Social media networks have become hubs for disseminating health-related information (Vaghefi et al. 2024). However, there are concerns about the potential for disseminating unreliable or low-quality details on these platforms, particularly X (formerly Twitter), as the most popular social media platform used for infectious disease communication (Kullar et al. 2020). This study, therefore, evaluated the quality and reliability of consumer health information about Mpox on X. We found that most posts we analyzed had low likes and retweets. This could be because health-related topics, especially those focused on infectious diseases, attract only a niche audience because they might require some medical background knowledge to understand. It could also be that users are overwhelmed by the volume of health-related content on X, making it difficult for Mpox posts to stand out. This, however, contrasts with a similar study on Mpox-related content on X, wherein many of the posts analyzed had a minimum of 100 likes, retweets, and replies (Ortiz-Martínez et al. 2022).

While the number of posts in our study is comparatively low relative to other content analyses of health-related topics on X such as COVID-19 (Al-Rawi et al. 2023; Hong 2023; Kornides et al. 2023; Yiannakoulias et al. 2022), this is primarily due to our specific inclusion criteria and focus. Only English-language posts with at least five retweets were included in our study to ensure a minimum level of user engagement and public visibility. This threshold was chosen to focus the analysis on content that had some degree of dissemination and influence within the X platform. Posts with fewer retweets were excluded to reduce the likelihood of analyzing content that had limited reach or relevance in the broader public discourse on Mpox.

Most of the posts were made by individuals, and the fewest were made by healthcare providers (health professionals and health organizations). This is important, as it implies that credible voices are not dominating the conversation, which could have significant implications, ranging from the spread of inaccurate or misleading information, to delay in consumers seeking treatment, potentially leading to worsening of symptoms, and undermining of public health efforts by healthcare providers. Our findings are similar to a study on the Mpox misinformation outbreak on X, where 60% of the posts were made by individuals (Ortiz-Martínez et al. 2022).

The number of posts about Mpox was found to increase each year. This trend could be due to the 2022 Mpox outbreak, which might have led to increased awareness and online conversations (Duarte et al. 2024). It may also be attributable to the aftermath of the COVID-19 pandemic, which probably heightened global awareness of infectious diseases and might have increased interest and discussion about other infectious diseases like Mpox. This finding is similar to a study that analyzed online posts on Mpox among key populations on Reddit, where the researchers found an increasing trend in Mpox-related posts on Reddit since the outbreak in May 2022 (Hong 2023).

It was concerning that the majority of the posts were of low quality. One major factor that may be responsible for this is that many posts were made by individuals rather than healthcare providers, potentially leading to the spread of inaccurate and misleading information. Furthermore, the lack of checks and balances on what can be posted on X may exacerbate this problem, allowing misleading information to spread unchecked (Borges Do Nascimento et al. 2022). Another factor could be that consumers of information on X may be sharing misinformation or unverified claims without fact-checking or verifying the sources, or consumers may be interacting only with other consumers who share similar views, creating echo chambers that increase misinformation (Borges Do Nascimento et al. 2022). These findings are consistent with previous studies, such as Ortiz-Martínez et al. 2022, which found that a significant proportion of Mpox-related information on X was posted by individuals and contained unverifiable or misleading information (Ortiz-Martínez et al. 2022).

An inverse relationship was found between the quality and reliability of posts and their engagement. Studies have shown that misinformation spreads faster and attracts more engagement on X than accurate information (Vosoughi et al. 2018). Social media algorithms may prioritize posts that generate high engagement even if they contain misinformation (Gillespie 2014), and consumers may engage more with posts that confirm their pre-existing beliefs, thereby reinforcing misinformation (Rhodes 2022).

This study showed faster and wider spread of misinformation, difficulty in promoting accurate information about Mpox by public health campaigns, and an increased risk of potential future Mpox outbreaks, as consumers may not take necessary precautions or seek urgent medical attention due to inaccurate information. The results highlight the need for further research into the way that social media platforms function, effective communication strategies to promote accurate information and to counter misinformation, more active engagement of healthcare providers on social media, development of fact-checking tools by social media platforms, and public education campaigns on media literacy skills to help consumers effectively evaluate online information.

Our study had some limitations. Our sample may not be representative of the entire body of Mpox-related posts on X, as other hashtags in addition to the ones we used in gathering data may contain important information about Mpox. Our study’s time frame may also be too short to capture long-term trends or patterns in Mpox-related posts. Another possible limitation is that the metrics used for engagement—likes, retweets, and replies—may not capture the full range of user interactions with Mpox-related posts. There could also have been changes to X’s algorithm during the study period, which may have impacted the visibility or engagement of Mpox-related posts. Findings from this study may not be generalizable, as user behavior on X may differ from other social media platforms and may be specific to Mpox, hence inapplicable to other health topics or infectious diseases.

Despite these limitations, this study utilized a reliability assessment framework to evaluate the credibility of Mpox-related posts on X, and investigated the relationship between post reliability and engagement, revealing an inverse relationship. This study, therefore, contributes to our understanding of online health communication and can inform future research on Mpox, a relevant public health topic. This study also highlights the challenges of promoting accurate information on social media.