Hu W, Everett B. Clinical supervision and ward orientation predict new graduate nurses’ intention to work in critical care: findings from a prospective observational study. Aust Crit Care. 2019;325:397–402. https://doi.org/10.1016/j.aucc.2018.09.003 .

Love B, Sidebotham M, Fenwick J, Harvey S, Fairbrother G. Unscrambling what’s in your head: a mixed method evaluation of clinical supervision for midwives. Women Birth. 2017;30:271–81. https://doi.org/10.1016/j.wombi.2016.11.002 .

Berry S, Robertson N. Burnout within forensic psychiatric nursing: its relationship with ward environment and effective clinical supervision? J Psychiatr Ment Health Nurs. 2019;26:7–8. https://doi.org/10.1111/jpm.12538 .

Markey K, Murphy L, O’Donnell C, Turner J, Doody O. Clinical supervision: a panacea for missed care. J Nurs Manage. 2020;28:2113–7. https://doi.org/10.1111/jonm.13001 .

Brody AA, Edelman L, Siegel EO, Foster V, Bailey DE Jr., Bryant AL, Bond SM. Evaluation of a peer mentoring program for early career gerontological nursing faculty and its potential for application to other fields in nursing and health sciences. Nurs Outlook. 2016;64(4):332–8. https://doi.org/10.1016/j.outlook.2016.03.004 .

Bulman C, Forde-Johnson C, Griffiths A, Hallworth S, Kerry A, Khan S, Mills K, Sharp P. The development of peer reflective supervision amongst nurse educator colleagues: an action research project. Nurs Educ Today. 2016;45:148–55. https://doi.org/10.1016/j.nedt.2016.07.010 .

Pack M. Unsticking the stuckness’: a qualitative study of the clinical supervisory needs of early-career health social workers. Brit J Soc Work. 2015;45:1821–36. https://doi.org/10.1093/bjsw/bcu069 .

Bayliss J. Clinical supervision for palliative care. London: Quay Books; 2006.

Kenny A, Allenby A. Implementing clinical supervision for Australian rural nurses. Nurs Educ Pract. 2013;13(3):165–9. https://doi.org/10.1016/j.nepr.2012.08.009 .

MacLaren J, Stenhouse R, Ritchie D. Mental health nurses’ experiences of managing work-related emotions through supervision. J Adv Nurs. 2016;72:2423–34. https://doi.org/10.1111/jan.12995 .

Wilson HM, Davies JS, Weatherhead S. Trainee therapists’ experiences of supervision during training: a meta-synthesis. Clinl Psychol Psychother. 2016;23:340–51. https://doi.org/10.1002/cpp.1957 .

Noelker LS, Ejaz FK, Menne HL, Bagaka’s JG. Factors affecting frontline workers’ satisfaction with supervision. J Aging Health. 2009;21(1):85–101. https://doi.org/10.1177/0898264308328641 .

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Acknowledgements

The research team would like to thank all participants for their collaboration, the HSE steering group members and Carmel Hoey, NMPDU Director, HSE West Mid West, Dr Patrick Glackin, NMPD Area Director, HSE West, Annette Cuddy, Director, Centre of Nurse and Midwifery Education Mayo/Roscommon; Ms Ruth Hoban, Assistant Director of Nursing and Midwifery (Prescribing), HSE West; Ms Annette Connolly, NMPD Officer, NMPDU HSE West Mid West.

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Exploring vaccine hesitancy: the twofold role of critical thinking

Loreta cannito.

1 Department of Psychological Sciences, Health and Territory, University G. d’Annunzio of Chieti - Pescara, 66100 Chieti Scalo, Italy

3 Center for Advanced Studies and Technology (CAST), University G. d’Annunzio of Chieti - Pescara, Via dei Vestini, 31, 66100 Chieti, Italy

Irene Ceccato

Alessandro bortolotti.

2 Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti - Pescara, 66100 Chieti Scalo, Italy

Adolfo Di Crosta

Pasquale la malva, rocco palumbo, alberto di domenico, riccardo palumbo, associated data.

The datasets generated during and/or analyzed the current study are available in the Open Science Framework repository: [ https://osf.io/83mzb/?view_only=d6763991d8df45aba49cbd93860c85a1 ]

With the progress of the vaccination campaign against the SARS-COV-2, we are ever closer to reaching that part of the population that refuses or is hesitant about vaccination. This study investigated the association between critical thinking motivation factors (i.e., intrinsic value of critical thinking and expectancy of one’s critical thinking ability), conspiracy mentality, intolerance of uncertainty and hesitancy toward vaccination. A sample of 390 participants completed an online survey during April 2021. Across participants, results indicate that conspiracy mentality and expectancy about personal ability as a critical thinker positively predict vaccine hesitancy. On the contrary, the intrinsic value attributed to critical thinking, intolerance of uncertainty, and education are negatively associated with hesitancy. While the findings confirm existing evidence, particularly on the detrimental role of conspiracy mentality on vaccine acceptance, they also shed light on the double-faced role exercised by critical thinking. Practical implications and future directions are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04165-w.

Introduction

From the first clinical trial for a COVID-19 vaccine in March 2020, we have witnessed a growing development of different vaccine solutions and a simultaneous diffusion of the vaccine among the population in the last few months. While during the first pandemic phase, as vaccine availability was limited, much attention has been paid to investigate possible solutions to manage COVID-19 vaccine allocation priority (e.g. Ceccato, Di Crosta, et al., 2021 ; Ceccato, Palumbo, et al., 2021 ), nowadays national governments are concentrating their efforts on accelerating the vaccination campaign, as clinical and socio-economic benefits are linked to a high vaccination coverage. However, a portion of the population reports to be skeptics and/or shows hesitancy toward the vaccination. Vaccine hesitancy refers to “delay in acceptance or refusal of vaccines despite availability of vaccination services” (MacDonald, 2015 ). For example, related to the COVID-19 vaccination, in a recent survey across European countries 27% of Europeans were found to be vaccine hesitant (Ahrendt et al., 2021 ). As the vaccination campaign progresses, this could be a crucial point as we are getting closer and closer to this resistant part of the population (Feleszko et al., 2021 ).

