Distrust by default: analysis of parent and child reactions to health misinformation exposure on TikTok

ABSTRACT

Social networks have become a recurrent source of health information, but they also represent a space for the dissemination of erroneous or false information, which becomes more worrying when dealing with underage audiences. The aim of this study was to find out what resources and capabilities adolescents have to deal with the erroneous health content they receive through TikTok. To provide a comprehensive perspective, one of the parents of each sampled child was also interviewed with the aim of discovering their assessment of how their children dealt with this content. 40 interviews were carried out, and among the main findings, a common practice of distrust by default of the contents consumed on the Internet stood out, both in adults and in minors. While the latter always sought in the content an occasion to entertain themselves, parents doubted that their children were capable of recognizing erroneous information.

KEYWORDS:

• misinformation
• TikTok
• adolescents
• parents
• health content
• critical thinking

Introduction

The significance of the Internet and social networks in consuming health-related information was already a well-established trend. However, the advent of the COVID-19 health crisis has further accentuated their importance. Unfortunately, this conjunction has also witnessed a proliferation of inaccurate and misleading content that rapidly disseminates (Salaverría et al., 2020), leading to a second pandemic: the spread of misinformation. This misinformation poses potential risks to the well-being of individuals and the social fabric of communities (Rubin, 2022). Notably, social networks have played a pivotal role in the amplification of such erroneous or false content (Gabarrón et al., 2021), exacerbating the situation.

In the current landscape, various voices are putting forth demands on social media platforms that were once regarded as mere conduits of information. However, critics have argued for a greater sense of responsibility in moderating the content shared on these platforms (Baker et al., 2020). The notion that social networks are not impartial is now stronger than ever (Gillespie, 2018). Moreover, in the aftermath of the pandemic, significant attention has been given to their role in reinforcing confirmation bias (Apuke & Omar, 2021; Betsch et al., 2013; Nguyen & Catalan, 2020).

Considering the responsibility that platforms should shoulder, it becomes particularly relevant to focus on the adolescent age group, which exhibits a special affinity for digital media, especially social networks. Adolescents turn to these platforms to fulfill various needs, including entertainment, education, and information-seeking (Bossen & Kottasz, 2020; García-Jiménez et al., 2012). Networks like Instagram and the more recent TikTok have captured their attention, and they spend a significant amount of time consuming content on these platforms (De Leyn et al., 2022; Días & Duarte, 2022; Wang et al., 2022).

In the realm of social media, the influential figure of content creators, known as influencers, has gained considerable prominence. These influencers, by sharing content about their lifestyles or opinions that resonate with their audiences, establish a sense of similarity and trust (Audrezet et al., 2020; Djafarova & Rushworth, 2017; Lim et al., 2017; Silva et al., 2021). Consequently, they have the ability to inspire adolescents to form parasocial relationships (Reinikainen et al., 2020; Yuan & Lou, 2020). However, concerns have been raised about the kind of content influencers share with this age group, particularly considering that many adolescents have not yet fully developed critical thinking skills (Feijoo et al., 2023; Zozaya et al., 2022).

Complicating matters is the challenge of parental mediation, as personal access devices and the comparatively lower digital proficiency of parents contribute to difficulties in monitoring and guiding adolescents’ online experiences (Daneels & Vanwynsberghe, 2017; López de Ayala et al., 2019; Lozano-Blasco et al., 2023; Zaman et al., 2016). Additionally, throughout the pandemic, influencers actively participated in campaigns endorsed by authorities to disseminate public health messages to audiences that shared similar interests (Bozzola et al., 2021). However, there were also instances where influencers contributed to the propagation of falsehoods or misleading content, posing a tangible risk to their audience (Wasike, 2022).

In this particular context, the present study focuses on exploring the viewpoints and evaluations of adolescents and their parents regarding the content shared by influencers on their preferred social media platforms, particularly TikTok, which is known to facilitate the dissemination of disinformation. As highlighted by Howard et al. (2021), disinformation can have adverse effects on the social, cognitive, and emotional development of minors, thus affecting their overall well-being. Given the potentially significant risks involved, the study specifically examines health-related content. The primary objective of this research is twofold: to enhance our understanding of the resources and personal skills that adolescents employ to navigate such content on social networks and to investigate how parents assess their children’s ability to cope with this content. Adopting an exploratory approach, this study aims to establish a foundation for future research on combating misinformative messages.

Minors faced with health information generated by influencers on social media networks

Younger audiences are regular and active users of social networks (Lozano-Blasco et al., 2023; Orben, 2020) and are no strangers to consuming health-related content online (Borzekowski & Rickert, 2001; Plaisime et al., 2020; Yonker et al., 2015). These digital spaces serve as platforms for minors to expand their medical knowledge beyond professional consultations, allowing them to compare information with other users in forums and social networks (Park & Kwon, 2018). Particularly for adolescents, these digital spaces become crucial sources of information on topics they may feel uncomfortable discussing with adults (Kelly et al., 2011; Reid Chassiakos et al., 2016). As Livingstone (2008) highlighted, it can be argued that young individuals feel confident and empowered when seeking and finding health information online.

