People Make Irrational Trust Decisions Precisely: “Shouting” and Spelling Mistakes Add Together to Make Online Health Information Appear Doubly Less Trustworthy

Online health information is deemed doubly less trustworthy if the text includes both “shouting” and spelling errors together, according to a new study at Brighton and Sussex Medical School (BSMS).

As the world desperately seeks answers to their questions about the coronavirus, this timely study shows how vital it is for anyone giving valid health advice online to understand how readers judge the backdrop and atmosphere surrounding the presented information as well as the words.

Dr Harry J Witchel, an expert in body language at BSMS and lead author of the study, said, “This is all about trust, which is vital at the moment. If you’re reading something online and you instinctively don’t believe what it’s saying, then you won’t follow the advice. If the advice is genuine and important, then that’s a real problem, particularly at present when people are dying because others aren’t following important guidance.

“We’ve known for some time that people profoundly alter their judgments about what they hear based on contextual cues rather than just the content of what is said. But this research looks at how ‘shouting’ – using capital letters – and typographic errors both reduce the credibility of what is being read, and is the first to show that the effects of both these errors add together quite precisely — as though readers were keeping score in their minds of all these little things.

“On the back of this research, my advice to any government or medical professional giving online advice on COVID-19 would be – research your audience!”

Published in the Journal of Medical Internet Research, the study asked 301 healthy participants to read information on a health forum about multiple sclerosis, ranking it for trustworthiness.

They were asked to rate various paragraphs online in terms of how much they trusted the paragraph; however, the volunteers were not told that some of the paragraphs had typographic spelling errors, a few words of “shouting” text (all caps), or a combination of both types of errors.

The results showed that spelling mistakes alone made the copy appear less trustworthy by 9%, “shouting” made it less trustworthy by 6%, and a combination of these errors made it less trustworthy by 14%, showing an additive effect.

About BSMS:
Brighton and Sussex Medical School (BSMS) is a partnership between the Universities of Brighton and Sussex and the local NHS health community. At BSMS, we identify research areas in medicine where we believe we can make a rapid and real difference. Our focus is on the continuous improvement of medical treatment to deliver more personalized health care for patients by applying basic science to answer fundamental clinical questions.

For further information: contact Julie Wilton, Communications Manager, BSMS at 07411 493183 or

Original article

Wykes T, Schueller S. Witchel HJ, Thompson GA, Jones CI, Westling CEI, Romero J, Nicotra A, Maag B, Critchley HD
Spelling Errors and Shouting Capitalization Lead to Additive Penalties to Trustworthiness of Online Health Information: Randomized Experiment With Laypersons.
J Med Internet Res 2020;22(6):e15171
DOI: 10.2196/15171

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