To date, several psychological factors and processes have been explored in relation to vaccine hesitancy. For example, the lack of trust in authorized members of society (e.g., scientists, pharmaceutical companies, or governments in general) have been associated with negative attitudes towards vaccines (e.g. Kennedy, 2019 ; Mesch & Schwirian, 2015 ). More recently, regarding the COVID-19 pandemic, conspiracy-related variables (both generic conspiracy beliefs and specific COVID-19 related conspiracy beliefs) have been largely confirmed as negative predictor of compliance with preventive measures (e.g. Pavela Banai et al., 2021 ) and as a positive predictors of vaccine hesitancy across different populations and during different stages of the pandemic (Allington et al., 2021 ; Bertin et al., 2020 ; Murphy et al., 2021 ). It should be noted that conspiracy beliefs have been sometimes related to intolerance of uncertainty, as their formation is supposed to be due to an individual’s perceived necessity to find a causal explanation to a situation with a high level of uncertainty (Douglas et al., 2019 ). Given the social and epidemiological relevance of the hesitancy phenomenon, researchers are urged to identify which variables may reduce or modulate the hesitancy toward vaccination. For example, critical/analytical thinking skills have been suggested as “protective” factors against general vaccine hesitancy (Arede et al., 2019 ). Some studies also reported that analytic thinking is associated with reduced endorsement of conspiracy theories (Pytlik et al., 2020 ). It should be noted that, as critical/analytical thinking is cognitively demanding and usually produces longer processing of information, some scholars argued that when assessing this ability, motivation towards this ability “activation” should be considered as well (Valenzuela et al., 2011 ).

Overall, the current study adopted an integrative approach to fill previous gaps in the literature by analyzing at once conspiracy mentality, intolerance of uncertainty, and critical thinking motivation, examining their separate role on people’s hesitancy toward COVID-19 vaccination. Furthermore, for the first time, critical thinking was analyzed not as a cognitive skill, but as an attitudinal and motivational factor able to orient decisions and health behaviors.

Theorical background

Conspiracy mentality and intolerance of uncertainty.

In the last few years, a topic that has increasingly caught scholars’ attention is the investigation of psychological drivers and consequences of individuals’ tendency to believe in conspiracy theories (Douglas et al., 2017 ). According to the most recent literature, the expression “conspiracy theories” identifies the “attempts to explain the ultimate causes of significant social and political events and circumstances with claims of secret plots by two or more powerful actors” (Douglas et al., 2019 ). Another widely shared definition was proposed by Swami and colleagues (Swami et al., 2014 ), who suggested that conspiracy theories can be defined as “a subset of false beliefs in which the ultimate cause of an event is believed to be due to a plot by multiple actors working together with a clear goal in mind, often unlawfully and in secret” (Swami et al., 2014 ; Swami & Furnham, 2014 ). One of the first psychological contributions on this topic supported the hypothesis that conspiracy beliefs are defined by a “monological functioning”, as believing in one conspiracy theory is associated with believing in all conspiracy theories (Goertzel, 1994 ). While more recent evidence suggested that sometimes conspiracy beliefs can also be associated with a singular topic (Sutton & Douglas, 2014 ), some studies highlighted that a person who believes in a specific conspiracy theory is more likely to trust all other conspiracy theories even if not related to the first one (Swami et al., 2010 ; Wood et al., 2012 ). This evidence led to the conceptualization of a more general thinking style, usually referred to as “conspiracy mentality” or “conspiracy mindset” (Dagnall et al., 2015 ). According to the available literature, this “style” may arise from different factors. For example, schizotypy, a personality style associated with magical thinking and distorted odds beliefs, has been systematically found to be a strong predictor of beliefs in conspiracy theories (Barron et al., 2018 ; Barron et al., 2014 ). Moreover, conspiracy mentality has been associated with greater proneness to specific cognitive biases, such as the Bias Against Disconfirmatory Evidence (Buchy et al., 2007 ; Georgiou et al., 2021 ). Also, other factors, such as low level of education (Georgiou et al., 2019 ; Van Prooijen & Jostmann, 2013 ) and extreme political orientation (Van Prooijen & Acker, 2015 ), have been identified as positive predictors of conspiracy beliefs. Taken together, available evidence suggests a role of three possible unmet psychological needs in people’s proneness to believe in conspiracy theories (Douglas et al., 2019 ; Stojanov et al., 2021 ). First, on a social level, when people feel that their need to maintain a positive self-image (Fairfield et al., 2015 ; Lantian et al., 2017 ) or a positive image of their ingroup (Cichocka et al., 2016 ) is threatened, they are more likely to adopt conspiracy beliefs. Second, conspiracy beliefs may arise when existential needs are activated and people need to feel safe and in control, such as when feeling powerless (Abalakina-Paap et al., 1999 ; Zebrowitz et al., 2015 ); this explanation was further supported by evidence of a reduction in conspiracy beliefs when the individual regained control (Van Prooijen & Acker, 2015 ). At last, as conspiracy beliefs may be seen as hypothesized causal explanations of the relationship between different events that might satisfy unsolved epistemic needs. Specifically, conspiracy beliefs can reduce uncertainty by engaging in mental sense-making processes that make the world understandable and predictable. This enhanced cognitive activity works as a coping strategy to restore a feeling of control (Park, 2010 ). Intolerance of uncertainty can be defined as “an individual’s dispositional incapacity to endure the aversive response triggered by the perceived absence of salient, key, or sufficient information, and sustained by the associated perception of uncertainty” (Carleton, 2016 ). Results on the relationship between intolerance of uncertainty and conspiracy theories’ endorsement are mixed, with some findings suggesting no relationship (Maftei & Holman 2022 ; Moulding et al., 2016 ) and others reporting a positive association between the two variables (Mari et al., 2022 ). By the way, for what concerns the direct influence of intolerance of uncertainty on COVID-19 vaccine hesitancy, more recent evidence suggests no significant role of this variable (Nazlı et al., 2021 ).