However, concerns have been raised about the media literacy and health literacy levels of minors, which are vital for effectively navigating and engaging with online content (Jain & Bickham, 2014). Adolescents often encounter challenges in assessing the accuracy of statements they come across online (Gray et al., 2005). Furthermore, as pointed out by Morahan-Martin (2004), they may not be accustomed to verifying authorship, evaluating source credibility, or considering the influence of potential sponsorships on the content they consume. These factors complicate the exercise of critical literacy in the realm of health information, which entails the ability to analyse and utilize information for exerting greater control over various situations and life events, as described by Nutbeam (2000).

Critical literacy assumes particular significance when considering the consumption of content generated by influencers by minors. As highlighted by Gottlieb et al. (2020), these individuals, whether or not affiliated with the health domain, have played a significant role in disseminating information during the pandemic. However, the influence they wield is not solely derived from the accuracy of the information they share, but rather from their vast number of followers. The success of their online content hinges on the trust they foster and their ability to entertain their audience (Feijoo et al., 2023). This perspective, grounded in the theory of uses and gratifications that emphasizes the importance of entertainment, has garnered validation in recent studies (Falgoust et al., 2022).

The close relationship between influencers and their audience, as well as the content they create, calls for careful consideration of the potential impact on health-related behaviours. Additionally, aside from the pros and cons of informal consultations, the phenomenon of challenges, commonly known as viral challenges, encourages users to participate in global trends by performing specific actions (Kriegel et al., 2021; Ortega-Barón et al., 2022). While these challenges existed before the rise of TikTok, some studies point to TikTok as the platform most likely to host this type of content (Wang et al., 2022). It is worth noting that, as highlighted by Kriegel et al. (2021), these challenges are generally harmless, but in certain cases, they can have fatal consequences for those who attempt them (Grant-Alfieri et al., 2013). TikTok’s presentation of content in a visually stimulating and dynamic manner has made it a popular choice among adolescents (De Leyn et al., 2022; Días & Duarte, 2022; Wang et al., 2022). However, these characteristics also make it a potential breeding ground for the spread of disinformation.

In recent years, the proliferation of erroneous or misleading content on the Internet has witnessed an exponential increase, although such content has existed even before the advent of online platforms. Within the domain of health, the pandemic has accelerated the dissemination of hoaxes, deceptions, and false myths surrounding health issues (Salaverría et al., 2020). Public communication inherently entails a certain level of disseminating erroneous content due to occasional confusions, misunderstandings, and unintentional misinterpretations, resulting in the propagation of incorrect information. Termed as ‘misinformation’ in the English-speaking world (Burnam, 1975), this phenomenon is not exclusive to less reputable sources, as even highly regarded media outlets occasionally commit inadvertent errors by misreporting data, misidentifying individuals, making incorrect attributions, or misrepresenting circumstances. While these errors are more than mere typos, reputable sources usually rectify them publicly if they are of significant gravity. Another noteworthy phenomenon is ‘malinformation’ (Wardle & Derakhshan, 2017), referring to truthful yet ethically inappropriate information that should not be disseminated due to its potential harm. Of utmost concern, however, is the deliberate spread of falsehoods, referred to as ‘disinformation,’ as defined by the European Commission (2019) as ‘verifiably false or misleading information created, presented, and disseminated for the purpose of financial gain or intentional deception of the public’ (web document).

The dissemination of misinformative content through social media poses a significant challenge for minors who consume such content. In this study, we specifically examined the impact of a particular type of misinformation that appears less severe and more prone to subconscious consumption by minors and their parents. It is noteworthy that parents themselves may also fall victim to misinformation or disinformation (Howard et al., 2021), often acting out of concern for their children’s potential harm (Martín-Ramallal & Ruiz-Mondaza, 2022). However, parents may not be fully aware of the risks associated with misinformation. Their role is crucial in ensuring that minors engage in a healthy and informed consumption of this content. Thus, it is essential to obtain their perspective on this phenomenon and determine their perceptions regarding their children’s ability to navigate it effectively.

Objectives and research questions

The objective of this study was to examine the perspectives and assessments expressed by adolescents and their parents when faced with exposure to erroneous health content disseminated on the TikTok platform. Additionally, the research aimed to explore the reactions and inquiries made by parents and children concerning non-peer-reviewed publications. Furthermore, the study sought to investigate the extent of parents’ knowledge regarding their children’s ability to critically evaluate this type of content. The research questions (RQs) guiding this study were as follows:

• RQ1: What are the opinions of adolescents and their parents regarding the nature of the content presented?

• RQ2: How do the participants perceive TikTok as a platform for the dissemination of health-related content?

• RQ3: What is the level of critical awareness among parents and adolescents regarding erroneous health information?

• RQ3a: How do parents perceive the critical review capacity of their children?

Methodology

This study utilized virtual dyad interviews to investigate the dissemination of misinformation through TikTok. A total of 20 minors aged 11 to 17 years, along with one of their parents, participated in the study. The interviews were semi-structured and lasted for an average duration of 30 minutes, with interviews involving minors being slightly shorter at 20–25 minutes. An interview script was developed to address the research topics from two perspectives, referred to as interview ‘profiles.’ These profiles encompassed an introductory section to understand the subjects’ perception of social networks, including their usage, consumption patterns, opportunities, and risks. Subsequently, the interviews delved into the topics of misinformation, disinformation, and social networks. To facilitate concrete responses from the participants, real examples were presented to both interviewee profiles, forming the basis for the interview questions.

Two videos were presented in sequence during the study. The first video (Figure 1),¹ lasting 1 minute and 3 seconds, demonstrated a ‘trick’ for dissolving pills, specifically targeting users who encounter difficulty swallowing them. In contrast, the second video (Figure 2),² lasting 46 seconds, featured a recognized influencer from Spain -pharmacist by profession- who provided objective arguments cautioning against the advice given in the first video.

Figure 1. Video 1 screenshots³.

Source: @javierlopezmontiel

Figure 2. Video 2 screenshots⁴.

Source: @farmaceuticofernandez

The selection of these real examples was based on specific criteria: (1) they exemplified the creative format commonly found on TikTok, particularly showcasing tricks; (2) they addressed a common health issue relevant to everyday life; and (3) the misinformation conveyed in the first video was evident. Table 1 displays the questions posed to both minors and adults during the study.

Table 1. Questions that guided the interview of adolescents and parents.

Interview with minors	Parent interview
Viewing Video 1: - What do you think of this content? Do you find it useful? Who is the source? Viewing Video 2: - Now how do you see it? Have you ever stopped to think about the reliability of the source?	Advice on the portrayed dissolution of tablets: - What do you think of this content? Viewing Video 2: - On the first viewing, would you have questioned it? - Would your child have questioned it?

To analyse the results, three categories were identified in alignment with the research questions (RQs), which guided the coding process. These categories are detailed in Table 2.

Table 2. Description of the categories of analysis.

RQ	Categories	Description	Example of a quotation	Number of interviews
				Adult	Minor
RQ1	Thematic content(what type of content?)	Comments regarding the type of content	I think it’s a bit of a trick, because it’s probably one of those pills that melts in your mouth, […] but pills like ibuprofen won’t melt no matter how much pressure you exert (girl, high school).	24	25
RQ2	Operation of the platform (how is the content presented?)	Comments on the characteristics of the platform and how it is approached	Sometimes I see videos on social networks of how to organize clothes – fold them so that they take up little space in the closet. It’s cool, it’s useful, […] then when you see others like these [the video], you can say ‘ah, well. This is good, too’ (mother of a girl, 1st cycle ESO).	8	7
RQ3	Critical awareness	Comments regarding questioning and attitudes towards erroneous content	I don’t know who made it [the video] because his face doesn’t appear […] [yet] it looks pretty real to me because it’s not cut […]. You can’t see any cuts or anything. […] You would have to try it. […] If it doesn’t work, you’re wasting a pill (girl, 1st cycle ESO).	41	33
		*In our sample of parents, comments were included that alluded to the capacity and resources they believed their children had to combat the misinformation phenomenon.	The pills are expensive. Some are so big that no one can swallow them. We don’t like them; how much more do they like them, and what would I have done? Well, surely yes (Mother of girl, 1st cycle ESO).

To ensure the rigour of our coding process, a concordance analysis was conducted using the entire sample of collected comments (N = 138). The analysis revealed a concordance rate of 0.83 between two independent codings performed by different researchers involved in this study. Considering the assessment criteria proposed by Landis and Koch (1977) for the Kappa coefficient, this level of concordance can be classified as ‘substantial.’

Sample

The interviews were conducted using Microsoft Teams or Zoom platforms, following a sequential conversation format with both the child and their parent. The interviews took place between November 2021 and April 2022. To ensure unbiased responses and encourage open expression, it was requested that parents and children be in separate rooms during the interview, minimizing mutual influence.

Regarding the participants, there were 20 interviews in total, with 11 girls and 9 boys among the adolescents. The educational levels of the adolescents varied, with 4 in the 6th grade of primary school, 6 in the 1st cycle of ESO, 8 in the 2nd cycle of ESO, and 2 in high school. Most of the adults interviewed were mothers (16 out of 20), as they typically served as the primary contact managing their children’s access and interactions.