Regardless of the origin of a conspiracy mindset and its relationship with intolerance of uncertainty, several studies have reported an influence of this variable on the propensity to vaccinate. For example, in a cross-country study, Hornsey and colleagues reported conspirative thinking as the strongest predictor of anti-vaccine attitudes in general (Hornsey et al., 2018 ). The relationship between conspiracy beliefs and vaccine hesitancy has also been reported as related to specific diseases such as Polio (Murakami et al., 2014 ) or a particular type of vaccination such as MMR (McHale et al., 2016 ). Based on the available literature, we hypothesized that conspiracy mentality and intolerance of uncertainty positively predict vaccine hesitancy.

Critical thinking motivation and conspiracy mentality

Thinking style preferences, particularly for critical/analytical thinking, have been investigated as a possible protective factor against the endorsement of conspiracy theories (Pytlik et al., 2020 ). For instance, analytic thinking is associated with reduced beliefs in conspiracy theories and, in line with that, experimentally eliciting analytic thinking produces a reduction in conspiracies ideation (Swami et al., 2014 ). Generally speaking, out of the different measures and constructs used in literature to assess this variable, a more intuitive vs. deliberative thinking style has been consistently reported as a predictor of conspiracy mentality (Denovan et al., 2020 ). As related to the COVID-19 pandemic and related behaviors, Stanley and colleagues recently showed that lower engagement in analytic thinking is a predictor of both the tendency to believe that the pandemic is a hoax and the lack of respect for social distancing measures (Stanley et al., 2021 ). For what strictly regards vaccine hesitancy and refusal, an influence of parents’ analytical thinking has been proposed as a relevant variable in children’s vaccine uptake (Bertoncello et al., 2020 ; Tomljenovic et al., 2020 ). It should be noted that most of the contributions investigating the relationship between thinking style and vaccine-related behaviors have focused on analytic/critical thinking in its skill-based component. Nevertheless, no evidence is available for what concerns analytic/critical thinking motivation. Theoreticians of critical thinking, indeed, argued in favor of a bifactorial structure in the development of this style of thinking: on the one hand, the skill factor as a cognitive component, and on the other hand the disposition/motivation to put this style of thinking into practice (Elder & Paul, 2020 ). According to this approach, both components are required for critical thinking to be exercised. Moreover, critical thinking is a deliberative process, it is not automatically activated and presents activation costs. Therefore, the disposition/motivation component has been proposed as a prerequisite for activating and executing critical thinking skills (Faccione et al., 2000 ; Di Domenico et al., 2016 ). Thus, the literature investigating disposition/motivation toward critical thinking, by representing critical thinking as a task that requires resources to be performed, suggested that this variable depends on two different elements: first, the value that the individual assigns to critical thinking; and second, the expectation of a positive outcome as a consequence of the application of critical thinking (Eccles & Wigfield, 2002 ). Valenzuela and colleagues followed this line of reasoning and proposed a model and an associated measurement instrument for critical thinking motivation based on the value/expectation dichotomy. In this model, the value dimension reflects the positive intrinsic merit attributed to the critical thinking activity. In contrast, the dimension of expectation is defined as the individual self-evaluation of being a good critical thinker (Valenzuela et al., 2011 ). According to this model, both value and expectancy dimensions are required to be motivated to use one’s critical thinking skills. Therefore, this motivational component led to the activation of critical thinking skills (the cognitive component).

For the current work, given that critical thinking motivation is expected to be positively associated with critical thinking skill itself and that this skill has been proposed as a protective factor against vaccine hesitancy and refusal (Anderson, 2015 ), we hypothesized that both expectancy and value dimensions of critical thinking motivation negatively predicts vaccine hesitancy.

A total of 400 participants (39% male; mean age = 39.2 ± 13, mean years of education 14.2 ± 3.8) were recruited for this study using a snowball method. Students were recruited during faculty classes. When they completed the survey, they were invited to share the link to the survey with friends. Therefore, the final sample included both college students and adults from the general population (age range: 21–64). Participants provided written informed consent in accordance with the Declaration of Helsinki’s ethical standards. Data were collected via Qualtrics online platform (qualtrics.com) in three days during April 2021, when the national vaccine campaign in Italy had already started for a portion of the population and the first vaccination wave was just started. All participants were Italian speakers who physically resided in Italy during the pandemic. The research protocol was approved by the Institutional Review Board of Psychology (IRBP).

To ensure that participants had no previous history of psychiatric disorders or mental health conditions in general, as this can represent an influencing factor for study variables, the survey included a screening question on mental health. As based on this question, 10 participants were excluded from the dataset. Therefore, we obtained a final sample of 390 participants (38% male; mean age = 41 ± 13 years, mean years of education = 13.9 ± 3.7). The survey also included demographic questions about age, gender, years of education, political orientation, and a screening question to exclude potential respondents that had already received the vaccine because belonging to one of the groups that have accessed vaccination before the rest of the population in Italy at the moment of data collection (i.e., over 80 years old, some professionals and people with specific medical conditions). No participant was excluded after this question. Further, participants answered the vaccine hesitancy question “When it becomes available to you, how likely or unlikely is it that you will decide to get the vaccine?“ by using a 0 to 100 rating scale (from 0 = very likely to 100 = very unlikely). Thus, we obtain a score for which the higher the value, the higher respondent’s hesitancy. The survey also included the Italian version of the Intolerance of Uncertainty Scale (IUS-12) (Bottesi et al., 2015 ; Lauriola et al., 2016 ), the Italian adaptation of the Conspiracy Mentality Scale (Stojanov & Halberstadt, 2019 ) and the Italian adaptation of the Critical Thinking Motivational Scale (Valenzuela et al., 2011 ).

Intolerance of uncertainty (IUS-12)

The short form of the Intolerance of uncertainty scale (IUS-12) (Lauriola et al., 2016 ) was administered to assess this factor. The scale includes 12 items measuring two independent scores, prospective and inhibitory intolerance, and a general score (example item: “Unforeseen events upset me greatly”). Participants are required to answer using a 5-points Likert scale (from 1 = not at all characteristic of me to 5 = entirely characteristic of me). For the current study, we computed the general score for which the higher the score, the more the respondent feels intolerant toward uncertainty. The scale showed excellent reliability in the current sample, Cronbach’s α = 0.90.