To ensure the integrity of the study, the well-being of the participants, and the ethical standards of the research project, appropriate authorization was obtained. Informed consent was sought from the guardian through the signing of a consent form, while the child’s consent was obtained using a separate form. All relevant documents underwent rigorous review and validation by the Ethics Committee of the affiliated university, affirming compliance with ethical guidelines.

Results

Contextualization

This study examined two distinct user groups characterized by their varied usage and consumption of social networks. One group consisted of adolescents aged 11 to 17, who showed a preference for platforms like YouTube, TikTok, and Instagram. The other group comprised parents who reported their engagement with WhatsApp and Facebook, while Instagram appeared to serve as a connecting platform between the two. When discussing the risks associated with social networks, both parents and adolescents employed different terms. While terms such as ‘hoax’, ‘fake’, ‘scam’, and ‘danger’ were prevalent in both groups, adolescents commonly expressed concerns about ‘fear’, ‘lie’, and ‘strangers’, while adults often mentioned ‘worry’, ‘addiction’ and ‘harassment.’

Based on the aforementioned findings, there was a unanimous consensus among all interviewees regarding the prevalence of hoaxes, disinformation, and misinformation on social networks. These issues were primarily associated with WhatsApp, while Facebook and Twitter were also mentioned, with all platforms being commonly linked to older users.

Approach of parents: perception of erroneous content

In this section, we will present the viewpoints expressed by parents upon viewing the initial TikTok video, wherein a user demonstrates the process of dissolving pills using a syringe. As detailed in our methodology section, we analysed the comments from two angles: the evaluations concerning the content and its subject matter, and those associated with the platform and the approach to consuming the content.

About the content

Following their viewing of the initial video, parents directed their attention towards assessing the tutorial’s relevance and feasibility for incorporation into their daily lives. Among the parents, the prevailing response was one of indifference, disinterest, or apathy towards the content, deeming it inconsequential, absurd, and trivial, despite its focus on a crucial health topic such as medication intake. One parent expressed their perspective, stating: ‘It seems quite absurd because there’s no need to make such a fuss about using a syringe to reverse something. You can achieve the same result with a small glass of water and simply swallow it’ (mother of a girl, 2nd cycle ESO). In fact, a majority of the parents considered the consumption of such videos to be a waste of time, indicative of a certain disregard for the content their children encounter on social networks. Another parent shared:

Upon viewing this video, my initial thought is that some individuals invest their time in such trivial pursuits. It doesn’t cross my mind [laughter] to attempt the demonstrated technique and decide, ‘Well, it’s true that it can be done,’ only to close the browser window promptly. (father of a girl, high school)

Furthermore, it is crucial to acknowledge that the video selected for this research represents a typical form of content found on TikTok, characterized by tutorials, tricks, and trends.

It is worth noting that, initially, what alarmed parents more than the subject matter itself was the presence of a syringe in the tutorial for pill dilution. One mother expressed her concern, stating, ‘Poof! I don’t know what to tell you. I really don’t like it because, well, the fact of the syringe at the end… I don’t like it’ (mother of a girl, 1st cycle ESO). Throughout the interview, the parents tended to focus their attention on the societal topics and structural risks associated with modern society, rather than on how minors consume media, which has implications for information processing. For instance, one father commented, ‘I wouldn’t do it with any kind of pills… because it’s a way of telling kids to take any kind of pill, and with water, you swallow it all’ (father of a girl, high school). However, parents also expressed concern about the informal presentation of a health-related topic, with reggaeton music and less-than-ideal aesthetics in the background, which they perceived as lacking seriousness and diminishing the content’s credibility. One participant highlighted, ‘The person’s face is not shown; it’s a hand, right? So that makes you think’ (mother of a boy, 2nd cycle ESO).

About the platform

One aspect that drew the parents’ attention was the presence of health-related content on a platform like TikTok, which they predominantly associated with entertainment, humour, and dancing. For instance, a mother shared her perspective, stating,

‘I don’t understand why it’s on TikTok… these types of videos [laughs]. I don’t know, I don’t associate TikTok with factual information. They are usually videos of people dancing and such. I don’t make that connection’. (mother of a girl, 2nd cycle ESO)

The parents expressed surprise at encountering health-related advice on TikTok, as they considered it an unexpected platform for such content. One parent conveyed their astonishment, saying, ‘I’m taken aback. I hadn’t seen it before. TikTok and pills – medication that parents are expected to administer… what can I say? It horrifies me’ (mother of a boy, 1st cycle ESO).

Despite addressing a health-related topic, the adults interviewed emphasized the influence of TikTok’s content consumption patterns on users’ behaviour, particularly regarding the trick demonstrated in the video. The platform’s emphasis on rapid video consumption hinders critical reflection, and the continuous presentation of various tricks and daily tips, some of which are genuinely useful, may inadvertently encourage the audience to dilute medication. However, one parent recognized value in certain videos, stating,

Sometimes I come across videos on social networks that demonstrate how to efficiently organize clothes, folding them to maximize closet space. It’s interesting and practical… and then, when encountering videos like this one, you might think, ‘Ah, well. This could be useful too’ (Mother of a girl, 1st cycle ESO).

Likewise, a prominent creative trend on TikTok involves uploading content that replicates a previous action to contribute to its virality and join the trend. This dynamic can lead to seemingly irrelevant content for adults becoming news, as one parent shared, ‘TikTok videos are trending, like those “Things you say,” but really? Everyone is crazy about it… If you don’t TikTok something, it’s like you’re not even human’ (mother of a son, 1st cycle ESO).

On the other hand, parents displayed awareness of the fact that adolescents primarily access and consume social media content on their cell phones. The ubiquity of these devices, with constant connection to networks, implies that children receive inputs on a wide range of topics at all times.

Everything is on a cell phone; the good and the bad, of course. That’s what worries me… They have access to an overwhelming amount of information. Everything is just a few taps away, and if they don’t know how to handle it properly…

(mother of a boy, 6th grade)

Protection against erroneous content

To illustrate the inappropriateness of the content presented in the initial video, a second video was shown featuring a reputable and verified physician advising against the practice of dissolving pills. Upon viewing this second video, the majority of parents reaffirmed their initial argument that the trick was entirely ineffective, emphasizing that social networks are rife with ‘absurd’ content.

‘I find it quite alarming that someone would casually watch a video showing how to open a pill, only to later discover that a supposed professional—a pharmacist, doctor, or whoever—has to come forward and explain that the method shown is incorrect. The saddest part is that those who saw the first video, I doubt they will ever come across the second one’ (Mother of a girl, 2nd cycle ESO).

However, when asked whether their children would have questioned the appropriateness of the content, nearly all parents (n = 19) expressed doubt regarding their children’s ability to recognize the inappropriateness of the advice. They believed that adolescents would not critically evaluate the sources or credibility of the content, as one parent mentioned, ‘Pills can be expensive, some are difficult to swallow; we may not like it, but how much more appealing is it to them? What would I have done? Most likely, the same’ (mother of a girl, 1st cycle ESO).

Participants highlighted several factors that contribute to the reduced critical capacity of children, including:

1. The entertainment context associated with TikTok and the natural impulse of teenagers to explore and experiment with new experiences. As one parent expressed,

“Yes, when kids see these videos, they might say, ‘Well, maybe next time I need to take medication, I’ll give it a try’… I’m not saying they don’t have such thoughts, like ‘Well, let’s see… just for fun or to try something different, right?” (mother of a girl, 2nd cycle ESO).

2. The phenomenon of imitation and replication of trends promoted on TikTok, which has developed into a distinct format. This format, combined with peer pressure, often compels viewers to participate in challenges without much prior reflection. Another parent shared their understanding, stating,

‘If I put myself in my son’s shoes while watching such videos with his friends, I understand that he might feel the pressure of “Hey, let’s see who dares! Should we try this?” or “From now on, I’ll do it this way because it’s trendy”’ (father of a boy, 1st cycle ESO).

Finally, another factor that may contribute to reduced critical thinking among adolescents is their limited knowledge about health issues, which can make them more susceptible to trusting supposed advice they encounter on TikTok. As one parent shared,

‘He doesn’t know much about pills either. Sometimes we break paracetamol… in a spoon with a little water… well, you never know, maybe he thinks, “Well, look, this could be a way…” But, no, what would a 12-year-old know about specific pills meant for swallowing?’ (Mother of a boy, 6th grade).

Regarding the resources available to teenagers to combat health-related misinformation, most parents expressed trust that their children would approach them and ask before attempting to replicate any tips, tricks, or tutorials seen on social media. A parent reported,

‘Yes, I could tell him, “That’s cool, it comes apart,” and stand like that for a moment, but… the first thing he would do is come to me and ask, “Mom, can you undo it?” and I would say, “Noooo! You shouldn’t [laughs]!”’ (mother of a boy, 2nd cycle ESO).

The parents interviewed regarded their children as mature and confident enough to seek out adults for clarification regarding such content. In other words, parents saw themselves as a reliable source of comparison for their children.

Finally, it is noteworthy to consider the reflections shared by some parents regarding the challenges they face in discerning the veracity of content shared on social networks. One parent expressed this uncertainty, stating, ‘Seeing the pharmacist afterwards, I don’t know if he is a pharmacist either. In the end, who do you listen to?’ (mother of a girl, 1st cycle ESO). Similarly, another parent emphasized the importance of knowing the credentials of those creating the second video, suggesting, ‘It is crucial to know that the person making this second video is a qualified pharmacist’ (father of a boy, 2nd cycle ESO). As a result, these parents indicated that adopting a sceptical stance and defaulting to doubt when encountering information through these channels is the most practical approach. This inclination towards scepticism contributes to increased uncertainty and reinforces the audience’s scepticism.