Conspiracy mentality scale (CMS)

This scale includes 11 items measuring conspiracy mentality by asking participants to express their agreement with each item statement (example item: “Events throughout history are carefully planned and orchestrated by individuals for their betterment”) using a 7 points Likert scale (from 1 = completely disagree to 7 = completely agree) (Stojanov & Halberstadt, 2019 ). The original scale allows computing two scores (skepticism and conspiracy theories) and a total composite score reflecting conspiracy mentality. Higher scores are associated with a more conspiratorial mindset. Given our interest in measuring a conspiracy mentality in its whole and the lack of a priori hypothesis on the role of each subfactor, for the subsequent analyses we focused on the total composite score, including all 11 items (in the present study Cronbach’s α = 0.91) as suggested by previous literature (Stojanov & Halberstadt, 2019 ). It should be noted that none of the items in the CMS refers to specific conspiracy beliefs/theories about COVID-19 (more details on the Italian adaptation of the scale are provided in the Supplementary Material).

Critical thinking motivational scale (CTMS)

The critical thinking motivation scale (CTMS) (Valenzuela et al., 2011 ) contains 19 items measuring two factors: the intrinsic value of critical thinking (Value) and the expectations about one’s skills as a critical thinker (Expectancy) through a Likert scale (from 1 = completely agree to 6 = completely disagree). The Value factor of critical thinking is assessed via items such as: “Critical thinking will be useful for my future” (in the present study Cronbach’s α = 0.90). An example for the Expectancy factor is: “Concerning reasoning correctly, I am better than most of my peers” (in the present study Cronbach’s α = 0.75). To the aim of the current study, the independent influence of Value and Expectancy factors of critical thinking on vaccine hesitancy was assessed (see the Supplementary Material for details on the Italian adaptation of the scale).

Distribution of vaccine hesitancy

Across participants, vaccine hesitancy ranging from 0 (very likely to get the vaccine) to 100 (very unlikely to get the vaccine), was found to be moderate (M = 45.9, SD = 38.8). Mean vaccine hesitancy scores for each considered demographic variable are reported in Table  1 .

Participants’ vaccine hesitancy on a scale from 0 (very likely to get the vaccine) to 100 (very unlikely to get the vaccine)

Note. For descriptive purposes, years of education were converted into six educational levels.

Pearson correlation coefficients were computed to assess the relationships between intolerance of uncertainty, conspiracy mentality, and the two dimensions of critical thinking (i.e., expectancy and value) (Table  2 ). Intolerance of uncertainty was positively correlated with conspiracy mentality, p  < .001. On the contrary, there was a negative correlation between conspiracy mentality and both value of critical thinking, p  = .002, and expectancy of critical thinking, p  < .001. Moreover, a negative correlation between intolerance of uncertainty and expectancy of critical thinking was found, p  < .001.

Means ( M ), Standard Deviations ( SD ) and Pearson correlations ( r ) between variables

Note. CTMS = Critical thinking motivational scale. * p  < .01. ** p  < .001.

At last, a hierarchical multiple regression model was carried out to investigate whether conspiracy mentality, intolerance of uncertainty, value, and expectancy scores from the CTMS could significantly predict participants’ vaccine hesitancy while controlling for the potential role of demographic characteristics (gender, age, and years of education). Therefore, in the first step, we entered gender, age, and education. In the second step, conspiracy mentality, intolerance of uncertainty, value, and expectancy of CTMS were added. All the assumptions were met. The result indicated that the overall model explained a significant variance of vaccine hesitancy, 53%, F (4, 382) = 104.2, p  < .001. Results revealed that education was the only significant demographic predictor, while age and gender did not exhibit significant relationship with hesitancy. Specifically, higher levels of education intolerance of uncertainty and value of CTMS, predicted lower levels of vaccine hesitancy. On the contrary, conspiracy mentality and expectancy of CTMS were found to be positive predictors of hesitancy. Therefore, vaccine hesitancy increases by about 3% for each unit increase in conspiracy mentality and 4.4% for each unit increase critical thinking expectancy. On the contrary, vaccine hesitancy decreases by about 5% for each unit increase in critical thinking value, about 1.5% for each increase in intolerance of uncertainty unit, and about 3.7% for education. Therefore, results revealed that, while conspiracy mentality and one’s expectation as a critical thinker positively predict vaccine hesitancy, education, intolerance of uncertainty and value attributed to critical thinking were negative predictors of vaccine hesitancy (see Table  3 ).

Results for the hierarchical regression predicting vaccine hesitancy

Note . SE = Standard Error. 95% CI = Confidence Interval at 95% for the estimated coefficient, LL = lower level, and UP = upper level. N = 390.

The described analysis did not include political orientation as a predictor because about half of the participants answered “Prefer not to answer” on this question. Therefore, we replicated the same regression analysis described above by admitting only those participants who had reported their political orientation, adding political orientation into the first step. No significant association between vaccine hesitancy and political orientation was detected. For model 2 an R 2  = 0.62, F (4, 186) = 74.13, p  < .001 was obtained. Detailed results are reported in Table  4 .

Results for the hierarchical regression predicting vaccine hesitancy (including political orientation)

Note . SE = Standard Error. 95% CI = Confidence Interval at 95% for the estimated coefficient, LL = lower level, and UP = upper level. N = 195.

Going forward with vaccinations, nations are increasingly clashing with that portion of the population that has avoided vaccinating up to now. As current predictions suggest that we will need to continue vaccinating, it is helpful to understand which individual factors influence vaccine hesitancy we may have to continue to struggle with during the vaccination campaigns.

Our results highlighted a significant negative influence of education on vaccine hesitancy, similarly to what was reported by other studies (Bertoncello et al., 2020 ; Reno et al., 2021 ). On the other side, we found no relationship between political orientation and vaccine hesitancy, contrary to what was described in previous contributions (Fridman et al., 2021 ), possibly due to differences in the nationality of the involved participants. Regarding gender, we found no statistical differences contrary to some previous evidence which suggested more vaccine hesitancy in the female sample (Liu, 2021 ). Similarly, not significant role of age was detected in the present sample, while, for example, other evidence supported a higher hesitancy in the 35–54 years sample (Reno et al., 2021 ).