A summary of the main contributions of parents is shown in Figure 3.

Figure 3. Summary of the main findings from the interviews with parents.

Approach of minors: perception of erroneous content

About the content

Although the specific video used in the study was new to the minor participants, they displayed familiarity with this type of online publication. In addition to recognizing someone sharing a trick to solve a problem, the minors identified ‘boredom’ as one of the factors that contributes to the creation of such content. As one participant expressed, ‘Who does it? Well… people who are bored, I guess? Or people who struggle with swallowing pills; those are the two possibilities’ (son, 1st cycle ESO).

It was intriguing to observe the perspective of certain minors regarding the study of the video, as they perceived it as an attempt to identify any potential edits. Through their analysis of technical aspects, they deliberated on the authenticity of the content. As one participant expressed, ‘You can’t notice any cuts or anything… it seems quite real to me. It would have to be tested… if it doesn’t work, you’re wasting a pill’ (daughter, 1st cycle ESO). The findings revealed that for minors, engaging in what they see in this type of content was seen to have acceptable consequences.

Although some minor interviewees exhibited a sceptical attitude towards the video and expressed doubts about the promised effectiveness of the trick, they once again highlighted boredom as a motivating factor for trying out the proposals presented to them on social networks. One minor shared:

‘I would trust that it works… yes, maybe, if I had to put my hand in the fire, I would say “no, but let’s see; it looks like it could work, but I haven’t tried it.” Maybe I would even try it if I get bored’ (daughter, 1st cycle ESO).

Although it was suggested that dissolving the pill in water does not guarantee its effectiveness, the children generally responded to the content with a sense of triviality, perceiving it more as a trick than a health-related matter. Another participant commented,

‘I think that for people who can’t swallow pills, it’s good… but you don’t know if the properties of the pill will continue to work; maybe the water dissolves everything, but I think it’s not a bad trick’ (son, 2nd cycle ESO).

About the platform

The interviewees, who identified themselves as regular users of social networks, highlighted an issue of overexposure to false content and the presence of problematic users that characterizes their online experience. As one participant expressed,

‘There is already a lot of information, and people are over-informed; there is already a lot of hoaxes; there is already a lot of people doing things they shouldn’t; there is already a lot of false accounts and, really, I think it’s going to end badly’ (daughter, 1st cycle ESO).

Disinformation and the prevalence of fake accounts were cited as reasons for adolescents expressing a pessimistic view of the future of these platforms.

Although the minors mentioned their proactive approach in investigating suspicious content by delving into the account or comments to gain context, they also expressed concern about the transient nature of memory and the potential for forgetting the details that determine the veracity of information. As one subject shared:

‘When you don’t see this information at the first moment, you have the memory of “ah, I think I saw this” such and such, and you do not know from which source you got it… that you just have that knowledge because it stuck with you, so on and so forth. I think it’s more dangerous there’ (daughter, high school).

This sentiment reflects a generalized fear among the participants, stemming from the challenges posed by misinformation, the abundance of sources and users, and the rapid consumption of content on visual platforms. The minors expressed concerns about resorting to tricks or information they couldn’t remember clearly, highlighting the potential risks associated with incomplete or unreliable knowledge. Moreover, the participants emphasized that their experiences with health-related topics on the internet often resulted in increased anxiety rather than providing useful information. As one participant stated, ‘I know that on the Internet, anything you look at, in terms of medicine, is only going to worry you’ (son, 1st cycle ESO).

Protection against erroneous content

During the interviews, it became evident that the minors held a widespread belief in the prevalence of falsehoods within online content, leading them to value traditional media as more reliable sources of information. As one participant expressed, ‘Oh, I usually believe more of what comes from the TV, and not so much what comes out on the social networks’ (son, 1st cycle ESO).

Upon the presentation of the second video, which confirmed the first video as a hoax, some minors recognized that their initial trust had been placed in the content they saw. One participant remarked, ‘Sure, you see it with the pharmacist and you say “sure, he’s right,” but maybe you see it alone and say, “ah, what a good idea”’ (daughter, 2nd cycle ESO). When asked about considering the reliability of the source, the minors acknowledged that they did not typically engage in such assessments, despite recognizing the inherent danger of hoaxes.

One participant expressed the potential dangers associated with believing in misleading information, stating,

‘I could say “yes,” and look very good, but the truth is “no,” eh? […] Yes, you could end up doing something that is not at all good for your health or for you as a person and, in the end, seeing it there, maybe you feel like, “look, maybe this could work” […] Yes, it is really dangerous, these kinds of hoaxes’ (daughter, 1st cycle ESO).

In contrast, there were minors who emphasized the importance of verifying content, particularly when the topic was personally interesting to them. One participant expressed their intention to delve into real facts behind a video, stating, ‘I would look at the sources if I was interested in it. But I would like to find out real facts behind that video’ (son, 6th grade).

Interestingly, even though some minors had not seen the specific video, they recognized the authority of the pharmacist who refuted the hoax. They believed in the pharmacist’s knowledge and expertise on health-related matters, as one participant expressed,

‘He is a person, I have seen, who has a lot of videos, and so on; he is a person who really has some studies and knows, and, for example, I would trust him more than the previous presenter’ (daughter, high school).

On the other hand, some interviewees were sceptical about the credibility of a pharmacist’s explanation. They found the pharmacist’s statement confusing and questioned the authenticity of their expertise, as one participant expressed,

‘You don’t know if that person is really a doctor, or a pharmacist, and although it makes a lot of sense what they are saying—and it makes more sense than the TikTok video on the pill—you can’t take everything they tell you seriously’ (daughter, 2nd cycle ESO).

A summary of the main contributions of minors is shown in Figure 4.

Figure 4. Summary of the main findings in the interviews with adolescents.

Discussion

The findings of this study shed light on important aspects that warrant further discussion. Firstly, it was confirmed that TikTok is a platform with which minors are significantly more familiar than their parents. This was evident from the parents’ surprise regarding the content present on the platform and its unique display with music, effects, and other features (De Leyn et al., 2022; Días & Duarte, 2022; Wang et al., 2022).

The dominance of entertainment as a primary factor in consuming content on TikTok, as well as participating in challenges and tricks, emerged as a recurring theme in this study. This finding aligns with previous research by Falgoust et al. (2022), Feijoo et al. (2023), and Bossen and Kottasz (2020). Interestingly, while minors saw TikTok as an opportunity for entertainment, parents often viewed it as a waste of time. This difference in perception may divert parents’ attention from potential risks associated with their children’s use of these platforms (Martín-Ramallal & Ruiz-Mondaza, 2022).

TikTok, as a social media platform, not only provides entertainment but also encourages users, particularly minors, to participate in challenges as a way to combat boredom. However, it is crucial to recognize that in the realm of ‘lighter use’ on TikTok, certain challenges can pose serious risks for minors, as highlighted by Ortega-Barón et al. (2022). The role of influencers in this context becomes prominent, as they effectively motivate their followers to engage in these challenges. Further research is necessary to understand the impact of influencers on the dissemination of health information (Gottlieb et al., 2020).

While previous studies suggested that young people could feel empowered by accessing information online to address their health-related inquiries (Livingstone, 2008), this research indicates that their critical health literacy, particularly on TikTok, was limited (Plaisime et al., 2020). Minors demonstrated a lack of habit in verifying sources, instead relying on instinct and familiarity with the platform to identify possible deception (Morahan-Martin, 2004). Additionally, minors acknowledged that the consumption of health content on TikTok could lead to anxiety, possibly exacerbated by the pandemic-misinformation phenomenon (Rubin, 2022).

In terms of their ability to detect false information and errors, minors themselves identified psychological factors, including confirmation bias, as potential obstacles (Apuke & Omar, 2021; Nguyen & Catalan, 2020). It is noteworthy that minors recognized their inclination to adhere to initial disinformative versions rather than accepting videos that debunk or explain the errors.

The parent subjects generally expressed doubt about their children’s ability to critically assess the content displayed on TikTok. However, when analysing their children’s responses, the impact of age on their risk perception was evident. It should be noted that our study’s procedural constraints limited the extent of their questioning, which focused on the source’s credibility and the immediate consequences of the presented trick (Morahan-Martin, 2004). Moreover, unless the topic was of personal interest or aligned with their preferences, the minors did not demonstrate a tendency to seek information from additional sources, including digital platforms.

In the context of our study, parents had the expectation that their children would consult them to compare health advice obtained through social networks, particularly considering the relevance of the subject matter presented in our videos. However, it becomes apparent that this necessitates a deeper engagement from minors to recognize the significance of the content they are exposed to, which seems to be lacking. Furthermore, increasing parental awareness regarding the significance of this phenomenon (Howard et al., 2021) requires further reflection and investigation, which could be addressed in future research endeavours.

This study highlights the challenges of critically assessing messages presented on TikTok due to its characteristics, such as ephemeral content, short videos accompanied by music, and instructional demonstrations. The form of consumption on digital platforms like TikTok raises questions about the compatibility of disseminating certain content, particularly news, and warrants further investigation.

In a time where disinformation poses a significant threat to society, it is crucial to address the potential negative effects of widely spread content on social media platforms, especially concerning health. Social media platforms, particularly TikTok, have captured the attention of children and adolescents under the guise of entertainment and light content to combat boredom (De Leyn et al., 2022; Días & Duarte, 2022; Wang et al., 2022). The popularity of viral challenges on TikTok further encourages their participation in replicating activities or experiments to join global trends (Kriegel et al., 2021; Ortega-Barón et al., 2022). While this emotional perspective of content consumption can be engaging, it also limits critical thinking (Feijoo et al., 2023).