Results contribute to the investigation of this topic in two ways. First, from a theoretical point of view, present findings help clarify the association between intolerance of uncertainty and conspiracy beliefs. While a positive correlation between the two was detected, they intriguingly exerted an opposite influence of vaccine hesitancy. Indeed, while conspiracy mentality was found to positively predict hesitancy, as expected based on the literature, intolerance of uncertainty was a negative predictor of hesitancy. Overall, these findings supported the hypothesis of an association between intolerance towards uncertainty and a conspiratorial mentality and the influence of both factors on the propensity to receive the vaccination. Importantly, our results align with a recent study in the context of COVID-19 (Maftei & Holman, 2022 ), reporting a similar pattern of findings. Other authors investigated the predictors of compliance with the lockdown rules and found a small positive correlation between intolerance of uncertainty and conspiracy mentality and an opposite influence exerted by the two on the dependent variable (Maftei & Holman, 2022 ). A possible interpretation for our results stems from the hypothetical comparison of potential consequences to get (or not) vaccinated made by the individuals. Indeed, participants with high intolerance of uncertainty may have evaluated the effects of being vaccinated as less uncertain (more tolerable) than the consequences of not being vaccinated.

Second, our results suggest a dual role of critical thinking motivation in influencing hesitation about the vaccine. While, on the one hand, beliefs about oneself as a good critical thinker seem to promote hesitation, beliefs about the positive intrinsic value of critical thinking itself seem to work as a protective factor against hesitation. In other words, people who believe to be very able to reason systematically and rationally (i.e., expectancy) were also less prone to get vaccinated. On the contrary, people who believe that thinking in a critical and analytical way is a relevant skill and an important personal goal were less hesitant toward the vaccination. From a more practical point of view, this result is particularly interesting for what concerns policy-making efforts to promote vaccination among the hesitant population. In this regard, our results confirm the relevant role played by critical thinking as they suggest that attributing a high value to critical thinking is associated with less vaccine hesitancy, thus supporting those accounts that sustain the need for specific health and media literacy training (Dib et al., 2021 ; Pisl et al., 2021 ). It is important to acknowledge that the supplementary analysis on the construct validity of the CTMS questionnaire suggested substantial room for improvement. However, to date, this is the only instrument available in the literature to measure critical thinking motivation. Future studies are needed to confirm present findings and to delve into the topic, examining additional aspects and operationalizations of critical thinking attitude.

Following the line of reasoning delineated so far, promoting a culture of critical thinking and attention toward accuracy (Pennycook et el., 2021 ) would help the population navigate a world full of information that every day requires the ability to distinguish the truth from fake information (Arede et al., 2019 ; Mammarella et al., 2012 ). On the other side, our findings indicate that perceiving oneself as a good critical thinker increases the hesitation towards the vaccine, suggests being cautious of those training programs, social initiatives, or intervention protocols that aim to increase (or that cause an increase as an indirect consequence of other programs) critical thinking, without taking into account the possible negative consequences or without equipping individuals of any instrument to manage this effect.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contribution

LC conceived the experiment. AB, ADC, and PLM prepared tasks and conducted the experiment. LC and IC performed the statistical analyses. LC, IC, ROP, ADD, and RIP prepared the draft manuscript. All authors discussed, reviewed, and approved the final manuscript.

The authors received no specific funding for this work.