Efforts to promote media literacy and digital competence must go hand in hand to ensure both teenagers and their parents can navigate this reality in a healthy manner (Sádaba & Salaverría, 2023). Parents, who often perceive social media as sources of risks or dangers for their children (Martín-Ramallal & Ruiz-Mondaza, 2022), should also recognize that the time and activities their children engage in on these platforms hold relevance and are not merely a waste of time.

It is important to acknowledge the limitations of the methodology used in this study. Firstly, the participation of a specific sample of 40 individuals, with a focus on the ‘how’ rather than the ‘what,’ which is more typical of quantitative research, may restrict the generalizability of the findings. Secondly, the viewing of a video extracted from its original context, TikTok, with the associated nuances of this form of consumption, might have influenced participants to approach the content with a more cautious attitude than they would typically have.

Figure 5 summarry of the main lines of discussion of this research.

Figure 5. Main lines of discussion.

Conclusions

The sceptical attitude displayed by both adolescents and parents in this study, upon discovering the falseness of the content, reflects one of the most significant consequences of disinformation – loss of trust. Consequently, a default sense of distrust seems to have become ingrained in the way content is consumed on the internet. While this article focused on a piece of disinformative content of minor significance, it is reasonable to assume that this detached attitude might extend to other content encountered in different digital environments.

On one hand, the constant pursuit of entertainment by minors on social networks and the nature of content consumption on these platforms pose challenges to the exercise of critical thinking. Furthermore, the lack of interest displayed by parents in the content preferences of their children hinders the identification of their needs and the provision of necessary support to help them interpret and responsibly engage with such content. Interestingly, despite doubting their children’s ability to recognize erroneous content, parents tend to adopt a passive mediation approach, with adolescents taking the initiative to approach them and question the reliability of the content they encounter on their networks.

Overall, there is a clear imperative to enhance the critical capacity of individuals, especially minors, particularly when it comes to health-related content. It is equally urgent that this critical capacity be cultivated in a comprehensive manner, encompassing all forms of internet content consumption. For children, the proactive involvement of parents is crucial in countering the spread of misinformation (Howard et al., 2021), but it should also involve other stakeholders at various levels (Sádaba & Salaverría, 2023). Efforts must be directed towards equipping individuals with the necessary skills and knowledge to navigate the digital landscape responsibly and discerningly.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Ministry of Science and Innovation of the Government of Spain underI+D+i Project ref. PID2020‐116841RA‐I00. Research also funded by the Research Plan of the International University of La Rioja (UNIR), 2020–2022 biennium.

Notes on contributors

Beatriz Feijoo

Beatriz Feijoo Associate professor of advertising and marketing at the School of Business and Communication, International University of La Rioja (Spain). Her research focuses on communication and children, the use of screens in new generations, and more recently on the relationship between minors and advertising through the mobile devices. She is also the principal investigator of funded research projects on the same subject (Fondecyt N°11170336 - Chile; ADKIDSMOBILE - R+D+i project with ref. PID2020-116841RA-I00; PENSACRIGITAL-UNIR; DIGITAL_FIT-Fundación Mapfre).

Charo Sádaba

Luisa Zozaya Professor at the Faculty of Business and Communication at UNIR and is finishing her PHD at University of Navarra, Spain. Her research interests are the behaviour of children, teenagers, and young adults in the digital environment, advertising literacy for minors on social media, and the ethical implications of content shared by digital content creators. She has a master’s degree in Social Science from the University of Sonora in México.

Luisa Zozaya

Charo Sádaba Full professor of advertising and marketing at the School of Communication, University of Navarra (Spain). Her research has been focused on the impact of digitalization on children and teenagers, their behavior, attitudes and opinions towards technology, particularly in Spain and Latin American countries. More recently she has started a project on the impact of technology in emerging adulthood.

Notes

1. @javierlopezmontiel, with 114.2K followers: https://www.tiktok.com/search?q=javierlopezmontiel&t=1678877357709

2. @farmaceuticofernandez, with 2.6 M followers. https://www.tiktok.com/search?q=farmaceuticofernandez&t=1678877506924

3. transcription: ‘You are not able to swallow a pill’; ‘Put it in a syringe with some water’; ‘Plug the hole and pull several times, with pressure’; and ‘It falls apart whole’

4. transcription: ‘Tablets cannot be crushed or dissolved without consulting a doctor or pharmacist’; ‘Some are designed to take hours to dissolve completely, and if you crush them you alter the release of the active ingredient’; and ‘If you crush them you impair the coating and thus absorption of the drug and its efficacy’