Data Availability

Declarations.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

• Abalakina-Paap M, Stephan WG, Craig T, Gregory WL. Beliefs in conspiracies. Political Psychology. 1999; 20 (3):637–647. doi: 10.1111/0162-895X.00160. [ CrossRef ] [ Google Scholar ]
• Ahrendt, D., Mascherini, M., Nivakoski, S., & Sándor, E. (2021). Living, working and COVID-19 (Update April 2021): Mental health and trust decline across EU as pandemic enters another year. Eurofound.
• Allington, D., McAndrew, S., Moxham-Hall, V., & Duffy, B. (2021). Coronavirus conspiracy suspicions, general vaccine attitudes, trust and coronavirus information source as predictors of vaccine hesitancy among UK residents during the COVID-19 pandemic. Psychological medicine , 1–12. 10.1017/S0033291721001434 [ PMC free article ] [ PubMed ]
• Anderson, D. A. (2015). Analytic thinking predicts vaccine endorsement: linking cognitive style and affective orientation toward childhood vaccination. University Honors Theses Paper , 215 , 10.15760/honors.220
• Arede, M., Bravo-Araya, M., Bouchard, É., Singh Gill, G., Plajer, V., Shehraj, A., & Shuaib, A., Y (2019). Combating vaccine hesitancy: teaching the next generation to navigate through the post truth era. Frontiers in public health , 381. 10.3389/fpubh.2018.00381 [ PMC free article ] [ PubMed ]
• Barron D, Furnham A, Weis L, Morgan KD, Towell T, Swami V. The relationship between schizotypal facets and conspiracist beliefs via cognitive processes. Psychiatry research. 2018; 259 :15–20. doi: 10.1016/j.psychres.2017.10.001. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barron D, Morgan K, Towell T, Altemeyer B, Swami V. Associations between schizotypy and belief in conspiracist ideation. Personality and individual differences. 2014; 70 :156–159. doi: 10.1016/j.paid.2014.06.040. [ CrossRef ] [ Google Scholar ]
• Bertin, P., Nera, K., & Delouvée, S. (2020). Conspiracy Beliefs, Rejection of Vaccination, and Support for hydroxychloroquine: A Conceptual Replication-Extension in the COVID-19 Pandemic Context. Frontiers in psychology,2471. 10.3389/fpsyg.2020.565128 [ PMC free article ] [ PubMed ]
• Bertoncello C, Ferro A, Fonzo M, Zanovello S, Napoletano G, Russo F, Baldo V, Cocchio S. Socioeconomic determinants in Vaccine Hesitancy and Vaccine Refusal in Italy. Vaccines. 2020; 8 (2):276. doi: 10.3390/vaccines8020276. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bottesi G, Ghisi M, Novara C, Bertocchi J, Boido M, De Dominicis I, Freeston MH. Intolerance of uncertainty scale (IUS-27 e IUS-12): due studi preliminari. Psicoterapia Cognitiva e Comportamentale. 2015; 21 (3):345–365. [ Google Scholar ]
• Buchy L, Woodward TS, Liotti M. A cognitive bias against disconfirmatory evidence (BADE) is associated with schizotypy. Schizophrenia research. 2007; 90 (1–3):334–337. doi: 10.1016/j.schres.2006.11.012. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Carleton RN. Into the unknown: a review and synthesis of contemporary models involving uncertainty. Journal of anxiety disorders. 2016; 39 :30–43. doi: 10.1016/j.janxdis.2016.02.007. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ceccato, I., Di Crosta, A., La Malva, P., Cannito, L., Mammarella, N., Palumbo, R., & Di Domenico, A. (2021). Public opinion in vaccine allocation priority: who comes first. ? Psychology & health , 1–21. 10.1080/08870446.2021.2007914 [ PubMed ]
• Ceccato, I., Palumbo, R., Di Crosta, A., Marchetti, D., La Malva, P., Maiella, R., & Di Domenico, A. (2021). “What’s next?” Individual differences in expected repercussions of the COVID-19 pandemic. Personality and Individual Differences , 174. 10.1016/j.paid.2021.110674 [ PMC free article ] [ PubMed ]
• Cichocka A, Marchlewska M, Golec de Zavala A, Olechowski M. ‘They will not control us’: Ingroup positivity and belief in intergroup conspiracies. British Journal of Psychology. 2016; 107 (3):556–576. doi: 10.1111/bjop.12158. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dagnall N, Drinkwater K, Parker A, Denovan A, Parton M. Conspiracy theory and cognitive style: a worldview. Frontiers in psychology. 2015; 6 :206. doi: 10.3389/fpsyg.2015.00206. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Denovan A, Dagnall N, Drinkwater K, Parker A, Neave N. Conspiracist beliefs, intuitive thinking, and schizotypal facets: a further evaluation. Applied Cognitive Psychology. 2020; 34 (6):1394–1405. doi: 10.1002/acp.3716. [ CrossRef ] [ Google Scholar ]
• Di Domenico A, Palumbo R, Fairfield B, Mammarella N. Fighting apathy in alzheimer’s dementia: a brief emotional-based intervention. Psychiatry Research. 2016; 242 :331–335. doi: 10.1016/j.psychres.2016.06.009. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dib, F., Mayaud, P., Chauvin, P., & Launay, O. (2021). Online mis/disinformation and vaccine hesitancy in the era of COVID-19: why we need an eHealth literacy revolution. Human vaccines & immunotherapeutics , 1–3. 10.1080/21645515.2021.1874218 [ PMC free article ] [ PubMed ]
• Douglas KM, Sutton RM, Cichocka A. The psychology of conspiracy theories. Current Directions in Psychological Science. 2017; 26 (6):538–542. doi: 10.1177/0963721417718261. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Douglas KM, Uscinski JE, Sutton RM, Cichocka A, Nefes T, Ang CS, Deravi F. Understanding conspiracy theories. Political Psychology. 2019; 40 :3–35. doi: 10.1111/pops.12568. [ CrossRef ] [ Google Scholar ]
• Eccles JS, Wigfield A. Motivational beliefs, values, and goals. Annual review of psychology. 2002; 53 (1):109–132. doi: 10.1146/annurev.psych.53.100901.135153. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Elder, L., & Paul, R. (2020). Critical thinking: tools for taking charge of your learning and your life . Foundation for Critical Thinking.
• Faccione P, Faccione N, Giancarlo C. The disposition toward critical thinking: its character, measurement, and relationship to critical thinking skill. Informal Logic. 2000; 20 (1):61–84. doi: 10.22329/il.v20i1.2254. [ CrossRef ] [ Google Scholar ]
• Fairfield B, Mammarella N, Palumbo R, Di Domenico A. Emotional meta-memories: a review. Brain Sciences. 2015; 5 (4):509–520. doi: 10.3390/brainsci5040509. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Feleszko W, Lewulis P, Czarnecki A, Waszkiewicz P. Flattening the curve of COVID-19 vaccine Rejection-An International Overview. Vaccines. 2021; 9 (1):44. doi: 10.3390/vaccines9010044. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Fridman A, Gershon R, Gneezy A. COVID-19 and vaccine hesitancy: a longitudinal study. PloS one. 2021; 16 (4):e0250123. doi: 10.1371/journal.pone.0250123. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Georgiou N, Delfabbro P, Balzan R. Conspiracy beliefs in the general population: the importance of psychopathology, cognitive style and educational attainment. Personality and Individual Differences. 2019; 151 :109521. doi: 10.1016/j.paid.2019.109521. [ CrossRef ] [ Google Scholar ]
• Georgiou N, Delfabbro P, Balzan R. Conspiracy-beliefs and receptivity to Disconfirmatory Information: a study using the BADE Task. SAGE Open. 2021; 11 (1):21582440211006131. doi: 10.1177/21582440211006131. [ CrossRef ] [ Google Scholar ]
• Goertzel T. Belief in conspiracy theories. Political psychology. 1994; 15 (4):731–742. doi: 10.2307/3791630. [ CrossRef ] [ Google Scholar ]
• Hornsey MJ, Harris EA, Fielding KS. The psychological roots of anti-vaccination attitudes: a 24-nation investigation. Health psychology. 2018; 37 (4):307–315. doi: 10.1037/hea0000586. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kennedy J. Populist politics and vaccine hesitancy in Western Europe: an analysis of national-level data. European journal of public health. 2019; 29 (3):512–516. doi: 10.1093/eurpub/ckz004. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lantian A, Muller D, Nurra C, Douglas KM. “I know things they don’t know!”: the role of need for uniqueness in belief in conspiracy theories. Social Psychology. 2017; 48 (3):160–173. doi: 10.1027/1864-9335/a000306. [ CrossRef ] [ Google Scholar ]
• Lauriola, M., Mosca, O., & Carleton, R. N. (2016). Hierarchical factor structure of the intolerance of uncertainty scale short form (IUS-12) in the italian version. TPM: Testing Psychometrics Methodology in Applied Psychology , 23 (3), 10.4473/TPM23.3.8
• Liu R, Li GM. Hesitancy in the time of coronavirus: temporal, spatial, and sociodemographic variations in COVID-19 vaccine hesitancy. SSM-population health. 2021; 15 :100896. doi: 10.1016/j.ssmph.2021.100896. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• MacDonald NE. Vaccine hesitancy: definition, scope and determinants. Vaccine. 2015; 33 (34):4161–4164. doi: 10.1016/j.vaccine.2015.04.036. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Maftei A, Holman AC. Beliefs in conspiracy theories, intolerance of uncertainty, and moral disengagement during the coronavirus crisis. Ethics & Behavior. 2022; 32 (1):1–11. doi: 10.1080/10508422.2020.1843171. [ CrossRef ] [ Google Scholar ]
• Mammarella N, Fairfield B, Di Domenico A. Comparing different types of source memory attributes in dementia of alzheimer’s type. International Psychogeriatrics. 2012; 24 (4):666–673. doi: 10.1017/S1041610211002274. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mari S, Gil de Zúñiga H, Suerdem A, Hanke K, Brown G, Vilar R, Bilewicz M. Conspiracy theories and institutional trust: examining the role of uncertainty avoidance and active social media use. Political Psychology. 2022; 43 (2):277–296. doi: 10.1111/pops.12754. [ CrossRef ] [ Google Scholar ]
• McHale P, Keenan A, Ghebrehewet S. Reasons for measles cases not being vaccinated with MMR: investigation into parents’ and carers’ views following a large measles outbreak. Epidemiology & Infection. 2016; 144 (4):870–875. doi: 10.1017/S0950268815001909. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mesch GS, Schwirian KP. Social and political determinants of vaccine hesitancy: Lessons learned from the H1N1 pandemic of 2009–2010. American journal of infection control. 2015; 43 (11):1161–1165. doi: 10.1016/j.ajic.2015.06.031. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Moulding R, Nix-Carnell S, Schnabel A, Nedeljkovic M, Burnside EE, Lentini AF, Mehzabin N. Better the devil you know than a world you don’t? Intolerance of uncertainty and worldview explanations for belief in conspiracy theories. Personality and individual differences. 2016; 98 :345–354. doi: 10.1016/j.paid.2016.04.060. [ CrossRef ] [ Google Scholar ]
• Murakami H, Kobayashi M, Hachiya M, Khan ZS, Hassan SQ, Sakurada S. Refusal of oral polio vaccine in northwestern Pakistan: a qualitative and quantitative study. Vaccine. 2014; 32 (12):1382–1387. doi: 10.1016/j.vaccine.2014.01.018. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Murphy J, Vallières F, Bentall RP, Shevlin M, McBride O, Hartman TK, Hyland P. Psychological characteristics associated with COVID-19 vaccine hesitancy and resistance in Ireland and the United Kingdom. Nature communications. 2021; 12 (1):1–15. doi: 10.1038/s41467-020-20226-9. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Nazlı, Ş. B., Yığman, F., Sevindik, M., & Deniz Özturan, D. (2021). Psychological factors affecting COVID-19 vaccine hesitancy. Irish Journal of Medical Science (1971-) , 1–10. 10.1007/s11845-021-02640-0 [ PMC free article ] [ PubMed ]
• Park CL. Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological bulletin. 2010; 136 (2):257. doi: 10.1037/a0018301. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pavela Banai I, Banai B, Mikloušić I. Beliefs in COVID-19 conspiracy theories, compliance with the preventive measures, and trust in government medical officials. Current Psychology. 2021; 41 (10):7448–7458. doi: 10.1007/s12144-021-01898-y. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pennycook G, Epstein Z, Mosleh M, Arechar AA, Eckles D, Rand DG. Shifting attention to accuracy can reduce misinformation online. Nature. 2021; 592 (7855):590–595. doi: 10.1038/s41586-021-03344-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pisl V, Volavka J, Chvojkova E, Cechova K, Kavalirova G, Vevera J. Dissociation, cognitive reflection and health literacy have a modest effect on belief in conspiracy theories about Covid-19. International Journal of Environmental Research and Public Health. 2021; 18 (10):5065. doi: 10.3390/ijerph18105065. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Pytlik, N., Soll, D., & Mehl, S. (2020). Thinking preferences and conspiracy belief: intuitive thinking and the jumping to conclusions-bias as a basis for the belief in conspiracy theories. Frontiers in psychiatry , 987. 10.3389/fpsyt.2020.568942 [ PMC free article ] [ PubMed ]
• Reno C, Maietti E, Fantini MP, Savoia E, Manzoli L, Montalti M, Gori D. Enhancing COVID-19 vaccines acceptance: results from a survey on vaccine hesitancy in northern Italy. Vaccines. 2021; 9 (4):378. doi: 10.3390/vaccines9040378. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Stanley ML, Barr N, Peters K, Seli P. Analytic-thinking predicts hoax beliefs and helping behaviors in response to the COVID-19 pandemic. Thinking & Reasoning. 2021; 27 (3):464–477. doi: 10.1080/13546783.2020.1813806. [ CrossRef ] [ Google Scholar ]
• Stojanov A, Halberstadt J. The conspiracy mentality scale. Social Psychology. 2019; 50 :215–232. doi: 10.1027/1864-9335/a000381. [ CrossRef ] [ Google Scholar ]
• Stojanov, A., Halberstadt, J., Bering, J. M., & Kenig, N. (2021). Examining a domain-specific link between perceived control and conspiracy beliefs: a brief report in the context of COVID-19. Current Psychology , 1–10. 10.1007/s12144-021-01977-0 [ PMC free article ] [ PubMed ]
• Sutton, R. M., & Douglas, K. M. (2014). Examining the monological nature of conspiracy theories in Van Prooijen JW & Van Lange P (Eds.), Power, politics, and paranoia: Why people are suspicious of their leaders (pp. 254–272). 10.1017/CBO9781139565417.018
• Swami, V., & Furnham, A. (2014). Political paranoia and conspiracy theories in Van Prooijen JW & Van Lange P (Eds.). Power, politics, and paranoia: Why people are suspicious of their leaders (pp. 218–236). 10.1017/CBO9781139565417.016
• Swami V, Chamorro-Premuzic T, Furnham A. Unanswered questions: a preliminary investigation of personality and individual difference predictors of 9/11 conspiracist beliefs. Applied Cognitive Psychology. 2010; 24 (6):749–761. doi: 10.1002/acp.1583. [ CrossRef ] [ Google Scholar ]
• Swami V, Voracek M, Stieger S, Tran US, Furnham A. Analytic thinking reduces belief in conspiracy theories. Cognition. 2014; 133 (3):572–585. doi: 10.1016/j.cognition.2014.08.006. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Tomljenovic H, Bubic A, Erceg N. It just doesn’t feel right–the relevance of emotions and intuition for parental vaccine conspiracy beliefs and vaccination uptake. Psychology & health. 2020; 35 (5):538–554. doi: 10.1080/08870446.2019.1673894. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Valenzuela J, Nieto AM, Saiz C. Critical thinking motivational scale (CTMS): una aportación para el estudio de la relación entre el pensamiento crítico y la motivación. Electronic Journal of Research in Educational Psychology. 2011; 9 (2):823–848. doi: 10.25115/ejrep.v9i24.1475. [ CrossRef ] [ Google Scholar ]
• Van Prooijen JW, Acker M. The influence of control on belief in conspiracy theories: conceptual and applied extensions. Applied Cognitive Psychology. 2015; 29 (5):753–761. doi: 10.1002/acp.3161. [ CrossRef ] [ Google Scholar ]
• Van Prooijen JW, Jostmann NB. Belief in conspiracy theories: the influence of uncertainty and perceived morality. European Journal of Social Psychology. 2013; 43 (1):109–115. doi: 10.1002/ejsp.1922. [ CrossRef ] [ Google Scholar ]
• Wood MJ, Douglas KM, Sutton RM. Dead and alive: beliefs in contradictory conspiracy theories. Social psychological and personality science. 2012; 3 (6):767–773. doi: 10.1177/1948550611434786. [ CrossRef ] [ Google Scholar ]
• Zebrowitz LA, Franklin RG, Jr, Palumbo R. Ailing voters advance attractive congressional candidates. Evolutionary Psychology. 2015; 13 (1):16–28. doi: 10.1177/147470491501300102. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]

Critical Thinking for Professional and Language Education

A Machine-Generated Literature Overview

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• K. Venkat Reddy 0 ,
• G. Suvarna Lakshmi 1

Department of Training and Development, The English and Foreign Languages University, Hyderabad, India

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• A Machine-Generated Literature Overview of Critical Thinking Research
• Discusses integrating ICT tools for teaching critical thinking
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This book is the result of a collaboration between a human editor and an artificial intelligence algorithm to create a machine-generated literature overview of research articles analyzing importance of critical thinking in Educational Settings. It’s a new publication format in which state-of-the-art computer algorithms are applied to select the most relevant articles published in Springer Nature journals and create machine-generated literature reviews by arranging the selected articles in a topical order and creating short summaries of these articles.

This book is a comprehensive guide to critical thinking research in education. It explores different definitions of critical thinking and its importance in specialized fields like business, engineering, and science. Presenting research on assessment, this resource delves into the integration of ICT tools for teaching critical thinking.

With practical tools, strategies and tasks to develop critical thinking skills, thisbook is intended for researchers, educators, and those seeking to improve their critical thinking abilities.

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Front matter, introduction to critical thinking skills.

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Teaching language through critical thinking strategies, tasks for critical thinking and language learning, practicing critical thinking: issues and challenges, ict and critical thinking, editors and affiliations.

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Dr. K. Venkat Reddy is a professor with almost three decades of experience in teaching English (ELT). His research focuses on critical discourse analysis and critical pedagogy.

Dr. G. Suvarna Lakshmi is a Professor in the Department of ELT with over two decades of teaching experience. Her specialty is critical thinking in language pedagogy.

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Book Title : Critical Thinking for Professional and Language Education

Book Subtitle : A Machine-Generated Literature Overview

Editors : K. Venkat Reddy, G. Suvarna Lakshmi

DOI : https://doi.org/10.1007/978-3-031-37951-2

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Hardcover ISBN : 978-3-031-37950-5 Published: 04 September 2024

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Number of Pages : VII, 168

Topics : Critical Thinking , Professional & Vocational Education

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MMCTAgent: Multi-modal Critical Thinking Agent Framework for Complex Visual Reasoning

• Somnath Kumar ,
• Yash Gadhia ,
• Tanuja Ganu ,
• Akshay Nambi

Recent advancements in Multi-modal Large Language Models (MLLMs) have significantly improved their performance in tasks combining vision and language. However, challenges persist in detailed multi-modal understanding, comprehension of complex tasks, and reasoning over multi-modal information. This paper introduces MMCTAgent, a novel multi-modal critical thinking agent framework designed to address the inherent limitations of current MLLMs in complex visual reasoning tasks. Inspired by human cognitive processes and critical thinking, MMCTAgent iteratively analyzes multi-modal information, decomposes queries, plans strategies, and dynamically evolves its reasoning. Additionally, MMCTAgent incorporates critical thinking elements such as verification of final answers and self-reflection through a novel approach that defines a vision-based critic and identifies task-specific evaluation criteria, thereby enhancing its decision-making abilities. Through rigorous evaluations across various image and video understanding benchmarks, we demonstrate that MMCTAgent (with and without the critic) outperforms both foundational MLLMs and other tool-augmented pipelines.

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